Can tendon vibration therapy improve motor recovery in the arm following stroke? A pilot feasibility study of a clinical protocol in 11 patients

Abstract

The positive effects on motor cortical excitability of stimulating proprioception with tendon vibration therapy have previously been reported in healthy individuals and in chronic stroke patient (Marconi et al., 2008 and 2011). The aim of this study is to evaluate the feasibility of a protocol of tendon vibration therapy in a neurorehabilitation service, with a view to proceeding to an efficacy study. We performed a prospective, single-centre study, including 11 patients, 8 men, mean age 61,7 ± 10,6, with upper limb motor deficit secondary to a first stroke (5 ischaemic). Average time post-stroke was 116.8 days. Mean NIHSS at inclusion was 7,9 ± 5,7. Two 15-minute sessions per day for 5 days of vibration therapy associated to voluntary movement were applied to the elbow and wrist flexor and extensors of the hemiplegic arm. The vibration therapy was in addition to standard rehabilitation. The feasibility was assessed by the implementation of the protocol (logistic regression of sessions, who did it? Where? When?), adverses outcomes and tolerance. Assessment of motor function at baseline and at day 7 was performed with Fugl-Meyer (upper limb), ARAT, Box and Blocks Test and ARMEO was used to assess the volume of exploration of the arm. Functional recovery was measured by the difference between the two scores. Nine patients were eligible (1 transferred to another ward for a septicaemia; 1 incomplete assessment at day 7). 97.7% of planned vibration sessions were performed. There were no adverse outcomes. Treatment was well tolerated; 1 patient reported transient paraesthesias and 4 patients reported significant fatigue whilst undergoing therapy. Every patient improved motor control: mean delta (±SD): ARAT: +8.6 points ± 14.2; BBT: +3.5 points ± 10.8; Fugl Meyer: +3.3 points ± 4.2; volume of exploration ARMEO: +38% ± 75.1%. This preliminary, open-labelled, study demonstrates that this protocol is achievable in a neurorehabilitation clinic setting. Given the functional improvement seen, randomised controlled trials should be performed to further evaluate the effects on motor control.