Advertisement

Whole Body Vibration Versus Conventional Physiotherapy to Improve Balance and Gait in Parkinson’s Disease

      Abstract

      Ebersbach G, Edler D, Kaufhold O, Wissel J. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson’s disease.

      Objective

      To compare the effects of whole body vibration (WBV) and conventional physiotherapy (PT) on levodopa-resistant disturbances of balance and gait in idiopathic Parkinson’s disease (PD).

      Design

      Randomized controlled rater-blinded trial comparing 2 active interventions, final follow-up assessment 4 weeks after termination of active intervention.

      Setting

      Specialized referral center, hospitalized care.

      Participants

      Patients with PD and dopa-resistant imbalance on stable dopamine replacement medication (N=27) were randomized (intent-to-treat population) to receive WBV (n=13) or conventional PT (controls, n=14). Twenty-one patients (per protocol population) completed follow-up (14 men, 7 women; mean age, 73.8y; age range, 62–84y; mean disease duration, 7.2y; mean dopa-equivalent dose, 768mg/d).

      Intervention

      Subjects were randomized to receive 30 sessions (two 15-min sessions a day, 5 days a week) of either WBV on an oscillating platform or conventional balance training including exercises on a tilt board. Twenty-one subjects (10 with WBV, 11 controls) were available for follow-up 4 weeks after treatment termination.

      Main Outcome Measures

      The primary measure was Tinetti Balance Scale score. Secondary clinical ratings included stand-walk-sit test, walking velocity, Unified Parkinson’s Disease Rating Scale (section III motor examination) score, performance in the pull test, and dynamic posturography.

      Results

      The Tinetti score improved from 9.3 to 12.8 points in the WBV group and from 8.3 to 11.7 in the controls. All secondary measures, except posturography, likewise improved at follow-up compared with baseline in both groups. Quantitative dynamic posturography only improved in patients with WBV (1937–1467mm) whereas there was no significant change in controls (1832–2030mm).

