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             Spinal Cord Injury ~ Parkinson's disease Obesity ~  Arthritis   

Spinal Cord Injury

Definition and Symptoms
Spinal Cord Injury (SCI) damages the myelinated fibre tracts or white matter which carries signals to and from the brain. Depending on its classification and severity, this type of traumatic injury can also damage the grey matter in the central part of the cord, which can cause segmental loss of interneruons and motor neurons, both integral parts of the central nervous system. SCI can result from a variety of causes, including trauma, tumour, ischemia (restriction in blood supply or low blood circulation), developmental disorders, neurodegenerative diseases, demyelinative diseases, transverse myelitis and vascular malformations. (www.wikipedia.org)
Traumatic spinal cord injury is classified into five categories by the American Spinal Injury Association and the International Spinal Cord Injury Classification System:

  • A = Complete lesion
  • B = Incomplete lesion: sensory but not motor function below the neurological level.
  • C = Incomplete lesion: sensory and motor function below the neurological level, with more than half of the key muscles below the neurological level able to be moved actively over full range of motion .
  • D = Incomplete lesion: sensory and motor function below the neurological level, with more than half of the key muscles below the neurological level able to be moved actively over full range of motion against gravity.
  • E = Normal: motor and sensory scores are normal.
    (http://www.asia-spinalinjury.org/publications/2006_Classif_worksheet.pdf)

The focus for spinal cord injury rehabilitation is to help the individual reach the highest level of independence possible. The exact nature of treatment depends on the classification of the individuals SCI and their own needs. Most SCI rehabilitation programs combine physical therapy with skill-building activities and counselling for social and emotional support. Physical therapy includes exercise programsgeared towards muscle strengthening, while occupational therapy helps to redevelop fine motor skills to assist with coordination and dexterity.

Concerns for exercise
The ability of a patient with SCI to exercise is also very much dependent on their level of SCI according to the international classification system. If they are able to exercise, then this is an ideal way for them to improve their overall health and ability to carry out everyday activities. Most doctors recommend exercise as a way to improve health, but anyone planning to start or change their exercise program should always consult their own medical specialist first. (http://www.spinalcord.uab.edu/show.asp?durki=55969)
In the initial phase of rehabilitation, therapists will usually focus on a program that helps the patient to regain leg and arm strength, as mobility and communication are the two most important areas of function. For some, mobility will only be possible with the assistance of devices such as a walker, leg braces or a wheelchair. Communication skills, such as writing, typing or using the telephone may also require an adaptive device.
One of the main barriers to exercise for patients with SCI is spasticity, where certain muscles continually receive a message to tighten and contract. This can cause stiffness and tightness of the muscles, as well as interfering with gait, movement and sometimes speech. (www.wikipedia.org) Many patients with SCI have spasticity in one or both of their legs, which can affect both their ability to carry out everyday tasks and to exercise

Power Plate and Spinal Cord Injury
Power Plate equipment is already used as an intervention in Project Walk in the USA and in Standing Start in the UK. Both these projects are focused on helping patients with varying levels of SCI regain as much function as possible. Standing Start has integrated the Power Plate machine into their standing program. Exercise on the machine results in the subconscious stimulation of the axons, activating muscles which would otherwise have remained unused. Standing Start (www.standingstart.org)
Research into the effects of whole body vibration training on patients with SCI, suggest that it can help:

  • Increase bone mineral density (Davis et al. 2008 poster presentation)
  • Reduce body fat percentage (Davis et al. 2008 poster presentation)
  • Improve walking function (Ness et al. 2009)

Anecdotal evidence from those patients with SCI who have used the Power Plate�machine also suggest that it may also be helpful in:

  • Reducing spasticity
  • Alleviating pain
  • Increasing voluntary muscle contraction
  • Allowing patients to have better control of the body

The main goal of rehabilitation for patients with SCI is to help improve their quality of life, and the results, both scientific and anecdotal, outlined above have the potential to improve quality of life.
Power Plate equipment offers some advantages over other training machines. A patient with SCI can use the Power Plate machine while sitting in his or her wheelchair, and results have been observed in those who have simply rested their feet on the vibrating platform. As and when a patient is able to stand, they can use the handlebars for additional support. The other advantage is that the load on the joints is minimal, as training on the Power Plate machine increases acceleration, rather than mass (weights), to create the force needed to improve muscle strength.
Another possible advantage of the Power Plate machine is that the reflexive muscle contractions caused by the external stimulation (the vibrations) activate the muscle spindles, which may help prevent paralysed muscles from atrophy. It is believed that this may also cause a sensory signal to the cortex, which could help patients to regain neurological functioning and motor control. Further research to help understand this effect and its potential to assist with SCI rehabilitation is being conducted.

