Lin-Rong Liao

The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis:

Objective: A systematic review and meta-analysis of randomized controlled trials was undertaken to determine whether whole body vibration improves bone mineral density and leg muscle strength in older adults. Data sources: Sources included MEDLINE, CINAHL, EMBASE, PEDro, PubMed, Science Citation Index and the reference list of each eligible article. Review methods: Article search and selection was performed independently by two researchers. The methodological quality of each selected article was rated by the PEDro scale. Results: Thirteen randomized trials (18 articles) totalling 896 subjects fulfilled the selection criteria. Four were considered to have good or excellent methodological quality and the rest were rated as fair. Meta-analyses revealed that whole body vibration has no significant effect on hip or lumbar spine bone mineral density in older women when compared with no intervention or active exercise (P > 0.05). Whole body vibration, however, had a significant treatment effect on knee extension dynamic strength (standardized mean difference = 0.63, P = 0.006), leg extension isometric strength (standardized mean difference = 0.57, P = 0.003), and functional measures of leg muscle strength such as jumping height (standardized mean difference = 0.51, P = 0.010) and performance in sit-to-stand (standardized mean difference = 0.72, P < 0.001) among older adults compared with no intervention. Conclusion: Whole body vibration is beneficial for enhancing leg muscle strength among older adults. However, the review suggests that whole body vibration has no overall treatment effect on bone mineral density in older women. No randomized trial has examined the effects of whole body vibration on bone mineral density in older men.

Psychometric Properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in Community-Dwelling Individuals With Chronic Stroke

Background The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new balance assessment, but its psychometric properties have not been specifically tested in individuals with stroke. Objectives The purpose of this study was to examine the reliability and validity of the Mini-BESTest and its accuracy in categorizing people with stroke based on fall history. Design An observational measurement study with a test-retest design was conducted. Methods One hundred six people with chronic stroke were recruited. Intrarater reliability was evaluated by repeating the Mini-BESTest within 10 days by the same rater. The Mini-BESTest was administered by 2 independent raters to establish interrater reliability. Validity was assessed by correlating Mini-BESTest scores with scores of other balance measures (Berg Balance Scale, one-leg-standing, Functional Reach Test, and Timed “Up & Go” Test) in the stroke group and by comparing Mini-BESTest scores between the stroke group and 48 control participants, and between fallers (≥1 falls in the previous 12 months, n=25) and nonfallers (n=81) in the stroke group. Results The Mini-BESTest had excellent internal consistency (Cronbach alpha=.89–.94), intrarater reliability (intraclass correlation coefficient [3,1]=.97), and interrater reliability (intraclass correlation coefficient [2,1]=.96). The minimal detectable change at 95% confidence interval was 3.0 points. The Mini-BESTest was strongly correlated with other balance measures. Significant differences in Mini-BESTest total scores were found between the stroke and control groups and between fallers and nonfallers in the stroke group. In terms of floor and ceiling effects, the Mini-BESTest was significantly less skewed than other balance measures, except for one-leg-standing on the nonparetic side. The Berg Balance Scale showed significantly better ability to identify fallers (positive likelihood ratio=2.6) than the Mini-BESTest (positive likelihood ratio=1.8). Limitations The results are generalizable only to people with mild to moderate chronic stroke. Conclusions The Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke.

Leg muscle activity during whole-body vibration in individuals with chronic stroke

