Modulating Effects of Whole-body Vibration on Cortical Activity and Gait Function in Chronic Stroke Patients

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Abstract

Whole-body vibration exercise (WBVe) can provide proper somatosensory stimulation and improve muscle strength in stroke patients. This study investigated the effects of WBVe on gait function and cortical activity in patients with chronic stroke. Thirty stroke patients were randomly assigned to either the WBVe or the control group. The WBVe group received the vibration in a half-squat position for 5 minutes at an intensity of 20 Hz. The control group kept the same posture but did not receive the vibration. Cortical activity was investigated using functional near-infrared spectroscopy (fNIRS). Gait function was assessed by a 10-m walk test (10MWT), a timed up and go (TUG) test, a Fugl-Meyer Assessment, and a Tinetti Performance-Oriented Mobility Assessment (TPOMA). In group analysis of the fNIRS data, oxygenated hemoglobin concentration was significantly increased in the ipsilesional supplementary motor area, bilateral sensorimotor cortex, and contralesional prefrontal cortex in the WBVe group compared to the control group (p < 0.05). Functional assessment demonstrated a significant interaction between time and group for the 10MWT and TUG test, suggesting that the WBVe group demonstrated meaningful improvement after intervention (p < 0.05). These results suggested that WBVe modulated the cerebral cortical activities and resulted in improvement of gait function in chronic stroke patients.

Trial Registration

ClinicalTrials.gov Identifier: NCT03375346

Highlights

• Whole-body vibration exercise (WBVe) can provide proper somatosensory stimulation.
• WBVe increased the cortical activity in the bilateral sensorimotor cortex.
• WBVe improved gait speed and balance related to the gait function.

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Most cited references 35

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Attention and the control of posture and gait: a review of an emerging area of research.

Marjorie Hines Woollacott, Anne Shumway-Cook (2002)

Research on the relationship between attention and the control of posture and gait is a new and expanding area with studies on young adults revealing the role of cognitive factors in the control of balance during standing and walking. The use of dual task paradigms to examine the effect of age related changes in attentional requirements of balance control and age-related reductions in stability when performing a secondary task has shown that these are important contributors to instability in both healthy and balance-impaired older adults. The attentional demands of balance control vary depending on the complexity of the task and the type of secondary task being performed. New clinical assessment methods incorporating dual-task paradigms are helpful in revealing the effect of disease (e.g. Parkinson's disease) on the ability to allocate attention to postural tasks and appear to be sensitive measures in both predicting fall risk and in documenting recovery of stability. Copyright 2002 Elsevier Science B.V.

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A quantitative comparison of simultaneous BOLD fMRI and NIRS recordings during functional brain activation.

Laura Thompson, David Boas, Joseph Culver … (2002)

Near-infrared spectroscopy (NIRS) has been used to noninvasively monitor adult human brain function in a wide variety of tasks. While rough spatial correspondences with maps generated from functional magnetic resonance imaging (fMRI) have been found in such experiments, the amplitude correspondences between the two recording modalities have not been fully characterized. To do so, we simultaneously acquired NIRS and blood-oxygenation level-dependent (BOLD) fMRI data and compared Delta(1/BOLD) (approximately R(2)(*)) to changes in oxyhemoglobin, deoxyhemoglobin, and total hemoglobin concentrations derived from the NIRS data from subjects performing a simple motor task. We expected the correlation with deoxyhemoglobin to be strongest, due to the causal relation between changes in deoxyhemoglobin concentrations and BOLD signal. Instead we found highly variable correlations, suggesting the need to account for individual subject differences in our NIRS calculations. We argue that the variability resulted from systematic errors associated with each of the signals, including: (1) partial volume errors due to focal concentration changes, (2) wavelength dependence of this partial volume effect, (3) tissue model errors, and (4) possible spatial incongruence between oxy- and deoxyhemoglobin concentration changes. After such effects were accounted for, strong correlations were found between fMRI changes and all optical measures, with oxyhemoglobin providing the strongest correlation. Importantly, this finding held even when including scalp, skull, and inactive brain tissue in the average BOLD signal. This may reflect, at least in part, the superior contrast-to-noise ratio for oxyhemoglobin relative to deoxyhemoglobin (from optical measurements), rather than physiology related to BOLD signal interpretation.

