alternative treatments Flashcards by Rebecca Nam

contraindications to Whole Body vibration
True or False:
-pregnancy
-acute DVTs
-epilepsy
-severe migraines
-severe neuropathy or arthropathy
-CP

True, all contraindicated except CP

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mirror therapy is positioned _, in front of patient, blocking view of affected limb

parallel to midline
patient views unaffected limb’s reflection as affected limb

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mirror makes a visual illusion such that _ or _ of the intact limb may be perceived as the affected limb

movement or touch

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observation of mvmt of intact limb in mirror stimulates ___ brain sites
what areas?

ipsilateral brain sites
-motor cortex
-premotor
-supplemental motor areas

idea of mental practice

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mirror therapy allows for what to happen in the brain?

dissociation between sensation of pain from mvmt

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for what populations can mirror therapy be used?

STROKE: hemiparesis (hemineglect, motor control)
PARKINSONS: bradykinesia
pain (CRPS, phantom limb pain= PLP)

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What is the evidence regarding mirror therapy for stroke population?

moderate evidence that mirror therapy improves
-motor function
-ADL

limited evidence that improves:
-pain
-hemineglect

lasts 6 months after mirror therapy intervention

we don’t know who it would benefit, how it should be applied

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mirror therapy evidence for UE stroke

improved
UE FUNCTION but not spasticity

changes maintained for 6 months

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mirror therapy evidence for LE stroke

improved:
Brunnstrom stages and FIM motor (function)

no change in functional ambulation category or MAS (spasticity)

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mirror therapy evidence for hemi-neglect

worked for some, didn’t for others
changes in neglect: improvements in
Star cancellation test
Line bisection test
Picture identification task

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does mirror therapy help with bradykinesia for parkinsons?

yes but just immediately after, improved speed

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systematic review of phantom limb pain and mirror therapy

yes, decreases pain within 1 month
patients with chronic pain >1 year benefited most
*no evidence on long term effects

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even though there are no standardized protocols for mirror therapy, what should you do?
days/week?

-5 days/week, x4 weeks
0.5 to 5 hours/day

low tech treatment, easy to apply

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What is whole body vibration?

mechanical vibration through platform/plate impacting entire body
-soloflex at home
-powerplate

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early studies in whole body vibration show it improves:

balance
bone mineral density
flexibility
pain levels
strength

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what populations has whole body vibration been used?

athletes
adults and children with various neuro conditions
well and frail older adults

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Whole body vibration physiological effects
1. motor unit recruitment -> stimulation of _ and _ through _
2. repeated vibrations (stretch) stimulates _

stimulation of mm spindles and alpha motor neurons through Ia afferents

repeated vibrations: stimulates Tonic Vibration Reflex, increased recruitment evidenced by EMG

strength gains, power, and mm mass with WBV, especially high frequency for what people?

athletes
older adults
bed rest study
frail older adults in SNF

meta-analyses suggest effects for whole body vibration are similar to resistance training and greater in WHICH PEOPLE

greater for untrained people
greater among women
greater in people over 50 yrs
greater with high frequency and intensity platforms

what are theories for flexibility improvements with use of whole body vibration?

Neural inhibition
Pain fiber
Autogenic inhibition (GTOs)
Reciprocal inhibition (Ias)

Altered proprioception (adaptation of sensors)
Thermal effect (blood flow to contracting fibers)

whole body vibration pain inhibition improvements for what types/populations:

-DOMS
-chronic LBP
-fibromyalgia
-PPS

does WBV improve
strength?
flexibility?
pain?
balance?
tone?

strength-yes
flexibility-yes
pain-yes
balance- sure, conflicting
tone-short term, maybe for CP but not enough evidence for stroke, SCA, MS

what are whole body treatment parameters?

amplitude
frequency
intensity (amp and freq)
duration
2 types of vibration
synchronous: vertical
asynchronous: rotatory

is there evidence that WBV improves strength? what about other stuff?

yes-moderate evidence for strength
weak evidence:
-proprioception
-QOL
-gait
-balance/postural control
-spasticity

biomechanical effects of whole body vibration: does it help bone density? Blood flow? arterial stiffness?

bone density: sure ish? Wolf's law BF: yes to gastroc, quads, skin arterial stiffness reduced, yes

# **** DR WILSON SAID TO KNOW THIS WBV treatment parameters for bone mineral density

low amplitude (0.3 g) high frequency (30-50Hz)

# **** DR WILSON SAID TO KNOW THIS WBV treatment parameters for blood flow

high frequency (20-60Hz)

# **** DR WILSON SAID TO KNOW THIS WBV treatment parameters for mm/ligaments

high amplitude high frequency (30-50 Hz) *unless very weak, then start lower

# **** DR WILSON SAID TO KNOW THIS WBV treatment parameters for balance/pain

low frequency (less than 20 Hz)

is there evidence that WBV improves strength? what about other stuff?

yes-moderate evidence for strength weak evidence: -proprioception -QOL -gait -balance/postural control -spasticity

True or False: No or few/rare adverse events reported for any of the Whole BODY VIBRATION studies with people with neurological conditions!

TRUE *spotty evidence *okay to give it a go

VR is defined as:

-multisensory -interactive -computer based -generates illusory realities, in order to get mind to believe the virtual as real

who can you make the VR experience more real?

-immersion -interaction (natural, meaningful interactions) -sensorimotor contingencies: action and sensory feedback should MATCH, initiate our own actions -illusion: self location, agency, body ownership (make someone feel like they are at the beach: temperature, sounds, smell, everything MATCH UP)

video games used in neurorehab to stimulate learning and motivation: what structural changes in brain?

hippocampal gray matter increase and help with attention, processing speeds, alternating tasks

true or false: VR makes a difference when used as an adjunct with normal PT for stroke rehab

true

recommendation from ANPT CPG for walking ability in people 6 months post stroke

SHOULD use during walking practice to improve gait speed and endurance | no evidence for people post TBI, SCI

Contraindications for whole body vibration: True or false: -implants (joint, metal fixation, pacemakers) -pulmonary embolism -known retinal conditions -active cancer -active infection -RA

True, contra for all except RA

Contraindications for whole body vibration: true or false -severe vestibular conditions -BPPV -fresh wounds -recent surgery -acute hernia, discopathy, spondylolysis

contra for all except BPPV

whole body vibration treatment parameters: how long should you do it? how many times per week?

10-20 minute bouts in 1-2 min increments 2-3 x/week | changes seen 6-8 mo for bone density 4-8 weeks for others

mirror therapy evidence for stroke, CRPS

improvements in pain for CRPS type 1 *small studies, hard to do on large scale