Recommendations

  • Patients with SCI often experience bladder problems, so they should be advised to void their bladder before using the Power Plate machine.
  • Always ensure there is support available in case of loss of balance, and avoid any exercises that may be unsafe if a patient does lose their balance.
  • Start with a low intensity workout and progress slowly.
  • Ensure the patient is well hydrated before the training session
Research

Davis, R., C. Sanborn, D. Niehols, E. Dugan, and D. Bazett-Jones.
WEffects of whole body vibration and assisted standing on bone mineral density, body fat and lean tissue mass of an individual with spinal cord injury. Poster Presentation.

Ness, L.L., and E.C. Field-Note.
Whole-body vibration improves walking function in individuals with spinal cord injury: A pilot study. Gait & Posture. Vol. 30(4), pp: 436-440. 2009.


Parkinson's Disease

Definition and Symptoms
Parkinson's disease is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skill, speech and other functions. Symptoms include resting tremor, movement slowness, muscle rigidity and/or stiffness, and balance problems. Other possible symptoms include cramped handwriting, decreased facial expression, decreased voice volume/hoarseness, stooped posture, decreased arm swing on the affected side, loss of ability to perform rapid alternating movements, shuffling, fatigue, impaired gross motor coordination, depression, slower reaction time, sleep disturbances, dizziness and fainting, impaired proprioception, pain, constipation, and gait problems.The primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain. Secondary symptoms may include high level cognitive dysfunction and subtle language problems. PD is both chronic and progressive.

Concerns for exercise

  • Risk of fall. Most patients with PD present with shuffling gait, and even small obstacles tend to trip them. Gait freezing, characterized by an inability to move the feet, also increase the chance of falling
  • Fatigue level
  • Dizziness and fainting due to orthostatic hypotension
  • Impaired fine and gross motor coordination
  • Slowed voluntary and involuntary motor responses (reaction time)
  • Dementia (20-40% of patients), hallucinations and paranoia
  • Medication effects
  • Excessive daytime somnolence due to poor sleeping patterns
  • Impaired proprioception
  • Pain sensations due to muscle rigidity and compensation patterns

Power Plate and Parkinson's Disease
Power Plate will most likely not have any effect on the disease, but can improve fitness and wellbeing so symptoms are reduced.

  • Stability and coordination training on the Power Plate have been shown to improve both intra-muscular and inter-muscular coordination. These two components play an essential role in gait control.
  • The Power Plate produces 25 to 50 vibrations per second, causing the muscles to contract reflexively. This high demand of muscle activity will cause more motor units to fire at the right time, at the right speed and with a better synchronization (therefore improving both fine and gross motor coordination as well as reaction time).
  • Many clients using the Power Plate report improved sleeping patterns, which may be due to a decreased cortisol level. Power Plate may have positive influence on PD patients sleep cycles and reduce daytime somnolence.
  • Slowed voluntary and involuntary motor responses (reaction time)
  • The tri-dimensional displacement of the Power Plate platform is optimal to improve proprioception and motor control in all planes of motion.
  • Pain sensations can be decreased due to the high level of stimulation of the mechano-receptors and desensitization of the pain receptors.
  • Power Plate training enhances the response of fast twitch muscle fibers, leading to a higher speed of movement, limiting the chance of falling.
  • Power Plate can help diminish muscle stiffness and increase flexibility through stretching modalities performed with vibration.

What to avoid
It is very important not to adopt an aggressive approach to Acceleration Training. Give patients plenty of opportunity to rest, do not progress too fast too soon, avoid unsafe positions that would increase the risk of falling and/or sudden changes of body position (since, because of orthostatic hypotension, these may increase the risk of falling and an exacerbation of tremors). If, while using the Power Plate machine, you feel dizzy, faint, short of breath, or any pain, stop using the Power Plate machine immediately, and consult a physician.