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Improvements in speed-based gait classifications are meaningful.

Liang Wu, Subashan Perera, Lorie Richards … (2007)

Gait velocity is a powerful indicator of function and prognosis after stroke. Gait velocity can be stratified into clinically meaningful functional ambulation classes, such as household ambulation ( 0.8 m/s). The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinically meaningful changes in stroke-related function and quality of life. In subacute stroke survivors with mild to moderate deficits who participated in a randomized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less, we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale (SIS). Of 64 eligible participants, 19 were initially household ambulators, and 12 of them (68%) transitioned to limited community ambulation, whereas of 45 initially limited community ambulators, 17 (38%) became full community ambulators. Function and quality-of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not. Among household ambulators, those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility (P=0.0299) and participation (P=0.0277). Among limited community ambulators, those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation (P=0.0085). A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life, especially for household ambulators. Household ambulators possibly had more severe stroke deficits, reducing the risk of "ceiling" effects in SIS-measured activities of daily living and instrumental activities of daily living. Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit. Outcomes should be selected that are clinically meaningful for all levels of severity.

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Author and article information

Journal

Journal ID (nlm-ta): Brain Neurorehabil

Journal ID (iso-abbrev): Brain Neurorehabil

Journal ID (publisher-id): BN

Title: Brain & NeuroRehabilitation

Publisher: Korean Society for Neurorehabilitation

ISSN (Print): 1976-8753

ISSN (Electronic): 2383-9910

Publication date Collection: July 2020

Publication date (Electronic): 26 March 2020

Volume: 13

Issue: 2

Electronic Location Identifier: e12

Affiliations

[1 ]Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.

[2 ]Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

[3 ]Center for Sport Science in Daegu, Daegu, Korea.

[4 ]Department of Physical and Rehabilitation Medicine, Ilsan Central Hospital, Ilsan, Korea.

[5 ]Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.

Author notes

Correspondence to Yun-Hee Kim. Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, 115 Irwon-ro, Gangnam-gu, Seoul 06355, Korea. yun1225.kim@ 123456samsung.com

Author information

Ahee Lee https://orcid.org/0000-0002-8150-2170

Heegoo Kim https://orcid.org/0000-0002-9695-8410

Jinuk Kim https://orcid.org/0000-0003-2941-4904

Dong-Sung Choi https://orcid.org/0000-0003-3904-0619

Jae Hwan Jung https://orcid.org/0000-0003-1352-165X

Jungsoo Lee https://orcid.org/0000-0001-9439-0166

Yun-Hee Kim https://orcid.org/0000-0001-6101-8851

Article

DOI: 10.12786/bn.2020.13.e12

PMC ID: 9879458

PubMed ID: 36744184

SO-VID: 5f201515-7213-4cdd-9563-3a0eecf93482

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 28 January 2020

Date revision received : 28 February 2020

Date accepted : 05 March 2020

Funding

Funded by: National Research Foundation of Korea, CrossRef https://doi.org/10.13039/501100003725;

Award ID: NRF-2017M3A9G5083690

Funded by: Korea Evaluation Institute of Industrial Technology, CrossRef https://doi.org/10.13039/501100003662;

Modulating Effects of Whole-body Vibration on Cortical Activity and Gait Function in Chronic Stroke Patients

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Highlights

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Stroke MRI

Most cited references 35

Attention and the control of posture and gait: a review of an emerging area of research.

A quantitative comparison of simultaneous BOLD fMRI and NIRS recordings during functional brain activation.

Improvements in speed-based gait classifications are meaningful.

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