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Background: Whole-body vibration (WBV) has increasingly been used as an adjunct treatment in neurological rehabilitation. However, how muscle activation level changes during exposure to different WBV protocols in individuals after stroke remains understudied., Objective: The purpose of this study was to examine the influence of WBV intensity on the magnitude of biceps femoris (BF) and tibialis anterior (TA) muscle activity and its interaction with exercise and with severity of motor impairment and spasticity among individuals with chronic stroke., Methods: Each of the 36 individuals with chronic stroke (mean age=57.3 years, SD=10.7) performed 8 different static exercises under 3 WBV conditions: (1) no WBV, (2) low-intensity WBV (frequency=20 Hz, amplitude=0.60 mm, peak acceleration=0.96g), and (3) high-intensity WBV (30 Hz, 0.44 mm, 1.61g). The levels of bilateral TA and BF muscle activity were recorded using surface electromyography (EMG)., Results: The main effect of intensity was significant. Exposure to the low-intensity and high-intensity protocols led to a significantly greater increase in normalized BF and TA muscle electromyographic magnitude in both legs compared with no WBV. The intensity × exercise interaction also was significant, suggesting that the WBV-induced increase in EMG activity was exercise dependent. The EMG responses to WBV were similar between the paretic and nonparetic legs and were not associated with level of lower extremity motor impairment and spasticity., Limitations: Leg muscle activity was measured during static exercises only., Conclusions: Adding WBV during exercise significantly increased EMG activity in the TA and BF muscles. The EMG responses to WBV in the paretic and nonparetic legs were similar and were not related to degree of motor impairment and spasticity. The findings are useful for guiding the design of WBV training protocols for people with stroke., (© 2015 American Physical Therapy Association.)

Background: Although whole-body vibration (WBV) has sparked tremendous research interest in neurorehabilitation, the cardiovascular responses to WBV in people with stroke remain unknown., Objective: The aim of this study was to determine the acute effects of different WBV protocols on oxygen consumption (V̇o2), heart rate (HR), rate of perceived exertion (RPE), blood pressure (BP), and rate-pressure product (RPP) during the performance of 6 different exercises among people with chronic stroke (time since onset ≥6 months)., Design: A repeated-measures design was used., Methods: Each of the 48 participants experienced all 3 WBV protocols in separate sessions: (1) no WBV, (2) low-intensity WBV (peak acceleration=0.96 unit of gravity of Earth [g]), and (3) high-intensity WBV (1.61g). The order in which they encountered the WBV protocols was randomized, as was the order of exercises performed during each session. Oxygen consumption, HR, and RPE were measured throughout the study. Blood pressure and RPP were measured before and after each session., Results: Low-intensity and high-intensity WBV induced significantly higher V̇o2 by an average of 0.69 and 0.79 mL/kg/min, respectively, compared with the control condition. These protocols also increased HR by an average of 4 bpm. The 2 WBV protocols induced higher RPE than the control condition during static standing exercise only. Although the diastolic and systolic BP and RPP were increased at the end of each exercise session, the addition of WBV had no significant effect on these variables., Limitations: The results are generalizable only to ambulatory and community-dwelling people with chronic stroke., Conclusions: Addition of high- and low-intensity WBV significantly increased the V̇o2 and HR, but the increase was modest. Thus, WBV should not pose any substantial cardiovascular hazard in people with chronic stroke., (© 2015 American Physical Therapy Association.)

Background: Whole-body vibration (WBV) has gained increasing popularity in rehabilitation. Recent studies have investigated the application of WBV in individuals with chronic illnesses, including stroke., Purpose: The purpose of this study was to compare WBV exercise with the same exercise condition without WBV and with other types of physical exercise in enhancing body functions and structures, activity, and participation in individuals with stroke and examine its safety., Data Source: Electronic searches were conducted on MEDLINE, CINAHL, PEDro, PubMed, PsycINFO, and Science Citation Index., Study Selection: Randomized controlled trials (RCTs) that investigated the effects of WBV among individuals with stroke were identified by 2 independent researchers. Ten articles (9 studies, totaling 333 study participants) satisfied the selection criteria and were included in this review., Data Extraction: The methodological quality was rated using the PEDro scale. The results were extracted by 2 independent researchers and confirmed with the principal investigator., Data Synthesis: Only 2 RCTs were considered as demonstrating level 1 evidence (PEDro score ≥6 and sample size >50). Two RCTs examined the effects of a single WBV session, and 7 RCTs examined the effects of WBV programs spanning 3 to 12 weeks. No consistent benefits on bone turnover, leg motor function, balance, mobility, sensation, fall rate, activities of daily living, or societal participation were found, regardless of the nature of the comparison group. Adverse events were minor., Limitations: A broad approach was used, with stroke as an inclusion criterion for review. No solid evidence was found concerning the effects of WBV on subgroups of people with specific stroke-related deficits due to the heterogeneity of patient groups., Conclusions: Based on the review, there is insufficient evidence to support clinical use of WBV in enhancing body functions and structures, activity, and participation after stroke., (© 2014 American Physical Therapy Association.)

Background: The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new balance assessment, but its psychometric properties have not been specifically tested in individuals with stroke., Objectives: The purpose of this study was to examine the reliability and validity of the Mini-BESTest and its accuracy in categorizing people with stroke based on fall history., Design: An observational measurement study with a test-retest design was conducted., Methods: One hundred six people with chronic stroke were recruited. Intrarater reliability was evaluated by repeating the Mini-BESTest within 10 days by the same rater. The Mini-BESTest was administered by 2 independent raters to establish interrater reliability. Validity was assessed by correlating Mini-BESTest scores with scores of other balance measures (Berg Balance Scale, one-leg-standing, Functional Reach Test, and Timed "Up & Go" Test) in the stroke group and by comparing Mini-BESTest scores between the stroke group and 48 control participants, and between fallers (≥1 falls in the previous 12 months, n=25) and nonfallers (n=81) in the stroke group., Results: The Mini-BESTest had excellent internal consistency (Cronbach alpha=.89-.94), intrarater reliability (intraclass correlation coefficient [3,1]=.97), and interrater reliability (intraclass correlation coefficient [2,1]=.96). The minimal detectable change at 95% confidence interval was 3.0 points. The Mini-BESTest was strongly correlated with other balance measures. Significant differences in Mini-BESTest total scores were found between the stroke and control groups and between fallers and nonfallers in the stroke group. In terms of floor and ceiling effects, the Mini-BESTest was significantly less skewed than other balance measures, except for one-leg-standing on the nonparetic side. The Berg Balance Scale showed significantly better ability to identify fallers (positive likelihood ratio=2.6) than the Mini-BESTest (positive likelihood ratio=1.8)., Limitations: The results are generalizable only to people with mild to moderate chronic stroke., Conclusions: The Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke.