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Effectiveness of Vibramoov Therapy in Transverse Myelitis
* Corresponding author: Dr. Jagriti Modi, All India Institute of Medical Sciences/S4 Research, New Delhi, India. modijagrity@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Modi J, Kaushik H. Effectiveness of Vibramoov Therapy in Transverse Myelitis. J Health Allied Sci NU. doi: 10.25259/JHS-2024-8-8-(1479)
Abstract
Transverse myelitis (TM) is characterised by focal inflammation of one or more levels of the spinal cord. Vibramoov, a novel technology developed by Techno Concept, utilises proprioceptive functional stimulation (PFS) for sensory-motor rehabilitation. This case report aims to investigate the efficacy of Vibramoov therapy in the rehabilitation of a male patient with TM. The findings indicated that Vibramoov therapy effectively enhanced muscle strength, balance, and mobility while reducing spasticity in individuals with TM. Furthermore, improvements in pain levels and functional outcomes, as assessed by manual muscle testing (MMT), timed up and go test (TUG), and Berg balance scale (BBS), were observed. The utilisation of Vibramoov therapy demonstrates promising results in improving health-related outcomes for TM patients, thereby enhancing their quality of life. To further validate these findings and minimise bias, future research of high methodological quality is warranted in this area.
Keywords
Advanced technology
Neurorehabilitation
Rehabilitation
Transverse myelitis
Vibramoov therapy
INTRODUCTION
Most cases of transverse myelitis (TM) are associated with infections, particularly in individuals with compromised immune systems.[1] It is a focal inflammation of one or more levels of the spinal cord. The time it takes for symptoms to progress to peak weakness can range from 10 hours to 28 days in idiopathic cases.[2-4]
Studies show variation in recovery outcomes for individuals diagnosed with this condition. They range from minimal symptoms and moderate permanent disability to no improvement, resulting in severe functional limitations.[3-5] With the right equipment and gadgets, patients can manage their care and take charge of their surroundings at home.
Over the past decade, researchers have conducted numerous studies to investigate the impact of vibrational stimuli on various areas of the central nervous system. The new technology of vibration therapy aims to create a sensory-motor illusion, allowing patients to perceive movement in their body parts even when they are not moving.[6] Vibramoov is an emerging technology designed to aid sensory-motor rehabilitation through Proprioceptive Functional Stimulation (PFS), developed by the French company Techno Concept.[7] This enables sensory-motor stimulation with various therapeutic benefits, such as functional proprioceptive stimulation, muscle activation, and pain relief, all rooted in the gate control theory.[7,8] In the Vibramoov setup, patients are outfitted with sensors on either their lower or upper limbs. While sitting or standing, they are positioned in front of a screen that displays the exercises they will be performing, as well as providing a visual representation of the walking movements in synchrony with the physical sensations they experience. Despite the limbs remaining still, the vibrations convey the feeling of movement to the brain. The setup includes a reclined chair, 12 sensors, and various-sized and shaped straps for upper and lower limbs, which help attach sensors and a monitor, allowing patients to receive visual feedback during therapy sessions.[9,10]
This study aims to explore the underutilised potential benefits of the innovative technology Vibramoov in addressing pain relief, activating muscles, and enhancing proprioceptive stimulation in individuals diagnosed with TM. The research discusses the benefits of Vibramoov, which have not been extensively studied, therefore highlighting the potential for new insights and advancements in the treatment of TM.
CASE REPORT
A 62-year-old Indian male patient came to the emergency room after a sudden fall while getting up from his chair. The patient was conscious and recalled no history of trauma or similar episodes. The patient was admitted before in May 2023, with a history of recurrent fever, cold, and cough, which was cured with antibiotics, including amoxicillin 500 mg and erythromycin 500 mg per day for ten days.
On the day of the fall (June 2023), he experienced bilateral lower limb weakness, difficulty in transfers, and generalised fatigue. He also experienced a “weird sensation” around his lower back and lower limbs bilaterally, as well as a fear of falling while walking due to his inability to lift his foot while ambulating.
