THE EFFECT OF COUNTER-CLOCKWISE VIBRATION PLATFORM ...

RUNNINGHEAD:THEEFFECTSOFACOUNTER-CLOCKWISEOSCILLATIONVIBRATIONPLATFORM

THEEFFECTOFCOUNTER-CLOCKWISEVIBRATION

PLATFORMTRAININGINTHEGERIATRICPOPULATION

ONPOSTURALSWAY

AnIndependentResearchProject

Presentedto

TheFacultyofthe

CollegeofHealthProfessionsandSocialWork

FloridaGulfCoastUniversity

InPartialFulfillment

oftheRequirementfortheDegreeof

DoctorofPhysicalTherapy

By

RyanP.Hickey

AlexS.Wann

2016

All rights reserved

INFORMATION TO ALL USERSThe qua lity o f this rep roduction is dependent upon the qua lity o f the copy submitted .

In the unlike ly event tha t the author d id no t send a comp le te manuscrip tand the re a re missing pages, these will be no ted . Also , if ma te ria l had to be removed ,

a no te will ind ica te the de le tion.

All rights reserved .

This work is p ro tected aga inst unauthorized copying under Title 17, United Sta tes CodeMicro fo rm Ed ition © ProQuest LLC.

ProQuest LLC.789 East Eisenhower Parkway

P.O. Box 1346Ann Arbor, MI 48106 - 1346

ProQuest 10113152

Pub lished by ProQuest LLC (2016). Copyright o f the Disserta tion is he ld by the Author.

ProQuest Number: 10113152

THEEFFECTSOFACOUNTER-CLOCKWISEOSCILLATIONVIBRATIONPLATFORM

APPROVALSHEET

ThisIndependentResearchProjectissubmittedinpartial

fulfillmentoftherequirementsforthedegreeof

DoctorofPhysicalTherapy

______________________________________

RyanHickey

______________________________________

AlexWann

Approved:May5th,2016

______________________________________

EricShamus,PhD,DPT

CommitteeChair

______________________________________

ArievanDuijn,EdD,PT,OCS

CommitteeMember

ThefinalcopyofthisIndependentResearchhasbeenexaminedbythesignatories,and

wefindthatboththecontentandtheformmeetacceptablepresentationstandardsof

scholarlyworkintheabovementioneddiscipline.

THEEFFECTSOFACOUNTER-CLOCKWISEOSCILLATIONVIBRATIONPLATFORM

ACKNOWLEDGMENTS

Wewouldliketorecognizethosethathavemadeourresearchpossible.We

wanttothankFloridaGulfCoastUniversityandtheCollegeofHealthProfessionsand

SocialWorkforgivingustheopportunitytosucceedintheDoctorofPhysicalTherapy

Program.WewouldalsoliketorecognizethefacultyoftheDepartmentof

RehabilitationSciencesfortheirongoingsupportandencouragementthroughoutour

education.Inparticular,wewouldliketoacknowledgeandthankourresearch

committeemembers,Dr.EricShamusandDr.ArievanDuijnforalloftheireffortsto

makethispossible.

WewouldalsoliketothankCypressCoveIndependentLivingFacilityfor

partneringwithusincompletionofourresearch.VictoriaDunnandMaryFranklinwere

instrumentaltothesuccessofthisproject.Wewanttorecognizeandthankthe

residentsatCypressCoveaswellfortheirdedicationandkindness.Youwereamazingto

workwith.

WewouldalsoliketothankSWAYMedicalandOSFLOWforallowingustouse

theirproductsinordertoconductthisresearch.Yourcommitmenttofurtheringour

educationandthehealthofourcommunityistrulyappreciated.

Lastly,wewouldliketothankourfamilyandfriendsforalloftheirdedication,

love,andsupport.Withoutyou,wewouldn’tbewherewearetoday.

THEEFFECTSOFACOUNTER-CLOCKWISEOSCILLATIONVIBRATIONPLATFORM 1

TABLEOFCONTENTS

Abstract...................................................................................................................2

Introduction……………………………………………………..….………………………………………..…..3

Balance………………………………………………………………………………...…..…...….………….…..4

BalanceSystems……………………….……………………………………..……………………..5

BalanceStrategies……………………..………….………………………..…….……..………..7

BalanceandStrength…………………….……………………………...…..….……...……….8

BalanceBoardsandVibrationPlatforms……………………………..…………….....10

TheoreticalFramework……………………………………………….………………...………….…..…13

Methods…………………………………………………….……………………..……………………....…….14

StudyDesign…………………………………………….……………………..…..………..……..14

Sample……………………………………………………………...………………………………….14

Instrumentation……………………………………………..……………..............………….15

Procedure……………………………………………………………..…………..............………17

Results………………..………………………………………………….…………….............………….…..20

Discussion……………………..….………………………………………….……............……….………..24

RecommendationsforFutureStudies…………………..………............…………..27

Conclusion……………….…..……………………………………………………………............…….…..29

References………………………….…………………..…………………………….............……………..30


ABSTRACT

Introduction:Thisstudyanalyzedtheeffectsacounterclockwiseoscillating

vibrationplatformhasonthecommunitydwellingolderadult’sbalanceandpostural

sway.Thecurrentliteratureismixedinregardstotheeffectsthatvibrationplatforms

canhaveonimprovingbalanceandposturalsway,however,therearenoexisting

studiesthatlookattheeffectsofacounterclockwiseoscillatingvibrationplatform.

Previousstudiesinvestigatedverticalandhorizontalvibrations.Methods:Atotalof34

subjects(meanageof80+7.57years)completedtheentireprotocol.Eachsubject

completedaMini-MentalEvaluation,ABCBalanceConfidenceScale,andtheCDC4

SWAYMedicalBalanceProtocolpriortoparticipatingintheinterventionforbaseline

measures.Theinterventionwasoverafive-weektimeperiod,whichrequiredsubjects

tostandonthevibrationplatformforfiveminutesaday,forfourdaysaweek.Atthe

endofthefive-weekprotocol,theABCBalanceConfidenceScaleandtheSWAYMedical

BalanceProtocolwerere-measured.Results:Theresultsshowedastatistically

significantdifferenceforincreaseintheABCBalanceConfidenceScale.Therewasa

numericalincreaseinposturalsway,howeveritwasnotstatisticallysignificant.

Conclusion:Therewasastatisticallysignificantincreaseinbalanceconfidenceperthe

ABCBalanceConfidenceScale.AveragescoresontheSWAYBalancetestimproved,but

nottoastatisticallysignificantlevel.Thisispossiblyduetobrevityofprotocolduration

orhighoverallbalancelevelsofthoseparticipating.


INTRODUCTION

ThepopulationdemographicsoftheUnitedStatesareshifting.Thereisa

pronouncedincreaseinthepercentageofthepopulationovertheageof65andthis

numberisprojectedtorapidlymultiplyoverthenextseveralyears.Currently,more

than13%ofthepopulationisovertheageof65,accountingforover33million

individuals.Bytheyear2050,theelderlypopulationisexpectedtoexceed20%ofall

Americans,2withthegreatestincreasebeinginthoseaged85andolder.

