Whole-body vibration improves walking function in individuals with spinal cord injury: A pilot study
Introduction
Loss of walking function is a common consequence of spinal cord injury (SCI), and for these individuals, regaining walking function is a high priority [1]. Individuals with SCI, and other populations with disorders of the central nervous system, often have various impairments that negatively impact walking function. For example, muscle weakness and sensory impairment result in reduced levels of muscle activation and decreased walking speed [2]. Spasticity may result in altered muscle timing and co-contraction associated with spastic gait patterns [2], [3]. Decreased walking function results from any one, or a combination, of these deficits [2], [4].
In non-disabled (ND) individuals, vibration to the muscle body or tendon increases walking speed, depending on the combination of vibration placement and direction of progression [5]. In individuals with Parkinson's disease, vibration applied through the soles of the feet during walking increases walking distance, speed, stride length, and improves stride variability [6]. Vibration may also excite spinal circuitry (i.e., locomotor pattern generators) involved in the production of locomotor output [7].
Whole-body vibration (WBV) is increasingly being used in elderly individuals [8], [9] and in clinical populations [10], [11], [12], [13], [14]. In individuals with SCI, our studies offer preliminary evidence that a 12-session intervention of WBV decreases spasticity of the quadriceps muscles [15]. The use of WBV has also been associated with changes in walking function [8], [10], [11], [12]. Elderly individuals who received a 2-month WBV intervention in combination with balance, muscle strengthening, and walking exercises demonstrated increased walking speed and step length compared to individuals who did the same exercise program without WBV [8]. In individuals with Parkinson's disease, a 3-week intervention of WBV is associated with improvements in walking speed [11]. In adults with spastic diplegia due to cerebral palsy, an 8-week intervention of WBV is associated with improvements in muscle strength and reductions in spasticity of the knee extensor muscles, but the distance walked in 6 min was unchanged [10]. In individuals with SCI who were unable to stand without long-leg braces, a case series published in an abstract attributed the use of WBV with the progression of function from standing to walking [12]. Evidence of the effects of WBV on walking function is limited in individuals with SCI.
The purpose of this study was to determine whether repeated use of WBV is associated with improvements in walking function, as defined by changes in walking speed, in individuals with chronic, motor-incomplete SCI. In individuals with SCI, increased walking speed is a standard benchmark for improvement in walking function [16], [17], [18]. In addition, we assessed changes in secondary gait parameters including step length, cadence, and consistency of hip-knee intralimb coordination. Our prior studies of interventions to improve walking function in individuals with SCI have focused on locomotor training [16], [19] or nutrient supplementation [20]. While there is preliminary evidence in that WBV may improve walking function in elderly individuals [9] and individuals with Parkinson's disease [11], there are no published studies related to the influence of WBV on walking function in individuals with SCI, many of whom have a limited ability to maintain standing. Based on the prior evidence, we hypothesized that the 12-session intervention of WBV would be associated with improvements in walking speed and the secondary gait parameters. In this consideration-of-concept study [21], our goal was to determine whether there was value in pursuing this line of study, and whether it was feasible to use WBV in individuals with SCI relative to subject tolerance and incidence of adverse events.
Section snippets
Subjects and methods
Seventeen subjects (3 women and 14 men; age 28–65) with SCI enrolled in the study. All subjects underwent clinical examination prior to testing. Subject inclusion criteria were motor incomplete, chronic (≥1 year duration) SCI, and ability to rise from sitting to standing with no more than moderate assistance from one person, and ability to stand (using upper extremity support) for at least 1 min. American Spinal Injury Association (ASIA) motor and sensory scores [22], and ASIA Impairment Scale
Results
The group mean walking speed (SPEED) increased by 0.062 ± 0.011 m/s (mean ± standard error) (from 0.259 ± 0.248 m/s in the initial test to 0.321 ± 0.260 m/s in the final test), an increase that was statistically significant (p < 0.001) but considered a small effect size (d = 0.249).
Subject 16, who returned for a follow-up test 5-week after the last WBV session, had an initial SPEED of 0.128 m/s, a final SPEED of 0.215 m/s and a 5-week follow-up SPEED of 0.241 m/s. SPEED values of all subjects, group mean, and
Discussion
Our results indicate that consistent use of WBV is associated with an increase in walking function, as defined by walking speed, in individuals with SCI who have some ability to maintain voluntary standing. While the lack of a control group, the inclusion of individuals with varying degrees of walking ability, and the fact that it was not possible to blind subjects to the intervention limits the conclusions that can be drawn from these findings, the fact remains that the observed changes in
Implications for function
These results provide preliminary support for the use of WBV as an intervention to improve walking function in individuals with SCI, with changes that appear to be comparable to those achieved with some forms of locomotor training. With a 12-session intervention of WBV, we found significant improvements in walking speed, cadence, step lengths, and intralimb coordination over multiple steps. Furthermore, the effect of WBV on walking function may continue to improve walking function even after
Conflict of interest
There is no conflict of interest with any of the authors.
Acknowledgements
We gratefully acknowledge the technical contributions of Stephen Lindley. This study was supported by The Miami Project to Cure Paralysis and the NIH grant #R01HD41487.
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