Stroke, which is a leading cause of long-term disability, is often associated with persistent involvement of an upper extremity [
Improving upper extremity motor function is important for increasing occupational engagement [
Upper extremity motor recovery is aided by task-oriented practice [
Whole-body vibration (WBV) is a form of somatosensory stimulation used to rehabilitate stroke patients [
Previous studies on chronic stroke patients showed that WBV improved walking speed, step length, stride length, double-limb support [
We recruited patients with subacute stroke (
A sample size of 30 of each group was calculated with an alpha of 0.05, power of 80%, an effect size of 0.7, and a drop-out rate of 10%, using the G-power program.
This was a prospective two-group randomised controlled trial. Each of the 60 participants was randomly allocated to a WBV group (
The WBV group received WBV (Galileo 2000, Germany; 2011 model) for 30 min prior to task-orientated training. Each subject was seated on an armless chair in front of the platform and instructed to flex both shoulders at 90°, slightly bend both elbows, and then bend the trunk forward to allow both hands to be placed on the platform. Each subject was allowed to hold the palms slightly off the platform to minimise discomfort and prevent strong stimulation of the organs, eyes, and head. The WBV protocol featured seven elements at 4 to 7, 8 to 11, 12 to 15, 16 to 19, 12 to 15, 8 to 11, and 4 to 7 Hz. Each element was delivered for 2 min, and 2 min of rest separated the elements. The frequency of each element was increased by 1 Hz weekly. Thus, the frequencies delivered in week 1 were 4, 8, 12, 16, 12, 8, and 4 Hz; those in week 2 were 5, 9, 13, 17, 13, 9, and 5 Hz; those in week 3 were 6, 10, 14, 18, 14, 10, and 6 Hz; and those in week 4 were 7, 11, 15, 19, 15, 11, and 7 Hz to prevent adaptation. The ULC group received ULC training for 30 min before task-oriented training. The intensities (five levels were possible) of both cycles were chosen by the patient. All subjects in both groups received task-orientated training for 30 min after WBV or ULC, including eating (use of a spoon and cup), dressing (donning and removing a shirt), and personal hygiene (use of a toothbrush, comb, and towel). All subjects participated for 60 min/day, 5 days per week, for 4 weeks. All also received conventional physical therapy.
All subjects were assessed at baseline and after intervention. Motor function was measured using the MFT, and grip strength was measured using a Jamar hydraulic hand dynamometer.
The MFT was developed to assess the impairments in motor function of the affected upper extremity of stroke patients and to statistically analyse the possible recovery processes during rehabilitation. The MFT is composed of 32 test items, which examine arm motions and manipulative activities. The test-retest reliability coefficient and interrater reliability of the MFT were consistently above 0.95. Cronbach’s
Grip strength is useful in clinical practice for the assessment of disease and/or rehabilitation progression. The Jamar hydraulic hand dynamometer was used to measure muscle strength (isometric grip strength test). The participant was asked to squeeze the dynamometer as hard as possible with each of his or her hands. Both maximal handgrip force and endurance were assessed. The Jamar dynamometer was found to be highly
All data were analysed using the Statistical Package for the Social Sciences (SPSS) version 12.0 for Windows (SPSS, Chicago, IL, USA). The WBV and ULC groups were compared employing the
The general characteristics of the WBV and ULC groups are shown in Table
Characteristics of participants.
Variables | WBV group |
ULC group |
Between-group |
---|---|---|---|
Age (years), |
0.371 | ||
Gender | |||
Male | 18 | 17 | 0.712 |
Female | 12 | 16 | |
Stroke | |||
Intracranial hemorrhage | 15 | 16 | 0.462 |
Cerebral infarction | 15 | 14 | |
Time since onset of stroke (days), |
0.741 | ||
MMSE-K, |
0.313 | ||
MAS, |
0.393 | ||
Brunnstrom stage, |
0.543 | ||
MFT score, |
0.223 | ||
Grip strength (kg), |
0.571 |
SD: standard deviation, WBV: whole-body vibration, ULC: upper and lower cycle, MMSE-K: Mini-Mental Status Examination-Korean version, MAS: modified Ashworth scale, MFT: manual function test,
After intervention, both groups exhibited significant increases in MFT scores (
Parameters before and after treatment.
WBV group ( |
ULC group ( |
Between-group | |||||
---|---|---|---|---|---|---|---|
Before treatment | After treatment | Before treatment | After treatment | ||||
MFT score | 0.001 |
0.002 |
0.016† | ||||
Grip strength (kg) | 0.001 |
0.001 |
0.023† |
SD: standard deviation, WBV: whole-body vibration, ULC: upper and lower cycle, MFT: manual function test,
In this study, we found that the use of WBV on motor function and grip strength in patients with subacute stroke was more effective than the use of ULC. Of course, motor function and grip strength improved in both groups, but it improved more in the WBV group. Therefore, task-oriented training after WBV effectively improved motor function and increased grip strength.
All participants had subacute strokes. Although some recovery may occur spontaneously within the first 3 months after stroke [
All participants received task-oriented training, which reduces upper extremity impairment and improves both motor function [
In the previous studies, WBV effectively improved motor function in stroke patients [
Our study had several limitations. First, the sample size was small, and the results thus cannot be generalised. Second, we did not schedule follow-up after interventions ended; long-term outcomes were not explored.
These findings suggest that the use of WBV and ULC was effective as remedial treatments for improving upper extremity motor function and increasing grip strength for patients with subacute strokes. The improvement was more pronounced for the WBV treatment.
(1) The data used to support the findings of this study were supplied under license and so cannot be made freely available. Requests for access to these data should be made to
The authors declare that there is no conflict of interest regarding the publication of this paper.
This paper was supported by Konkuk University in 2018.