Site-Specific Transmission of a Floor-Based, High-Frequency, Low-Magnitude Vibration Stimulus in Children With Spastic Cerebral Palsy

Published:September 18, 2015DOI:



      To determine the degree to which a high-frequency, low-magnitude vibration signal emitted by a floor-based platform transmits to the distal tibia and distal femur of children with spastic cerebral palsy (CP) during standing.


      Cross-sectional study.


      University research laboratory.


      Children with spastic CP who could stand independently (n=18) and typically developing children (n=10) (age range, 4–12y) participated in the study (N=28).


      Not applicable.

      Main Outcome Measures

      The vibration signal at the high-frequency, low-magnitude vibration platform (approximately 33Hz and 0.3g), distal tibia, and distal femur was measured using accelerometers. The degree of plantar flexor spasticity was assessed using the Modified Ashworth Scale.


      The high-frequency, low-magnitude vibration signal was greater (P<.001) at the distal tibia than at the platform in children with CP (.36±.06g vs .29±.05g) and controls (.40±.09g vs .24±.07g). Although the vibration signal was also higher at the distal femur (.35±.09g, P<.001) than at the platform in controls, it was lower in children with CP (.20±.07g, P<.001). The degree of spasticity was negatively related to the vibration signal transmitted to the distal tibia (Spearman ρ=−.547) and distal femur (Spearman ρ=−.566) in children with CP (both P<.05).


      A high-frequency, low-magnitude vibration signal from a floor-based platform was amplified at the distal tibia, attenuated at the distal femur, and inversely related to the degree of muscle spasticity in children with spastic CP. Whether this transmission pattern affects the adaptation of the bones of children with CP to high-frequency, low-magnitude vibration requires further investigation.


      List of abbreviations:

      CP (cerebral palsy), GMFCS (Gross Motor Function Classification System), MAS (Modified Ashworth Scale)
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        • Elder G.C.
        • Kirk J.
        • Stewart G.
        • et al.
        Contributing factors to muscle weakness in children with cerebral palsy.
        Dev Med Child Neurol. 2003; 45: 542-550
        • Modlesky C.M.
        • Kanoff S.A.
        • Johnson D.L.
        • Subramanian P.
        • Miller F.
        Evaluation of the femoral midshaft in children with cerebral palsy using magnetic resonance imaging.
        Osteoporos Int. 2009; 20: 609-615
        • Modlesky C.M.
        • Whitney D.G.
        • Singh H.
        • Barbe M.F.
        • Kirby J.T.
        • Miller F.
        Underdevelopment of trabecular bone microarchitecture in the distal femur of nonambulatory children with cerebral palsy becomes more pronounced with distance from the growth plate.
        Osteoporos Int. 2015; 26: 505-512
        • Riad J.
        • Haglund-Akerlind Y.
        • Miller F.
        Power generation in children with spastic hemiplegic cerebral palsy.
        Gait Posture. 2008; 27: 641-647
        • Presedo A.
        • Dabney K.W.
        • Miller F.
        Fractures in patients with cerebral palsy.
        J Pediatr Orthoped. 2007; 27: 147-153
        • Carlon S.L.
        • Taylor N.F.
        • Dodd K.J.
        • Shields N.
        Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: a systematic review.
        Disabil Rehabil. 2013; 35: 647-655
        • Houlihan C.M.
        • Stevenson R.D.
        Bone density in cerebral palsy.
        Phys Med Rehabil Clin N Am. 2009; 20: 493-508
        • Rubin C.
        • Recker R.
        • Cullen D.
        • Ryaby J.
        • McCabe J.
        • McLeod K.
        Prevention of postmenopausal bone loss by a low-magnitude, high-frequency mechanical stimuli: a clinical trial assessing compliance, efficacy, and safety.
        J Bone Miner Res. 2004; 19: 343-351
        • Gilsanz V.
        • Wren T.A.
        • Sanchez M.
        • Dorey F.
        • Judex S.
        • Rubin C.
        Low-level, high-frequency mechanical signals enhance musculoskeletal development of young women with low BMD.
        J Bone Miner Res. 2006; 21: 1464-1474
        • Wren T.A.
        • Lee D.C.
        • Hara R.
        • et al.
        Effect of high-frequency, low-magnitude vibration on bone and muscle in children with cerebral palsy.
        J Pediatr Orthoped. 2010; 30: 732-738
        • Ward K.
        • Alsop C.
        • Caulton J.
        • Rubin C.
        • Adams J.
        • Mughal Z.
        Low magnitude mechanical loading is osteogenic in children with disabling conditions.
        J Bone Miner Res. 2004; 19: 360-369
        • Slatkovska L.
        • Alibhai S.M.
        • Beyene J.
        • Hu H.X.
        • Demaras A.
        • Cheung A.M.
        Effect of 12 months of whole-body vibration therapy on bone density and structure in postmenopausal women a randomized trial.
        Ann Intern Med. 2011; 155 (W205): 668-679
        • Leung K.S.
        • Li C.Y.
        • Tse Y.K.
        • et al.
        Effects of 18-month low-magnitude high-frequency vibration on fall rate and fracture risks in 710 community elderly-a cluster-randomized controlled trial.
        Osteoporos Int. 2014; 25: 1785-1795
        • Lam T.P.
        • Ng B.K.
        • Cheung L.W.
        • Lee K.M.
        • Qin L.
        • Cheng J.C.
        Effect of whole body vibration (WBV) therapy on bone density and bone quality in osteopenic girls with adolescent idiopathic scoliosis: a randomized, controlled trial.
        Osteoporos Int. 2013; 24: 1623-1636
        • Judex S.
        • Lei X.
        • Han D.
        • Rubin C.
        Low-magnitude mechanical signals that stimulate bone formation in the ovariectomized rat are dependent on the applied frequency but not on the strain magnitude.
        J Biomech. 2007; 40: 1333-1339
        • Haapasalo H.
        • Kannus P.
        • Sievanen H.
        • Heinonen A.
        • Oja P.
        • Vuori I.
        Long-term unilateral loading and bone-mineral density and content in female squash players.
        Calcif Tissue Int. 1994; 54: 249-255
        • Bressel E.
        • Smith G.
        • Branscomb J.
        Transmission of whole body vibration in children while standing.
        Clin Biomech. 2010; 25: 181-186
        • Harazin B.
        • Grzesik J.
        The transmission of vertical whole-body vibration to the body segments of standing subjects.
        J Sound Vib. 1998; 215: 775-787
        • Marshall W.A.
        • Tanner J.M.
        Variations in pattern of pubertal changes in girls.
        Arch Dis Child. 1969; 44: 291-303
        • Marshall W.A.
        • Tanner J.M.
        Variations in pattern of pubertal changes in boys.
        Arch Dis Child. 1970; 45: 13-23
        • Ashworth B.
        Preliminary trial of carisoprodol in multiple sclerosis.
        Practitioner. 1964; 192: 540-542
        • Palisano R.
        • Rosenbaum P.
        • Walter S.
        • Russell D.
        • Wood E.
        • Galuppi B.
        Development and reliability of a system to classify gross motor function in children with cerebral palsy.
        Dev Med Child Neurol. 1997; 39: 214-223
        • van Gaalen J.
        • Kerstens F.G.
        • Maas R.P.
        • Harmark L.
        • van de Warrenburg B.P.
        Drug-induced cerebellar ataxia: a systematic review.
        CNS Drugs. 2014; 28: 1139-1153
        • Rauch F.
        • Sievanen H.
        • Boonen S.
        • et al.
        Reporting whole-body vibration intervention studies: recommendations of the International Society of Musculoskeletal and Neuronal Interactions.
        J Musculoskelet Neuronal Interact. 2010; 10: 193-198
        • Cohen J.
        Statistical power analysis for behavioral sciences.
        2nd ed. Erlbaum, Hillsdale1987
        • Lidbeck C.M.
        • Gutierrez-Farewik E.M.
        • Brostrom E.
        • Bartonek A.
        Postural orientation during standing in children with bilateral cerebral palsy.
        Pediatr PhysTher. 2014; 26: 223-229
        • Matsumoto Y.
        • Griffin M.J.
        Dynamic response of the standing human body exposed to vertical vibration: influence of posture and vibration magnitude.
        J Sound Vib. 1998; 212: 85-107
        • Wakeling J.M.
        • Nigg B.M.
        Modification of soft tissue vibrations in the leg by muscular activity.
        J Appl Physiol. 2001; 90: 412-420
        • Noble J.J.
        • Charles-Edwards G.D.
        • Keevil S.F.
        • Lewis A.P.
        • Gough M.
        • Shortland A.P.
        Intramuscular fat in ambulant young adults with bilateral spastic cerebral palsy.
        BMC Musculoskelet Disord. 2014; 15: 236
        • Johnson D.L.
        • Miller F.
        • Subramanian P.
        • Modlesky C.M.
        Adipose tissue infiltration of skeletal muscle in children with cerebral palsy.
        J Pediatr. 2009; 154: 715-720
        • Kiiski J.
        • Heinonen A.
        • Jaervinen T.L.
        • Kannus P.
        • Sievanen H.
        Transmission of vertical whole body vibration to the human body.
        J Bone Miner Res. 2008; 23: 1318-1325
        • Voloshin A.
        • Wosk J.
        An in vivo study of low back pain and shock absorption in the human locomotor system.
        J Biomech. 1982; 15: 21-27
        • Zhao L.M.
        • Dodge T.
        • Nemani A.
        • Yokota H.
        Resonance in the mouse tibia as a predictor of frequencies and locations of loading-induced bone formation.
        Biomech Model Mechanobiol. 2014; 13: 141-151
        • Kim W.
        • Voloshin A.S.
        • Johnson S.H.
        • Simkin A.
        Measurement of the impulsive bone motion by skin-mounted accelerometers.
        J Biomech Eng. 1993; 115: 47-52