European Journal of Physical Education and Sport Science
ISSN: 2501 - 1235
ISSN-L: 2501 - 1235
Available on-line at: www.oapub.org/edu
Volume 3 │ Issue 2 │ 2017
doi: 10.5281/zenodo.401402
EFFECTS OF WHOLE-BODY VIBRATION DURING
WHEELCHAIR PROPULSION IN INDIVIDUALS WITH
COMPLETE SPINAL CORD INJURY
Uriel Sena Lopes Gomes da Silva1i,
Hernán Ariel Villagra2,
Laura Luna Oliva3,
Nádia Fernanda Marconi4
PhD candidate, Department of Education,
1
Physical Activity and Human Motor Control,
Autonomous University of Madrid, Madrid, Spain
Dr. PhD, Department of Education,
2
Physical Activity and Human Motor Control,
Autonomous University of Madrid, Madrid, Spain
Dr. PhD, Department of Sciences,
3
Physiotherapy and Rehabilitation,
Universidad Rey Juan Carlos, Madrid, Spain
Dr. PhD, Physical Therapy Department,
4
College of Health and Human Sciences,
Western Carolina University, Cullowhee, NC, USA
Abstract:
Background: Push the manual wheelchair is one of the most important activities to the
wheelchair users like individuals with spinal cord injury (SCI). The excessive or bad use
of the upper limb would lead to biomechanical issues and pain. Whole-body vibration
applied by vibratory platform (WBV) has been showing great results increasing
muscular performance of the upper limb. Although researches regarding the influence
of WBV on activity of the upper limb muscles are unclear due to contradictory findings
and dissimilar protocols. Objective: The aim of this study was to evaluate the effects of
one single session of WBV increasing muscular performance during the propulsion of
the wheelchair in SCI. Methods: Fifteen complete SCI were recruited and performed
wheelchair propulsion test that consists in to push the manual wheelchair in a 10 meters
path as fast as possible. Average speed, push frequency (cadence) and time of
i
Correspondence: email uriel_fisio@hotmail.com
Copyright © The Author(s). All Rights Reserved.
© 2015 – 2017 Open Access Publishing Group
114
Uriel Sena Lopes Gomes da Silva, Hernán Ariel Villagra, Laura Luna Oliva, Nádia Fernanda Marconi
EFFECTS OF WHOLE-BODY VIBRATION DURING WHEELCHAIR PROPULSION IN
INDIVIDUALS WITH COMPLETE SPINAL CORD INJURY
displacement were measured before and after WBV intervention. WBV consisted in 5
sets of 30 second vibration with 60 second rest between. The positioning on the
platform consisted in supporting the elbows and forearms. Results: Results show a
significant increase in average speed and time of displacement. There was no significant
difference in push frequency. Conclusion: In conclusion, WBV is an effective tool
increasing upper limb performance during propulsion of the wheelchair and it can be
useful during the treatment of SCI individuals.
Keywords: spinal cord; upper extremity; wheelchair; vibration
1. Introduction
The correct functionality of the upper limbs is an essential condition for the autonomy
of people with disabilities, especially for wheelchair users (1, 2, 3). Individuals with a
spinal cord injury (SCI) demonstrate strength deficits and pain that can limit their
functional ability to perform activities of daily living such propulsion of the wheelchair
(4, 5, 6).
Recently, whole body vibration applied by vibratory platform (WBV) has been
used as an efficient neuromuscular tool (7-12). WBV has slowly emerged as an
alternative method of neuromuscular overload to enhance physical performance (13).
Several mechanisms for the acute effects of WBV training have been suggested,
including neural adaptation, related to increased muscle activation, caused by increased
excitability input from muscle spindles exposed to vibration (13-15). Vibrations applied
to the upper body showed enhancement of mechanical power and an increase in
neuromuscular efficiency supporting the evidence that vibrations represent a strong
stimulus for the neuromuscular system (16, 17). Acute changes in motor output, in fact,
have been associated with increased sensitivity of muscle spindles, which would lead to
facilitation in homonymous α motoneurons (13). Vibrations applied to the lower limb in
SCI have not reported positive results (18). Some studies have found positive results of
WBV in a short period: one single session (7, 8, 19-24).WBV applied to the upper
extremity has been showing positive results in muscular performance and EMG signal
(7, 17, 25, 26).
