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Published on: October 17, 2018
Effect of high-frequency, low-magnitude vibration on bone and muscle in children with cerebral palsy
Tishya A L Wren1, David C Lee, Reiko Hara
1Childrens Orthopaedic Center, Childrens Hospital, Los Angeles, Los Angeles, CA 90027, USA. twren@chla.usc.edu
Insights
High-frequency vibration therapy improved cortical bone properties in children with cerebral palsy (CP), potentially reducing fracture risk. Further research is needed to confirm these findings and optimize treatment protocols for musculoskeletal deficits.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Children with cerebral palsy (CP) often experience reduced bone mass and increased fracture risk.
- Noninvasive, home-based treatments like vibration therapy may address these musculoskeletal deficits.
Purpose of the Study:
- To investigate the effects of high-frequency, low-magnitude vibration on bone and muscle in children with CP.
Main Methods:
- A randomized crossover study involving 31 children with CP (ages 6-12) who used a vibrating platform for 10 minutes daily for 6 months, followed by 6 months of standing without vibration.
- Outcome measures included bone density and geometry (vertebral and tibial) via computed tomography and muscle strength via dynamometry.
- Data were analyzed using mixed-model linear regression and Pearson correlation.
Main Results:
- Vibration therapy significantly increased cortical bone properties (area, moments of inertia) in the appendicular skeleton compared to standing alone.
- No significant differences were observed in cancellous bone density or plantarflexor muscle strength between the two conditions.
- Treatment outcomes were independent of the order of intervention and consistent across different Gross Motor Function Classification System (GMFCS) levels.
Conclusions:
- High-frequency vibration therapy primarily benefits cortical bone structure in children with CP, potentially lowering long bone fracture risk.
- Further research is required to validate these findings, understand the underlying mechanisms, and establish optimal treatment parameters (age, duration).
Background:
Children with cerebral palsy (CP) have decreased strength, low bone mass, and an increased propensity to fracture. High-frequency, low-magnitude vibration might provide a noninvasive, nonpharmacologic, home-based treatment for these musculoskeletal deficits. The purpose of this study was to examine the effects of this intervention on bone and muscle in children with CP.
Methods:
Thirty-one children with CP ages 6 to 12 years (mean 9.4, SD 1.4) stood on a vibrating platform (30 Hz, 0.3 g peak acceleration) at home for 10 min/d for 6 months and on the floor without the platform for another 6 months. The order of vibration and standing was randomized, and outcomes were measured at 0, 6, and 12 months. The outcome measures included computed tomography measurements of vertebral cancellous bone density (CBD) and cross-sectional area, CBD of the proximal tibia, geometric properties of the tibial diaphysis, and dynamometer measurements of plantarflexor strength. They were assessed using mixed model linear regression and Pearson correlation.
Results:
The main difference between vibration and standing was that there was a greater increase in the cortical bone properties (cortical bone area and moments of inertia) during the vibration period (all P's ≤ 0.03). There was no difference in cancellous bone or muscle between vibration and standing (all P's > 0.10) and no correlation between compliance and outcome (all r's < 0.27; all P's > 0.15). The results did not depend on the order of treatment (P > 0.43) and were similar for children in gross motor function classification system (GMFCS) 1 to 2 and GMFCS 3 to 4.
Conclusions:
The primary benefit of the vibration intervention in children with CP was to the cortical bone in the appendicular skeleton. Increased cortical bone area and the structural (strength) properties could translate into a decreased risk of long bone fractures in some patients. More research is needed to corroborate these findings, to elucidate the mechanisms of the intervention, and to determine the most effective age and duration of the treatment.
Level Of Evidence:
Level II, prospective randomized cross-over study.
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