3This

redistributionoftheagedemographicwillnecessitateanincreasedfocusonthehealth

andwell-beingoftheelderlypopulation.

Thispopulationfacesauniquesetofchallengesandobstaclesaslifeprogresses

intoitslateryears.Unfortunately,itisoftenacceptedthattheagingprocessistiedto

lossoffunctionandindependence.Theselossesareoftenrelatedtophysiological

changesbroughtuponbylackofactivityorasedentarylifestyle.Thereareseveral

differentphysiologicalreasonsthatcanmaketheagedindividualatgreaterriskforfalls.

Itisusuallymultifactorialdisorderssuchasimpairedvision,vestibulardysfunction,

sensoryloss,muscularweakness,orgaitdisordersthatcontributetothemorefrequent

fallsexperiencedbytheelderly.4Byutilizinganeffectiveinterventionprogram,

however,thesephysiologicalchangescanbedelayedorevenreversed.Theaging

processisconsideredtohavemultiplecomponents,andsomeofthesevariablesare

abletobemanipulatedbyparticipationinexerciseandregularphysicalactivity.

Balance,coordination,andstrengthareallabilitiesthatcanbeimprovedwithproper

training.Regularparticipationinphysicalactivityhasbeenshowntolimitmanyadverse


effectsassociatedwithsecondaryagingprocesses,andcanevenprolonglife

expectancy.5Itishypothesizedthatthemostsignificantunderlyingreasonforweakness

andatrophyintheolderadultisactuallymuscledisuseandlackofactivity,ratherthan

theagingprocessitself.6Thisemphasizesthenecessityoffindingatechniquethatcan

improvefunction,fosterpatientcompliance,andremaintimeandcosteffective.

BALANCE

ResultsfromarandomsurveyoftheelderlypopulationconductedbySheldonet

al.7revealedthatahistoryoffallswasobtainedfrom24%ofmenand44%ofwomen

wholiveathome.Statisticsshowthatfallshavebecomeamajorproblemwithtoday’s

elderly.Upto5%offallsresultinfracturesandanywherefrom30%to50%resultinsoft

tissuedamagethatdoesnotreceivemedicalattention.8Oneoftheleadingcausesof

accidentalfallsamongtheelderlycitizensisalackofbalance.9Balancecanbedefined

astheabilitytomaintainthebody’scenterofgravityoverthebaseofsupportwith

minimalposturalsway.Balanceisprimarilyconcernedwithmaintaining,attaining,or

correctingthecenterofmassinrelationtothebaseofsupportandisthesecond

leadingcauseofallfallsintheelderly.10

Balanceandposturemustbemaintainedinbothstaticanddynamicactivities.In

astaticposturethebodysegmentsarealignedandmaintainedincertainpositions,such

asstanding,sitting,orkneeling.Inthenormal,static-standingpositionlittletonovisible

accelerationormovementofthebodyoccursexceptforaswayingmotionknownas

posturalsway.Thisswayingmotionoccursinresponsetointernalinertialforcesand

actsastomaintainthecenterofgravityoverthebaseofsupport.Dynamicbalance


mustbemaintainedwhenthebodyoritssegmentsaremoving.Examplesofdynamic

balancesituationsarerunning,walking,orlifting.

BalanceSystems

Balancedeficitscanbemultifactorialandincludeissueswithmanyseparatebut

relatedbodysystems.Thesesystemsincludethecentralandperipheralnervous

systems,thevestibularsystem,thevisualsystem,andthemusculoskeletalsystem.

Informationfromallofthesesystemsisintegratedinordertomaintainproperbalance.

Allofthesesystemsneedtobefunctioningoptimallyforthebodytofullyengageallof

thenecessarybalancestrategiesusedindailylife.Eachoftheserelatedcomponents

provideauniquesetofinformationregardingthemovementandpositionofthebody

withinspace.

Thevestibularsystemisanactivepartofmaintainingbalanceandposture.This

systeminvolvesthestructuresintheinnerearthatmonitorandsensevariouschanges

inthepositionofthehead.Thissystemcanbeseparatedintotwodivisions,withone

monitoringstaticequilibriumandtheothermonitoringdynamicequilibrium.Receptors

intheinnerearthatareresponsibleforthemonitoringofstaticequilibriumrespondto

linearheadmovementsandheadtilt,andrespondonlytochangesinthevelocityof

headmovement.11Thismeansthattheydonotreportunchangingheadpositions,

makingthemanimportantpartofthemaintenanceofnormalheadposition.The

receptorsthatareconcernedwithdynamicbalancerespondtochangesinrotary

movementsofthehead.Thevestibularbalancesystemdoesnotdirectlyor

automaticallycompensateforforcesactingonthebody,ratheritsendsimpulsesto


reflexcentersinthebrain.Impulsesareeithersenttothevestibularnucleiinthe

brainstemforintegrationwithinputfromthevisualandsomatosensorysystems,orto

thecerebellumtocoordinateskeletalmuscleactivity.Theseimpulsesarethen

integratedbythecentralnervoussysteminordertoinitiatetheappropriate

compensationforadisturbanceinbalance.

Thevisualsystemalsoplaysanimportantroleinbalance.Reflexesmediatedby

inputfromthevestibularsystemeffecthowtheeyesmoverelativetothepositionof

thehead.Everytimetheheadrotates,thesemicircularcanalsofthevestibularsystem

sendsignalsthatcausetheeyestorotateinanequalandoppositedirectiontothe

rotationofthehead.12Thisrelationshipbetweenthevestibularsystemandvisual

systemallowsonetomaintainastableimageontheretinawhiletheheadmovesin

space.Withoutthismechanismtheeyeswouldnotbeabletoremainfixedonanobject

longenoughtoobtainaclearimage.

Thesomatosensorysystemisanothercriticalcomponentinbalance.

Proprioceptorsintheneckandbodysendsignalstothevestibularnucleirelaying

informationaboutthebody’spositioninspace.Thisinformationisthensenttothe

cerebellumformodificationofbothstaticanddynamicbalance.Thejointreceptorsin

thecervicalregionareofparticularimportancetotheproperfunctionofbalance

systems.Thesereceptorshelptokeeponefromfeelingdisequilibriumbytransmitting

signalsthatpreciselyopposethesignalssentbythevestibularapparatus.12Thisensures

thatthesignalsbeingsentfromthevestibularsystemarerelayingappropriate

informationregardingthepositionofthehead.