Propulse the wheelchair is one of the main tasks during daily living in SCI. The
Wheelchair Propulsion Test (WPT) consists of wheeling 10 meters while time is
recorded with a stopwatch, and the number of cycles and time are recorded by
observation. The WPT appears to be a simple and inexpensive test with excellent
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Uriel Sena Lopes Gomes da Silva, Hernán Ariel Villagra, Laura Luna Oliva, Nádia Fernanda Marconi
EFFECTS OF WHOLE-BODY VIBRATION DURING WHEELCHAIR PROPULSION IN
INDIVIDUALS WITH COMPLETE SPINAL CORD INJURY
measurement properties that can be used for people who use hand and/or foot
propulsion (27).
The aim of this study was to investigate de effects of one single session of WBV
in complete SCI during wheelchair propulsion. To the best author’s knowledge,
however, there are no studies investigating the upper limb muscle performance in
complete SCI during exposure to WBV. Although researches regarding the influence of
WBV on activity of the upper limb muscles and contradictory findings have been
reported as result of dissimilar protocols (17). In this study, we have tried to adopt the
parameters with positive results in literature to confirm its efficiency in SCI.
2. Materials and Methods
2.1 Participants
For this study, 15 individuals with complete SCI (46±20 years) were recruited. All
subjects had their injury level beneath T3 and they were all wheelchair users for more
than one year prior to the intervention. To participate in this study, they should be
manual wheelchair users more than one hour per day and have no orthopedic issues
concerning the upper limb. They also cannot have any contraindications to WBV such
as epilepsy, active tumor or severe arthrosis. None of the subjects was experienced with
WBV training. This study has the approval of the local Ethics Committee and informed
consent was obtained from all participants.
2.2 Experimental procedures
2.2.1 Wheelchair propulsion test (WPT)
WPT is a valid method to assess upper extremity performance in a wheelchair (27). It
consists:
A. Equipment and set-up: Means of recording the time (to the nearest second). A 10m
path at least 1.2m wide on a smooth level surface, with at least 2 m before the starting
line and at least 2m beyond the finish line. The starting lines and path width were
clearly indicated.
B. Starting position: Wheelchair user seated in wheelchair at rest, with the wheel locks
off, behind the starting line, facing forward. The casters were oriented as they will be
for moving in the selected direction. The tester positions himself where it is best
possible to view the limb being used to record the number of cycles and to view the
leading wheel as it crosses the finish line.
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Uriel Sena Lopes Gomes da Silva, Hernán Ariel Villagra, Laura Luna Oliva, Nádia Fernanda Marconi
EFFECTS OF WHOLE-BODY VIBRATION DURING WHEELCHAIR PROPULSION IN
INDIVIDUALS WITH COMPLETE SPINAL CORD INJURY
C. Safety: The tester is attentive to and in a position to spot for rear tips or forward falls
from the wheelchair, especially during the starting and stopping stages of the test.
D. Instructions: • The test subject may do a practice attempt to familiarize him with the
instructions and to provide the tester with an indication of what limb should be used
for counting the cycles and propulsion method. • Orally or in writing, the tester
instructs the test subject as follows: When you are ready, please propel your wheelchair to
the finish area using your usual method and speed . The tester should indicate the finish
area beyond the finish line.
E. What the tester records: The tester used the form on the appendix to record the
following data:
1. Success at completing the
m task: always yes individuals.
2. Direction of travel: only forward.
3. Limbs contributing to propulsion, steering or braking: only with both arms.
4. Limb monitored for timing propulsion cycles: dominant one.
5. Time (to the nearest second) from when the leading wheels cross the starting line
until they cross the finish line.
6. Total number of propulsive cycles in 10m (to nearest full cycle). A cycle was
defined as beginning when the limb being monitored makes the initial contact
with the hand-rim (if an arm) or the ground (if a leg). The end of the cycle is
when this event occurs the next time.
7. All subjects have used both arms to push the wheelchair the way they used to do
in their daily life tasks.
8. F. What the tester assessed: The tester has calculated the following derived
parameters:
9. Average speed: in 10 meters (m/s).
10. Push frequency (or cadence): cycles in 10 meters.
11. Effectiveness: time spent to displace 10 meters (27).
2.2.2 WBV session
WBV intervention was composed of one single session, five series of thirty second
vibrations with one-minute rest between. The frequency employed was 30Hz while the
amplitude was kept constant at 5mm. The vibratory platform model Galileo Advanced
Novotec Medical had been used for this study. The position assumed on the platform was
to support the upper limbs over the platform with elbows and forearm (Figure 1).
