The Effect of Whole Body Vibration (WBV) on Spasticity in Poststroke Hemiplegia

Patients with a stroke of at least 1 month before and with a history of ankle plantar flexion spasticity will be included in the study. Conventional rehabilitation program will be applied to all patients (n=48).The intervention group (n=24) will be applied for 4 weeks, 3days a week, a total of 12 sessions with the WBV powerplate pro5 device. In the WBV group, the frequency and acceleration of vibration will be 30Hz and 18.0m/s2, respectively. The WBV exercise intensity will progressively increase throughout the twelve-session. In the control group, the same procedures will be followed. However, unlike the WBV group, a vibration will be given whose acceleration is attenuated by 99.5%.The surface Electromyography (EMG) and degree of spasticity of soleus muscle will be evaluated at the beginning and end of the all sessions. Soleus H-reflex will be recorded with surface EMG.To obtain the H-reflex response, the posterior tibial nerve in the popliteal region will be stimulated by using a stimulator (FE155 Stimulator HC ADInstrument, Oxford UK) with 1 ms-pulse current. The records will be taken with the Ag / AgCl electrodes (Kendall ®Coviden, self-adhesive electrodes) placed on skin according to the SENIAM protocol. The degree of spasticity will be measured as a soleus muscle tone torque on a fixed angular velocity moving platform.The data will be recorded with the PowerLab data acquisition device

Inclusion criteria

• Ischemic / hemorrhagic poststroke hemiplegia aged 18-90 years,
• Stroke time ≥1 months,
• Ankle plantar flexor spasticity MAS ≥1,
• Brunnstrom stage ≥3 for lower extremity,
• Patients who were standing for more than five minutes and had a static balance

Exclusion criteria

• Cardiac disorder (rhythm / conduction disorder, cardiac pacemaker, ischemic heart disease)
• Lower extremity fracture,
• Findings or suspicion of active deep vein thrombosis,
• A history of deep vein thrombosis and pulmonary embolism,
• Orthostatic hypotension
• Resistant hypertension,
• Peripheral nerve lesions such as polyneuropathy, radiculopathy
• Active inflammatory, rheumatologic or infectious disease,
• Ankle,knee or hip joint contracture,
• Presence of panic attacks,
• Patients with dizziness and balance problems,
• Patients with not intact skin surface to connect electrodes
• Patients with communication problems: aphasia, major depression
• Epilepsy
• Patients who received botulinum A toxin in the last 6 months