Focal Muscle Vibration Reduces Spasticity and Improves Functional Level in Incomplete Spinal Cord Injury: A Case Report

Abstract

Background Spasticity is a common impairment following spinal cord injury (SCI) that negatively affects the activity of daily livings (ADLs). Focal muscle vibration (FMV) has beneficial effects in reducing spasticity post-stroke.

Objectives This case report aimed to investigate the effects of 8-week FMV on spasticity and ADLs in a single patient with an incomplete spinal cord injury.

Case description The patient was a 26-year-old man with 6-month post-SCI. Twenty-four sessions of FMV were provided for 15 minutes per session. Outcome measures included the Modified Ashworth Scale (MAS) and the Barthel Index (BI).

Findings The FMV treatment resulted in spasticity reduction of biceps muscle (reduction from 2 to 1+point median), quadriceps (reduction from 2 to 1 point median), and dorsiflexors (reduction from 3 to 1+point median) as measured by the Modified Ashworth Scale. The activity of daily livings assessed by the Barthel Index (improved from 67 to 79 points median) postintervention and at follow-up.

Conclusions This case report demonstrates that FMV reduces spasticity and improves the activity of daily livings in patients with incomplete spinal cord injury. Further research is needed in a larger patient population to verify our findings.

Keywords

Spinal cord - Spasticity - Rehabilitation - activity of daily living - therapy

Publication History

Received: 04 December 2021

Accepted: 01 April 2022

Article published online:
17 June 2022

• References

• 1 McKay WB, Sweatman WM, Field-Fote EC. The experience of spasticity after spinal cord injury: perceived characteristics and impact on daily life published correction appears in Spinal Cord. 2018 Mar 28. Spinal Cord 2018; 56: 478-486 DOI: 10.1038/s41393-017-0038-y.
• 2 Burchiel KJ, Hsu FP. Pain and spasticity after spinal cord injury: mechanisms and treatment. Spine (Phila Pa 1976) 2001; 26: S146-S160 DOI: 10.1097/00007632-200112151-00024.
• 3 Gorgey AS, Chiodo AE, Zemper ED, Hornyak JE, Rodriguez GM, Gater DR. Relationship of spasticity to soft tissue body composition and the metabolic profile in persons with chronic motor complete spinal cord injury. J Spinal Cord Med 2010; 33: 6-15 DOI: 10.1080/10790268.2010.11689669.
• 4 Rabchevsky AG, Kitzman PH. Latest approaches for the treatment of spasticity and autonomic dysreflexia in chronic spinal cord injury. Neurotherapeutics 2011; 8: 274-282 DOI: 10.1007/s13311-011-0025-5.
• 5 Elbasiouny SM, Moroz D, Bakr MM, Mushahwar VK. Management of spasticity after spinal cord injury: current techniques and future directions. Neurorehabil Neural Repair 2010; 24: 23-33 DOI: 10.1177/1545968309343213.
• 6 Kirshblum S. Treatment alternatives for spinal cord injury related spasticity. J Spinal Cord Med 1999; 22: 199-217 DOI: 10.1080/10790268.1999.11719570.
• 7 Taricco M, Adone R, Pagliacci C, Telaro E. Pharmacological interventions for spasticity following spinal cord injury. Cochrane Database Syst Rev 2000; 2000: CD001131 DOI: 10.1002/14651858.CD001131.
• 8 Alashram AR, Annino G, Padua E. Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat. J Clin Neurosci 2021; 91: 260-269 DOI: 10.1016/j.jocn.2021.07.019.
• 9 Alashram AR, Annino G, Mercuri NB. Changes in spasticity following functional electrical stimulation cycling in patients with spinal cord injury: A systematic review [published online ahead of print, 2020 May 14]. J Spinal Cord Med 2020; 1-14 DOI: 10.1080/10790268.2020.1763713.
• 10 Alashram AR, Annino G, Mercuri NB. Rhythmic auditory stimulation in gait rehabilitation for traumatic brain and spinal cord injury. J Clin Neurosci 2019; 69: 287-288 DOI: 10.1016/j.jocn.2019.08.080.
• 11 Alashram AR, Padua E, Annino G. Effects of Whole-Body Vibration on Motor Impairments in Patients With Neurological Disorders: A Systematic Review. Am J Phys Med Rehabil 2019; 98: 1084-1098 DOI: 10.1097/PHM.0000000000001252.
