Whole Body Vibration on Muscle Strength in Patients With Postpolio Syndrome
Condition: Postpolio Syndrome
MeSH terms: Postpoliomyelitis Syndrome; Syndrome
Study type: Interventional

Summary: 
      Post-polio syndrome (PPS) is a neurological disease that affects polio survivors at least 15
      years after the initial polio infection. PPS is characterized by new neurological
      deficiencies after a period of neurological stability, especially at least 1 decade after the
      initial infection. PPS may manifest as new, persistent, and progressive muscle weakness,
      atrophy, limb fatigability, myalgia, arthralgia, and dysphagia, but also as generalized
      fatigue, which typically has a considerable impact on the patients' quality of life. Whole
      body vibration (WBV) has become a popular form of exercise therapy especially among elderly
      individuals, in past decades. This training method is performed by standing on a vibrating
      platform which is supposed to activate muscle contractions. WBV has been studied in
      neurologic populations with stroke, Parkinson's disease, cerebral palsy, incomplete spinal
      cord injury, and multiple sclerosis.Our aim was to investigate the effectiveness of
      whole-body vibration (WBV) exercises performed with home exercise program and patient
      education in patients with postpolio syndrome (PPS) on muscle strength, fatigue, quality of
      life and laboratory parameters by comparing them with home exercise program and patient
      education alone.
    

Detailed description: 
      Post-polio syndrome (PPS) is a neurological disease that affects polio survivors at least 15
      years after the initial polio infection. The description of PPS is attributed to Jean-Martin
      Charcot in 1875 but was only widely recognized in the early 1980s [1].

      PPS is characterized by new neurological deficiencies after a period of neurological
      stability, especially at least 1 decade after the initial infection. PPS may manifest as new,
      persistent, and progressive muscle weakness, atrophy, limb fatigability, myalgia, arthralgia,
      and dysphagia, but also as generalized fatigue, which typically has a considerable impact on
      the patients' quality of life. The estimates of the percentage of polio patients affected by
      PPS are inconsistent, varying between 20 and 85% depending on the diagnostic criteria applied
      [1].

      Despite its prevalence, post-polio syndrome remains surprisingly under-researched. People
      with PPS generally have fewer options for exercise because it may exacerbate PPS symptoms
      such as pain, fatigue, and muscle weakness [2].

      The pathophysiological framework relating to the genesis of PPS is based on the theory of
      super training, considering that shortly after an episode of acute poliomyelitis, the
      remaining motor neurons increase the number of sprouts for the reinnervation of muscle fibers
      after they have been denervated. About two to three decades after the acute episode, there is
      a tendency to overload this system, that can be accelerated depending on individual factors
      especially the activities and exercises carried out that promote overuse of the affected
      muscles. In this case of overuse and super training, an intense metabolic demand in the
      residual motor units occurs, which then triggers a process of secondary neuronal death, and
      active inflammatory process is present in the spinal cord with increased level of cytokines
      in the cerebrospinal fluid but without any convincing evidence of viral reactivation. Another
      hypothesis for the genesis of PPS is that it results from an autoimmune disorder, a theory
      that is reinforced by the presence of anti-neurofilament antibodies in the cerebrospinal
      fluid [1, 3, 4].

      There is an ongoing process of denervation and reinnervation in the muscle fibers of motor
      units that survived in PPS patients. Excessive physical activity accelerates the loss of
      motor units. Therefore, it is very important to plan the exercise so as not to cause
      additional harmful effects on the integrity of the muscle and survived motor units, to ensure
      maximal improvement and to prevent overload.

      In Cochrane review published in 2015, Koopman et al. reported that data on the effectiveness
      of muscle strengthening in PPS was controversial. In two studies, it was stated that
      strengthening thumb muscles and applying static magnetic field were reliable and effective,
      they increased muscle strength, but their effect on functional limitation was unknown. There
      is not any available data on the effectiveness of exercise for major muscle groups [5].

      Whole body vibration (WBV) has become a popular form of exercise therapy especially among
      elderly individuals, in past decades. This training method is performed by standing on a
      vibrating platform which is supposed to activate muscle contractions. WBV has been studied in
      neurologic populations with stroke, Parkinson's disease, cerebral palsy, incomplete spinal
      cord injury, and multiple sclerosis, with del Pozo-Cruz et al. conducting a systematic review
      presenting varying results pertaining to impairments, activity limitations, and
      health-related quality of life. Limited data is available about the WBV in patients with
      polio syndrome [6].
    

Intervention name(s): Whole-body Vibration Device
Intervention type(s): Device
Intervention description(s): Power Plate® (pro5TM; Power Plate North America, Inc., Northbrook, IL, USA)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: postpolio syndrome; whole body vibration; exercises; muscle strength; poliomiyelitis