PURPOSE It has been previously shown that whole-body vibration (WBV) can augment muscle activity in young healthy adults. However, the EMG response of leg muscles during WBV in individuals with stroke is unknown. The objective of this study was to determine the influence of WBV on the activity of the vastus lateralis (VL) and gastrocnemius (GS) muscles during the performance of different exercises in chronic stroke patients. METHODS Forty-five chronic stroke patients were studied. Each subject was exposed to three WBV conditions of 1) no WBV, 2) low-intensity WBV protocol (peak acceleration: 0.96 unit of gravitational constant [g]), and 3) high-intensity WBV protocol (peak acceleration: 1.61g) while performing eight different static exercises involving upright standing, semisquat, deep squat, weight shifted forward, weight shifted backward, weight shifted to the side, forward lunge, and single-leg standing. Bilateral VL and GS muscle activity was recorded with surface EMG and expressed as a percentage of the EMG amplitude recorded during a maximal voluntary contraction of the respective muscles. RESULTS Two-way repeated-measures ANOVA revealed that exposure to WBV (low- and high-intensity protocols) significantly increased VL and GS EMG amplitude (large effect size, partial η = 0.135-0.643, P < 0.001) on both the paretic and nonparetic sides in different exercise conditions compared with no WBV. No significant difference in EMG magnitude was found between the high- and the low-intensity WBV protocols (P > 0.05). With a few exceptions, WBV enhanced EMG activity in the paretic and nonparetic leg muscles to a similar extent in different exercise conditions. CONCLUSIONS Leg muscle activity was increased significantly with the addition of WBV. Further clinical trials are needed to determine the effectiveness of different WBV protocols for strengthening leg muscles in chronic stroke patients.

Effects of Whole-Body Vibration Therapy on Body Functions and Structures, Activity, and Participation Poststroke: A Systematic Review

Background Whole-body vibration (WBV) has gained increasing popularity in rehabilitation. Recent studies have investigated the application of WBV in individuals with chronic illnesses, including stroke. Purpose The purpose of this study was to compare WBV exercise with the same exercise condition without WBV and with other types of physical exercise in enhancing body functions and structures, activity, and participation in individuals with stroke and examine its safety. Data Source Electronic searches were conducted on MEDLINE, CINAHL, PEDro, PubMed, PsycINFO, and Science Citation Index. Study Selection Randomized controlled trials (RCTs) that investigated the effects of WBV among individuals with stroke were identified by 2 independent researchers. Ten articles (9 studies, totaling 333 study participants) satisfied the selection criteria and were included in this review. Data Extraction The methodological quality was rated using the PEDro scale. The results were extracted by 2 independent researchers and confirmed with the principal investigator. Data Synthesis Only 2 RCTs were considered as demonstrating level 1 evidence (PEDro score ≥6 and sample size >50). Two RCTs examined the effects of a single WBV session, and 7 RCTs examined the effects of WBV programs spanning 3 to 12 weeks. No consistent benefits on bone turnover, leg motor function, balance, mobility, sensation, fall rate, activities of daily living, or societal participation were found, regardless of the nature of the comparison group. Adverse events were minor. Limitations A broad approach was used, with stroke as an inclusion criterion for review. No solid evidence was found concerning the effects of WBV on subgroups of people with specific stroke-related deficits due to the heterogeneity of patient groups. Conclusions Based on the review, there is insufficient evidence to support clinical use of WBV in enhancing body functions and structures, activity, and participation after stroke.

Whole-Body Vibration Intensities in Chronic Stroke: A Randomized Controlled Trial.

PURPOSE A single-blinded randomized controlled study was conducted to investigate the effects of different whole-body vibration (WBV) intensities on body functions/structures, activity, and participation in individuals with stroke. METHODS Eighty-four individuals with chronic stroke (mean age = 61.2 yr, SD = 9.2) with mild to moderate motor impairment (Chedoke-McMaster Stroke Assessment lower limb motor score: median = 9 out of 14, interquartile range = 7-11.8) were randomly assigned to a low-intensity WBV, high-intensity WBV, or control group. The former two groups performed various leg exercises while receiving low-intensity and high-intensity WBV, respectively. Controls performed the same exercises without WBV. All individuals received 30 training sessions over an average period of 75.5 d (SD = 5.2). Outcome measurements included knee muscle strength (isokinetic dynamometry), knee and ankle joint spasticity (Modified Ashworth Scale), balance (Mini Balance Evaluation Systems Test), mobility (Timed-Up-and-Go test), walking endurance (6-Minute Walk Test), balance self-efficacy (Activities-specific Balance Confidence scale), participation in daily activities (Frenchay Activity Index), perceived environmental barriers to societal participation (Craig Hospital Inventory of Environmental Factors), and quality of life (Short-Form 12 Health Survey). Assessments were performed at baseline and postintervention. RESULTS Intention-to-treat analysis revealed a significant time effect for muscle strength, Timed-Up-and-Go distance, and oxygen consumption rate achieved during the 6-Minute Walk Test, the Mini Balance Evaluation Systems Test, the Activities-specific Balance Confidence scale, and the Short-Form 12 Health Survey physical composite score domain (P < 0.05). However, the time-group interaction was not significant for any of the outcome measures (P > 0.05). CONCLUSION The addition of the 30-session WBV paradigm to the leg exercise protocol was no more effective in enhancing body functions/structures, activity, and participation than leg exercises alone in chronic stroke patients with mild to moderate motor impairments.