Research

Ebersbach, G., D. Edler, O. Kaufhold, and J. Wissel.
Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's Disease. Archives of Physical Medicine and Rehabilitation. Vol.89, pp: 399-403. 2008

Haas, C.T., S. Turbanski, K. Kessler, and D. Schmidtbleicher.
The effects of random whole-body-vibration on motor symptoms in Parkinson's disease. NeuroRehabilitation Vol. 21, pp: 29-36. 2006.

Turbanski, S., C.T. Haas, and D. Schmidtbleicher.
Effect of random whole-body vibration on postural control in Parkinson's disease. Research in Sports Medicine. Vol. 13, pp:243-256. 2005.


Obesity

Definition and Symptoms
Unfortunately, this is probably the most prevalent medical problem in the Western World. The cause is an increase of the natural energy reserves (the fatty tissues) to the point where the percentage of body fat is higher than whats considered healthy. Obesity is typically evaluated in absolute terms by measuring BMI (body mass index). There are many different degrees of obesity, usually resulting from several other contributing factors: lack of exercise, overeating, genetics etc. Obesity occurs when you consume more calories than you use. This balance is different for each person. Obesity puts a huge strain on the heart, kidneys, liver and all large weight-bearing joints such as hips, knees and ankles; a large number of medical conditions have been associated with this condition. Health problems can be the result of increased fat mass (osteoarthritis, breathing problems) or of the increased number of fat cells (diabetes, cancer, cardiovascular diseases). In most cases the body's response to insulin will change, and many patients show an increased tendency to thrombosis.

Concerns for exercise
The basic principle of losing weight is simple: expend more calories than you consume. In time, this will force your body to draw on the fat reserves, causing you to lose weight. However, our body is designed for survival, it will adjust itself during periods of scarcity, lowering the metabolism. Starving yourself will increase the rate at which you build up emergency stores of energy-rich fat as soon as you increase the amount of calories you consume again after having been on a (crash) diet, causing the infamous yoyo effect. An effective weight loss plan is a change in lifestyle. In order to increase caloric expenditure it is important to stay active, and exercise reduces the risk of muscle atrophy, decrease in bone density, and fractures. Most experts recommend that someone attempting to lose a significant amount of weight should consult with a personal physician or health care professional before beginning a weight-loss program, advising them to:

  • Aim for a healthy weight and lose weight gradually, no more than 1 kilogram per week (its not healthy to lose weight quickly, then gaining it again) - depriving yourself of essential nutrients can backfire, like slowing down the rate at which your body uses energy, or burns calories.
  • Exercise - the safest and most effective way to lose weight is to reduce the amount of calories you consume while increasing physical activity.
  • Make healthy choices in food (keep to a healthy diet) without excluding any particular foodstuffs. Aim for balance and choose meals and snacks that include all food groups. Eat small portions, but frequently throughout the day.

Power Plate and Obesity
Exercising on Power Plate equipment can be an excellent way to support your efforts in losing weight. The vibrating platform elicits involuntary muscle activity at a rate of 30-50 muscle contractions per second. It is well known that the higher the intensity of training, the longer the body will continue burning calories after the end of the workout. This is why Power Plate is very effective in boosting the metabolism, increasing muscle mass and burning fat. Power Plate can also be very helpful in managing the side effects and complications related to other medication conditions associated with obesity (improved circulation in patients with diabetes, improved mobility and reduced pain sensations in clients with osteoarthritis, and improved lymphatic and circulatory functions in subjects with circulatory problems).

What to avoid
Never make promises about weight loss. Due to the increase in muscle mass, quite often people will actually GAIN weight when training on the Power Plate, and this may seriously affect their motivation however, their silhouette will change significantly. After all, a kilogram of muscle is a lot more compact and tight than a kilogram of fatty tissue (muscle tissue weights about three times as much as fat tissue). In the initial phase of training, you shouldnt demand your client to exercise every day, but 2-3 times a week. Obese people dont usually enjoy exercising and an aggressive jump start may just scare them away and leave feelings of failure. If, while using the Power Plate machine, you feel dizzy, faint, short of breath, or any pain, stop using the Power Plate machine immediately, and consult a physician.

