Effect of high-frequency, low-magnitude vibration on bone and muscle in children with cerebral palsy.
Effect of high-frequency, low-magnitude vibration on bone and muscle in children with cerebral palsy.
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DOI：
10.1097/bpo.0b013e3181efbabc
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发表时间：
2010-10
期刊：
影响因子：
--
通讯作者：
Gilsanz V
中科院分区：
文献类型：
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作者：
Wren TA;Lee DC;Hara R;Rethlefsen SA;Kay RM;Dorey FJ;Gilsanz V
脑瘫儿童的力量下降，骨量减少，骨折倾向增加。高频率，低幅度的振动可能会提供一个非侵入性，非药物，家庭为基础的治疗这些肌肉骨骼缺陷。本研究的目的是检查这种干预对CP儿童骨骼和肌肉的影响。31名6-12岁的CP儿童（平均9.4，SD 1.4）在家中站在振动平台（30 Hz，0.3 g峰值加速度）上，每天10 min，持续6个月，并在没有平台的地板上再持续6个月。振动和站立的顺序是随机的，并在0、6和12个月时测量结果。结果测量包括椎体松质骨密度（CBD）和横截面积的计算机断层扫描测量，胫骨近端CBD，胫骨骨干的几何特性，和跖屈肌强度的测力计测量。使用混合模型线性回归和Pearson相关性评估结果。振动和站立之间的主要差异是振动期间皮质骨特性（皮质骨面积和惯性矩）的较大增加（所有p ≤ 0.03）。在松质骨或肌肉方面，振动和站立之间没有差异（所有p> 0.10），依从性和结果之间没有相关性（所有r < 0.27;所有p> 0.15）。结果不依赖于治疗顺序（p > 0.43），并且在GMFCS 1-2和GMFCS 3-4中的儿童中相似。振动干预对CP儿童的主要益处是对无骨骨骼中的皮质骨。增加皮质骨面积和结构（强度）特性可以降低某些患者的长骨骨折风险。需要更多的研究来证实这些发现，阐明干预的机制，并确定最有效的治疗年龄和持续时间。II级前瞻性随机交叉研究。
Children with cerebral palsy (CP) have decreased strength, low bone mass, and an increased propensity to fracture. High frequency, low magnitude vibration might provide a non-invasive, non-pharmacological, home-based treatment for these musculoskeletal deficits. The purpose of this study was to examine the effects of this intervention on bone and muscle in children with CP. Thirty-one children with CP ages 6-12 years (mean 9.4, SD 1.4) stood on a vibrating platform (30 Hz, 0.3 g peak acceleration) at home for 10 min/day for 6 months and on the floor without the platform for another 6 months. The order of vibration and standing was randomized, and outcomes were measured at 0, 6, and 12 months. The outcome measures included computed tomography measurements of vertebral cancellous bone density (CBD) and cross-sectional area, CBD of the proximal tibia, geometric properties of the tibial diaphysis, and dynamometer measurements of plantarflexor strength. Outcomes were assessed using mixed model linear regression and Pearson's correlation. The main difference between vibration and standing was greater increases in the cortical bone properties (cortical bone area and moments of inertia) during the vibration period (all p's ≤ 0.03). There was no difference in cancellous bone or muscle between vibration and standing (all p's > 0.10) and no correlation between compliance and outcome (all r's < 0.27; all p's > 0.15). The results did not depend on the order of treatment (p > 0.43) and was similar for children in GMFCS 1-2 and GMFCS 3-4. The primary benefit of the vibration intervention in children with CP was to cortical bone in the appendicular skeleton. Increased cortical bone area and structural (strength) properties could translate into a decreased risk of long bone fractures for some patients. More research is needed to corroborate these findings, to elucidate the mechanisms of the intervention, and to determine the most effective age and duration for the treatment. Level II, prospective randomized cross-over study.