Whole Body Vibration for Dystonia Cerebral Palsy
Condition: Cerebral Palsy; Dystonia
MeSH terms: Paralysis; Cerebral Palsy; Dystonia; Dystonic Disorders
Study type: Interventional

Summary: 
      Health bones allow us to move and walk freely without pain. Physical activities have been
      shown to relate to healthy bone growth. Children with physical disabilities are not able to
      do the same amount of exercises as their healthy peers. They are vulnerable to poor bone
      health, bone pain, and at high risk of osteopenia or even broken bones. This problem will
      extend to their adulthood.

      Recently, whole body vibration therapy (WBVT) has been proven to improve bone health and
      muscle function in healthy adults and post-menopausal women. Promising results have been
      shown on gross motor skills, balance and muscle strength for children and young adults with
      mild cerebral palsy (CP). Most of the vibration protocols require the participants perform
      some simple exercises on the vibration platform.

      Very limited studies have been done on children and young adults with moderate CP and almost
      none solely on individuals with dystonia CP. We do not know if the effect of the WBVT on
      individuals with dystonia CP would be the same as those with spastic CP and on those with
      moderate CP as those with mild CP. We also do not know if static standing on the vibration
      platform would have similar effects on tone abnormalities, balance and gross motor skills as
      doing simple exercises on the vibration platform because children and young adults with
      dystonia CP may not be able to freely do simple exercises on the vibration platform without
      extra support.

      The present pilot study is to systematically investigate the effects of WBVT on tone
      abnormalities, balance and functional abilities in children and young adults with dystonia
      CP.
    

Detailed description: 
      Muscle contractions during normal movements and regular exercises are believed to build
      strong bones or good bone health. Children with cerebral palsy (CP), especially those with
      moderate severity, are unable to perform the required amount of exercise to improve their
      bone health as their typically developing counterparts. As a result, non-traumatic fractures
      and bone pain are common in children with moderate to severe CP. This problem extends to
      their adulthood, causing osteopenia or osteoporosis.

      Whole body vibration therapy (WBVT) has been recently proven to improve bone health and
      muscle function in healthy adults, post-menopausal women and individuals with mild to
      moderate severity of CP. It has been postulated that the vibration can stimulate the muscle
      spindles and elicit consistent muscle contractions. This would be a great advantage to the
      individuals with moderate severity of CP, who have limited control in their body movements
      and prevent them to perform regular exercises as the normal individuals. Among the research
      of the WBVT for children with CP, promising results have been shown on gross motor function,
      balance and muscle strength for children with mild disability. Most of the studies, which
      yielded positive results, required the study participants to perform simple exercises on the
      vibration platform as the intervention. Very limited studies have been conducted on children
      and young adults with moderate severity of CP and almost no study solely on individuals with
      dystonia CP. Other than this lack of knowledge on this sub-group of CP, there are other
      knowledge gaps of this potential intervention to improve bone health for individuals with CP.
      Firstly, we do not know if the effect of WBVT on this population group would be similar or
      more effective than those with mild CP in terms of their tone abnormalities, gross motor
      function and balance, because the moderate group is greatly compromised in their mobility and
      extent of regular exercises when compared with those with mild CP. Secondly, preliminary
      results of the WBVT are promising in children and young adults with moderate severity of
      spastic CP. However, we do not know if these promising effects will be similar to those with
      dystonia or spastic dystonia CP because the vast differences in their tone and movement
      patterns. This pilot study aims to fill in these knowledge gaps and examine the effect of
      WBVT on children and young adults with moderate severity of dystonia CP in terms of muscle
      tone, balance and functional motor abilities.

      Methods A convenience sample of 5 children and adolescents aged between 6 to 17 years and 5
      young adults aged between 18 to 45 years with dystonia or spastic dystonia CP will be
      recruited. As this is a pilot study, we recruit mild to moderate severity of CP, i.e. Gross
      Motor Function Classification System (GMFCS) levels I to IV. In general, individuals of
      levels I and II ambulate unaided and are able to perform more advanced motor skills such as
      running and jumping with limitations. Individuals of level III mobilise with hand-held
      mobility devices such as crutches or walking frames. Individuals of levels IV have very
      limited functional mobility and are mostly limited to an indoor environment. Individuals with
      level V are non-ambulatory or totally rely on wheeled mobility aids in all environment
      settings.

      The presence of dystonia in the recruited participants will be firstly confirmed using the
      Hypertonia Assessment Tool (HAT). It is a reliable and valid clinical tool to confirm the
      presence of dystonia in individuals with CP. Only those confirmed with dystonia or spastic
      dystonia CP will be included in this study. Assessments will be performed at baseline and at
      completion of the intervention to examine the functional abilities of the study participants.

      The study participants will receive the WBVT when standing still on a vibration platform
      independently or with own hand support on the platform rail. The vibration protocol is
      modified from the study by Gusso et al (2016) and has also been tested in a pilot study by PI
      on a group of children, adolescents and young adults with spastic CP. The WBVT training is of
      20 Hertz, a peak-to-peak amplitude of 2 mm and peak acceleration of 15.79m/s or 1.61g. The
      sessions will be 18 minutes in length, 4 days per week for 4 weeks. The vibration frequency,
      duration and amplitude will be progressively increased over 2 weeks to the desired
      parameters.

      The study results will be presented as means and standard deviations. Due to the small sample
      size, non-parametric Wilcoxon Signed Ranks test will be used to compare the results before
      and after the WBVT. The statistical significance level is set at p< 0.05.
    

Intervention name(s): whole body vibration therapy
Intervention type(s): Device
Intervention description(s): The study participants will receive the WBVT when standing still on a vibration platform independently or with own hand support on the platform rail. The vibration protocol is modified from the study by Gusso et al (2016). The WBVT training is of 20 Hertz, a peak-to-peak amplitude of 2 mm and peak acceleration of 15.79m/s or 1.61g. The sessions will be 18 minutes in length, 4 days per week for 4 weeks. The vibration frequency, duration and amplitude will be progressively increased over 2 weeks to the desired parameters.
Intervention model: Single Group Assignment
Intervention model description: Before and after cohort study with sample size less than 20
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: whole body vibration therapy; cerebral palsy; dystonia; functional abilities; tone abnormalities