      Conclusions

      Equilibrium and gait improved in patients with PD receiving conventional WBV or conventional PT in the setting of a comprehensive rehabilitation program. There was no conclusive evidence for superior efficacy of WBV compared with conventional balance training.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bloem B.R.
        • Beckley D.J.
        • van Dijk J.G.
        • Zwinderman A.H.
        • Remler M.P.
        • Roos R.A.
        Influence of dopaminergic medication on automatic postural responses and balance impairment in Parkinson’s disease.
        Mov Disord. 1996; 11: 509-521
        • Pinto S.
        • Ozsancak C.
        • Tripoliti E.
        • Thobois S.
        • Limousin-Dowsey P.
        • Auzou P.
        Treatments for dysarthria in Parkinson’s disease.
        Lancet Neurol. 2004; 3: 547-556
        • Bonnet A.M.
        • Loria Y.
        • Saint-Hilaire M.H.
        • Lhermitte F.
        • Agid Y.
        Does long-term aggravation of Parkinson’s disease result from nondopaminergic lesions?.
        Neurology. 1987; 37: 1539-1542
        • Deane K.H.
        • Jones D.
        • Playford E.D.
        • Ben Shlomo Y.
        • Clarke C.E.
        Physiotherapy for patients with Parkinson’s disease.
        Cochrane Database. 2001; (3):CD002817
        • Goetz C.G.
        • Koller W.C.
        • Poewe W.
        • et al.
        Management of Parkinson’s disease: an evidence-based review.
        Mov Disord. 2002; 17: S120-S127
        • Suchowersky O.
        • Gronseth G.
        • Perlmutter J.
        • et al.
        Practice parameter: neuroprotective strategies and alternative therapies for Parkinson’s disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
        Neurology. 2006; 66: 976-982
        • Miyai I.
        • Fujimoto Y.
        • Ueda Y.
        • et al.
        Treadmill training with body weight support: its effect on Parkinson’s disease.
        Arch Phys Med Rehabil. 2000; 81: 849-852
        • Miyai I.
        • Fujimoto Y.
        • Yamamoto H.
        Long-term effect of body weight-supported treadmill training in Parkinson’s disease: a randomized controlled trial.
        Arch Phys Med Rehabil. 2002; 83: 1370-1373
        • Pohl M.
        • Rockstroh G.
        • Ruckriem S.
        • Mrass G.
        • Mehrholz J.
        Immediate effects of speed-dependent treadmill training on gait parameters in early Parkinson’s disease.
        Arch Phys Med Rehabil. 2003; 84: 1760-1766
        • Frenkel-Toledo S.
        • Giladi N.
        • Peretz C.
        • Herman T.
        • Gruendlinger L.
        • Hausdorff J.M.
        Treadmill walking as an external pacemaker to improve gait rhythm and stability in Parkinson’s disease.
        Mov Disord. 2005; 20: 1109-1114
        • Dibble L.E.
        • Hale T.F.
        • Marcus R.L.
        • Droge J.
        • Gerber J.P.
        • LaStayo P.C.
        High-intensity resistance training amplifies muscle hypertrophy and functional gains in persons with Parkinson’s disease.
        Mov Disord. 2006; 21: 1444-1452
        • Hirsch M.A.
        • Toole T.
        • Maitland C.G.
        • Rider R.A.
        The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson’s disease.
        Arch Phys Med Rehabil. 2003; 84: 1109-1117
        • Abbruzzese G.
        • Berardelli A.
        Sensorimotor integration in movement disorders.
        Mov Disord. 2003; 18: 231-240
        • Ahlborg L.
        • Andersson C.
        • Julin P.
        Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy.
        J Rehabil Med. 2006; 38: 302-308
        • Schuhfried O.
        • Mittermaier C.
        • Jovanovic T.
        • Pieber K.
        • Paternostro-Sluga T.
        Effects of whole-body vibration in patients with multiple sclerosis: a pilot study.
        Clin Rehabil. 2005; 19: 834-842
        • van Nes I.
        • Latour H.
        • Schils F.
        • Meijer R.
        • van K.A.
        • Geurts A.C.
        Long-term effects of 6-week whole-body vibration on balance recovery and activities of daily living in the postacute phase of stroke: a randomized, controlled trial.
        Stroke. 2006; 37: 2331-2335
        • Bruyere O.
        • Wuidart M.A.
        • Di Palma E.
        • et al.
        Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents.
        Arch Phys Med Rehabil. 2005; 86: 303-307
        • Rickards C.
        • Cody F.W.
        Proprioceptive control of wrist movements in Parkinson’s disease.
        Brain. 1997; 120: 977-990
        • Khudados E.
        • Cody F.W.
        • O’Boyle D.J.
        Proprioceptive regulation of voluntary ankle movements, demonstrated using muscle vibration, is impaired by Parkinson’s disease.
        J Neurol Neurosurg Psychiatry. 1999; 67: 504-510
        • Haas C.T.
        • Turbanski S.
        • Kessler K.
        • Schmidtbleicher D.
        The effects of random whole-body-vibration on motor symptoms in Parkinson’s disease.
        NeuroRehabilitation. 2006; 21: 29-36
        • Hughes A.J.
        • Ben-Shlomo Y.
        • Daniels S.E.
        • Lees A.J.
        What features improve the clinical diagnosis in Parkinson’s disease: a clinicopathologic study.
        Neurology. 1992; 42: 1142-1146
        • Tinetti M.E.
        Performance-oriented assessment of mobility problems in elderly patients.
        J Am Geriatr Soc. 1986; 34: 119-126
        • Hunt A.L.
        • Sethi K.D.
        The pull test: a history.
        Mov Disord. 2006; 21: 894-899
        • Müller J.
        • Ebersbach G.
        • Wissel J.
        • Brenneis C.
        • Badry L.
        • Poewe W.
        Disturbances of dynamic balance in phasic cervical dystonia.
        J Neurol Neurosurg Psychiatry. 1999; 67: 807-810
        • Keus S.H.
        • Bloem B.R.
        • Hendriks E.J.
        • Bredero-Cohen A.B.
        • Munneke M.
        • Practice Recommendations Development Group
        Evidence based analysis of physical therapy in Parkinson’s disease with recommendations for practice and research.
        Mov Disord. 2007; 22: 451-460
        • Jöbges M.
        • Heuschkel G.
        • Pretzel C.
        • Illhardt C.
        • Renner C.
        • Hummelsheim H.
        Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease.
        J Neurol Neurosurg Psychiatry. 2004; 75: 1682-1687
        • Toole T.
        • Hirsch M.A.
        • Forkink A.
        • Lehman D.A.
        • Maitland C.G.
        The effects of a balance and strength training program on equilibrium in Parkinsonism: a preliminary study.
        NeuroRehabilitation. 2000; 14: 165-174
        • Morris M.E.
        • Iansek R.
        • Matyas T.A.
        • Summers J.J.
        Stride length regulation in Parkinson’s disease.
        Brain. 1996; 119: 551-568
        • Thaut M.H.
        • McIntosh G.C.
        • Rice R.R.
        • Miller R.A.
        • Rathbun J.
        • Brault J.M.
        Rhythmic auditory stimulation in gait training for Parkinson’s disease patients.
        Mov Disord. 1996; 11: 193-200
        • Müller V.
        • Mohr B.
        • Rosin R.
        • Pulvermüller F.
        • Müller F.
        • Birbaumer N.
        Short-term effects of behavioral treatment on movement initiation and postural control in Parkinson’s disease: a controlled clinical study.
        Mov Disord. 1997; 12: 306-314
        • Farley B.G.
        • Koshland G.F.
        Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease.
        Exp Brain Res. 2005; 167: 462-467
        • Haas C.T.
        • Turbanski S.
        • Schmidtbleicher D.
        Nerval and mechanical rhythms in balance training.
        Isokinet Exerc Sci. 2004; 1: 54-55
        • Runge M.
        • Rehfeld G.
        • Resnicek E.
        Balance training and exercise in geriatric patients.
        J Musculoskel Neuron Interact. 2000; 1: 61-65
        • Turbanski S.
        • Haas C.T.
        • Friedrich A.
        • Duisberg P.
        • Schmidtbleicher D.
        Effects of random whole-body vibration on postural control in Parkinson’s disease.
        Res Sports Med. 2005; : 3243-3256