First stroke; Stroke onset >6 months previously; Ankle MAS score ≥2; Able to ambulate with or without assistive device for at least 100m; MMSE score ≥24; No joint contractures; Able to complete functional walking tests
Gallbladder or kidney stones; Recent leg fractures; Internal fixation implants; Cardiac pacemaker, intractable hypertension; Recent thromboembolism; Recent infectious diseases
Ambulatory device use (n) Regular cane Quad cane MAS score (0-5)
6 8 2.4 ± 0.5
GS H-reflex in both legs; GS Hmax/Mmax ratio on affected side; Achilles deep tendon reflex on affected side; Cadence
↓GS Hmax/Mmax ratio on unaffected side (SES=0.87; ↓MA; ↓VAS (perceived spasticity) (SES=1.96); ↓Time to complete TUG (SES=1.80); ↑10MWT (maximal speed) (SES=0.79); ↑TBW% on affected side (SES=0.87); ↓TBW% on unaffected side (SES=0.87)
“A single session of WBV can reduce ankle plantar- flexion spasticity in chronic stroke patients, thereby potentially increasing ambulatory capacity"
Studies that assessed the effects of multiple WBV sessions (comparison 1)
Lau et al, 2012 [41] and Pang et al, 2013 [42] Single-Blinded RCT Local Stroke Self- Help Group
82 Chronic Stroke (58 men, 24 women) WBV41 Control 41
Hemispheric stroke; Stroke onset >6 months previously; Medically stable; AMT score ≥6; Age ≥18 years; Able to stand independently with or without aids for at least 90sec
Other neurological conditions; Serious musculoskeletal conditions; Pain that affected the performance of physical activities; Metal implants or recent fractures in the lower extremity; Vestibular disorders; Peripheral vascular disease; Other serious illness; Pregnancy
Walking aids indoors (none/cane/quad cane) CMSA leg score (out of 7) CMSA foot score (out of 7) participants with at least 1 fall in prev. 3 months (n) FAC score (1–5) BBS score (0–56) Knee concentric extension peak power (W/kg): Paretic leg Nonparetic leg
BBS; Limit of stability test (MVL, EPE, MXE, DCL); 6MWT; 10MWT (comfortable speed); CMSA on paretic leg and foot; Ankle spasticity (MAS); ABC; CTx; BAP; Paretic leg isometric muscle strength (Knee extension, Knee flexion, Paretic and non-paretic knee peak power, Concentric extension, Concentric flexion, Eccentric extension, Eccentric flexion); Incidence of falls
↓ Knee MAS (week 12)
The addition of WBV to a leg exercise protocol was no more effective in improving neuromotor performance, bone turnover, and paretic leg motor function and reducing the incidence of falls than leg exercises alone in patients with chronic stroke who have mild to moderate motor impairments. WBV may have potential to modulate spasticity.
Brogårdh et al, 2012 [43] Double-Blinded RCT Rehabilitation Center
Able to walk ≥300m; ≥10% self- perceived muscle weakness in the knee extensors or knee flexors in the paretic leg; Not engaging in any heavy resistance or high- intensity training;
Epilepsy; Cardiac disease; Cardiac pacemaker; Osteoarthritis in the lower limbs; Knee or hip joint replacement; Thrombosis in the lower limbs in previous 6 months
FIM score (18–126) BBS score (0–56) Isometric knee extension (Nm): Paretic leg Nonparetic leg
83.3 ± 3.2 51.2 ± 2.3 98.2 ± 33.7 144.8 ± 36.2
MAS; BBS; Muscle strenght (Isokinetic knee extension in both legs(60°/s), Isokinetic knee flexion in both legs (60°/s), maximum isokinetic knee extension in both legs); TUG; 10MWT (comfortable and maximal speed); 6MWT; SIS
Six weeks of WBV training had small treatment affects on balance and gait performance in individuals with chronic stroke but was not more effective than a placebo vibrating platform
Dementia or severe cognitive impairment; Knee joint pain; Unable to remain standing without external support for ≥30 s
NIHSS score (0–42) BBS score (0–56)
1.3 ± 0.5 46.1 ± 9.1
Muscle thickness of RF, VL, and MG in both legs; Maximum isokinetic knee extension strength; BBS
“WBV exercise did not augment the increase in neuromuscular performance and lower limb muscle architecture induced by isometric exercise alone in stroke patients."
