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Neuromuscular training based on whole body vibration in children with spina bifida: a retrospective analysis of a new physiotherapy treatment program

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Abstract

Introduction

Spina bifida is the most common congenital cause of spinal cord lesions resulting in paralysis and secondary conditions like osteoporosis due to immobilization. Physiotherapy is performed for optimizing muscle function and prevention of secondary conditions. Therefore, training of the musculoskeletal system is one of the major aims in the rehabilitation of children with spinal cord lesions.

Intervention and methods

The neuromuscular physiotherapy treatment program Auf die Beine combines 6 months of home-based whole body vibration (WBV) with interval blocks at the rehabilitation center: 13 days of intensive therapy at the beginning and 6 days after 3 months. Measurements are taken at the beginning (M0), after 6 months of training (M6), and after a 6-month follow-up period (M12). Gait parameters are assessed by ground reaction force and motor function by the Gross Motor Function Measurement (GMFM-66). Sixty children (mean age 8.71 ± 4.7 years) who participated in the program until February 2014 were retrospectively analyzed.

Results

Walking velocity improved significantly by 0.11 m/s (p = 0.0026) and mobility (GMFM-66) by 2.54 points (p = 0.001) after the training. All changes at follow-up were not significant, but significant changes were observed after the training period. Decreased contractures were observed with increased muscle function.

Conclusion

Significant improvements in motor function were observed after the active training period of the new neuromuscular training concept. This first analysis of the new neuromuscular rehabilitation concept Auf die Beine showed encouraging results for a safe and efficient physiotherapy treatment program which increases motor function in children with spina bifida.

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References

  1. Abercromby AF, Amonette WE, Layne CS et al (2007) Vibration exposure and biodynamic responses during whole-body vibration training. Med Sci Sports Exerc 39:1794–1800

    Article  PubMed  Google Scholar 

  2. Ausili E, Focarelli B, Tabacco F et al (2008) Bone mineral density and body composition in a myelomeningocele children population: effects of walking ability and sport activity. Eur Rev Med Pharmacol Sci 12:349–354

    CAS  PubMed  Google Scholar 

  3. Bartonek A, Saraste H (2001) Factors influencing ambulation in myelomeningocele: a cross-sectional study. Dev Med Child Neurol 43:253–260

    Article  CAS  PubMed  Google Scholar 

  4. Beauparlant J, van den Brand R, Barraud Q et al (2013) Undirected compensatory plasticity contributes to neuronal dysfunction after severe spinal cord injury. Brain 136:3347–3361

    Article  PubMed  Google Scholar 

  5. Borton D, Bonizzato M, Beauparlant J et al (2014) Corticospinal neuroprostheses to restore locomotion after spinal cord injury. Neurosci Res 78:21–29

    Article  PubMed  Google Scholar 

  6. Dosa NP, Eckrich M, Katz DA et al (2007) Incidence, prevalence, and characteristics of fractures in children, adolescents, and adults with spina bifida. J Spinal Cord Med 30(Suppl 1):S5–S9

    PubMed Central  PubMed  Google Scholar 

  7. Gemus M, Palisano R, Russell D et al (2001) Using the gross motor function measure to evaluate motor development in children with Down syndrome. Phys Occup Ther Pediatr 21:69–79

    CAS  PubMed  Google Scholar 

  8. Herrero AJ, Menendez H, Gil L et al (2011) Effects of whole-body vibration on blood flow and neuromuscular activity in spinal cord injury. Spinal Cord 49:554–559

    Article  CAS  PubMed  Google Scholar 

  9. Hoffer MM, Feiwell E, Perry R et al (1973) Functional ambulation in patients with myelomeningocele. J Bone Joint Surg Am 55:137–148

    CAS  PubMed  Google Scholar 

  10. Hubli M, Bolliger M, Dietz V (2011) Neuronal dysfunction in chronic spinal cord injury. Spinal Cord 49:582–587

    Article  CAS  PubMed  Google Scholar 

  11. Linder-Lucht M, Othmer V, Walther M et al (2007) Validation of the gross motor function measure for use in children and adolescents with traumatic brain injuries. Pediatrics 120:e880–e886