The patient was seen in the physiotherapy department with a chief complaint of generalised pain and difficulty in getting up, walking, and transfers. Additionally, he reported impaired sensation around his lower limbs and back. On arrival, the patient was wheelchair bound, conscious, febrile, and oriented with stable vitals but also complained of severe cough and cold. On motor examination, muscle strength, as assessed using the Medical Research Council (MRC) scale, was found to be reduced in the bilateral (B/L) lower limb [Table 1]. For the upper limb, muscle strength was within normal limits (WNL), bilaterally. In addition to this, the knee jerk 3+ (B/L) and a positive Babinski sign were examined. No signs of bladder and bowel dysfunction were visible. Examination of muscle tone revealed muscle hypotonia 1+ (B/L lower limbs). Sensory examination revealed a marked loss of vibration and fine touch; however, kinesthesia and proprioception were intact. The balance and mobility assessment included the Timed Up and Go test (TUG) and Berg balance scale (BBS), summarised in Table 2. The patient’s complaint of generalised pain was measured using the Numeric Pain Rating Scale, which was 9/10 at the time of admission.
Manual muscle testing (MMT) | Pre-scores (baseline) | Post scores (follow-up) | ||
---|---|---|---|---|
MMT (Lower Limb) | Left | Right | Left | Right |
Hip flexion. (Psoas major and iliacus) | 2+ | 2+ | 3 | 3 |
Knee extension (Quadriceps femoris) | 2 | 2 | 2+ | 2+ |
Ankle dorsiflexion (Tibialis anterior) | 2 | 2 | 2+ | 2+ |
Grade 2: Full range of motion in gravity eliminated position, Grade 2+ : Full range of motion in gravity eliminated position, with minimum resistance applied, Grade 3: Full range of motion against gravity.
S.no | Balance and Mobility outcome measure | Baseline | 4th week | 8th week | Follow-up 9th week |
---|---|---|---|---|---|
1. | Timed Up and Go test (TUG) | 50s | 38s | 27s | 20s |
2. | Berg balance scale (BBS) | 8 | 18 | 22 | 27 |
Special investigation
A brain and full-spine MRI were conducted to facilitate a final diagnosis. The brain MRI was normal; however, the spine MRI revealed a longitudinal extensive T4 hyperintense cord lesion between the T2 and T6 levels, including a few scattered focal areas of relative hyperintensity within the abnormal region at the T3 level. The patient’s medical history and typical clinical symptoms resembed those of TM. This played a crucial role in confirming the diagnosis of acute TM.
The medical investigation included a serum blood test, which showed positive antibodies. (Aquaporin-4). Medical treatment consisted of Intravenous (IV) Corticosteroids for inflammation and ibuprofen for pain relief.
Treatment plans and physiotherapy interventions
To manage this case, the primary goals, as agreed upon by the multidisciplinary rehabilitation team and the patient’s family, were to alleviate symptoms, reduce pain, minimise disability, improve overall function, and enhance quality of life while preventing further physical deterioration [Table 3]. The secondary goals included maintaining and enhancing mobility, strengthening affected muscles, focusing on sensory re-education, and preventing complications such as contractures and atrophy, with a particular emphasis on gait and balance rehabilitation. The physiotherapy intervention involved the use of a new technology called “Vibramoov” in conjunction with other physiotherapeutic techniques. Therapy sessions with Vibramoov were held 5 times a week for 45 minutes a day. Additionally, other physiotherapeutic sessions were provided as a combined treatment, twice a week, for 45 minutes per day, over 8 weeks. A follow-up session was planned for the ninth week to take measurements, as summarised in Table 2.
1 | Weakness | Strengthening, prevent disuse | Vibramoov mode 4(tonicity), Strengthening exercises, reduce compensatory movements |
2 | Balance, Incoordination | Balance control | Vibramoov mode 1 (mobility), targeted exercises |
3 | Pain | Reduce pain and discomfort | Vibramoov mode 2 (antalgic), Relaxation techniques, stretching, patient education |
4 | Impaired sensation | Enhance sensory awareness | Vibramoov mode 1 and 4 |
5 | Upper respiratory tract infection | Airway clearance, improve lung capacity, make breathing easier | Clapping, vibrations, diaphragmatic breathing, postural drainage, spirometry |
Vibramoov is equipped with various sensors placed at targeted sites, such as the musculotendinous junction and muscle bellies. Three modes, namely Modes 1, 2, and 4, were used for rehabilitation. Mode 1 improved balance and coordination, particularly in the standing position, as sensors were placed bilaterally at the ankles, knees, and hips.