Forearm had been completely supported over the platform with elbows opened
underneath shoulders. Hands were kept together with the eyes looking to the horizon.
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Uriel Sena Lopes Gomes da Silva, Hernán Ariel Villagra, Laura Luna Oliva, Nádia Fernanda Marconi
EFFECTS OF WHOLE-BODY VIBRATION DURING WHEELCHAIR PROPULSION IN
INDIVIDUALS WITH COMPLETE SPINAL CORD INJURY
Trunk and lower limb had assumed the most comfortable and possible position to each
subject respecting personal limitations.
Figure 1: Positioning of the upper limbs on the platform
2.3 Data analysis and statistics
The pattern of normality of the data was analyzed using Shapiro Wilk test (less than
fifty individuals). As variables average speed and propulsion followed the normal
pattern, T-student test for independent samples matched was applied to compare the
average before and after WBV. Variable time did not follow the normal pattern;
Wilcoxon test was applied to compare the average before and after WBV.
Statistical significance level was assumed if p < 0.05. IBM-SPSS software version
22 package for Windows (Chicago, IL, California) was used for all statistical tests.
3. Results
3.1 Time of Displacement
Time of displacement was measured in seconds using a chronometer while SCI
propulse the wheelchair. Thirteen of the fifteen subjects have performed a better/faster
wheelchair propulsion reducing the time spent during the test. The mean average
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Uriel Sena Lopes Gomes da Silva, Hernán Ariel Villagra, Laura Luna Oliva, Nádia Fernanda Marconi
EFFECTS OF WHOLE-BODY VIBRATION DURING WHEELCHAIR PROPULSION IN
INDIVIDUALS WITH COMPLETE SPINAL CORD INJURY
before WBV was 6.30 seconds. The mean average after WBV improved to 5.47 seconds
(an increase of 0.83 second). It shows a better/faster performance after WBV. Table 1
shows the time spent during displacement for each individual before and after WBV.
Individual
Pretest
Posttest
Difference
1
5.15
4.27
0.88
2
7.75
6.42
1.33
3
5.46
5.04
0.42
4
4.93
4.71
0.22
5
4.35
4.36
0.01
6
5.81
5.02
0.79
7
6.73
6.18
0.55
8
6.52
5.69
0.83
9
6.52
5.77
0.75
10
6.72
5.07
1.65
11
5.16
4.02
1.14
12
12.7
11.45
1.25
13
4.92
3.38
1.54
14
5.52
5.61
0.09
15
5.04
5.06
0.02
mean
6.30
5.47
0.83a
Table 1: Time of displacement during wheelchair propulsion for each individual, in seconds.
Individuals 5, 14 and 15 were the only ones that have performed a slower propulsion after
WBV. a Significant increase. Baseline measurement comparing pretest and posttest
(p < .001; Confidence interval: 99% with Z = 2.58).
3.2 Push Frequency
Push frequency represents the total cycles during the 10 meters displacement. There
was no significant difference, that is, individuals have performed a faster displacement
without to change cadence. Table 2 shows push frequency of each individual before and
after WBV.
Individual
Pretest
Posttest
Difference
1
7
8
+1
2
10
10
0
3
6
7
+1
4
6
7
+1
5
8
7
-1
6
6
6
0
7
8
8
0
8
10
9
-1
9
10
10
0
10
8
6
-2
11
10
8
-2
12
12
10
-2
13
7
8
+1
14
6
7
+1
15
8
9
+1
mean
8.13
8
-0.13 b
Table 2: Push frequency of each individual before and after WBV. Negative values represent
the cycles that have decreased in the posttest and positive values represent an increase of cycles.
b
There was no significant difference in the average of individuals. Baseline measurement
comparing pretest and posttest (p < .001; Confidence interval: 99% with Z = 2.58).
3.3 Average Speed
Average speed was measured in meters per second (m/s). Table 3 describes the average
speed of each individual during the test. The fourth row shows the speed improvement
comparing pre and posttest. All individuals, but number 5, have increased their speed
after WBV.
Individual
Pretest
Posttest
Difference
1
1.94
2.34
0.4
2
1.29
1.55
0.26
3
1.73
1.98
0.25
4
2.02
2.12
0.1
5
2.29
2.29
0
6
1.72
1.99
0.27
7
1.48
1.61
0.13
8
1.53
1.75
0.22
9
1.53
1.73
0.2
10
1.48
1.97
0.49
11
1.93
2.48
0.55
12
0.78
0.87
0.09
13
2.03
2.95
0.92
14
1.53
1.78
0.25
15
1.98
1.97
0.01
mean
1.68
1.95
0.27 c
Table 3: Average speed of each individual pre and posttest. All individuals (but number 5)
have increased their average speed. c Significant. Baseline measurement comparing pretest and
posttest (p < .001; Confidence interval: 99% with Z = 2.58).
