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Effects of vibration on hypertonia and hyperreflexia in the wrist joint of patients with spastic hemiparesis
Ageranioti SA, Hayes KC
Physiotherapy Canada 1990 Winter;42(1):24-33
clinical trial
5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: No; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

The immediate effects of tendon vibration on wrist hypertonia and hyperreflexia were determined in 29 subjects with spastic hemiparesis secondary to a cerebrovascular accident. The study employed a two-group crossover design in which the subjects were randomly assigned to one of two groups. One group received the vibration treatment befor the control condition (rest), and the second group received the treatment after the control. Hypertonia and hyperreflexia were measured using a strain gauged torque motor system that displaced the hand periodically through flexion and extension. The outcome measures of hypertonia included the total resistive torque of the wrist joint, its component nonlinear stiffness and damping torques, and the mean energy loss during passive wrist flexion and extension. The total integrated electromyographic activity of the wrist flexors and extensors served as the measures of hyperreflexia. Results revealed that vibration consistently and significantly decreased wrist hypertonia and hyperreflexia in subjects at Brunnstrom stage 2 or 3. Specifically, one minute of vibration over the wrist extensor tendons produced a significant decrease (mean 50%) in the total resistive torque of the wrist during passive extension. The reduction in total resistive torque was attributable to a decrease in the velocity-dependent damping torque. Vibration of the extensor tendons significantly decreased flexor electromyographic activity suggesting that the stretch reflex in these muscles was reciprocally inhibited and that this accounted for the reduced damping torque in extension. Shortening reflexes appeared in the muscles of some subjects during the shortening phase of their displacement cycle. The frequency of occurrence of these reflexes was reduced following vibration. In summary, it appears that the therapeutic application of vibration is effective in providing short-term symptomatic relief of wrist joint hypertonia and hyperreflexia in patients with spastic hemiparesis.

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