Stroke onset >6 months previously; ability to sit independently for at least 10 minutes; no participation in any balance training program during the previous six months; no orthopedic problems, such as a fracture, deformity, or severe osteoarthritis; Korean version of MMSE score ≥21
Comorbidity or disability other than stroke; Uncontrolled health condition for which vibration is contraindicated
Static Sitting Balance - COP: Velocity average (cm/s) Total Path Lenght (cm) Dynamic sitting balance MFRT (cm): MFRT-A MFRT-N MFRT-P
Hemispheric stroke onset >6 months previously; Age ≥18 years; Community dweller; AMT score ≥ 6; Able to stand independently with or without aids for at least 90 sec
Brainstem or cerebellar stroke; Other neurological disorders; Neoplasms; Pregnancy; Pain that affected the ability to participate in physical activities; Vestibular conditions; Metal implants or recent fractures in the lower limbs; Other serious medical problems; Severe cardiovascular diseases (pacemaker and uncontrolled hypertension)
CMSA lower limb score (2–14) Paretic knee MAS of spasticity (0–4): 0/1/1.5/2/3/4 (n) Median (IQR) Paretic ankle MAS of spasticity (0–4): 0/1/1.5/2/3/4 (n) Median (IQR) Functional ambulation category (0–5) Walking aids (none/cane/quad/frame/ rollators/wheelchair) (n) participants with at least 1 fall in prev 12 months (n) Total number of comorbid medical conditions Hypertension (n) High cholesterol (n) Total number of medications Antihypertensive agents (n) Hypolipidemic agents (n) Antidiabetic agents (n) Muscle relaxants (n)
Paretic and Non-paretic leg muscle strength (Isometric extension at 70°, Isometric flexion at 70°, Isometric extension at 30°, Isometric flexion at 30°, Concentric extension, Concentric flexion, Eccentric extension, Eccentric flexion); Body functions and structures (Knee spasticity median (IQR), Ankle spasticity median (IQR), VO2 during 6MWT); Activity (TUG, 6MWT distance, Mini-BESTest); Participation (ABC, FAI, CHIEF-C, SF-12, PCS, MCS)
“The addition of the 30- session WBV paradigm to the leg exercise protocol was no more effective in enhancing body functions/structures, activity, and participation than leg exercises alone in chronic stroke patients with mild to moderate motor impairments.”
Gait deviation; stroke onset >6 months previously; ability to walk more than 30 seconds at >0.8 km/h; ability to understand the nature of the intervention and perform the protocol independently; MMSE score ≥21
participation in similar experiments during the previous 6 months; fracture, infectious disease, cardiac pacemakers, vestibular disorders, cerebellar diseases, visual and auditory problems, walking disability due to orthopedic problems, chronic pain, contracture in the lower extremity joints.
Walking speed (cm/s) Cadence (step/min) Step length affected side (cm) Step length less affected side (cm) Stride length (cm) Single limb support affected side (%) Single limb support less affected side (%) double limbs support (%)
↑ GAITRite: Walking speed (SES=0.241), Step length of affected side (SES=0.337), Stride length (SES=0.318)
6 weeks of WBV combined with treadmill training might be a more intensive and effective training program than treadmill training to improve the walking performance of patience with chronic stroke.
Studies that assessed the effects of multiple WBV sessions (comparison 2)
Stroke onset <6 weeks previously; Moderate or severe balance impairments (BBS score <40)
Gallbladder or kidney stones; Unable to follow simple verbal instructions; Cardiac pacemaker; Non-Stroke-related sensory or motor impairments; Medication that could interfere with postural control; Malignancies; Pregnancy; Recent fractures
MI (0-100) MAS (0-5) Knee Flexion MAS (0-5) Knee extension MAS (0-5) Ankle DF MAS (0-5) Ankle PF BBS score (0-56) BI (0-20) Trunk Control Test (0-100) RMI score (0-15) FAC score (0-5)
BBS, BI; Rivermead Mobility Index; Trunk Control Test; FAC; Motricity Index; Somatosensory threshold of affected leg
WBV was “not more effective in enhancing recovery of balance and activities of daily living than the same amount of exercise therapy on music in the postacute phase of stroke."