Balancestrategies

Individualsusemanydifferentbalancestrategiesinordertorespond

appropriatelytoamultitudeofdifferentsituationsthatchallengethebodytomaintain

postureandbalance.Twoofthesestrategiesarereactivestrategiesandproactive

strategies.Reactivestrategiesareusedwhenthereisanexternalforcethataltersthe

body’scenterofmass.Proactivestrategiesareusedinanticipationofinternally

generateddestabilizingforcesthatwillshiftthebody’scenterofmass,suchasreaching

outthearms.13Theelderlyindividual,however,oftencannotintegratethesestrategies

tocorrectfortheirlackofbalanceintimetopreventafall.Decreasedreactionspeed

andtheinabilitytocorrectforadisturbanceinbalanceisanotherfactorthatleadsto

theprevalenceoffallsintheelderlypopulation.Asindividualsage,nerveconduction

speedisreducedconsiderably.Thisdecreaseinconductionvelocitymeansthatboth

thesignalsbeingreceivedbythesensorysystemsandthesignalsbeingsentoutbythe

centralnervoussystemarenotreachingtheirdestinationsasquicklyastheyoncehad.

Whileanindividualeitheryoungoroldmayhaveanequallylikelychancetotripoveran

unseenobject,theyoungerindividualhasabetterabilitytoregainbalanceandavoida

fall.

Thebodyusesdifferentmusclesynergiestocompensateforlossofbalanceof

differentmagnitudes.Therearethreemainstrategiesthatthebodyusesinorderto

maintainorregainbalance:anklestrategy,hipstrategy,andsteppingstrategy.Ankle

strategyandhipstrategyareexamplesoffixed-supportstrategies,wherethebaseof

supportremainsfixedduringperturbationandrecovery.Theanklestrategyisemployed


first,whenthereisaminorperturbationordisturbanceinbalance.Thebodywillsend

quickburstsofactivityineithertheanteriororposterioraspectoftheleginorderto

preventmovementinthesagittalplane.13Importantmusclegroupsinvolvedinthis

strategyincludetheankleplantarflexorsanddorsiflexors,alongwiththeabdominals

andhipflexors.Musclesfiringwhentheanklestrategyisutilizedbegintofiredistally

andcontinuemoreproximallyasthebalancetaskbecomesmoredifficult.Hipstrategy

isthenextfixed-supportstrategythatisusedwhentheanklestrategyisnotsufficientto

maintainorregainbalance.Hipstrategygenerallyinitiatesforlargerperturbations,and

operatesinaproximaltodistalmusclefiringpattern.Themusclesinvolvedinthis

strategyincludethequadriceps,hamstrings,abdominals,andparaspinals.Ifthesetwo

strategiesfail,athirdstrategyisutilized:steppingstrategy.Thisistechniqueisknown

asachange-in-supportstrategy,asopposedtothefixed-supportstrategiesdescribed

earlier.Inachange-in-supportstrategythecenterofgravitymovestoofarfromthe

baseofsupporttomaintainafixedposition.Thebodywillreactbysteppinginacertain

directioninordertomovethecenterofgravitybackoverthebaseofsupportthereby

regainingbalance.Thisstrategyismosteffectivewhenrecoveringfromalarge

perturbation.13

BalanceandStrength

Diminishingbalanceismultifactorial,butseveralstudieshaveshownthatalack

oflowerextremitystrengthisoneofthecommonfactorsleadingtodecreasedbalance,

andeventuallyfalls.14Theincreasedriskoffallsintheelderlyiscloselyrelatedwiththe

decreaseinmuscularstrengthtypicallyexperiencedbythispopulation,andcanprovide


anadditionaldeterrenttothefunctionalindependenceoftheolderadult.15Byage40,

musclestrengthcanbeexpectedtodecreaseabout1%eachyear,16withtheselosses

beingexaggeratedtoup3%peryearinthoseoverage65.3

Thereareafewdifferentspecificmusclesinthelowerextremitiesthathave

beenlinkedaskeycomponentsofbalance.Lordetal’s.17findingsonankledorsiflexion

determinedthatincreasedstrengthhasadirectrelationtobalance.Withthisinmind,

HessandWoollacott14concludedintheirownstudythatstrengthis1of3variables

significantlydiscriminatingbetweenolderadultswithahistoryof0to1fallstothose

withahistoryofmultiplefalls.Dorsiflexors(tibialisanterior)wereextremelyweakin

thosewithmultiplefalls,whichsuggeststhatthesemusclesgreatlycontributetopoor

balance.Thisshowedthatweakkneeflexors(hamstrings),extensors(quadriceps),and

plantarflexors(gastrocnemiusandsoleus)allhadaneffectonpatientswithmultiple

falls.HessandWoollacott14furtherstudiedthefourmuscleslistedaboveandfound

usingtheBergBalanceScale,thatthesubjectsincreasedbalancewithincreasedplantar

flexormusclestrength.TheTUGtestwasusedaswellandyieldedsimilarresultsasthe

BergScale.Theparticipantswereaskedtoratetheperceptionoftheirbalanceusingthe

ABCscalebeforeandafterthestudy.Thoseintheexperimentalgrouprankedover26%

higherthanthecontrolgroupattheendofthestudy.Theynotedthatstrengthtraining

canreducefallriskanywherefrom5%to20%ina10weekprogram,whilealso

increasingbalanceconfidence.


BalanceBoardsandVibrationPlatforms

Wholebodyvibrationisatrainingmethodthatexposestheentirebodyto

mechanicalvibrationsoroscillationswhilestandingonaplatform.18Theuseofbalance

boardsandvibrationplatformsinefforttoimprovebalanceisanovelconceptthatis

growinginpopularityandresearch.Asresearchintothisconceptprogresses,itis

importanttodefinethevariablesthatarethemosteffectiveinproducingthedesired

resultsinthepatient.

Vibrationboardshaveanumberofdifferentparametersincludingfrequency,

amplitude,anddirectionofthevibratoryforce.Frequencyreferstothenumberof

oscillationspersecondthatareproducedbytheplatform.Theamplitudedescribesthe

magnitudeofexcursionoftheplatform.Thedirectionofvibrationofaconventional

vibrationplatformistypicallyeitherside-to-sideorvertical.Astudyconductedby

Pollocketal.investigatedtheeffectsofdifferentvibratoryparametersonvarious

outcomesusinganelderlypopulation.19Resultsdemonstratedthathigherfrequencies

intherangeof40to50cyclespersecondproducedthemostmusclestimulation.The

effectoffrequencywasalsomagnifiedastheamplitudeofvibrationsincreased.

HoweverinastudyconductedbyGusietal.20participantsreportedsignificantresults

usingafrequencyrangeof12.6to26cyclespersecond.Higheramplitudeshavebeen

demonstratedtocausegreatermuscleactivation,withatendencyformusclesnearest

totheplatformtobemostactive.

Thereareseveraldifferenttypesofvibrationplatform,eachusingadifferent

mechanismofvibration.Astochasticvibratoryplatformhasseparateplatformsforeach


footandvibratesinarandommanner.Amoreconventionaltypeofvibrationplatform

hastheuserstandingonasingleplatform.Thistypeofplatformgenerallyoperates

usingasinusoidalwaveandvibratingineitheraside-to-sidealternatingorvertical

direction.4Acounter-clockwiseoscillatingvibrationplatformusesspirallyformed

oscillationsthatrotateinacounterclockwisedirection.Accordingtotheinventorofthe

counter-clockwiseoscillatingvibrationplatform,“thegravitationalforcepullsthebody

down.Theforceisstrengthenedthroughthespiraldynamicoftheplatformduetothe

gravitationalforce.Thelevitationforcepushesthebodyupwardsandisenhancedby

theoscillations.Therefore,bothforces,thedownwardpullandtheupwardpush,are

beingreinforced.”1Thisisopposedtotheconventionalside-to-sideorverticalwhole

bodyvibrationplatforms.