Research

Vissers, D., A. Verrijken, I. Mertens, C. van Gils, A. van de Sompel, S. Truijen, and L. van Gaal.
Does whole body vibration contribute to reduction in visceral adipose tissue?. Poster presentation presented at the European Congress of Obesity 2009.

Fjeldstad, C., I.J. Palmer, M.G. Bemben, and D.A. Bemben..
Whole-body vibration augments resistance training effects on body composition in postmenopausal women. Maturitas. Vol. 63, pp: 79-83, 2009.


Arthritis

Definition and Symptoms
Arthritis is in fact a collective term for over 200 different disorders of the locomotor apparatus, also known as rheumatic diseases. This includes not only the joints, but also the muscles, tendons, capsules and connective tissues. Some general features of all rheamatic disorders: constant pain and stiffness (with different patterns of both location and pain depending on the specific disease) pain in muscles and joints, and swelling of one or more joints. Arthritis is one of the most prevalent common diseases. Millions of people all over the world suffer from arthritis, in some countries as many as 1 in 3 adults. About a third of these patients have a chronic disorder, meaning for at least 6 months continuously.

Arthritis and concerns for exercise
For many arthritic disorders, heat, massages and exercises for posture and movement can help manage the pain. Physical therapy may alleviate pain and stiffness, prevent deformities due to fusion of tissues or the formation of bone spurs and increase muscle strength, coordination and stamina. To reduce the compliants and other consequences of the disease, doctors will often prescribe pain killers and anti-inflammatory drugs. These medicines will often cause a marked regression of complaints, but they also have many unpleasant side effects such as stomach and intestinal complaints, seriously affecting the quality of life. Besides, in some cases even stronger drugs will be needed to suppress the pain.

Arthritis and the Power Plate

  • Exercising and training on the Power Plate will stimulate the cartilage, making it possible to retain its normal function.
  • The vibration of the Power Plate will cause an improvement of the circulation in the entire body, and will also stimulate a process known as 'capillarization' (groth of the capillaries, the smallest blood vessels in our body, providing our tissue with blood and oxygen)
  • Exercise and training on the Power Plate in particular, will ensure that the synovial fluid, and consequently the cartilage, receives more oxygen and more nutrients.
  • The muscle pump will stimulate the lymph drainage and thus increase the speed and efficiency with which all of the waste products are removed, such as those produced by inflammations, uric acis or the waste that is caused by the constant wear and tear of the cartilage in arthrosis
  • The possibility to train the muscles, ligaments and tendons without excessively loading them. Every kind of exercise is worthwhile, mainly to prevent rigidity of the joints and make sure that the daily activities can be performed
  • Strengthening the muscles, for example around the spinal column, will make sure the patient's posture improves and he/she will have less problems with activities of daily living. Exercise will also make the muscles more flexible, reducing pain in the long run and thus improving the quality of life even further

What to avoid
In case of inflammatory arthritis, training on a Power Plate should be avoided in case of a flare up, since the vibration can cause an increase in circulation and temperature in an area that is already hot and inflamed. In arthritis caused by wear and tear where the cartilage is damaged, it is best to avoid performing strength training exercises on the Power Plate using a high amplitude and higher frequency settings, in order to avoid excessive stress to a joint that no longer has the structure and function to absorb shocks. Because patients with arthritis can have good days and bad days, forcing the same training routine on your client each time he/she uses the Power Plate is not a good idea. It may be necessary to adjust the intensity level and the selection of exercises on a daily basis when working with clients with arthritis.

Research

Lohman, E., J. Petrofsky, and H. Betts.
The effect of Power-Plate training on lower extremity skin blood flow in normal subjects. Medical Science Monitor. Vol.13(2), pp: CR71-76. 2007

Maloney-Hinds, C., J.S. Petrofsky, and G. Zimmerman.
The effect of 30 Hz vs. 50 Hz passive vibration and duration on skin blood flow in the arm. Medical Science Monitor. Vol.14(3), pp: CR112-116. 2008.