Effects of Vibration Intensity, Exercise, and Motor Impairment on Leg Muscle Activity Induced by Whole-Body Vibration in People With Stroke

Background Whole-body vibration (WBV) has increasingly been used as an adjunct treatment in neurological rehabilitation. However, how muscle activation level changes during exposure to different WBV protocols in individuals after stroke remains understudied. Objective The purpose of this study was to examine the influence of WBV intensity on the magnitude of biceps femoris (BF) and tibialis anterior (TA) muscle activity and its interaction with exercise and with severity of motor impairment and spasticity among individuals with chronic stroke. Methods Each of the 36 individuals with chronic stroke (mean age=57.3 years, SD=10.7) performed 8 different static exercises under 3 WBV conditions: (1) no WBV, (2) low-intensity WBV (frequency=20 Hz, amplitude=0.60 mm, peak acceleration=0.96g), and (3) high-intensity WBV (30 Hz, 0.44 mm, 1.61g). The levels of bilateral TA and BF muscle activity were recorded using surface electromyography (EMG). Results The main effect of intensity was significant. Exposure to the low-intensity and high-intensity protocols led to a significantly greater increase in normalized BF and TA muscle electromyographic magnitude in both legs compared with no WBV. The intensity × exercise interaction also was significant, suggesting that the WBV-induced increase in EMG activity was exercise dependent. The EMG responses to WBV were similar between the paretic and nonparetic legs and were not associated with level of lower extremity motor impairment and spasticity. Limitations Leg muscle activity was measured during static exercises only. Conclusions Adding WBV during exercise significantly increased EMG activity in the TA and BF muscles. The EMG responses to WBV in the paretic and nonparetic legs were similar and were not related to degree of motor impairment and spasticity. The findings are useful for guiding the design of WBV training protocols for people with stroke.

Development and validation of the Chinese version of the Reintegration to Normal Living Index for use with stroke patients

OBJECTIVE To develop and validate a Chinese version of the Reintegration to Normal Living Index. DESIGN Descriptive case-series. SUBJECTS Seventy-five individuals with chronic stroke and 55 age-matched healthy subjects. METHODS The English version of the Reintegration to Normal Living Index was translated into Chinese using standardized procedures, and then administered to both the stroke and control groups. The same instrument was administered again to the stroke subjects 1-2 weeks later. RESULTS The Chinese version of the Reintegration to Normal Living Index had good internal consistency (Cronbachs α = 0.92) and test-retest reliability (intraclass coefficient = 0.87). The minimal detectable difference of the Index score was 14.8 (out of 100). Convergent validity of the Index was demonstrated by its significant association with Frenchay Activities Index (r = 0.439, p < 0.001) and Personal Wellbeing Index (r = 0.250, p = 0.033) scores among stroke subjects. The Reintegration to Normal Living Index score was significantly lower in the stroke group than in controls (p < 0.001), thus demonstrating discriminant validity. Factor analysis confirmed the two-factor structure of the Index, namely, daily functioning and perception of self. CONCLUSION The Reintegration to Normal Living Index is a reliable and valid tool for assessing satisfaction with community reintegration among Chinese people with chronic stroke.