Vibrationplatformtrainingcausesrapidverticaland/orhorizontaldisplacements

withhighlevelsofacceleration.Thistypeofperturbationcausesadisturbanceofthe

user’smotionandequilibrium.Theseperturbationscaninterferewithposturalcontrol,

challengingthebodytorespondwithappropriatebalancecorrectingstrategies.

Perturbationsareknowntobeanappropriatetrainingstimulustoimprovebalanceand

balanceconfidence.18Bernhardtetal.

18concludedthatposturalcontrolwasimproved

inasimilarmannerusingeithervibrationboardinducedperturbationsoraspecific

balancetrainingprotocol.Perturbationsprovideaninputthatchallengesthebalance

systemstoreacttoanexternalforce.Balancestrategiesmustbeappropriatelyand

sequentiallyexecutedinordertomaintainthedesiredposturalposition.


Torvinenetal.21haveconductedmultiplestudiesusingavarietyofbalance

boardsandseveraldifferentprotocols,butthesestudieshavereturnedmixedresults.A

twelveweekstudyofmiddleagedwomenutilizingaside-alternatingvibrationplatform

trainingprogramdemonstratedsignificantgainsinisokineticstrengthoftheknee

extensormusculature.Asimilartrainingprogramconductedwithayoungerpopulation,

however,didnotdemonstrateanysignificantkneeextensormusculaturegains.Another

studythatwasconductedbyBelaveyetal.22concludedthatvibrationcouldminimize

riskfactorsforfallingbyimprovingmusclestrengthandbodybalance.Inasystematic

reviewof15vibrationplatformstudies,deBruinetal.4concludedthatside-alternating

sinusoidalvibrationscanhaveabeneficialeffectonthedynamicbalanceofelderly

individuals.Verticalsinusoidalvibrations,however,didnotdemonstratethesepositive

results.Ofthefifteenstudiesreviewed,onethirdofthemwerenotabletoshow

beneficialresultsfromtheuseofavibrationplatform.

Severalstudies4,14,18,23-25

reportingtheeffectsofwhole-bodyvibrationonthe

elderlyhavedemonstratedadverseeffectsresultingfromtraining.Complaintsincluded

erythema,itchingoflegs,headache,andgroinpain.InastudyconductedbyBogaerts

etal.,269outof119participantscomplainedofkneepainafterwhole-bodyvibration

training,howeverthesereportswerefoundtoberelatedtodegenerativechangesfrom

previousinjuries.Oneofthecommoncomplaintsamongseveralstudieswasmuscle

sorenessaftertheinitialtrainingsession,butthiscanbeexpectedwhenintroducinga

newtrainingprotocol.Lametal.23notethatprolongedexposuretowhole-body

vibrationhasalsobeenshowntohaveadverseeffects,however,itisunspecifiedasto


whatprolongedexposuremayconstitute.Theyalsonotetherelativelyshortdurationof

trainingsessionsinmoststudies,whicheliminatesthisnegativeconsequence.Thelow

frequencyofoccurrenceofadverseeffects,andthefactthattheseeffectshave

generallybeenmildandusuallysubsidedsoonafterthecompletionofthetraining

sessionindicatesthatwhole-bodyvibrationiswelltoleratedamongolderadults.23

Itisclearthatmoreinvestigationintotheuseofbalanceandvibrationplatforms

asatooltoimprovebothstaticanddynamicbalanceiswarrantedbythedisparityof

resultsfrompreviousstudies.Whileseveralstudiesmaybeusingthesametypeof

balanceboard(i.e.side-alternatingsinusoidal),othervariousparameterssuchas

frequencyoramplitudeofvibrationcouldbedifferent.Studies4,18,19,21,25

havealso

attemptedtodeterminethemostbeneficialdurationoftraining,rangingfromanacute

boutofvibrationlastingonlyseveralminutestoayear-longtrainingprogression.

THEORETICALFRAMEWORK

Astheelderlypopulationcontinuestoincreaseinnumber,itisimportantthat

newandinnovativewaystoreducethenumberoffallsthatleadtodecreasedqualityof

lifeareinvestigated.Foraninterventiontobemaximallyeffective,itshouldbe

manageablefromatimeperspective,ensureflexibilityinscheduling,andelicitthe

desiredpsychologicalandphysiologicaleffects.Participationinregularphysicalactivity

seemstobetheonlylifestylemodificationidentifiedtodate,otherthancaloric

restriction,thatcanfavorablyinfluenceabroadrangeofphysiologicalsystemsaswell

chronicdiseasepatterns.Physicalactivityisalsocloselyrelatedtobettermentalhealth

andsocialintegration.27


Thepurposeofthisstudywastodeterminewhetherthecounter-clockwise

oscillatingvibrationplatformhasasignificanteffectonbalanceinageriatricpopulation.

METHODS

StudyDesign

Thiswasaquantitativeresearchstudywithaonegrouprepeatedmeasures

(non-control)quasi-experimentaldesign.Theinterventionwasa5-weektreatment

protocolusingacounterclockwiseoscillatingvibrationplatform.Eachparticipant

completedanABCBalanceConfidenceScaleandSWAYbalancemeasurementpriorto

the5-weekprotocol.Eachparticipantwasreassessedattheendofthe5-weekprotocol.

ThestudywasapprovedbytheInstitutionalReviewBoardofFloridaGulfCoast

University.

Sample

Anon-probabilityconveniencesamplingstrategywasusedtogather

participants.APrioripoweranalysiswasconductedusinganeffectsizeof0.4,powerof

0.8,and3degreesoffreedom,whichdeterminedthat30participantswereneededin

thestudy.TheresearcherscontactedlocalIndependentLivingFacilitiesinordertoseeif

theyfelttheirresidentsmighthaveinterestinparticipatinginastudyregardingbalance.

AHealthFairatCypressCoveIndependentLivingFacilitywasattended,wherethe

researchersgainedinterestfrom54participantsovertheageof65throughflyers,face-

to-faceconversation,andwordofmouth.

Physicalexclusionarycriteriafortheparticipantsincluded:

1. Haveanacutethrombosis


2. Anyinjuryorexistinginflammation

3. Recentfracture

4. Recentjointimplant

5. Recentsurgery

6. Havingarheumaticepisode

7. Havingatumorofanysort

Instrumentation

TheOSFLOWcounterclockwiseoscillationvibrationplatformwasusedforthe

interventioninthisstudy.Theplatformfrequencyisadjustable,butcanbeset

anywherebetween8to12Hzbythemanufacturer.Forthepurposesofthisstudy,both

machinesusedwerecalibratedto10Hzoverthefive-weekcourseofthestudy.The

dimensionsoftheplatformare31.5inchesinlength,15.75inchesinwidth,and7.09

inchesinheight.Thetotalweightoftheplatformis29.99pounds.Theamplitudeofthe

OSFLOWissetto1-2mm.1

Figure1.VibrationPlatformDimensions.AdaptedfromOSFLOW.

