Potential of vibrotherapy in the rehabilitation of Parkinson’s disease symptoms: freezing and flexibility – a pilot study.

After Alzheimer’s disease, Parkinson’s disease (PD) is the second most common neurodegenerative disease in elderly. The main symptoms relate to various aspects of the movement, such as slowing it down or inhibiting it’s initiation. There is also stiffness (abnormal muscle tone and limited mobility), tremors and postural instability. With several years of dopaminergic treatment, the tendency to fall forward increases and freezing (involuntary blockage of movement) occurs. Treatment includes medications, physical therapy, exercise, and occupational therapy. Whole body vibration (WBV) has also been used in physiotherapy of PD for several years. The effect of WBV has been tested for several symptoms of PD often giving positive results, however the influence of WBV on freezing and flexibility has not been studied so far. Therefore, the aim of the German scientists at the University of Saarlandes was to evaluate the effectiveness of different vibration frequencies in improving freezing and flexibility of PD patients.

• In the tested range (6 – 18 Hz), the higher vibration frequencies turned out to be more effective.
• The 18 Hz vibration significantly improved flexibility: the range of motion in the Sit and Reach Test (SR) increased by 3.9 cm.
• Vibration did not affect freezing as assessed by the 360° Turn Test (T360).

Prepared on the basis of:

Effect of whole-body vibration on freezing and flexibility in Parkinson’s disease-a pilot study. Dincher A, Becker P, Wydra G. Neurol Sci. 2021;42(7):2795-2801.

Study population

Patients (n = 36; 50% women) were randomly assigned to the tested frequency (6, 12 or 18 Hz) or to the control group with no vibration. Equal gender proportions were maintained in each of the groups. The mean age of the patient was 69.3 ± 11.5 years; the average stage of the disease was 2.11 ± 0.79, according to Hoehn and Yahr; the subjects had been ill for 7.4 ± 4.6 years on average.

Test procedure

Two tests were performed:

• SR – evaluating flexibility and
• T360 – evaluating freezing.

SR and T360 were performed just before and immediately after the procedure. 

Use of vibration in the study

Vibrations of 6, 12 or 18 Hz and an amplitude of 4 mm were given to patients standing with slightly bent legs on a vibration platform (Galileo med Advanced; Novotec Medical). The vibrotherapy treatment consisted of five 60-second series of vibrations, separated by a 60-second break.

Results

Statistically significant differences were shown only in the SR at 18 Hz: improvement in the range of movement by 3.9 cm [F(3, 30) = 5.98]. 

Vibrations did not affect the results in the T360.

For the tested frequencies, the size of the effect they caused was determined – from weak to large (standardized mean differences), both for:

• SR (from 0.01 to 0.64) and
• T360 (-0.72 to -1.25).

The greatest effect size was obtained for 18 and the smallest for 6 Hz – in both tests.

Comment

The impact of WBV on PD patients has previously been studied in many symptomatologic aspects. There are many studies on balance, mobility, gait, and other motor symptoms such as tremor or slowing movement, but the results are still inconsistent with different test protocols and methods used. The effect of WBV on freezing and flexibility has not been previously investigated. Although, the effects of locally administered vibration, i.e. local vibrotherapy, with the use of special vibrating shoes were positive on freezing. Elasticity was also tested for the effect of local vibrations (vibrating cuffs), and beneficial effects were also observed: the range of motion in the hip joint (but not in the shoulder joint) improved.

The presented report describes the effect of a single WBV application on freezing and mobility in PD patients. It was shown that higher frequencies, in the tested range (6 – 12 Hz), induce greater improvement than the lower ones. However, higher frequencies are not suitable for everyone. Therefore, the described paradigm should continue to be tested in a larger population and in accordance to age, gender, and symptom severity, using higher frequency levels.

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