Exercises included flexion-extension and bilateral trunk rotations. Similarly, to address weaknesses, Mode 4 was employed in a lying position on the Vibramoov chair with sensors placed similarly as during balance training. Patients performed exercises that included a combination of hip flexion, knee flexion, ankle dorsiflexion, hip extension, knee extension, ankle plantarflexion, and bilateral hip and knee flexion.
For pain management, Mode 2 was used with the patient in a lying position to assist in relaxation and alleviate pain, with no movement or exercises involved.
The protocol designed for therapeutic exercises in IPD was specifically focused on improving the patient’s activities of daily living and transfers. These included grooming, bed mobility, use of mobility aids, task-oriented training, and other gait and balance exercises. Therapeutic exercises consisted of sitting balance in conjunction with task-oriented training. The patient was seated with minimal support by the bedside. The therapist used objects like a pen, a ball, and a glass, with the patient aiming to touch the object in different directions, i.e., up, down, and to both sides. The difficulty level increased as the patient had to touch objects beyond his reach while maintaining balance.
Other exercises included bridging, which progressed to single-leg bridging, seated heel raise, toe raise, and kicking the ball while sitting at the edge of the couch. Core training consisted of tummy tucks and abdominal curls, as tolerated and within the patient’s capacity.
Gait rehabilitation initially focused on task-specific movements, such as heel strikes, knee flexions, and tandem stance, and then progressed to parallel bars, turning, and stepping.
DISCUSSION
This case study discusses the physiotherapy assessment and treatment of a 62-year-old male patient diagnosed with TM. The treatment was provided for 8 weeks, and a follow-up was taken on the ninth week. Patient progression and objective outcome measures during treatment have been summarised in [Table 3].
Key outcomes of the intervention included improvements in muscle strength, gait, balance, and overall pain reduction. The patient exhibited enhanced mobility, increased muscle strength in the lower limb, and improved balance as demonstrated by the Times Up and Go (TUG) test and Berg balance scale (BBS) scores.
The introduction of Vibramoov in the patient’s treatment has yielded significant results, including a decrease in pain intensity and an improvement in balance, thereby enhancing the patient’s quality of life and overall function. Therapeutic exercises performed by the patient during weekends helped reduce fatigue levels and maintain muscle strength, promoting a healthy lifestyle. The number of repetitions and frequency progressed as per the patient’s tolerance, which contributed to improved endurance.
Upon examining the patient on the follow-up day, his functional status shows a significant difference between the TUG and BBS, as well as an overall quality of life comparison to baseline data He also reported improved endurance and less fatigue throughout the day while performing his daily living activities The patient’s functional status at the time of discharge suggested that he was prone to fatigue easily and had lesser exercise tolerance. The patient was also educated on proper body mechanics and strategies to prevent future injuries. The successful outcome of the recovery can be attributed largely to the combined therapy approach and the patient’s commitment to following the prescribed home exercise plan.
CONCLUSION
Exercise therapies combined with vibration therapy (Vibramoov) have shown significant potential in enhancing motor functions. This improvement can lead to better motor and balance activities. Current findings suggest that incorporating Vibramoov into physiotherapy exercise protocols may be a promising strategy for managing patients with TM, potentially enhancing their overall health and functional outcomes. However, exercise therapies remain the established basis of treatment, with Vibramoov serving as an emerging adjunct. More extensive research is required to demonstrate the superiority of this modern approach, and its role should be considered additional. Therefore, further evidence and randomised control trials are required to assess the long-term effectiveness and broader applicability of vibration therapy in a larger patient population with gold-standard outcome measures.
Ethical approval
Institutional Review Board approval is not required.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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