1


Figure2.OSFLOWVibrationPlatform.AdaptedfromOSFLOW.

1

TheSWAYMedicalBalancephoneapplicationwasusedtocollectdataonthe

subject’sbalanceandposturalsway.ThisAppisanFDAapprovedmedicaldevicethatis

intendedtoassessposturalswayasanindicatorofbalance.Itisconsideredtobe

reliablewithtest-retestreliability(ICC(3,1)=0.76;SEM=5.39).28Researchalsoindicates

thatitishighlycomparabletotheBalanceErrorScoringSystem(BESS).29TheCDC4

protocolwasusedforthisresearch,asitwasdeterminedtobethemostrelevanttothe

studybeingconductedwiththegeriatricpopulationthantheotherprotocolsthatwere

available.TheCDC4protocolisexclusionaryofreactiontime,astheothersarenot.

Figure3.SWAYMedicalBalanceApp.AdaptedfromSWAYMedical.

29


TheActivities-SpecificBalanceConfidenceScale(ABCScale)wasusedasa

subjectivemeasureofconfidenceforthecommunitydwellingadultinperforming

variousambulatoryactivitieswithoutfallingorasenseofunsteadiness.Itisa16

question,papersurvey.Ascoreoflessthan67%isindicativeofthatsubjectbeing

consideredafallrisk.Thetesthasexcellenttest-retestreliabilityintheelderly

population(r=0.92,p<0.001),aswellasexcellentinternalconsistencyforcommunity

dwellingolderadults(Cronbach’salpha=0.96).30

TheFolsteinMini-MentalStateExaminationwasusedasabriefscreeningtoolto

provideaquantitativeassessmentofcognitiveimpairment.Thisassessmentconsistsof

11questionsortasks,groupedinto7cognitivedomains:orientationtotime,orientation

toplace,registrationofthreewords,attentionandcalculation,recallofthreewords,

language,andvisualconstruction.30Scoringaminimumof24outofthe30possible

pointsindicatesthatthereisnolevelofimpairmentincognition.Allparticipantsinthis

studiedscoredatleasta24.TheMini-Mentalwasusedinordertoensurethatthe

potentialparticipantsfullyunderstoodthepotentialrisksthatwereinvolvedwith

signingupforthisstudy.Itwasalsousedbytheresearcherstoensurethatthesubjects

thatcommittedtoparticipatewerefullyawareofthelargetimecommitmentthatwas

involvedtodecreaseoddsofsubjectdropout.

Procedure

Potentialparticipantsattendedaninformationsessionthedaybeforethefirst

interventionsessionwasimplemented.TheInformedConsentformwasgoneoverin

detailatthistime.ConfirmedparticipantswerethenadministeredaMiniMental


Evaluation,aswellasgivenaRecentHealthSurveytodetermineiftheywerefitboth

physicallyandmentallytoparticipate.Potentialparticipantsneededaminimumof

24/30tobeconsideredeligible.Confirmedparticipantswerethenrequiredtofilloutan

initialABCBalanceConfidenceScalefortheirbaselinemeasurement.

Thestudylastedatimeperiodoffiveweeks.Eachparticipantwasaskedto

attendfoursessionsaweekforthefive-weektimeperiod.Theresearcherswere

presentsixdaysaweek,foratimeperiodofthreehourseachday.Participantswere

abletoattendanytimeduringtheallocatedtimeblock.Ascheduleofthetimesforthe

followingweekwasprovidedattheendofeachweek.Aweeklysigninsheetwassetup

atthefrontdesksothatparticipantsandresearcherscouldkeeptrackofthenumberof

sessionsattendedfortheweek.Eachparticipantwasallocatedathreesessiongrace

periodfortheentiretyoftheresearchprocess.Iftheymissedmorethanthreesessions,

theywereremovedfromthestudy.

Onthefirstday,participantsunderwentaninitialbalanceevaluationusingthe

SWAYMedicalBalanceApplication.Allparticipantswereaskedtoremovetheirshoes

priortothetestingoftheirbalance.Theresearchersmeasuredtheposturalswayof

eachparticipantineachofthefollowingsevenpositions:

1. Feettogether

2. Semitandemwithrightfootleading

3. Tandemwithrightfootleading

4. Singlelegstanceonleftleg

5. Semitandemwithleftfootleading


6. Tandemwithleftfootleading

7. Singlelegstanceonrightleg

Agaitbeltwasplacedoneachparticipantduringtheinitialbalanceevaluationfor

safety,aswellastodeterminethosethatwereatagreaterfallrisk.

AfterthepreliminarySWAYdatahadbeencollected,eachparticipantwasable

tocompletethefive-weekprotocol.Eachsessionthatwasattended,participantswere

askediftheyhadconsumedanyalcohol,aswellasiftheywereexperiencingany

abnormalsignsandsymptoms.Oncecleared,participantswereaskedtoremovetheir

shoesandpartakeintheintervention.Theparticipantssteppedontothevibration

platform,andtheplatformwasturnedonforfiveminutes.Eachparticipantwas

instructedonhowtoappropriatelypositionhimorherselfontheplatformthroughout

thetimeperiod(feetshoulderwidthapart,chinup,andrelaxedposture).The

researcherswerestand-byassistfortheentiretyoftheinterventionforeachsession

withinonefootproximity.Forthosewhoweredeemedafallriskbytheresearchers,a

gaitbeltwasusedeverysession.Participantswereconsideredafallriskiftheyhad

lowerthana70overallscoreontheSWAYpre-intervention,orlowerthan67%onthe

ABCScale,whichisthecut-offscoreforfallersandnon-fallers.30Afterthefiveminute

timeperiodwasup,theparticipantswereaskedtostandontheplatformforan

additionalminutetoensuretheirsafety.Participantswereabletoleaveaftertheywere

deemedsafetoambulateagain.

Afterthefive-weekprotocolwasconcluded,eachparticipantselectedatimeslot

tocompletehisorherfinalsession.Thisincludedtheirfinal5-minuteinterventionon


thevibrationplatform,fillingoutanewABCBalanceConfidenceScale,andafinal

measurementoftheirbalanceusingtheSWAYMedicalBalanceApplication.Thesame

sevenpositionsweretested,asstatedabove.

TheCypressCoveHealthCenterlocationwasusedforalldatacollectionand

interventions.Itwasusedforparticipantaccessibilityandtoensurethatsufficient

participantsweremaintainedthroughouttheresearch.