Tankisheva et al, 2014 [50] RCT Rehabilitation Center
Aged 40-75 years; First-ever stroke; Stroke onset >6 months previously; Medically stable; Able to stand independently with or without aids for at least 20 min; Able to perform the experimental treatment independently
Cardiac pacemaker; Acute hernia; Diabetes; Tumors; Acute thrombotic diseases; Severe heart and vascular diseases; Other neurologic disorders (rheumatoid arthritis, arthrosis); Osteoarthritis; Discopathy; Spondylosis
Isometric knee extension (Nm): Paretic leg Nonparetic leg BI (0-20) FAC score (1-6) Brunnström-Fugl-Meyer test score Ashworth scale composite score (0- 24) SOT score: C1 C2 C3 C4 C5 C6
MAS; Muscle strength; Isokinetic knee extension in both legs (60°/s); Isokinetic knee flexion in both legs (60°/s); Isokinetic knee extension in nonparetic leg; Isokinetic knee flexion in both legs; Isokinetic knee extension in nonparetic leg (240°/s); Isokinetic knee flexion in both legs (240°/s); SOT; Equilibrium scores (%) in conditions 1,2,3,5 and 6
↑ Isometric knee extension torque in paretic leg (week 6) (SES=1.74); ↑ Isokinetic knee extension strength (240°/s) in paretic leg (week 12) (SES=0.96); ↑ Equilibrium scores (%) in condition 4: normal vision and sway- referenced support surface (week 6) (SES=1.47
Six weeks of intensive WBV might “potentially be a safe and feasible way to increase some aspect of lower limb muscle strength and postural control in adults with chronic stroke”
6MWT: Six-Minute walk Test, 10MWT: 10-Meter Walk Test, ABC: Activities-Specific Balance Confidence Scale, AMT: Abbreviated Mental Test, BAP: Bone-specific Alkaline Phosphatase, BBS: Berg Balance Scale, BF: Biceps Femoris Muscle, BI: Barthel Index, C: Condition, CGS: Comfortable Gait Speed, CHIEF-C: Chinese version of the Craig Hospital Inventory of Environmental Factors, CMSA: Chedoke-McMaster Stroke Assessment, COP: Center Of Pressure, CTx: Serum C-Telopeptide of type I collagen cross-links, DCL: Directional Control, EPE: Endpoint Excursion, F: female, M: male, FAI: Frenchay Activity Index, FGS: Fast Gait Speed, FAC: Functional Ambulation Categories, FIM: Functional independence Measure, GS: Gastrocnemius-soleus Muscle, H-reflex: Hoffmann reflex, Hmax/Mmax ratio: maximum H-reflex/maximum M-response ratio, IQR: Interquartile range, L: left, R: right, MAS: Modified Ashworth Scale, MCS: Mental Health Composite Score, MFRT: Modified Functional Reach Test, MFRT-A: MFRT-Anterior Reach, MFRT-N: MFRT-Nonparetic Reach, MFRT-P: MFRT-Paretic Reach, MG: Medial Gastrocnemius Muscle, MI: Motricity Index, Mini-BESTest: Mini Balance Evaluation System Test, MMSE: Mini-Mental State Examination, MVL: Movement Velocity, MXE: Maximum Excursion, NIHSS: National Institutes of Health Stroke Scale, NP/P: Nonparetic to Paretic, NR: not reported, PCS: Physical Composite Score, RF: Rectus Femoris Muscle, RMI: Rivermead Mobility Index, SES: Standardized Effect Size, SF-12: Short-Form 12 Health Survey, version 2 (Chinese version), SIS: Stroke Impact Scale, SOT: Sensory Organization Test, TUG: Timed “Up & Go” Test, TBW%: Percentage of total body weight, VAS: Visual Analog Scale, VL: Vastus Lateralis Muscle, WBV: Whole Body Vibration Group, LWBW: Low-Intensity Whole Body Vibration, HWBW: High-Intensity Whole Body Vibration, ↓: increase, ↑: decrease. Mean±SD presented unless indicated otherwise. Median (range). The results shown in this table refer to the difference between the WBV and comparison groups. The SES was calculated from the mean and standard deviation of the change scores unless indicated otherwise. The SES was not reported because MAS is an ordinal variable. The SES for this particular outcome was reported in the text by the authors. The electromyographic amplitude data of individual muscles were not included because they were not normalized, making it difficult to compare groups.