    Article  PubMed  Google Scholar 

  12. Manella KJ, Roach KE, Field-Fote EC (2013) Operant conditioning to increase ankle control or decrease reflex excitability improves reflex modulation and walking function in chronic spinal cord injury. J Neurophysiol 109:2666–2679

    Article  PubMed  Google Scholar 

  13. Marreiros H, Loff C, Calado E (2012) Osteoporosis in paediatric patients with spina bifida. J Spinal Cord Med 35:9–21

    Article  PubMed Central  PubMed  Google Scholar 

  14. Matute-Llorente A, Gonzalez-Aguero A, Gomez-Cabello A et al (2014) Effect of whole-body vibration therapy on health-related physical fitness in children and adolescents with disabilities: a systematic review. J Adolesc Health 54:385–396

    Article  PubMed  Google Scholar 

  15. Ness LL, Field-Fote EC (2009) Effect of whole-body vibration on quadriceps spasticity in individuals with spastic hypertonia due to spinal cord injury. Restor Neurol Neurosci 27:621–631

    PubMed  Google Scholar 

  16. Norrlin S, Strinnholm M, Carlsson M et al (2003) Factors of significance for mobility in children with myelomeningocele. Acta Paediatr 92:204–210

    Article  CAS  PubMed  Google Scholar 

  17. Oliveira A, Jacome C, Marques A (2014) Physical fitness and exercise training on individuals with spina bifida: a systematic review. Res Dev Disabil 35:1119–1136

    Article  PubMed  Google Scholar 

  18. Pauly M, Cremer R (2013) Levels of mobility in children and adolescents with spina bifida-clinical parameters predicting mobility and maintenance of these skills. Eur J Pediatr Surg 23(2):110–114

    PubMed  Google Scholar 

  19. Pittman R, Oppenheim RW (1979) Cell death of motoneurons in the chick embryo spinal cord. IV. Evidence that a functional neuromuscular interaction is involved in the regulation of naturally occurring cell death and the stabilization of synapses. J Comp Neurol 187:425–446

    Article  CAS  PubMed  Google Scholar 

  20. Rittweger J (2010) Vibration as an exercise modality: how it may work, and what its potential might be. Eur J Appl Physiol 108:877–904

    Article  PubMed  Google Scholar 

  21. Ritzmann R, Kramer A, Gruber M et al (2010) EMG activity during whole body vibration: motion artifacts or stretch reflexes? Eur J Appl Physiol 110:143–151

    Article  PubMed  Google Scholar 

  22. Ritzmann R, Kramer A, Gollhofer A et al (2011) The effect of whole body vibration on the H-reflex, the stretch reflex, and the short-latency response during hopping. Scand J Med Sci Sports. doi:10.1111/j.1600-0838.2011.01388.x

    PubMed  Google Scholar 

  23. Ruck J, Chabot G, Rauch F (2010) Vibration treatment in cerebral palsy: a randomized controlled pilot study. J Musculoskelet Neuronal Interact 10:77–83

    CAS  PubMed  Google Scholar 

  24. Ruck-Gibis J, Plotkin H, Hanley J et al (2001) Reliability of the gross motor function measure for children with osteogenesis imperfecta. Pediatr Phys Ther 13:10–17

    Article  CAS  PubMed  Google Scholar 

  25. Russell DJ, Rosenbaum PL, Avery LM et al (2002) Gross motor function measure (GMFM-66 & GMFM-88) user's manual. Mac Keith, London

    Google Scholar 

  26. Russell DJ, Rosenbaum PL, Cadman DT et al (1989) The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 31:341–352

    Article  CAS  PubMed  Google Scholar 

  27. Schoenau E, Neu CM, Beck B et al (2002) Bone mineral content per muscle cross-sectional area as an index of the functional muscle-bone unit. J Bone Miner Res 17:1095–1101

    Article  PubMed  Google Scholar 

  28. Schoenau E (2005) From mechanostat theory to development of the “functional muscle-bone-unit”. J Musculoskelet Neuronal Interact 5:232–238

    CAS  PubMed  Google Scholar 

  29. Schoenmakers MA, Uiterwaal CS, Gulmans VA et al (2005) Determinants of functional independence and quality of life in children with spina bifida. Clin Rehabil 19:677–685