Effects of whole body vibration on muscle spasticity for people with central nervous system disorders: a systematic review

Objectives: To examine the effects of whole-body vibration on spasticity among people with central nervous system disorders. Methods: Electronic searches were conducted using CINAHL, Cochrane Library, MEDLINE, Physiotherapy Evidence Database, PubMed, PsycINFO, SPORTDiscus and Scopus to identify randomized controlled trials that investigated the effect of whole-body vibration on spasticity among people with central nervous system disorders (last search in August 2015). The methodological quality and level of evidence were rated using the PEDro scale and guidelines set by the Oxford Centre for Evidence-Based Medicine. Results: Nine trials with totally 266 subjects (three in cerebral palsy, one in multiple sclerosis, one in spinocerebellar ataxia, and four in stroke) fulfilled all selection criteria. One study was level 1b (PEDro⩾6 and sample size>50) and eight were level 2b (PEDro<6 or sample size ⩽50). All three cerebral palsy trials (level 2b) reported some beneficial effects of whole-body vibration on reducing leg muscle spasticity. Otherwise, the results revealed no consistent benefits on spasticity in other neurological conditions studied. There is little evidence that change in spasticity was related to change in functional performance. The optimal protocol could not be identified. Many reviewed studies were limited by weak methodological and reporting quality. Adverse events were minor and rare. Conclusion: Whole-body vibration may be useful in reducing leg muscle spasticity in cerebral palsy but this needs to be verified by future high quality trials. There is insufficient evidence to support or refute the notion that whole-body vibration can reduce spasticity in stroke, spinocerebellar ataxia or multiple sclerosis.

Measuring environmental barriers faced by individuals living with stroke: development and validation of the Chinese version of the Craig Hospital Inventory of Environmental Factors.

OBJECTIVE To develop and validate a Chinese version of the Craig Hospital Inventory of Environmental Factors. DESIGN Descriptive case-series. SUBJECTS A total of 107 individuals with chronic stroke and 56 age-matched healthy subjects. METHODS The English version of the 25-item Craig Hospital Inventory of Environmental Factors was translated into Chinese using standardized procedures, and then administered to both the stroke and control groups. The same questionnaire was administered again to the stroke group 1-2 weeks after the first session. RESULTS The Craig Hospital Inventory of Environmental Factors had good internal consistency (Cronbachs alpha = 0.916) and test-retest reliability (intra-class correlation coefficient = 0.845). It also had significant association with Personal Wellbeing Index (r(s) = -0.379, p = 0.001) but not with Fugl-Meyer Assessment upper limb (r(s) = -0.107, p = 0.320) and lower limb motor scores (r(s) = -0.032, p = 0.768) among stroke subjects, thus demonstrating convergent and discriminant validity, respectively. The mean Craig Hospital Inventory of Environmental Factors score in the stroke group was also significantly higher than that in controls (p = 0.020), thus showing good known-groups validity. CONCLUSION The Chinese version of the Craig Hospital Inventory of Environmental Factors is a reliable and valid tool for evaluating the perceived environmental barriers experienced by people with chronic stroke.

Cardiovascular Stress Induced by Whole-Body Vibration Exercise in Individuals With Chronic Stroke

Background Although whole-body vibration (WBV) has sparked tremendous research interest in neurorehabilitation, the cardiovascular responses to WBV in people with stroke remain unknown. Objective The aim of this study was to determine the acute effects of different WBV protocols on oxygen consumption (V̇o2), heart rate (HR), rate of perceived exertion (RPE), blood pressure (BP), and rate-pressure product (RPP) during the performance of 6 different exercises among people with chronic stroke (time since onset ≥6 months). Design A repeated-measures design was used. Methods Each of the 48 participants experienced all 3 WBV protocols in separate sessions: (1) no WBV, (2) low-intensity WBV (peak acceleration=0.96 unit of gravity of Earth [g]), and (3) high-intensity WBV (1.61g). The order in which they encountered the WBV protocols was randomized, as was the order of exercises performed during each session. Oxygen consumption, HR, and RPE were measured throughout the study. Blood pressure and RPP were measured before and after each session. Results Low-intensity and high-intensity WBV induced significantly higher V̇o2 by an average of 0.69 and 0.79 mL/kg/min, respectively, compared with the control condition. These protocols also increased HR by an average of 4 bpm. The 2 WBV protocols induced higher RPE than the control condition during static standing exercise only. Although the diastolic and systolic BP and RPP were increased at the end of each exercise session, the addition of WBV had no significant effect on these variables. Limitations The results are generalizable only to ambulatory and community-dwelling people with chronic stroke. Conclusions Addition of high- and low-intensity WBV significantly increased the V̇o2 and HR, but the increase was modest. Thus, WBV should not pose any substantial cardiovascular hazard in people with chronic stroke.