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Uriel Sena Lopes Gomes da Silva, Hernán Ariel Villagra, Laura Luna Oliva, Nádia Fernanda Marconi
EFFECTS OF WHOLE-BODY VIBRATION DURING WHEELCHAIR PROPULSION IN
INDIVIDUALS WITH COMPLETE SPINAL CORD INJURY
4. Discussion
Wheelchair propulsion is an alternative form of mobility that can facilitate community
participation and functional independence for people with mobility impairments.
Reliance on wheeled mobility ranges from complete - as often is the case for people
with paraplegia or tetraplegia resulting from spinal cord injury. WPT is a very simple
and effective test to measure objectively the performance of the upper limb in SCI; some
studies have been demonstrated the viability of this test and the need of further
investigations (1, 17, 27, 29). Few studies have examined biomechanics of wheelchair
propulsion at a self-selected velocity over surfaces commonly encountered in the
community (28). Differences in parameters and positions in WBV would explain such
different results literature (18).
Masani (18) have studied the effects of 40 weeks WBV on lower limbs of SCI with
no results. When WBV is applied on upper limbs, it gets great results over
neuromuscular system (7, 12, 25, 26, 30). Our study agrees to the literature increasing
muscular performance in upper limb using WBV (7, 12, 25, 26, 30).
Bosveld (8) have studied the effects of one single session of WBV on quadriceps
of motor-incomplete SCI. This one single session was enough to increase quadriceps
force-generating capacity and suggest further studies in this area. Our study also has
used one single session with positive results but in upper limb muscles.
Ashnagar et al (17) also have studied the effects of one single session of whole
body vibration over the upper limb adopting the modified push up position but in a
healthy population. They also used the same positioning and parameters applied in this
study (30Hz, push position, 5 sets of 30-second vibration, 5mm). EMG signal has
increased significantly on Upper Trapezius, Serratus Anterior, Biceps Brachii and
Triceps Brachii. We have used the same parameters of Ashnagar due to the positive
results. One single session of WBV was enough to get positive results in both studies. It
proves that these parameters and positioning over the platform are correct and can lead
to an increase in neuromuscular response of upper limb in both healthy and SCI
individuals. These findings have clinical utility when they can be reproduced and used
by professionals that treat SCI.
In our study, one single session WBV applied to the upper limb was able to
increase the time of displacement and the average speed during wheelchair propulsion
test in SCI. Cadence have not changed in this study. It means that SCI were able to
increase speed and timed of displacement using the same cycles.
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Uriel Sena Lopes Gomes da Silva, Hernán Ariel Villagra, Laura Luna Oliva, Nádia Fernanda Marconi
EFFECTS OF WHOLE-BODY VIBRATION DURING WHEELCHAIR PROPULSION IN
INDIVIDUALS WITH COMPLETE SPINAL CORD INJURY
The vibration exposure to wheelchair users exceeds international standards
when the vibration is applied directly to the wheelchair (31); due to this, vibration was
applied right to the arms. Based on Ashnagar study (17), modified push up position
over the platform stimulates upper extremity muscles.
The sample was small to achieve the same strict characteristics between
individuals and get the most reliable results. Parameters and positioning were the same
used in previous studies; it can explain the positive results. Considering the reduced
mobility of the SCI, the adopted position over the platform was able, comfortable and
safe. Wheelchair propulsion test is a valid, reliable and easily reproductive test to assess
the upper extremity performance (27).
Our study agrees to the literature concluding that WBV, under the same
parameters of this study, is effective increasing upper limb performance in SCI. It
confirms that different parameters and methods can lead to despair results and that
WBV is an efficient tool to treat the upper limbs of SCI.
5. Conclusions
One single session of WBV is able to improve the time of displacement and the average
speed of the upper limb in SCI during wheelchair propulsion. Push frequency has not
change significantly. WBV can be an additional tool during rehabilitation of upper limb
in SCI.
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INDIVIDUALS WITH COMPLETE SPINAL CORD INJURY
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EFFECTS OF WHOLE-BODY VIBRATION DURING WHEELCHAIR PROPULSION IN
INDIVIDUALS WITH COMPLETE SPINAL CORD INJURY
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