Effect of tendon vibration on upper-limb motor recovery with sub-acute hemiplegia after a stroke: a case report

Mr Florian DELCOMBREa, Dr Marylène JOUSSEa, Mr Clément PROVOSTa, Prof Alain YELNIKa

a CHU Saint Louis Lariboisière Fernand Widal

Introduction: A few studies have found short-term effects of tendon vibration therapy on upper-limb function in chronic hemiplegia (1-2). We report the effect of tendon vibrations of the elbow and wrist flexor muscles on recovery of the upper limb in a recent hemiplegic patient.

Observation: A 69-year-old woman was admitted to our department for right hemiplegia and aphasia after a left middle cerebral artery (MCA) stroke and a left cerebellar infarct secondary to cardiac arrhythmia. Initial NIHSS 22/44. Motor function on upper limb was limited to slight abduction and elevation of the shoulder, slight flexion of the wrist and elbow. The initial Functional Independence Measure score was 38/126. Intensive classical reeducation was started with little progress of upper-limb recovery despite upper-limb suspension, bimanual work and mirror therapy for 1 month.

Two months after the stroke, the vibration program began. Evaluation using Fugl-Meyer assessment (FMA) for the upper limb, the Action Research Arm Test (ARAT) and the modified Tardieu scale was performed at days 0, 7, 21, 28 and 35. The tolerance and feasibility were studied. Vibrations (80Hz) were applied on right distal biceps brachii, flexor carpi radialis and ulnaris muscle tendons during 16 min, twice a day, 5 days a week for 2 weeks on days 7 to 21.

No side effects or pain were reported. The FMA score increased 6 points the first week, 9 points during the vibration period, 9 new points the third week, and then stabilized. The ARAT score increased from 0 to 11 during the vibration period and reach 24 at D35.

Discussion: Tendon vibration seemed to give a new impetus to motor recovery in this patient and leads to the elaboration of a controlled trial to assess its real effectiveness in subacute stroke.

1. Tavernese E, Paoloni M, Mangone M, et al. Segmental muscle vibration improves reaching movement in patients with chronic stroke. A randomized controlled trial. NeuroRehabilitation. 2013;32(3):591?9.

2. Marconi B, Filippi GM, Koch G et al. Long-term effects on cortical excitability and motor recovery induced by repeated muscle vibration in chronic stroke patients. Neurorehabil Neural Repair. janv 2011;25(1):48?60.

Keywords : stroke, upper-limb, rehabilitation, tendon vibration