RESULTS

Thisstudyinvestigatedthefollowingresearchquestion:Doesacounter-

clockwiseoscillatingvibrationplatformhavepositiveeffectsonbalanceintheelderly

population?Ofover50potentialparticipantswhoexpressedinterestinbeingapartof

thestudyattheCypressCoveHealthFair,atotalof43individualsreturnedtofilloutthe

requiredformsforthestudy.These43peopleeachfilledoutaHealthHistoryform,

ABCScale,andcompletedtheFolsteinMini-Mentalexamination.Thus,atotalof43

participantswererecruitedatthebeginningofthestudy.Ofthese43,atotalof34

participantscompletedtheentireprotocolandwereeligibletobere-testedusingABC

ScaleandSwayBalanceapp.The9peoplewhowereineligibletobere-testedeitherdid

notcompletetheprotocolinitsentiretyorhadtodropoutofthestudyforvarious

reasons.Reasonsforthese9notmeetingtheinclusioncriteriaareasfollows:one

personsustainedafallandaninjurywhichpreventedthemfromreturning,twopeople

droppedoutofthestudyafterreportingthattheycouldnotmakethetime

commitment,and6peopledidnotmeettherequiredtotalnumberofsessionsto

qualifyforre-testing.Atotalof34participantscompletedthestudythroughtheentire


five-weekprotocolafterdropout.Thegroupincluded17malesand17females.The

averageageoftheparticipantswas80+7.57years,withtheyoungestat66,andthe

oldestat96yearsold.

Thedifferencebetweenpre-testandpost-testscoreswascalculatedforboththe

ActivitiesSpecificBalanceConfidenceScaleandtheresultsoftheSWAYbalance

applicationtest.ThestatisticswereanalyzedbytheIBMSPSSversion20software.

Descriptivestatisticswereusedtoprovideinformationabouttherelevanceand

significanceofthechangeinscoresbeforeandaftertheintroductionofthefiveweek

protocol.Toprovidethemostaccurateandcompletepictureofthedatacollecteda

PairedT-Testwasusedtodeterminethesignificanceofthechangeinbalance

confidenceaswellastheactualbalancemeasurecalculatedbySWAY.

UsingthePairedT-Test,twohypotheseswereconceivedforeachbalance

measure.ThenullhypothesisfortheABCscalestatedthattherewouldbeno

differencebetweenthepreandpost-testmarks.Theworkinghypothesisstatedthat

therewouldbeasignificantdifferencebetweenthepreandpost-testmarks.Thenull

hypothesisfortheSWAYbalancestatedthattherewouldbenodifferencebetweenthe

preandpost-testmarksusingtheaveragecalculatedfromthetestscoresusingbothleft

andrightfootscores.Theworkinghypothesisstatedthattherewouldbeasignificant

differencebetweenthepreandpost-testscoresusingtheaveragecalculatedfromthe

testscoresusingbothleftandrightfootscores.

TherelativechangeinActivitiesSpecificBalanceConfidence(ABC)Scalescores

forthe34participantswasasfollows:20participantshadscoresreflectinganincrease


inbalanceconfidence,9hadscoresreflectingadecreaseinconfidence,and5had

scoresreflectingnochange.DescriptivestatisticsfortheresultsoftheABCScalewere

calculatedusingtheSPSSsoftwareandtheresultsaredisplayedinTables1and2.Table

1demonstratestheaveragescoresontheABCscaletestedpriortoperformingthefive-

weekprotocolandonthefinaldayoftheprotocol.

Table1.ABCPairedSampleStatistics

Mean N Std.Deviation Std.ErrorMean

Pre-Intervention 13.1906 34 2.86756 0.50692

Post-Intervention 13.8038 34 2.44764 0.43269

Theaveragescoreofthegroupbeforetheinterventionwas13.19outofapossible16

points.Theaveragescoreofthegroupaftertheprotocolhadbeencompleted13.80

outofapossible16points.Thesescoresrepresentpercentagescoresof82.44%and

86.27%,respectively.Thedifferencebetweenthesetwoscoreswas0.61.This

representsthemeanchangebetweenthetestscoresbeforeandaftertheintervention

period.ResultsofthePairedT-testcalculatedbytheSPSSsoftwarearedisplayedin

Table2.ThePairedT-testdemonstratedthatthereisasignificantdifferencebetween

theABCScalescoresinthepreandpost-testgroups(p=.044).

Table2.ABCPairedSamplesTest

Mean Std.

Deviation

Std.

Error

Mean

95%CI

Lower

95%CI

Upper

t Sig.(2-

tailed)

Pre-PostPaired .61313 1.65297 .29221 0.01717 1.20908 2.098 .044

DescriptivestatisticsfortheresultsofSWAYBalancetestwerealsocalculated

usingtheSPSSsoftwareandtheresultsaredisplayedinTables3and4.Table3


demonstratestheaveragebalancescoresofthegrouptakenpriortobeginningthe5

weekprotocolandthenagainaftercompletionoftheprotocol.

Table3.SWAYAveragesPairedSampleStatistics

Mean N Std.Deviation Std.ErrorMean

Pre-Intervention 81.6027 34 12.12175 2.11013

Post-Intervention 83.2439 34 11.66608 2.03080

Thisaveragescorerepresentsthemeanscoreofthreedifferentbalancetests

performedoneachfoot.Thesetestsincludeposturalswaymeasuredwiththe

participantstandingstationarywiththeirfeettogether,feetintandemstance,andthen

finallywhenstandingononefoot.FromthesescorestheSWAYapplicationcalculated

anoverallbalancescorefortheleftandtheright.Thesetwoaverageswerethenused

tocalculateafinaloverallbalancescorethatincludedboththeleftandright.The

averagescoreofthegroupbeforetheinterventionwas81.60outofapossible100

points.Theaveragescoreofthegroupaftertheprotocolhadbeencompleted83.24

outofapossible100points.Thedifferencebetweenthesetwoscoreswas1.64.This

representsthemeanchangebetweenthetestscoresbeforeandaftertheintervention

period.ResultsofthePairedT-testcalculatedbytheSPSSsoftwarearedisplayedin

Table4.ThePairedT-testdemonstratedthatthereisnosignificantdifferencebetween

theSWAYBalancescoresinthepreandpost-testgroups.

Table4.SWAYAveragesPairedSamplesTest

Mean Std.

Deviation

Std.

Error

Mean

95%CI

Lower

95%CI

Upper

t Sig.

(2-

tailed)

Pre-PostPaired 1.64121 8.42952 1.46739 -

1.34776

4.63019 1.1118 .272


DISCUSSION

Noadversesideeffectswerereportedbyanyonewhocompletedthe5week

protocol.Severalparticipantsnotedatransientfeelingdescribedas“gettingoffofa

boat”or“feelingunsteady”.Theseeffectsallsubsidedwithinthe1-minutewaiting

periodafterturningoffthevibrationplatform.Ofthe34participantswhocompleted

theprotocoltherewasa100%overalladherencerate.

ResultsfromtheSPSSdescriptivestatisticalanalysisdemonstrateasignificant

changeinActivitiesSpecificBalanceConfidencescoreaftercompletionoftheprotocol.

