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Title:
The Effects of Sound Wave Vibration Therapy on Motor Symptoms of
Parkinson’s Disease
Running Title: Vibration Therapy in PD
Authors: *Lauren K. King, Quincy J. Almeida
Address: Movement Disorders Research & Rehabilitation Centre Wilfrid Laurier
University 75 University Ave. W. Waterloo ON Canada N2L 3C5
(519) 884-0710 x3924 E-mail
Abstract
Background: Recent studies have suggested that vibration therapy may have a
positive influence on motor symptoms in individuals with Parkinson’s disease (PD).
However, quantitative evidence of these benefits is scarce, and the concept of
“whole-body” vibration in these studies is vague.
Objective: The objectives of the current study were to deliver sound waves to the
entire body in order to evaluate the effectiveness of vibration therapy on motor
symptoms and functional outcome measures in PD using both qualitative and
quantitative techniques of assessment.
Method: We delivered whole body sound wave vibration to 40 individuals with PD
using the Physioacoustic Chair, a piece of equipment that has speakers spaced
throughout the chair permitting a series of programmed low frequency sound waves
through the body. Using a parallel cross over design we utilized both qualitative
and quantitative
measures such as the Unified Parkinson’s Disease Rating Scale (UPDRS), walking
assessment using GAITRite technology, and a grooved pegboard for bradykinesia.
Results: Improvements were seen in all measures. Specifically, a significant
decrease in rigidity, bradykinesia, and tremor were shown, as well as a significant
increase in step length. Conclusions: Results of this investigation provide direction
for vibration therapy as a non-pharmacological treatment alternative.
Brink 12 A – 9401 HS Assen - T. Algemeen 0624 97 9264 - T. Sales 0685 75 3975
Key Terms: Parkinson’s, Physioacoustic, Vibration Therapy, Motor control, gait,
rehabilitation
INTRODUCTION
Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized
by the asymmetrical onset of motor symptoms including, tremor, rigidity,
bradykinesia, and postural instability. PD is typically treated with oral dopamine
replacement to compensate for the death of dopaminergic neurons in an area of
the midbrain referred to as the substantia nigra. Specifically, the substantia nigra
projects to other neural structures forming pathways that are responsible for
maintaining precision in voluntary movements . Levodopa remains the primary and most effective dopamine replacement agent, however, participants experience an increasingly shorter period of symptom relief. Many develop motor fluctuations, dyskinesia, and a wide array of psychiatric problems with prolonged use of this medication . Thus it is important to investigate alternative non-pharmacologic strategies to improve the symptoms of PD. Speculation exists that vibration therapy may provide relief for symptoms of PD by influencing the abnormal neural rhythms associated with the disease . The successful function of the basal ganglia is critically dependent on the level of dopamine available to modulate its neural synchrony . The subthalamic nucleus (STN) can be strongly influential on neuron activity in the basal ganglia. It is hypothesized that the characteristic over-stimulation of the STN that occurs in PD 5 may cause the basal ganglia to be held abnormally in a 15-30Hz oscillatory rhythm . It may be suggested that the mechanical perturbations of vibration therapy disrupt these hypersynchronized rhythms. Several studies have examined vibration as a potential therapeutic intervention for motor symptoms of PD. Jöbges and colleagues administered local vibration to single upper limb muscle groups in individuals with PD experiencing moderate resting tremor, and subsequently found reductions in tremor. The authors suggest that tremor frequency is influenced by manipulating local sensory feedback to a limb. In another study by Haas et al, the investigation was concerned with the effects of vibration using variable stimuli on the whole body of PD participants rather than single muscle groups . Brink 12 A – 9401 HS Assen - T. Algemeen 0624 97 9264 - T. Sales 0685 75 3975 The justification for variable stimuli comes from work by Schultz in a series of investigations showing that unpredictability of a stimulus is directly related to dopamine release. By logical extension, if random vibration causes small supplementary releases of dopamine, it may enhance activity of the affected brain circuits. In the experiment by Haas and colleagues , random unsynchronized vibration (varying in amplitude) was delivered to the feet of PD participants from a platform on the key assumption that the effects would be experienced throughout the whole body. An important feature of the current study is that the vibration is unquestionably experienced throughout the entire body. Haas et al found a highly significant improvement of 16.8% in the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score (tremor and rigidity scores improved by 25% and 24% respectively). The current study also uses the motor impairment section of the UPDRS as a primary assessment. However, unique to the current study was the creative tactic of videotaping assessments for ensuring rater blindness to the treatment status of the participant. The videotapes were shown in random order at a later date for rating. Quantitative measures were used for gait and bradykinesia, using a pressure sensitive carpet and a grooved pegboard respectively. Changes in parameters such as step length and velocity are important values to investigate in gait analysis because walking of PD participants is normally characterized by slow, short, and shuffling steps. The timing for placement and removal of pegs in a grooved board is a useful standardized measure to evaluate upper limb slowness in initiation and execution of movement in participants. The present study employs the use of the physioacoustic method to deliver vibrations, as it ensures the delivery of vibration to the entire body, and is a comfortable alternative to other methods of delivering vibration to the body. This is the first study to quantitatively test the effects of the physioacoustic method on motor symptoms associated with PD participants. Brink 12 A – 9401 HS Assen - T. Algemeen 0624 97 9264 - T. Sales 0685 75 3975

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