Promoting post-stroke recovery through focal or whole body vibration: criticisms and prospects from a narrative review

Objective: Several focal muscle vibration (fMV) and whole body vibration (WBV) protocols have been designed to promote brain reorganization processes in patients with stroke. However, whether fMV and WBV should be considered helpful tools to promote post-stroke recovery remains still largely unclear. Methods: We here achieve a comprehensive review of the application of fMV and WBV to promote brain reorganization processes in patients with stroke. By first discussing the putative physiological basis of fMV and WBV and then examining previous observations achieved in recent randomized controlled trials (RCT) in patients with stroke, we critically discuss possible strength and limitations of the currently available data. Results: We provide the first systematic assessment of fMV studies demonstrating some improvement in upper and lower limb functions, in patients with chronic stroke. We also confirm and expand previous considerations about the rather limited rationale for the application of current WBV protocols in patients with chronic stroke. Conclusion: Based on available information, we propose new recommendations for optimal stimulation parameters and strategies for recruitment of specific stroke populations that would more likely benefit from future fMV or WBV application, in terms of speed and amount of post-stroke functional recovery

Early and late follow-up of untreated traumatic aortic lesion: a support to delayed surgery

Fuente Fuente, Carlos;Montes Gil, Antonio;Periel Piquer, Montserra

Short-term effects of focal muscle vibration on motor recovery after acute stroke: a pilot randomized sham-controlled study

Repetitive focal muscle vibration (rMV) is known to promote neural plasticity and long-lasting motor recovery in chronic stroke patients. Those structural and functional changes within the motor network underlying motor recovery occur in the very first hours after stroke. Nonetheless, to our knowledge, no rMV-based studies have been carried out in acute stroke patients so far, and the clinical benefit of rMV in this phase of stroke is yet to be determined. The aim of this randomized double-blind sham-controlled study is to investigate the short-term effect of rMV on motor recovery in acute stroke patients. Out of 22 acute stroke patients, 10 were treated with the rMV (vibration group–VG), while 12 underwent the sham treatment (control group–CG). Both treatments were carried out for 3 consecutive days, starting within 72 h of stroke onset; each daily session consisted of three 10-min treatments (for each treated limb), interspersed with a 1-min interval. rMV was delivered using a specific device (Cro®System, NEMOCO srl, Italy). The transducer was applied perpendicular to the target muscle's belly, near its distal tendon insertion, generating a 0.2–0.5 mm peak-to-peak sinusoidal displacement at a frequency of 100 Hz. All participants also underwent a daily standard rehabilitation program. The study protocol underwent local ethics committee approval (ClinicalTrial.gov NCT03697525) and written informed consent was obtained from all of the participants. With regard to the different pre-treatment clinical statuses, VG patients showed significant clinical improvement with respect to CG-treated patients among the NIHSS (p < 0.001), Fugl-Meyer (p = 0.001), and Motricity Index (p < 0.001) scores. In addition, when the upper and lower limb scales scores were compared between the two groups, VG patients were found to have a better clinical improvement at all the clinical end points. This study provides the first evidence that rMV is able to improve the motor outcome in a cohort of acute stroke patients, regardless of the pretreatment clinical status. Being a safe and well-tolerated intervention, which is easy to perform at the bedside, rMV may represent a valid complementary non-pharmacological therapy to promote motor recovery in acute stroke patients

Plasticity Induced in the Human Spinal Cord by Focal Muscle Vibration

The spinal cord spinal cord has in the past been considered a hardwired system which responds to inputs in a stereotyped way. A growing body of data have instead demonstrated its ability to retain information and modify its effector capabilities, showing activity-dependent plasticity. Whereas, plasticity in the spinal cord is well documented after different forms of physical exercise, whether exogenous stimulation can induce similar changes is still a matter of debate. This issue is both of scientific and clinical relevance, since at least one form of stimulation, i.e., focal muscle vibration (fMV), is currently used as a treatment for spasticity. The aim of the present study was to assess whether fMV can induce plasticity at the SC level when applied to different muscles of the upper limb. Changes in different electrophysiological measures, such as H-reflex testing homonymous and heteronymous pathways, reciprocal inhibition and somatosensory evoked potentials were used as outcomes. We found that fMV was able to induce long-term depression-like plasticity in specific spinal cord circuits depending on the muscle vibrated. These findings helped understand the basic mechanisms underlying the effects of fMV and might help to develop more advanced stimulation protocols

Secular dynamics of a planar model of the Sun-Jupiter-Saturn-Uranus system; effective stability into the light of Kolmogorov and Nekhoroshev theories

We investigate the long-time stability of the Sun-Jupiter-Saturn-Uranus system by considering a planar secular model, that can be regarded as a major refinement of the approach first introduced by Lagrange. Indeed, concerning the planetary orbital revolutions, we improve the classical circular approximation by replacing it with a solution that is invariant up to order two in the masses; therefore, we investigate the stability of the secular system for rather small values of the eccentricities. First, we explicitly construct a Kolmogorov normal form, so as to find an invariant KAM torus which approximates very well the secular orbits. Finally, we adapt the approach that is at basis of the analytic part of the Nekhoroshev's theorem, so as to show that there is a neighborhood of that torus for which the estimated stability time is larger than the lifetime of the Solar System. The size of such a neighborhood, compared with the uncertainties of the astronomical observations, is about ten times smaller.Comment: 31 pages, 2 figures. arXiv admin note: text overlap with arXiv:1010.260

Corrigendum: Plasticity Induced in the Human Spinal Cord by Focal Muscle Vibration

Corrigendum: Plasticity Induced in the Human Spinal Cord by Focal Muscle Vibration by Rocchi, L., Suppa, A., Leodori, G., Celletti, C., Camerota, F., Rothwell, J., et al. (2018). Front. Neurol. 9:935. doi: 10.3389/fneur.2018.00935