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Department of Kinesiology

Denton, Texas

Department of Kinesiology Department of Kinesiology Department of Kinesiology

The Effect of Whole-Body Vibration on Balance and Gait in an Elderly Individual with Idiopathic Cerebellar Degeneration: A Case Study

Jacquelyn P. Allen, Honors Scholar, B. Rhett Rigby, PhD, & Ron Davis, PhD, CAPE (Advisors)

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ABSTRACT

INTRODUCTION

PURPOSE

METHOD

DISCUSSION

Participant

One elderly individual participated in the study. He had been previously diagnosed with Idiopathic Cerebellar Degeneration with associated Parkinsonism and displayed symptoms such as lack of balance, ataxia, stiff muscles, slurred speech, and bradykinesia. He was ambulatory with the assistance of a rolling walker. The participant had regularly been exercising with swimming three days per week and weight training two days per week. The participant was instructed to not partake in his personal workout sessions 48 hours prior to testing.

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Intervention

The participant took part in nine sessions of treatment and testing.  A randomized without replacement approach was taken in order to ensure that each of the three methods of treatment were administered for an equal number of trial sessions while keeping the sequence of treatment methods randomized. Nine slips of paper were placed into a hat numbered with three of each number: ‘one’, ‘two’, and ‘three’. At the beginning of each session, the participant would draw a number from the hat, after which the slip of paper would be discarded permanently.  If a ‘one’ was drawn, the participant would undergo three, 30-second bouts of whole-body vibration therapy at 30Hz whilst standing upon a Power Plate Next Generation vibration platform (Performance Health Systems, LLC, Northbrook, IL).  If a ‘two’ was drawn, the participant would undergo three, 30-second bouts of a supported shallow squat whilst standing upon the platform without the vibration.  If a ‘three’ was drawn, no activity would occur and the participant would stand upon the platform for approximately 90 seconds (see figure 1).  

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Figure 1. Schematic of exercise interventions and associated sessions

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Intervention Data Collection Session

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Data Collection

After a treatment, the participant underwent a Timed-Up-and-Go (TUG) test in which he stood up from a chair, walked with the assistance of his walker towards and around a marked spot on the floor approximately 17 ft. away, and returned to a sitting position at the starting point (see figures 2 and 3).  In order to obtain measurements, two stopwatches were started when the participant first rose from the chair. The first stopwatch was stopped when the participant’s leading foot crossed the marked spot for the 17 ft. duration measurement (i.e., split time) while the second stopwatch was stopped when the participant regained contact with the chair at the start point for the TUG measurement. Results, along with treatment method and additional comments, were recorded to a table immediately following each session. Statistical analyses, including computed means and standard deviations, were performed with respect to each treatment using Microsoft Excel (v. 15.0, Redmond, WA).

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Figure 2. Schematic of Timed-Up-and-Go test after intervention

The participant was a 70 year-old male with a height of 6’1”, weight of 203 pounds, and BMI of 26.6 kg/m². The average TUG and split times for trials involving WBV were less than those involving no activity which, in turn, were less than those involving squatting (see table 1 and figure 4).

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Table 1

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In this case study, the effects of WBV on gait and balance were investigated in an elderly individual with ICD and associated Parkinsonism. These results were compared to results following squatting exercises and no exercise. Three, 30-second bouts of WBV are more effective than bouts of squatting and no activity of similar duration of acutely improving the gait and balance in an individual with ICD. Furthermore, three, 30-second bouts of the squatting intervention resulted in the longest average duration for both the TUG test and split time; therefore, this intervention may be the least effective in cultivating balance and gait when compared to WBV and no activity. There are multiple theories as to why WBV may be effective in the immediate improvement of motor capabilities in certain individuals. WBV may impact hormonal and vascular systems, as well as the neuromuscular system, indicating any improvement may be based on concurrent influences on multiple physiological systems. Also, a bout of WBV can affect neurotransmitter concentrations. WBV may therefore have an effect on the dopaminergic system (Lau, Teo, Yu, Chung, & Pang, 2011), a key component in the inflammation in and progression of Parkinson’s disease (Life Extension, 2015). WBV may also improve the efficiency of the muscles needed for balance and coordination tasks by improving agonist muscle contraction while opposing antagonist muscle contraction (Lau, Teo, Yu, Chung, & Pang, 2011). The results recorded from the squatting intervention may be contributed to lower-body fatigue. Symptoms of Parkinsonism, such as ataxia, tremors, bradykinesia, and muscle stiffness, place more stress on the muscles which can elicit rapid fatigue with low-intensity activities (Parkinson’s UK, 2014). The short duration of isometric exercises, particularly squatting, may cause the muscles in the lower extremities to exhibit early-fatigue. Quadriceps fatigue has been shown to affect gait variables (i.e., stride length, step length, cadence) which may lead to a higher risk of falling. Biomechanically, the risk of falling is associated with abnormal lower-body kinetics, specifically a reduction in muscle force output and delayed synovial joint torque production while walking (Parijat & Lockhart, 2008). Some limitations to this study are that there was only one participant and that we did not monitor factors such as diet, sleep, and stress levels. We also did not personally monitor the participant to make certain that he did not engage in physical activity 48 hours prior to the visits. Further studies should include additional participants in order to have more applicable results. Additional training studies could also include the effects of WBV on other diagnoses.

