mechnical stimulation in neuromuscular diseases training.pdf · whole-body-vibration the shaking of...
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MechnicalMechnical Stimulation in Stimulation in neuromuscular Diseasesneuromuscular Diseases
DietmarDietmar SchmidtbleicherSchmidtbleicherChristian Haas Christian Haas
Institute of Sport SciencesJ. W. Goethe - University Frankfurt / Main
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Whole-Body-Vibration
�„The shaking of the human body �– a complex, active, intelligent, dynamic structure �– should not be expected to have a single, simple
or easily predictable consequence�“.
(GRIFFIN 1996, 1, Handbook of human vibration)
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mV
Vibration control in alpine skiracing
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Modification of Ground Reaction Forces
a) Pre
0
200
400
600
800
1000
0 250 500 750 1000 1250 1500t [ms]
F [N
]
b) Post
0
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0 250 500 750 1000 1250 1500t [ms]
F [N
]
Ground Reaction Forces
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0
0,1
0,2
0,3
0,4
250 500 750 1000t [ms]
mV
RF BF
EMG
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Aim of the study
Do Parkinson Disease Patients develop similar neuromuscular adaptation?
Are there any transfer effects between controlling exogenous and endogenous mechanical oscillation (tremor)?
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Methods
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a) Cross a) Cross SectionalSectional StudyStudy
b) Single b) Single CaseCase StudyStudy
c) Long Term c) Long Term StudyStudy
a) Cross a) Cross SectionalSectional StudyStudy
b) Single b) Single CaseCase StudyStudy
OSZILLATIONSAUSWAHLMethods
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Methods
ZEPTOR-med ®
Characteristics:
3 Dimensional Oscillation
Multiple Dregrees of Freedom
Stochastic Input
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Methods
Clinical Presentation:
300 Subj. Idiopathic Parkinson�’s DiseaseHOEHN & YAHR Stage: 1 - 4
Predominant Symptoms: HypokineticTremor
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OSZILLATIONSAUSWAHLMethods - Tests
a) a) GaitGait AnalysisAnalysis-- e.ge.g. . gait velocity, step frequencygait velocity, step frequency (3D 3D HighHigh--SpeedSpeed--VideoVideo))
b) Manual Coordination
- Writing-Tests, Drawing-Tests (digital graphic tablet)
c) Balance
- 2 D dynamic platform, postural reflexes
d) Whole symptom pattern
- Unified Parkinson Disease Rating Scale (UPDRS)
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OSZILLATIONSAUSWAHLMethods
StochasticStochastic--WholeWhole--BodyBody--VibrationVibration
- Duration: 3 - 5 x 1 min
- Average Frequency: 6 Hz (+/- 1 Hz/s)
- Amplitude: 3 mm
PrePre--TestTest PostPost--TestTestTreatmentTreatment
t 15 min
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Results
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Drawing
Pre Post
p<0,01
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Pre
Post
Writing
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Walking Pattern
a) Contact times decreased
b) Frequency increased
c) Step length increased
d) Velocity increased
e) Higher safety
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UPDRS
75
80
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90
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1 2 3Test
UP
DR
S Sc
ore
(%)
n.s.
n.s.
****Treatment
Treatment
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Postural Reflex
-0,15
-0,1
-0,05
0
0,05
0,1
t
ante
rior-p
oste
rior s
hifts
[a.u
.]
-0,15
-0,1
-0,05
0
0,05
0,1
t
ante
rior-p
oste
rior s
hifts
[a.u
.]
p< 0,05
Pre
Post
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Balance
-0,06
-0,04
-0,02
0
0,02
0,04
0,06
t
ante
rior-p
oste
rior s
hifts
[a.u
.]
-0,06
-0,04
-0,02
0
0,02
0,04
0,06
t
ante
rior-p
oste
rior s
hifts
[a.u
.]
p< 0,01
Pre
Post
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Model of rhythmical motor behaviorSummary
80 % of analyzed Patients improve motor control
Amount of Effects is characterized by wide variety
Duration of Effects between 2 h and 48 h
Effects are reproducible
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Discussion
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Why ???
Discussion
We don�’t know!
But we have an idea!
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Destructive Interference
physiological
pathological
Result
Hutchinson et al. 1997, Levy et al. 2002, Raz et al. 2001
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Brain Activation
Bonhomme et al. 2001, Tommerdahlet al. 1999
Modification of pathological BrainActivation
e.g. Cortex, Thalamus
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Cortex
Thalamus
Substantianigra
Striatum
Glob. Pallid. ex.
Ncl. Subthal.
Glob. Pallid. in.
D1 D2
Cortex
Thalamus
Substantianigra
Striatum
Glob. Pallid. ex.
Ncl. Subthal.
Glob. Pallid. in.
D1 D2
Modell of Basalganglia
Healthy Parkinson
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Increasing Thalamus Activation
Cortex
Thalamus
Substantianigra
Striatum
Glob. Pallid. ex.
Ncl. Subthal.
Glob. Pallid. in.
D1 D2
Parkinson
Vibration Additional Input
Normalization
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Neurotransmitter
Modification of Neurotransmitters
e.g. Dopamine, Serotonin
Ariizumi, Osaka 1985, Yamaguchi 1985, Nakamura et al. 1992
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learning
Sensoryinput
noise
Thalamocorticalinformation processing
Basalganglia
CPG CPG networknetwork Reflex Reflex networknetwork
MOTOR BEHAVIOR
success?!
modification
Model of Dopamine and Thalamus Functioning
dopamine
