Focal Muscular Vibration During Intensive Rehabilitation in the Treatment of Spasticity After a Severe Acquired Brain Injury: A Pilot Randomized Controlled Trial.

Background

Spasticity significantly impairs functional recovery after severe acquired brain injury. Current management methods predominantly rely on pharmacological interventions, which can cause substantial side effects or require invasive medical procedures in refractory cases. Focal muscle vibration, a noninvasive technique that applies mechanical vibrations to muscle-tendon units and alters spinal and cortical excitability via proprioceptive pathways, has been effective in reducing spasticity in subjects with stroke. However, there is limited data to support focal muscle vibration as a viable option for improving functional recovery in patients with severe acquired brain injury.

Objectives

To evaluate the clinical effects of adding focal muscle vibration to standard physiotherapy compared with standard physiotherapy alone in patients with severe acquired brain injury and spastic hypertonia.

Methods

Twenty-four patients were randomly assigned to receive focal muscle vibration in addition to standard care (n = 12) or standard care alone (n = 12) for 3 weeks. Assessments were conducted at baseline, immediately after physiotherapy, and 3 weeks after physiotherapy. The outcomes assessed included the Modified Ashworth Scale, Disability Rating Scale, Modified Barthel Index, and three pain measures.

Results

A significant reduction in spasticity was observed in the focal muscle vibration group, as indicated by the Modified Ashworth Scale scores (p = 0.014). Disability Rating Scale scores demonstrated a statistically significant decrease in disability ratings at the end of treatment (p = 0.002) and during the follow-up phase (p = 0.002). Between-group comparisons of change scores revealed a statistically significant improvement in disability ratings in the focal muscle vibration group during the treatment phase (p = 0.011). Significant functional gains were noted on the Disability Rating Scale, which persisted at the follow-up evaluation.

Conclusions

Focal muscle vibration reduces muscle spasticity and improves functional status in patients with severe acquired brain injury during inpatient rehabilitation. Future studies with larger sample sizes, blinded assessments, and stratified randomization are needed to verify these findings and develop standardized treatment protocols for this underserved population.