RESEARCH ARTICLE
Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: A pilot randomized controlled trial Rocco Salvatore Calabrò1☯*, Antonino Naro1☯, Margherita Russo1, Demetrio Milardi1,2, Antonino Leo1, Serena Filoni3, Antonia Trinchera1, Placido Bramanti1 1 IRCCS Centro Neurolesi “Bonino-Pulejo” Messina; Messina, Italy, 2 Department of Biomedical, Dental Sciences, and Morphological and Functional Images, University of Messina; Messina, Italy, 3 Fondazione Centri di Riabilitazione Padre Pio Onlus; San Giovanni Rotondo, Italy
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☯ These authors contributed equally to this work. *
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Abstract
OPEN ACCESS Citation: Calabrò RS, Naro A, Russo M, Milardi D, Leo A, Filoni S, et al. (2017) Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: A pilot randomized controlled trial. PLoS ONE 12(10): e0185936. https://doi.org/10.1371/journal. pone.0185936 Editor: Antoine Nordez, Universite de Nantes, FRANCE Received: May 19, 2017 Accepted: September 19, 2017 Published: October 3, 2017 Copyright: © 2017 Calabrò et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The authors received no specific funding for this work.
Even though robotic rehabilitation is very useful to improve motor function, there is no conclusive evidence on its role in reducing post-stroke spasticity. Focal muscle vibration (MV) is instead very useful to reduce segmental spasticity, with a consequent positive effect on motor function. Therefore, it could be possible to strengthen the effects of robotic rehabilitation by coupling MV. To this end, we designed a pilot randomized controlled trial (Clinical Trial NCT03110718) that included twenty patients suffering from unilateral post-stroke upper limb spasticity. Patients underwent 40 daily sessions of Armeo-Power training (1 hour/session, 5 sessions/week, for 8 weeks) with or without spastic antagonist MV. They were randomized into two groups of 10 individuals, which received (group-A) or not (groupB) MV. The intensity of MV, represented by the peak acceleration (a-peak), was calculated by the formula (2πf)2A, where f is the frequency of MV and A is the amplitude. Modified Ashworth Scale (MAS), short intracortical inhibition (SICI), and Hmax/Mmax ratio (HMR) were the primary outcomes measured before and after (immediately and 4 weeks later) the end of the treatment. In all patients of group-A, we observed a greater reduction of MAS (p = 0.007, d = 0.6) and HMR (p
