Focal Muscle Vibration on Upper Limb Function in Subacute Post-stroke Patients
Condition: Stroke, Subacute
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Stroke is the second leading cause of death, accounting for 11.13 % of total deaths, and the
      main cause of disability worldwide. The major type of stroke is ischemic, which occurs in
      about 87% of all stroke cases Stroke has different risk factors, which can be grouped into
      modifiable and non-modifiable risk factors. Major risk factors for stroke include age,
      history of cerebrovascular event, smoking, alcohol consumption, physical inactivity,
      hypertension, diabetes mellitus, cardiovascular diseases, obesity, metabolic syndrome, diet,
      nutrition, and genetic risk factors. Many new technique used for rehabilitation after stroke
      includes Constraint-Induced Movement Therapy for Arm or Leg Paralysis, Mirror Therapy for
      Hand Recovery, Harness the Relentless Force etc. Segmental muscle vibration (SMV) is also a
      new technique and effective to decrease the hyper-toned muscles spasticity but still less
      work done on it. SMV with different frequencies have different effects for both flaccid and
      spastic patients of all 3 stages of stroke. In our study we will work with 60hz and 120hz
      frequencies to reduce the spasticity of upper limb and improves their functional level.
    

Detailed description: 
      Evidence strongly suggest that a period of pure sensory stimulation can affect motor
      corticoids activity excitability.

      In 2019 segmental muscle vibration(SMV) used to improve upper extremity functional ability
      post stroke and concluded that patients in both groups improved significantly after treatment
      in Barthel index (BI), elbow Range of Motion (ROM) and elbow muscle strength. However muscle
      tone in elbow joint of hemiplegic upper extremity improved significantly after only in the
      experimental group. They suggested that with routine physiotherapy with extended exposure SMV
      will results in significant reduced spasticity and better improved Activities Of Daily
      Livings (ADLs).

      In 2019 a work done with SMV to improve gate performance in patients with foot drop after
      chronic stroke. Results of this study revealed moderate improvement in mean gate speed,
      normal side swing velocity, bilateral stride length and normal-side toe off in experimental
      group. Further studies needed to evaluate the optimal and minimum SMV dosage.

      Another study conducted in 2019 to see Results show that processing speed, inhibitory control
      and attention improved following SMV. But working memory between groups and also not show a
      association between executive functions course and fall risk, so they suggest further work to
      examine effects of vibration therapy on executive functions.

      In 2014 another therapist highlight the potential use of SMV to modulate electromyographic
      (EMG) for reaching movement in chronic stroke patients but needs to be confirmed by larger
      control perspective trials of SMV.

      In 2019 combined work done with repetitive focal muscle vibration with physiotherapy to
      improve the motor function even in very acute phase of stroke and finds it a valid
      complementary non pharmacological therapy In 2019 another study suggest that Whole Body
      Vibration (WBV) and Upper and Lower Cycle (ULC) effective upper for upper extremity motor
      function and grip strength in sub-acute stroke.

      In 2019 a study reported the risk factors (vibration injury to hands vascular components,
      intermediate blanching neurological components and lower back pain for drivers of work
      machines) and benefits (improvement in bone health and neuromuscular function). So is a room
      for research to design a balanced WBV protocol.

      A study in 2018 did a meta-analysis and compare the effects of WBV in stroke patients and
      concludes that it is a safe therapeutic method for improving symptoms.
    

Intervention name(s): Conventional Treatment; Focal Muscle Vibration (120Hz); Focal Muscle Vibration (60Hz)
Intervention type(s): Other; Other; Other
Intervention description(s): These individuals will receive the conventional intervention including the routine rehabilitation therapy like active and passive ROMs, stretching, strengthening of upper limb, balance improvement exercises. Time duration is of 40 minute 3 times per week.; These individuals will receive conventional therapy along with Focal Muscle Vibration applied to the hyper toned muscles (Bicep Brachialis and Extensor Carpi Radialis). Evaluation at baseline and after the end session (Total 24 session). i.e. 3 sessions/week for 8 weeks.; These individuals will receive conventional therapy along with Focal Muscle Vibration applied to the hyper toned muscles (Bicep Brachialis and Extensor Carpi Radialis). Evaluation at baseline and after the end session (Total 24 session). i.e. 3 sessions/week for 8 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment