Whole body vibration therapy, a revolutionary technique that efficiently treats Parkinson's disease

There is hope for advanced Parkinson's disease (PD) patients that do not respond well to medications such as L-dopamine. The whole body vibration therapy is a new non-traditional machine for physical therapy and is available for use in Ontario, Canada. However, there is still a question if the said machine can be made available in the Philippines based on its cost, effectivity and applicability.

A previous study was conducted about a year ago which showed that whole vibration therapy is more effective in reversing many of the clinical symptoms of PD patients compared to conventional physical therapy. Specifically, this particular study showed that whole body vibration therapy improved equilibrium and gait four weeks after undergoing an intensive three week regimen consisting of 15 minutes a day for five days a week.

Scientists from the Sun Life Financial Movement Disorders Research and Rehabilitation Center from Ontario, Canada have shown that short term whole body vibration therapy significantly improves the clinical symptoms (loss of gait, tremors and akinesia) of PD patients. In this clinical study, a sample population of 40 PD patients were subject to intensive therapy for a few weeks using a Physioacoustic Chair, a sophisticated device containing speakers that are strategically placed throughout the chair in order to deliver programmed low frequency sound waves throughout the body of the patient.The acoustic therapy has been found to have a significant impact on the well being and quality of life of PD patients.

In summary, the Unified Parkinson's Disease Rating Scale (UPDRS), gait assessments and upper limb control tests showed significant improvements on gait stability and posture, increased stepping time and speed on the peg-board task, a significant decrease in tremors and less rigidity in PD patients receiving whole body vibration therapy compared to a control group that received no therapy. This study also showed that whole body vibration therapy may also be applied to PD patients that do not respond well to L-dopamine medication or deep brain stimulation, a complicated risky surgery that involves delivering mild electrical shocks to the brain via implanted electrodes. The latter technique is used as a last resort to stabilize tremors and rigidity in PD patients.

This study quantitatively also suggests that whole body vibration therapy is more efficient (25% more efficient) than conventional physical therapy for partially reversing clinical symptoms in PD patients that do not respond well to L-dopamine. It has been recommended whether further study can be done to know if a combined therapy that uses both whole body and conventional intervention techniques has an additive/synergistic positive effect in reversing clinical PD symptoms compared to single treatment intervention.

The technology used for conventional physical therapeutic interventions of PD patients have included the use of treadmills, different optical and acoustic devices, balance/ gait training devices and low impact exercise machines. On the other hand, the concept and practice of whole body vibration therapy is not new since this technique has been used by athletes as part of a routine exercise to loose weight, improve muscle tone and increase muscle strength. But it has not been applied in clinical conditions like Parkinsons disease before.

Whole body vibration therapy was initially postulated and developed by Jean Martin Charcot, who also developed a vibration chair many decades ago. There are currently a few devices currently in the market that have been tweaked and redesigned with from other existing prototypes. Some of the most well known whole body vibrational devices are sold by Galileo Fitness and is used for many applications including relaxation therapy, strength training and muscle toning, and for physical therapy. The machine looks like a typical workout machine with arm rests, a bottom platform, and a console that allows a user to program a variety of amplitude and frequency settings (18-28 Hz). Once a patient stands on top of the platform and grabs the arm rests, he/she may receive a short session of either low frequency sound waves that allow for muscle relaxation while higher amplitude and frequency settings is used for increasing muscle tone and contraction.

Whole body vibration therapy has also been used in the past to treat patients affected by neuromuscular debilitating and neurodegenerative disorders such as multiple sclerosis, stroke, cerebral palsy, Huntington's chorea, and other movement disorders. It is not known how whole body acoustic therapy works in Parkinson's disease patients but it is believed that high vibrational frequencies help to partially restore some of the sensory perception (proprioception) that is lost during the progression of the disease and is also used to enhance muscle coordination, a physical trait that is lost during the progression of PD. Finally, high frequency sound waves delivered via physicoacoustic devices has been shown to improve blood flow, electrical conductivity and metabolism of muscle tissue.

Treatment for Parkinson's Disease

Although there is as yet no cure for Parkinson’s Disease (PD), scientists are working hard and fast to look for better treatments to manage its symptoms. There is also a search for treatments that can slow the progression of the disease. Drug therapy to both manage the symptoms of PD, and slow the progression of the disease, remains the ‘Gold Standard’ treatment option for PD. Likewise, the same treatment options are also being offered to patients afflicted with Parkinson's disease even in the Philippines.

Drug Therapies

Levodopa increases the level of dopamine in the brain and thus relieves the movement problems of PD. Levodopa however has side effects. One of Levodopa’s common side effects is nausea so it is usually given with a second drug, carbidopa, that prevents nausea. The combination of Levodopa/Carbidopa effectively treats the symptoms of PD, allowing many people with PD to live relatively normal, active, and productive lives for many years.

Dopamine Agonists are a class of drugs that, like levodopa, increase dopamine activity in the brain. Commonly prescribed dopamine agonists include: bromocriptine (Parlodel), pergolide (Permax), pramiprexole (Mirapex), and ropinirole (Requip). They do not work as well as levodopa for the movement problems of PD but they may be able to slow progression of the disease.

Surgical Treatments

A small percentage of patients with PD do not benefit from drug therapies or suffer from severely disabling dyskinisia as a consequence of drug therapies. When the symptoms become severe surgical procedures may be an option. There are four types of surgical procedures for PD, Pallidotomy, Thalamotomy, Electrical Stimulation (Deep Brain Stimulation) and Neural Implants.

In pallidotomy the globus pallidus, is destroyed. The globus pallidus is targeted because it is a regulatory center for movement circuits of the brain. When the pallidotomy works, it can reduce rigidity and abnormal movements.

In thalamotomy, a small portion of the thalamus, is destroyed. The thalamus relays excitatory information to motor circuits. When the surgery works it can relieve severe tremors.

With Electrical Stimulation (Deep Brain Stimulation) various brain regions involved in motor regulation can be given an electrical stimulus which temporarily blocks activity in that part of the brain. Blocking that activity in turn has beneficial effects on other parts of the brain. Because the blocking is temporary, this procedure is reversible (in contrast to pallidotomoty or thalamotomy). Stimulation to the thalamus controls tremor. Stimulation to the globus pallidus treats balance and rigidity problems, but is generally not used specifically for tremor. The two most common sites for stimulation are the subthalamic nucleus and the globus pallidus.

Neural Implants involve placing tissue that can manufacture dopamine into selected regions of the brain. This treatment option is still very much in the experimental stage.

Physical Therapy

Because PD involves a variety of movement problems a physical therapist can devise a program of exercises that can relieve the patient's pain and maintain the muscle integrity.

Treatment of Non-Motor Behavioral Symptoms

Up to 80% of patients with PD experience depression. Depression in PD can be treated with most of the standard drugs used to treat depression in people without PD such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and venlafaine (Effexor). Triavil and Asendin however should NOT be used by people with PD.
Rarely persons with PD will experience hallucinations. These are usually due to too high a dose of levodopa. These episodes can usually be handled by carefully reducing the levodopa dosage. If that does not help then anti-psychotic drug treatment will usually do the trick.

Sleep problems such as REM Behavior Disorder can be treated with clonazepam. Execessive daytime sleepiness can be treated with modafinil (Provigil).

The management options for PD patients encompass not just the alleviation of the physical signs and symptoms of the disease, but also the improvement of the quality of life and reduction of the potential side effects of whatever treatment modality to be adopted.