1. School of Physical Therapy
Effects of Whole Body Vibration on People with Post-Polio Syndrome
Carolyn P Da Silva, PT, DSc1,2, NCS, Natasha deSa2, PT, DPT, Lauren Szot1,2, PT, DPT, NCS
1Texas Woman’s University, Houston, TX , 2TIRR Memorial Hermann Rehabilitation and Research, Houston, TX
INTRODUCTION
METHODS
RESULTS
Post-Polio Syndrome (PPS) symptoms include increased muscle weakness, reduced functional capacity, pain, fatigue, & sleep disturbances. Quiben 2006
People with PPS have difficulty exercising in a conventional manner due to the potential for symptom exacerbation or overexertion of fatigued muscles.Quiben 2006
Whole Body Vibration (WBV) is a mode of exercise that elicits muscle stimulation through activation of muscle spindles & vibratory tonic reflex. del Pozo-Cruz 2011
WBV shown to improve lower extremity (LE) strength, balance, neuromuscular performance, health-related quality of life, & bone mineral density in healthy, untrained, & elderly populations. del Pozo-Cruz 2011, von Stengel 2011, Marin 2010
Weak-moderate evidence that WBV has a positive effect on people with other neurological conditions. del Pozo-Cruz 2012
Procedures:
Participants were randomly assigned to 1 of 2 treatment groups using crossover experimental design.
Group A:
8 sessions during 4 weeks of high intensity, low amplitude protocol (Power Plate: 8.82mm; 2.76g)
2-week washout period
8 sessions during 4 weeks of low intensity protocol (Soloflex: 4.53mm; 2.21g)
Group B:
Same program as Group A, in reverse order, starting with low intensity protocol, followed by high intensity protocol.
Testing by PT assessor blinded to group assignment & intervention
Baseline
Post-intervention 1
After 2-week washout period
Post-intervention 2
2-week follow-up
Study Flow
p=0.049
p=0.093
p=0.055
p=0.678
p=0.686
PURPOSE & HYPOTHESIS
p=0.087
p=0.017
Purpose: To determine the feasibility of WBV as a weight-bearing exercise in people with PPS by assessing its effects on the following outcome measures:
10 Meter Walk Test (10mWT)
2 Minute Walk Test (2MWT)
Brief Pain Inventory (BPI)
Pain Severity Subscale
Pain Interference Subscale
Pittsburgh Sleep Quality Index
Fatigue Severity Scale
LE Strength
Manual muscle testing (MMT)
Hand held dynamometry (HHD)
Muscle cramping: patient written logs throughout course of study
Hypothesis: There will be a significant improvement in the above outcome measures following WBV intervention in participants with PPS.
There were no study-related adverse events.
Group B had significantly higher total pain scores at baseline than Group A.
No significant changes following lower intensity intervention for either group.
No significant changes in any other outcome measure for either group.
CONCLUSIONS
Study strengths:
Blinding of testers
Randomized treatment order
Study limitations:
Small sample size
2x/wk intervention apparent barrier for recruitment/retention
Higher intensity protocol yielded significant increase in gait speed only for Group A & decrease in pain severity for both groups regardless of treatment intervention order.
No significant results were maintained through follow-up, suggesting:
Duration of intervention might not be long enough to yield long-term results
WBV may need to be part of regular regimen to maintain function & quality of life in people with PPS.
Intervention:
Participants stood on WBV platform with UE support as needed, or sat in wheelchair & placed feet on platform, leaning forward to put as much body weight through lower extremities as possible.
Intervention began with 10, 1-min WBV bouts.
Bouts increased by 15 sec each session until participant was able to tolerate 10, 2-min bouts for maximum of 20 total minutes of treatment time per session.
BP, HR, and rating of perceived exertion measured pre/post sessions.
PARTICIPANTS
21 participants were recruited from TIRR Memorial Hermann post-polio clinic & local polio support groups.
15 completed the study
Inclusion Criteria:
History of polio with/without diagnosis of PPS
Ages 40 to 85
Body weight less than 500 lbs
Ability to bear weight through LEs for 20 minutes
Ability to speak/read English
Medical approval from personal physician
Exclusion criteria:
Acute medical conditions
Implanted metal devices, joints or fixators
Lower limb amputation
Most frequent reasons for choosing not to participate when asked:
Time/effort/cost involved with coming to Texas Medical Center 2x/week
Metal implants (joint replacements, internal fixators)
CLINICAL RELEVANCE
WBV appears to be a safe, tolerable, & feasible form of weight-bearing exercise for people with PPS.
Short term changes in pain & gait speed for some individuals are encouraging for polio survivors who have limited methods to exercise.
Further research with greater sample sizes needs to be done to examine long-term use of WBV in people with PPS & other neurological conditions, addressing reduction of barriers to exercise participation.
Data Analysis:
Descriptive statistics, cross-tabulations, & Mann-Whitney U tests performed to examine significant differences between intervention groups for demographic variables.
Wilcoxon signed rank tests used to examine changes over time by intervention group.
ACKNOWLEDGEMENTS
Participant Demographics
This study was funded by Post-Polio Health International.
Statistical support provided by Rene Paulson, PhD & Zoheb Allum, MS, Texas Woman’s University, Denton, TX
Contributions from Arianne Stoker, PT, DPT, Kelly Hodges, PT, DPT, Mariana Sanjuan, SPT, Maggie Strange, SPT
Manuscript submitted to Journal of Neurologic Physical Therapy
Average Age (years)
Average Age Onset of Polio (years)
Gender
6 Male, 9 Female
Walking Status
11 Full-time, 3 Part-time, 1 Nonambulatory
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