REFERENCES

RESULTS

Idiopathic Cerebellar Degeneration (ICD) is a disorder that causes neuronal impairment within the cerebellum and is typically associated with Parkinsonism (i.e., Parkinson’s-like symptoms including rigidity, ataxia, or tremors). Whole-body vibration (WBV) can acutely improve mobility and balance in individuals with Parkinson’s disease. Purpose: To investigate the effects of WBV on gait and balance in an elderly individual with ICD. Methods: One 70 year-old male with ICD participated in nine weekly sessions in which he performed a Timed-Up-and-Go (TUG) test. Prior to the test, he underwent one of three treatments: standing in place, squatting, or WBV. Each treatment included three, 30-second bouts and was randomized without replacement. Results: Based on preliminary findings, it appears the TUG test was performed most efficiently following WBV. Conclusion: WBV can lead to improved gait speed and balance in an individual with ICD. WBV shows promise as a less-intense therapy modality to relieve Parkinson’s-like symptoms.

The primary purpose of this case study was to investigate the effects of WBV on gait and balance in an individual with ICD. These results will be compared to the results following two other interventions: isometric exercise (i.e., squatting), and no activity. Of the three interventions, we hypothesize that WBV will result in the greatest improvement in gait and balance.

Cerebellar Degeneration occurs when neurons in the cerebellum, the portion of the brain which controls balance and coordination of muscles, deteriorate and die. This condition may be genetically or environmentally acquired. Other causes can include: stroke, chronic alcohol abuse, or progressive degenerative disorders that affect the nervous system such as spinocerebellar ataxias, multiple sclerosis, paraneoplastic disorders, or transmissible spongiform encephalopathies. However, in many cases, the cause is unknown, and the condition is therefore referred to as Idiopathic Cerebellar Degeneration (ICD) (National Institutes of Health, 2014). Individuals with ICD typically exhibit Parkinsonism, a condition that causes a combination of the movement abnormalities observed with Parkinson’s disease. Common symptoms associated with Parkinsonism are: bradykinesia (slowing of movement), resting tremor (shakiness), balance and gait problems, rigidity or stiffness, and ataxia (uncoordinated movement) (Matsumoto, 2014). The typical individual with Parkinson’s disease has aggregates of the alpha-synuclein protein, also known as Lewy bodies, in their brain neurons and responds well to dopamine replacement therapy. In contrast, dopamine replacement therapy has minimal to no effect on symptom progression and severity in those with Parkinsonism (Parkinson’s Action Network, 2015). Lifestyle changes, such as exercise or diet modification, may reverse some of the symptoms in those with Parkinsonism and ICD (National Institutes of Health, 2014). One such exercise modality, whole body vibration (WBV), is a contemporary mode of treatment which transfers energy to the human body from forced sinusoidal oscillations through a vibration platform (Wysocki, Butler, & Shamliyan, 2001). This passive form of exercise has been shown to have positive training effects in individuals with Parkinson’s disease. For example, Rabert et al. reported a significant acute improvement in gait speed in individuals with Parkinson’s disease after one session of WBV in comparison to active physical therapy (Rabert et al., 1996). In another study, ten individuals with Parkinson’s disease performed 12 sessions of WBV at 35 Hz, with concurrent exercises. Each session included three, 30 second trials and a significant improvement in gait speed was reported (Soares, Pereira, Magno, de Melo Figueiras, & Sobral, 2014). In a study by Ebersbach, 21 individuals with either Parkinson’s disease or a dopa-resistant imbalance randomly received 30, 15-minute sessions of either balance training or WBV on a platform at 25 Hz in addition to their physical therapy treatment. Both treatments showed significant and approximately equal improvements in gait speed and equilibrium (Ebersbach, Edler, Kaufhold, & Wissel, 2008). There are currently no known studies that have been designed to investigate the effects of WBV on gait and balance in those with ICD and Parkinsonism.

Figure 4. A comparison of whole-body vibration, squatting exercises and no exercise on Timed-Up-and-Go test and split time

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CONCLUSION

Note: 1 – Whole-Body Vibration; 2 – Squatting Exercises; 3 – No exercise

Figure 3. Flow chart of intervention and data collection process

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Within the limits of this study, WBV can lead to improved gait speed and balance in an individual with ICD and Parkinsonism. WBV shows promise as a less-intense therapeutic technique to relieve Parkinson’s-like symptoms. However, this is only a preliminary investigation and further studies should be conducted.

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Ebersbach, G., Edler, D., Kaufhold, O., & Wissel, J. (2008). Whole Body Vibration Versus Conventional Physiotherapy to Improve Balance and Gait in Parkinson’s Disease. Archives of Physical Medicine and Rehabilitation, 89(3), 399–403.

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Lau, R., Teo, T., Yu, F., Chung, R., & Pang, M. (2011). Effects of Whole-Body Vibration on Sensorimotor Performance in People With Parkinson Disease: A Systematic Review. Physical Therapy, 91(2), 198-209.

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Matsumoto, J. (2014, August 13). Diseases and Conditions. Retrieved March 20, 2015, from http://www.mayoclinic.org/parkinsonism/expert-answers/faq-20058490

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Soares, L. T., Pereira, A. J. F., Magno, L. D. P., de Melo Figueiras, H., & Sobral, L. L. (2014). Balance, gait and quality of life in Parkinson’s disease: Effects of whole body vibration treatment. Fisioterapia Em Movimento, 27(2), 261–270.