Spinal Cord Injury and Whole Body Vibration

The spinal cord is a collection of nerve pathways within the Central Nervous System (CNS). It is protected by the vertebral column, which is a set of bones that run from the base of the skull to the buttock region. The spinal cord is responsible for relaying all messages from the brain to allow for movement (motor function), and for gathering stimuli from the environment to the brain for interpretation (sensory function). When the spinal cord is injured, some or all of these signals can become disrupted, possibly leading to a loss of motor function and/or sensation below the level that has been affected. Several events may lead to the spinal cord being damaged, including fractures of the spinal column (through trauma or pathological means), tumours, lack or blood to the area, and bleeding or bruising in the area. When the spinal cord has been completely severed by an injury, there will likely be no return of function and/or sensation. Meanwhile, if the injury is incomplete, there is a possibility for some level of recovery.

When someone has a spinal cord injury (SCI) they may be unable to walk or have great difficulty doing so. This may be due to weakness or paralysis of the muscles below the level of injury, and a loss of sensation that impacts coordination and movement. When someone has longer-term deficits, a spinal cord injury may lead to muscle wasting, muscle contractures, skin breakdown, and risk for osteoporosis to the bones below the level of injury. Individuals with spinal cord injuries are taught to self manage many of these issues. Depending on the level of injury, standing frames may be used to help offset bone loss. In addition, physical therapy may assist with the prevention of contractures and the strengthening of working muscles.

A recent study has indicated that Whole Body Vibration (WBV) may be useful for individuals with spinal cord injuries. The study looked at individuals with chronic SCI (> 1 year) who had spasticity in their quadriceps muscles. A WBV exercise program improved spasticity in the quadriceps muscle and this improvement lasted at least eight days following the intervention. It was concluded that WBV might be a beneficial addition to an exercise routine1. A second study looked at walking function in individuals with a chronic SCI who were considered motor incomplete. Improvements in cadence, step length, intra-limb coordination, and gait speed were noted. It was also shown that WBV exercise training results in the same improvements in walking as traditional locomotor training2. There are several studies looking at the beneficial effects of WBV on blood flow and bone density3-6. Both blood flow and bone density are important concerns for individuals with a spinal cord injury. However, results from the studies are population specific, suggesting that the benefits may not be indicative of other populations. There is one study that examined the effects of WBV on blood flow velocity in individuals with a SCI. Increases in blood flow velocity were found during, and for a brief period following a three minute protocol of WBV, along with increases in muscle activity of the quadriceps muscles in individuals with a SCI7.

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While some benefits using WBV have been observed, a review article looking at the effectiveness of WBV and bone density suggests that the use of WBV with the SCI population should be considered with caution. The article reviewed a clinical trial on “the effects of passive standing and WBV among individuals with SCI” and reported several adverse reactions. These reactions included pain, pressure sores, autonomic dysreflexia, and dizziness that were attributed to standing passively on the platform8. It was suggested that WBV might increase the following: inner ear complications, dizziness, headache, lower-limb spasticity, fractures (in individuals with severe osteoporosis) and loosening of surgical implants8. There is also the concern of causing a pulmonary embolism in individuals with a deep vein thrombosis (DVT). Due to poor circulation in the lower limbs, individuals with spinal cord injuries are at high risk for DVTs.

While there appears to be some benefits for the use of WBV within the SCI population, it is important to note that the research done with spinal cord injuries was with those who had a “chronic” injury. Chronic was defined as symptoms lasting greater than one year post injury. Due to potentially adverse complications and contraindications, any individual with a spinal cord injury must be cleared by a physician before using the platform. It is important that the physician understand the WBV platform to determine if an individual has any underlying health complications or contraindications that may prevent them from using it. If an individual is cleared by a physician, he/she should begin using the machine at a reduced intensity and duration. Individuals with a spinal cord injury may benefit from supervision of a health care professional with knowledge of WBV. If an individual cannot stand on the platform, modifications can be made (sitting in front of the platform with his/her feet resting on the platform) or devices such as a standing frame or harness can be used. It is important that if an individual experiences any adverse effects while on the platform that he/she discontinue using it immediately and discuss symptoms with a physician.

References

1.  Ness LL, Field-Fote EC. 2009. Effect of whole-body vibration on quadriceps spasticity in individuals with spastic hypertonia due to spinal cord injury, Restorative Neurology and Neuroscience, 27(6), 621-31.

2.  Ness LL, Field-Fote EC. 2009. Whole-body vibration improves walking function in individuals with spinal cord injury: a pilot study, Gait and Posture, 30(4), 436-40.

3.  Lythgo N, Eser P, de Groot P, Galea M. 2009. Whole-body vibration dosage alters leg blood flow, Clinical Physiology Funct Imaging, 29(1), 53-9.

4.  Lohman EB 3rd, Petrofsky JS, Maloney-Hinds C, Betts-Schwab H, Thorpe D. 2007. The effect of whole body vibration on lower extremity skin blood flow in normal subjects, Medical Science Monitor, 13(2), CR71-6.

5.  Gusi N, Raimundo A, Leal A. 2006. Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial, BMC Musculoskeletal Disorders, 7.

6.  Humphries B, Fenning A, Dugan E, Guinane J, MacRae K. 2009. Whole-body vibration effects on bone mineral density in women with or without resistance training, Aviation, Space and Environmental Medicine, 80(12), 1025-31.

7.  Herrero AJ, Menendez H, Gil L, Martin J, Martin T, Garcia­Lopez D, Gil-Agudo A, Marin PJ. 2011. Effects of whole-body vibration on blood flow and neuromuscular activity spinal cord injury, Spinal Cord, 49(4), 554-9.

8.  Totosy de Zepetnek JO, Giangregorio LM, Craven BC. 2009. Whole-body vibration as potential intervention for people with low bone mineral density and osteoporosis: A review, Journal of Rehabilitation Research and Development, 46(4), 529-42.

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