    Article  CAS  PubMed  Google Scholar 

  30. Schonau E, Werhahn E, Schiedermaier U et al (1996) Influence of muscle strength on bone strength during childhood and adolescence. Horm Res 45(Suppl 1):63–66

    PubMed  Google Scholar 

  31. Semler O, Fricke O, Vezyroglou K et al (2007) Preliminary results on the mobility after whole body vibration in immobilized children and adolescents. J Musculoskelet Neuronal Interact 7:77–81

    CAS  PubMed  Google Scholar 

  32. Short KR, Frimberger D (2012) A review of the potential for cardiometabolic dysfunction in youth with spina bifida and the role for physical activity and structured exercise. Int J Pediatr 2012:541363

    Article  PubMed Central  PubMed  Google Scholar 

  33. Stark C, Nikopoulou-Smyrni P, Stabrey A et al (2010) Effect of a new physiotherapy concept on bone mineral density, muscle force and gross motor function in children with bilateral cerebral palsy. J Musculoskelet Neuronal Interact 10:151–158

    CAS  PubMed  Google Scholar 

  34. Szalay EA, Cheema A (2011) Children with spina bifida are at risk for low bone density. Clin Orthop Relat Res 469:1253–1257

    Article  PubMed Central  PubMed  Google Scholar 

  35. van Schie PE, Schothorst M, Dallmeijer AJ et al (2011) Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia. J Neurosurg Pediatr 7:557–562

    PubMed  Google Scholar 

  36. Veilleux LN, Robert M, Ballaz L et al (2011) Gait analysis using a force-measuring gangway: intrasession repeatability in healthy adults. J Musculoskelet Neuronal Interact 11:27–33

    CAS  PubMed  Google Scholar 

  37. Wirth F, Schempf G, Stein G et al (2013) Whole-body vibration improves functional recovery in spinal cord-injured rats. J Neurotrauma 30:453–468

    Article  PubMed  Google Scholar 

  38. Zijdewind I, Thomas CK (2003) Motor unit firing during and after voluntary contractions of human thenar muscles weakened by spinal cord injury. J Neurophysiol 89:2065–2071

    Article  PubMed  Google Scholar 

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Acknowledgments

Kerstin Haller is acknowledged for the great help with data collection. Special thanks to the physiotherapists in the UniReha in Cologne for their high dedication on their work and assessment of the GMFM. Thanks to Baerbel Tutlewski and her team for collecting the muscle and bone parameters and to Angelika Stabrey for the statistical help. Finally, we want to thank all the patients and families participating in the Cologne physiotherapy treatment program Auf die Beine.

Conflict of interest

Eckhard Schönau is the medical director of UniReha GmbH, and Ibrahim Duran and Oliver Semler are employees of UniReha GmbH. All other authors have no conflict of interest. Novotec Medical GmbH is supporting research at UniReha GmbH.

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Authors and Affiliations

  1. Children’s Hospital, University of Cologne, Cologne, Germany

    C. Stark, H.-K. Hoyer-Kuhn, O. Semler, L. Hoebing & E. Schoenau

  2. Children’s Hospital, Clinics of the City of Cologne gGmbH, Cologne, Germany

    R. Cremer

  3. Cologne Centre for Musculoskeletal Biomechanics, Cologne, Germany

    C. Stark, O. Semler & E. Schoenau

  4. HSD Hochschule Döpfer, Cologne, Germany

    C. Stark

  5. Unireha GmbH, Paediatric Rehabilitation Center, University of Cologne, Cologne, Germany

    I. Duran & E. Schoenau

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  1. C. Stark
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  2. H.-K. Hoyer-Kuhn
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  3. O. Semler
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  4. L. Hoebing
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  5. I. Duran
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  6. R. Cremer
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  7. E. Schoenau
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Correspondence to C. Stark.

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Stark, C., Hoyer-Kuhn, HK., Semler, O. et al. Neuromuscular training based on whole body vibration in children with spina bifida: a retrospective analysis of a new physiotherapy treatment program. Childs Nerv Syst 31, 301–309 (2015). https://doi.org/10.1007/s00381-014-2577-2

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  • DOI: https://doi.org/10.1007/s00381-014-2577-2

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