Theaveragepre-testABCscorewas13.19,whichrepresentsapercentagescoreof

82.44%.Thisfigureissignificantlyhigherthantheaverageforthisagepopulation.The

averagebalanceconfidencescoreafterthecompletionoftheprotocolwas13.80,which

representsapercentagescoreof86.27%.Thisdemonstratesa3.83%increasefrom

baselinescoring.Despitethefactthatthepre-interventionABCscoreswerehigherthan

themeanscoreforthisagedemographic(leavinganarrowermarginforimprovement)

therewasastatisticallysignificantincreaseinbalanceconfidence.Whilethereisnotan

establishedvaluefortheminimallyclinicallyimportantdifferenceforthistest,

statisticallysignificantimprovementsinbalanceconfidencehavebeenlinked

improvementsinfunctionandpossibledecreaseinfallrisk.

Ofthe34participantswhocompletedanABCsurveybeforeandafterthe

protocol26.5%reportedadecreaseintheirbalanceconfidence.Thisdecreasein

balanceconfidencehadasignificantimpactonthemeanscoreforthepost-intervention

group.Thereareseveralpossibleexplanationsforthisdecreaseinbalanceconfidence,


astheSWAYbalancemeasuresdidnotreflectthissamedecreaseinoverallbalance.

Priortobeginningtheprotocolnoneoftheparticipantshadanyexperiencewitha

vibrationplatform.Furthermore,thebalancemeasurestestedbytheSWAYapplication

includedpositions(tandemstanceandsinglelegstance)thattheparticipantsdidnot

frequentlyassumeintheirdailylives.Aftercompletionoftheinitialbalancetesting

manyparticipantsverbalizedthattheyhadnotbeenawareoftheirbalancedeficiencies.

Thismayhaveledtopost-protocolscoresthatweremorereflectiveofactualbalance

scores,astheinitialbalanceconfidencescoresreflectedaninflatedsenseofability.

TheresultsoftheSPSSdescriptivestatisticalanalysisdidnotdemonstrate

significantimprovementinthescoresoftheSWAYbalancetestfrompre-interventionto

post-intervention.Theseresultsdidnotsupportthehypothesisthatthecounter-

clockwiseoscillatingvibrationplatformwouldhavepositiveeffectsonposturalsway.

Whiletherewasanumericalincreaseinthescoresaftercompletionofthefive-week

protocol,itwasnotenoughtobeconsideredstatisticallysignificant.Thereareseveral

possibleexplanationsforthelackofpositiveeffects.

First,theprotocolitselfrequiredtheparticipanttostandstationaryonthe

vibrationplatformwiththeirfeetshoulder-widthapartandtheirlower-extremitiesina

comfortablyrelaxedposition.Whilethisisanappropriateposturethatoneassumesin

every-daylife,itwasnotaposturethatwasdirectlymeasuredbytheSWAYapp.Ofthe

threetestsmeasuredbytheSWAYapplicationtheoneclosesttothepositiondescribed

intheprotocolwas“standingwiththefeettogether”.Thispositionisinherentlymore

challengingasitnarrowsthebaseofsupportinrelationtostandingwiththefeetat


shoulder-width.Theothertwotestingscenariosincludestandingwiththefeetin

tandemandstandingononefoot,bothofwhicharealsosignificantlymorechallenging

thanthepositionusedintheprotocol.Theprincipleofspecificityofadaptationsalso

demonstratesthattheadaptationsthatthebodymakesarespecifictothechallenges

imposeduponit.Thismeansthatanybalanceadaptationsmademayhavebeen

directlyrelatedtostandingstationarywiththefeetshoulder-widthapartonavibration

platformandnottranslatedtothethreespecifictestingscenarios.

Anotherpossibleexplanationforthelackofpositiveresultsisthefactthatthe

protocolcalledfortheparticipanttoremainstaticduringthe5minuteperiodwhile

standingonthevibrationplatform.Inorderforthebodytoimproveinitsbalance

strategiesthesystemsmustbechallengedbeyondtheirnormalabilities.Formany

participantstheprotocolitselfmaynothaveappropriatelychallengedthebalance

systemsenoughtoelicitanypositiveadaptations.Ifparticipantshadbeenchallenged

toalevelreflectingtheirownpersonalabilitiesratherthanusingauniformstatic

protocolresultsmayhavereflectedlargerimprovementsinposturalsway.

Whiletherewasnostatisticalsignificancefoundbetweenthepre-testandpost-

testscorestakenbytheSWAYapplication,manyoftheparticipantsverbalized

anecdotaldifferencesthroughoutthecourseoftheprotocol.Themostfrequently

notedimprovementwasinposture.Manyoftheparticipantsdescribedafeelingthat

theirposturewasimproving,notingthattheyfeltiteasiertostanderectwiththeir

shouldersbackandcervicalspineinaneutralposition.Thisfindingmayreflectthe

instructionsandposturalcuingthateachparticipantreceivedfromtheprinciple


researcherseachtimethattheystoodontheplatform.Participantswereencouraged

tostandinproperposturewithaslightbendinthekneessothatthetotal-bodyeffects

ofthevibrationscouldbemaximized.Othersreportedfeelingthattheyhadmade

improvementsintheirsleeppatterns,decreasedjointpain,orincreasedsenseof

energy.Overall,theparticipantsverymuchenjoyedparticipatinginthisresearchand

founditallveryinteresting.

RecommendationsforFutureStudies

Theresultsofthecurrentstudysupportedtheproposedhypothesisrelativeto

balanceconfidence.However,itdidnotsupportthehypothesisrelativetoincreasein

posturalswayasmeasuredbytheSWAYbalanceapplication.Asthisisapilotstudy,

muchwasgleanedtoimprovethequalityoffuturestudies.Onerecommendationfor

futurestudiesisthatparticipantsbegivenamorechallengingprotocolconsistingofa

seriesofactivemovements.Thestationarynatureoftheprotocolinthisstudymaynot

havebeenchallengingenoughfortheparticipantstoelicitadaptationsinbalance

strategies.Futureprotocolsshouldincorporatefunctionalmovementpatternsthatcan

beperformedontheplatformsuchassquattingorreaching.Thesemovementsprovide

achallengetotheparticipant’smusculoskeletalsystem.Hess&Woollacottdescribesa

relationshipbetweenbalanceandstrength.14Specificmusclesmentionedthathavea

particularimpactonbalanceincludetheanklestabilizers,kneeextensors/flexors,and

themusclessurroundingthehips.14Allofthesemusclegroupshavethepotentialtobe

trainedusingacounter-clockwiseoscillatingvibrationplatformifadynamicprotocolis

usedforintervention.


Anotherrecommendationforfuturestudieswishingtoinvestigatetheimpactof

avibrationplatformonposturalswayistoincludeoutcomemeasuresthatmoreclosely

replicatetheinterventionperformedintheprotocol.Theprotocolusedinthecurrent

studyhadtheparticipantstandingwiththeirfeetshoulder-widthapart,whilethe

outcomemeasureusedtodeterminetheparticipants’balancehadthemstandina

seriesofposturesthatweremuchmorechallenging.Futurestudieswouldbenefitfrom

usingameasurementdevicethatreplicatedtheexactposturethattheparticipantwas

trainedthroughouttheinterventionprotocol.Thiswillensurethatanybalance

adaptationsmadethroughouttheprotocolaremeasuredinawaythatreplicatesthe

protocolitself.

