A novel non-traditional physical therapy method is available for advanced Parkinson's disease (PD) patients that do not respond well to medications such as L-dopamine. Scientists from the Sun Life Financial Movement Disorders Research and Rehabilitation Centre 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, an 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.
This study is remarkable in the sense that acoustic therapy had a significant impact on the well being and quality of life of PD patients. In brief, 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. More importantly, this study 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.
Whole body acoustic stimulation vs. conventional physical therapy for treating PD
Before this study, another previous study conducted about a year ago showed that whole vibration therapy is even 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.
Remarkably, 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 will be interesting to know whether 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.
Brief background on whole body vibration therapy.
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 novel since this technique has been used by athletes as part of a routine exercise to loose weight, improve muscle tone and increase muscle strength.
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.
What is Parkinson’s disease?
PD is an age-related, relentless, chronic and incurable neurodegenerative disease that affects different regions in the brain (the midbrain) that are enriched with dopaminergic neurons, neurons that produce dopamine. A 90% loss of dopaminergic neurons in the brain results in motor impairment and muscle coordination in the affected patient. These symptoms include but are not limited to postural tremors, instability and loss of gait, slow movement (bradykinesia) or complete loss of movement (akinesia). Many of you are familiar the PD related tremors exhibited by the actor Michael J. Fox, a successful actor famous who starred in the Back to the Future movie sequels and who founded the Michael J. Fox Foundation.
To this date, there is no cure for this devastating disease that affects a little more than 1% of the total U.S. population. Over more than 90% of cases of PD have no known cause (sporadic cases). The only effective treatment so far is the administration of Levodopa, a synthetic analog of dopamine, and/or dopamine receptor agonists (bromocriptine) which efficiently alleviates tremors and bradykinesia in PD. Adjunct pharmacological therapy include administration of monoamine oxidase inhibitors (selegiline and rasagaline) and Carvidopa (an aromatic decarboxylase inhibitor) with the goal of increasing the levels of dopamine in the brain by inhibiting the enzymes involved in the breakdown of dopamine. Other more sophisticated and extremely expensive treatments include deep brain stimulation, a very complicated procedure that involves electrically inactivating small inhibitory regions of the brain in order to increase excitatory dopaminergic stimuli through electrical stimulations.
What causes Parkinson’s disease?
PD is a multi-factorial disease in which environmental and genetics play a role. One theory that has gained widespread attention in the medical and scientific community is that exposure to environmental factors, such as pesticides and oxidative stress (free radicals), lead to a rapid decline in the function of mitochondria, the energy generators and powerhouses of the cell, in dopaminergic neurons over time. Moreover, certain genes (PINK1, Parkin, DJ-1, alpha-synuclein, and Parkin) which are found to be mutated in PD patients, have been shown to lead to mitochondrial dysfunction, decrease energy production along with an increase in free radicals in animal models of PD.
To this end, it is necessary that more basic research and the outpour of more million of NIH dollars is needed to fund more clinical trials in order to make important progress to finding cures and therapies to this devastating disease.
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