Takojšnji vpliv vibracije celega telesa na mišični tonus in hojo pri otrocih s cerebralno paralizo – pregled literature : diplomsko delo

Kramer, Ota (author), Rugelj, Darja (mentor)

Uvod: Cerebralna paraliza je posledica okvare možganov v zgodnjem razvoju, ki se kaže z različnimi kliničnimi slikami. Pogosto imajo pacienti toge in šibke mišice, slabo koordinacijo ter okvare funkcioniranja. Pri okvari možganske skorje se razvije spastična oblika, pri kateri je velik del fizioterapije usmerjen v normalizacijo mišičnega tonusa. Resnost motoričnih okvar zmanjša repertoar izvedljivih postopkov, zato se v zadnjem času pri tistih z zmanjšano sposobnostjo aktivnega sodelovanja v fizioterapiji vse pogosteje uporablja vibracija celega telesa. Vibracije povzročijo nihanje tkiva, ki predstavlja dražljaj za živčno-mišične strukture. Uporabljajo se plošče, ki proizvajajo rotacijske ali vertikalne vibracije, intenzivnost določata frekvenca in amplituda. Namen: Namen diplomskega dela je bil pregledati raziskave o takojšnjem vpivu vibracije celega telesa na mišični tonus in časovne spremenljivke hoje pri otrocih s cerebralno paralizo. Metode dela: Raziskovalne članke smo iskali v angleščini v zbirkah PubMed, PEDro, ScienceDirect in CINAHL. Rezultati: Vključitvenim merilom so ustrezale štiri raziskave, objavljene med letoma 2015 in 2017. Število preiskovancev je bilo od 12 do 44. V dveh raziskavah so rezultate primerjali s kontrolno skupino, v dveh pa rezultate iste skupine takoj po obravnavi in pred njo. Ugotovili so, da enkratna obravnava zmanjša spastičnost plantarnih fleksorjev (dve raziskavi), ekstenzorjev kolena (ena raziskava), ter poveča aktivni obseg gibljivosti v kolenu (dve raziskavi). Poročajo o boljših učinkih kombinacije vibracije in pasivnega raztezanja pri zmanjševanju spastičnosti m. soleus kot samo pasivnega raztezanja (ena raziskava). Takoj po obravnavi je povečana hitrost hoje (ena raziskava). Učinki na mišični tonus trajajo eno do dve uri (ena raziskava). V eni raziskavi so nevrofiziološke odzive merili z elektromiografijo. Po obravnavi se je zmanjšal odziv refleksa na razteg, povečali so se latenca, razmerje med zavestno in refleksno aktivnostjo, moč mišic spodnjih udov, izboljšala se je kokontrakcija. Razprava in zaključek: Pregledane raziskave kažejo vpliv enkratne aplikacije vibracije celega telesa na zmanjšanje patoloških refleksnih odzivov in boljšo izvedbo zavestnega gibanja. Zaradi učinka na spastičnost in hojo bi lahko bila vibracija celega telesa uporabna priprava na terapijo. Obstoječih raziskav je malo, narejene so na majhnih vzorcih, z različnimi protokoli in merilnimi orodji, zato rezultatov ne moremo posplošiti. Potrebne so dodatne kakovostne in metodološko bolje zastavljene raziskave.

• Language: Slovenian
• Keywords: cerebralna paraliza, vibracije celega telesa, spastičnost, hoja, nevrofiziološki mehanizmi
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-111608
• COBISS.SI-ID: 5705323
• Publication date in RUL: 04.10.2019

KRAMER, Ota, 2019, Takojšnji vpliv vibracije celega telesa na mišični tonus in hojo pri otrocih s cerebralno paralizo – pregled literature : diplomsko delo [online]. Bachelor’s thesis. [Accessed 1 April 2025]. Retrieved from: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=eng&id=111608

Secondary language

• Language: English
• Title: Immediate effect of whole-body vibration on muscle tone and gait in children with cerebral palsy – literature review : diploma work

Abstract

Introduction: Cerebral palsy is caused by brain damage in the early development and can result in various clinical pictures. Patients often have rigid and weak muscles, poor coordination and functional impairments. Spastic cerebral palsy develops if the lesion occurs in the cortex. In this type of cerebral palsy a large part of physical therapy is dedicated to normalising the muscle tone. The severity of motor impairment narrows the repertoire of applicable treatments, and in the recent years, whole-body vibration has often been used in patients with reduced active participation in therapy. Vibration causes tissue oscillation, which is a stimulus for the neuromuscular system. Vibrating platforms produce rotatory or vertical vibration, and intensity is determined by frequency and amplitude. Purpose: The purpose of this diploma work was to review research on the acute effects of a single application of whole-body vibration in children with cerebral palsy on muscle tone and temporal parameters of gait. Methods: We searched for studies in PubMed, PEDro, ScienceDirect and CINAHL databases. Results: Four articles, published between 2015 and 2017, were included. Samples included from 12 to 44 subjects. Two studies compared results to the control group, and two compared results of post-intervention measurements to pre-intervention measurements. A single application of whole-body vibration can reduce spasticity in plantar flexors (two studies), extensors of the knee (one study), and can increase active range of motion in the knee joint (two studies). A combination of whole-body vibration and passive stretching reduces spasticity of m. soleus better than passive stretching alone (one study). Gait velocity is increased immediately after application (one study). Effects on muscle tone are maintained for one to two hours (one study). One study assessed neurophysiologic responses through electromyography. Immediarely after application stretch reflex activity was reduced, latency, strength of leg muscles, ratio of voluntary and reflex activity were increased, and co-contraction was normalised. Discussion and conclusion: The reviewed research shows that a single application of whole-body vibration can reduce pathological reflex responses and improve the execution of voluntary movement. Due to its effect on spasticity and gait, it could be useful as preparation for therapy. Since existing studies are few and have included small sample sizes and different protocols and measuring tools, results can not be generalised. Further quality and methodologically superior research is needed.

• Keywords: cerebral palsy, whole-body vibration, spasticity, gait, neurophysiologic mechanisms