• 12 Alashram AR, Padua E, Hammash AK, Lombardo M, Annino G. Effectiveness of virtual reality on balance ability in individuals with incomplete spinal cord injury: A systematic review. J Clin Neurosci 2020; 72: 322-327 DOI: 10.1016/j.jocn.2020.01.037.
• 13 Roll JP, Vedel JP, Ribot E. Alteration of proprioceptive messages induced by tendon vibration in man: a microneurographic study. Exp Brain Res 1989; 76: 213-222 DOI: 10.1007/BF00253639.
• 14 Steyvers M, Levin O, Van Baelen M, Swinnen SP. Corticospinal excitability changes following prolonged muscle tendon vibration. Neuroreport. 2003; 14: 1901-1905 DOI: 10.1097/01.wnr.0000093296.63079.fa.
• 15 Rosenkranz K, Rothwell JC. Differences between the effects of three plasticity inducing protocols on the organization of the human motor cortex. Eur J Neurosci 2006; 23: 822-829 DOI: 10.1111/j.1460-9568.2006.04605.x.
• 16 Rosenkranz K, Pesenti A, Paulus W, Tergau F. Focal reduction of intracortical inhibition in the motor cortex by selective proprioceptive stimulation. Exp Brain Res 2003; 149: 9-16 DOI: 10.1007/s00221-002-1330-3.
• 17 Annino G, Alashram AR, Alghwiri AA. et al. Effect of segmental muscle vibration on upper extremity functional ability poststroke: A randomized controlled trial. Medicine (Baltimore) 2019; 98: e14444 DOI: 10.1097/MD.0000000000014444.
• 18 Alashram AR, Padua E, Romagnoli C, Annino G. Effectiveness of focal muscle vibration on hemiplegic upper extremity spasticity in individuals with stroke: A systematic review. NeuroRehabilitation 2019; 45: 471-481 DOI: 10.3233/NRE-192863.
• 19 Ghotbi N, Ansari NN, Naghdi S, Hasson S, Jamshidpour B, Amiri S. Inter-rater reliability of the Modified Modified Ashworth Scale in assessing lower limb muscle spasticity. Brain Inj 2009; 23: 815-819 DOI: 10.1080/02699050903200548.
• 20 Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67: 206-207 DOI: 10.1093/ptj/67.2.206.
• 21 O’Sullivan SB, Schmitz TJ. Physical Rehabilitation. 5th ed. Philadelphia, PA: FA Davis Company; 2007. 385. 632-633
• 22 Mahoney F, Barthel D. Functional evaluation: the Barthel index. Md Med J 1965; 14: 61-65
• 23 Finnerup NB. Neuropathic pain and spasticity: intricate consequences of spinal cord injury. Spinal Cord 2017; 55: 1046-1050 DOI: 10.1038/sc.2017.70.
• 24 Bhimani R, Anderson L. Clinical understanding of spasticity: implications for practice. Rehabil Res Pract 2014; 2014: 279175 DOI: 10.1155/2014/279175.
• 25 Mileva KN, Bowtell JL, Kossev AR. Effects of low-frequency whole-body vibration on motor-evoked potentials in healthy men. Exp Physiol 2009; 94: 103-116 DOI: 10.1113/expphysiol.2008.042689.
• 26 Smith L, Brouwer B. Effectiveness of muscle vibration in modulating corticospinal excitability. J Rehabil Res Dev 2005; 42: 787-794 DOI: 10.1682/jrrd.2005.02.0041.
• 27 Binder C, Kaya AE, Liepert J. Vibration prolongs the cortical silent period in an antagonistic muscle. Muscle Nerve 2009; 39: 776-780 DOI: 10.1002/mus.21240.
• 28 Ford B, Fahn S, Pullman SL. Peripherally induced EMG silent periods. Normal physiology and disorders of motor control. Adv Neurol 1995; 67: 321-328
• 29 Careta MF, Delgado L, Patriota R. Report of Allergic Reaction After Application of Botulinum Toxin. Aesthet Surg J 2015; 35: NP102-NP105 DOI: 10.1093/asj/sju105.
• 30 Gracies JM, Brashear A, Jech R. et al. Safety and efficacy of abobotulinumtoxinA for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: a double-blind randomised controlled trial. Lancet Neurol 2015; 14: 992-1001 DOI: 10.1016/S1474-4422(15)00216-1.
• 31 Moon IJ, Chang SE, Kim SD. First case of anaphylaxis after botulinum toxin type A injection. Clin Exp Dermatol 2017; 42: 760-762 DOI: 10.1111/ced.13108.
• 32 Yucesoy CA, Ateş F. BTX-A has notable effects contradicting some treatment aims in the rat triceps surae compartment, which are not confined to the muscles injected. J Biomech 2018; 66: 78-85 DOI: 10.1016/j.jbiomech.2017.10.035.