One of the most considerable challenges the medical world will face in the next few decades is addressing the question of how we continue providing equitable treatment to all patients, regardless of income or status, as populations continue to grow and the purse strings for health care expenditure become tighter. 

Already we are seeing a decline in the quality of care experienced by some patients across disease spectrums, simply because the clinician-to-patient ratio has been reduced to unsustainable levels. In short, too few health care facilities and personnel are caring for a high volume of patients with complex individual needs. 

One potential way to address these issues is to encourage home-based treatment where possible. This is certainly the approach that many physicians are advocating for, especially in the field of neurodegenerative diseases such as Pompe disease and spinal muscular atrophy


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Pompe disease, caused by the abnormal accumulation of glycogen in the tissues, causes mobility issues with progressive debilitation. In addition, patients face difficulties with both fine and gross motor skills, meaning that simple tasks, such as picking up an object and writing, can be a challenge. 

Notably, the introduction of enzyme replacement therapy (ERT) has revolutionized Pompe disease care. Studies indicate that ERT improves muscular function and mobility and extends survival. It is the mainstay treatment for Pompe disease today. 

Read more about Pompe disease etiology 

Nonpharmacological treatment complements ERT in helping patients achieve better outcomes. Chief of these is physiotherapy, a discipline that has been around in some form or another for centuries. Physiotherapy in Pompe disease focuses on improving fine/gross motor function, as well as strengthening the respiratory muscles. Studies indicate that physiotherapy is crucial for recovery in neuromuscular disorders because healthy amounts of muscle movement can prevent the degradation of bone mass. 

The Science Behind Whole-Body Vibration

One treatment modality that is available through physiotherapy is whole-body vibration. Whole-body vibration is unique in that it can be applied regardless of the patients’ motility and health. Studies suggest that it shows considerable promise in children with neuromuscular disorders. 

“Vibrations are applied through an oscillating surface that induces reflex-based muscle contractions to the patient including involuntary muscle stimulation,” Jones and colleagues wrote in the Journal of Musculoskeletal and Neuronal Interactions. 

Whole-body vibration activates reflex-based muscles to contract and produces involuntary muscle contractions. It uses a vibrating surface that mechanically stimulates the patient on the platform. Studies have positively compared this program to traditional rehabilitation because it is both safe and effective in encouraging muscle recovery; it activates the muscle spindles and stimulates alpha-motor neurons. 

This form of therapy can produce immediate benefits, including increased muscle temperature, skin blood flow, and oxygen consumption. It may help reduce muscle and bone loss during periods of immobilization and improve a patient’s balance, thus reducing falls. 

Agreeing with Jones et al, Stark and colleagues wrote in Child Neurology: “Whole-body vibration has recently raised clinical and scientific interest as an effective, safe, and time-effective method to improve neuromuscular interactions in children and adolescents with neuromuscular diseases.” 

Whole-Body Vibration at Home 

The relevance of this form of therapy in the context of this article is that it can be used as part of a home-based rehabilitation program. Jones and colleagues conducted a study to analyze the possible use of whole-body vibration in the treatment of patients with infantile-onset Pompe disease. They recruited patients at the Center of Prevention and Rehabilitation, University of Cologne in Germany. All participants had been diagnosed with infantile-onset Pompe disease and were receiving standard ERT (n=3). 

Whole-body vibration is part of a rehabilitation program known as “Auf die Beine”, which is part of the health care system in Germany. It is a rehabilitation program that combines intensive, goal-directed training during hospital stays, and whole-body vibration as a home training program for 6 months. 

Read more about Pompe disease treatment 

The researchers assessed the merits of this therapy at baseline, after 6 months, and after 12 months. At each point of assessment, researchers analyzed lean body mass, bone mineral content, and bone mineral density. In the case of one patient, hand dynamometer strength was also assessed. 

The results indicated that 2 of the 3 patients achieved their immediate therapy goals, with clinicians setting them an additional long-term therapy goal of being able to walk independently with aids. Over the course of the trial, all 3 participants demonstrated an increase in their lean mass index. In 2 of the 3 patients, improvements in bone mineral content were noticeable. 

“To summarize, if executed properly, the [whole-body vibration] in the rehabilitation program ‘Auf die Beine’ shows promising results,” the authors of the study wrote. “The training was very well tolerated, with no mobility losses or other side effects.” 

The results of this study bode well for the global push to introduce home-based therapies that are safe, reliable, and effective. The availability of such programs means that physiotherapists can oversee the recovery of a larger number of patients vs having to spend time with each patient individually during each session. The further refinement of these programs will enhance their clinical effectiveness, potentially producing better results in the long term. 

References

Stark C, Duran I, Cirak S, et al. Vibration-assisted home training program for children with spinal muscular atrophyChild Neurol Open. 2018;5:2329048X18780477. doi:10.1177/2329048X18780477

Jones A, Duran I, Stark C, Spiess K, Semler O, Schoenau E. Vibration assisted rehabilitation in patients with Pompe disease: a case seriesJ Musculoskelet Neuronal Interact. 2022;22(2):284-291.