Repetitive muscle vibration was applied to the quadriceps and gastrocnemius muscles of 11 patients with spastic paraparesis for 90 minutes over 3 days. This led to a reduction in spasticity according to the Ashworth scale in 82% of patients one week later and 56% one month later. Muscle strength improved in 36% of patients and was maintained after one month. All patients who reported spasms or cramps showed improvement one week later that persisted after one month. Gait analysis showed improvements in kinematic and EMG data. All patients showed improved functional ability one month later. This preliminary study suggests repetitive muscle vibration may induce plastic changes in the brain and provide a non-invasive means to

2. SIN NAPOLI 2008
EFFECTIVENESS OF REPETITIVE MUSCLE VIBRATION IN SPASTIC
PARAPARESIS
F. Gragnani˝, L. De Armas˝, M.G. Piscaglia˝, N. Tenore˝, G. Albertini˝, S.
Giaquinto˝, M. Galli', G. Antonini*, G.M. Filippi˚
˝IRCCS San Raffaele Pisana, Roma; Dipartimento Bioingegneria, Politecnico di
Milano'; *Clinica Neurologica, II Facoltà di Medicina, Università di Roma “La
Sapienza”; ˚Istituto di Fisiologia Umana, Università Cattolica S.Cuore – Roma
Objective: to analyze the efficacy of repetitive muscle vibration (rMV) to reduce
spasticity in patients with spastic paraparesis.
Material and Methods: 11 patients with spastic paraparesis, resistant to oral
treatments for spasticity, were enrolled consecutively. They underwent to: clinical
evaluation for spasticity according to the Ashworth scale; muscle strength evaluation
by the Medical Research Council scale (MRC scale: 0-5); interview about frequency
and severity of spasms and cramps; physical ability assessment by using the Barthel
Index. In 7 patients the analysis of walking was also performed by Gait Analysis.
All the subjects underwent to rMV treatment (100 Hz, < 20 µm amplitude), 90
minutes over 3 consecutive days. The rMV was focally applied on quadriceps femoris
and gastrocnemius on both sides.
Treatment effects were determined by comparing the scale scores and gait analysis
data at the baseline (T0), at 7 days (T1) and at 30 days (T2) after rMV.
Results: following rMV we observed a reduction of spasticity at the Ashworth scale
in 9 patients (82%) at T1. In 6 subjects the improvement was still present after 30
days (T2). Muscle strength was improved in 4 patients (36%) and the effect was
maintained at T2. All 6 subjects that complained of cramps or spasm improved, and
showed a reduction of cramp and spasm score at T1, which was maintained at T2. In
all 7 patients that underwent to Gait Analysis there were changes in the kinematical
data and in 4 of them EMG data improved (electrical signals associated with muscle
activation and deactivation of agonist and antagonist muscle). All the subjects
improved in functional ability, evaluated with the Barthel Index (p < 0.001).
Discussion: the main finding of this preliminary study is the possibility of inducing
persistent improvements of some neurological symptoms by a repetitive and focal
muscle vibration. Vibratory stimulation input seems able to induce plastic changes of
excitability of selected population of neurons. This observation confirms a recent
study showing Primary Motor Cortex excitability changes persisting up to 60 minutes
after vibration ending.
Conclusions: These preliminary data suggest the possibility that rMV may be a non-
invasive and low expensive symptomatic aid in spasticity. A case-control study is
warranted.