Itisrecommendedthatfuturestudiesdevelopaprotocolthatpersistsforatime

periodsignificantlybeyond5weeks.Thefiveweekprotocoldevelopedinthecurrent

studywasacombinationoftimeconstraintsimposedbyresearchdeadlinesandthe

feasibilityofgatheringagroupofparticipantswillingtomakeasignificanttime

contributionoftheirown.Theprotocolconductedbythecurrentstudymaynothave

allowedasignificantamountoftimetoinducetrainingbenefitsorbalanceadaptations.

Thesamecouldbesaidforiftheparticipantsreceivedtheintervention6daysaweek,

versusthe4receivedinthisstudy.Receivingadditionaltimeontheplatformmayallow

fordifferingresults.However,thelackoftimepairedwiththerelativelystationary

natureoftheparticipants’posturemaynothavebeensufficienttochallengethe

participantsenoughtoelicitthepositiveresultsthatwouldhavesupportedour

hypothesis.


CONCLUSION

Theresultsofthisstudydemonstratedastatisticallysignificantincreaseinthe

ActivitiesSpecificBalanceConfidenceScale.TheSWAYbalanceapplicationscores

demonstratedanumericalincreaseaftercompletionofthefiveweekstudy,butthere

wasnostatisticallysignificantdifferentbetweenthepreandpost-intervention

measures.Futureresearchneedstobeconductedtoinvestigatethefurtherbenefitsof

acounter-clockwiseoscillatingvibrationplatformonbalanceintheelderlypopulation

thatincludesalowerlevelpopulationandalongertrainingtimeinadditiontothe

recommendationspreviously.


References

1. OSFLOWUSA.HowitWorks.http://www.counter-clockwiseoscillatingvibration

platformusa.com/counter-

clockwise_oscillating_vibration_platform_how_it_works.html.AccessedJune5,

2014.

2. DishmanR,HaskellW,HowleyE.PhysicalActivityGuidelinesforAmericans.

http://www.health.gov/paguidelines/.AccessedJune5,2014.

3. NelsonM,SeguinR.TheBenefitsofStrengthTrainingforOlderAdults.American

JournalofPreventativeMedicine.2003;25(3Sii):141-9.

4. deBruinE,HerrenK,HilfikerR,RadlingerL,RoganS.Effectsofwhole-body

vibrationonposturalcontrolinelderly:asystematicreviewandmeta-analysis.

BioMedCentral:Geriatrics.2011;11:72.

5. Chodzko-ZajikoJ,MinsonC,NiggC,etal.ExerciseandPhysicalActivityforOlder

Adults.AmericanCollegeofSportsMedicine.2009;1511-29.doi:

10.1249/MSS.0b013e3181a0c95c.

6. GordonP,PetersonM.ResistanceExercisefortheAgingAdult:Clinical

ImplicationsandPrescriptionGuidelines.TheAmericanJournalofMedicine.

2011;124:194-8.

7. Exton-SmithA,ImmsF,JohnsonA,OverstallP.Fallsintheelderlyrelatedto

posturalimbalance.BritishMedicalJournal.1977;1:261-4.

8. StenhagenM,EkstromH,NordellE,ElmstahlS.Accidentalfalls,health-related

qualityoflifeandlifesatisfaction:Aprospectivestudyofthegeneralelderly

population.ArchivesofGerontologyandGeriatrics.2013;58:95-100.

9. Shumway-CookA,WoollacottM,KernsKA,BaldwinM.Theeffectsoftwotypes

ofcognitivetasksonposturalstabilityinolderadultswithandwithoutahistory

offalls.TheJournalsofGerontologySeriesA:BiomedicalSciences.

1997;52:M232–40.

10. RubensteinLZ.Fallsinolderpeople:epidemiology,riskfactorsandstrategiesfor

prevention.JournalofBritishGeriatricsSociety:AgeandAging.2006;35(Suppl.

2)ii37eii41.

11. HoehnK,MariebE.AnatomyandPhysiology.SanFrancisco,CA:Pearson

Education;2011:468-471.


12. GuytonA,HallJ.TextbookofMedicalPhysiology,12e.Philadelphia:Saunders;

2005:674-678.

13. LevangieP,NorkinC.JointStructureandFunction:Acomprehensiveanalysis,5e.

Philadelphia,PA:F.A.Davis;2011:480-484.

14. HessJ,WoollacottM.Effectofhigh-intensitystrength-trainingonfunctional

measuresofbalance-impairedolderadults.JournalofManipulativeand

PhysiologicalTherapeutics.2005;28(8).

15. AdamsK,DeBelisoM,HarrisC,Spitzer-GibsonT.Acomparisonofperiodisedand

fixedrepetitiontrainingprotocolonstrengthinolderadults.JournalofScience

andMedicineinSport.2005;8(2):190-9.

16. BenekaA,FatourosI,GioftsidouA,etal.Resistancetrainingeffectsonmuscular

strengthofelderlyarerelatedtointensityandgender.JournalofScienceand

MedicineinSport.2005;8(3):274-83.

17. LordSR,WardJA,WilliamsP,AnsteyKJ.Physiologicalfactorsassociatedwith

fallsinoldercommunity-dwellingwomen.JournalofAmericanGeriatricsSociety.

1994;42:1110–7.

18. BernhardtS,GollhoferA,KramerA,RitzmannR.Wholebodyvibrationtraining–

improvingbalancecontrolandmuscleendurance.PublicLibraryofScienceOne

JournalofMedicine.2014;9(2).

19. PollockRD,WoledgeRC,MillsKR,MartinFC,NewhamDJ.Muscleactivityand

accelerationduringwholebodyvibration:Effectoffrequencyandamplitude.

ClinicalBiomechanics.2010;25:840-6.

20. GusiN,RaimundoA,LealA.Lower-frequencyvibratoryexercisereducestherisk

ofbonefracturemorethanwalking:arandomizedcontrolledtrial.BioMed

Central:MusculoskeletalDisorders.2006;7:92.

21. TorvinenS,JarvinenM,KannusP,etal.Effectoffour-monthverticalwhole-body

vibrationonperformanceandbalance.Medicine&ScienceinSportsand

Exercise.2002;1523-7.

22. BelavyDL,MiokovicT,ArmbrechtG,RittwegerJ.Resistivevibrationexercise

reduceslowerlimbmuscleatrophyduring56-daybed-rest.Journalof

MusculoskeletalNeuronalInteractions.2009;9(4):225-35.


23. LamFM,LauRW,ChungRC,PangMY.Theeffectofwholebodyvibrationon

balance,mobilityandfallsinolderadults:Asystematicreviewandmeta-

analysis.Maturitas.2012;72:206-13.

24. ChagdesJ,HaddadJ,RamanA,RietdykS,ZelaznikH.Dynamicstabilityofa

humanstandingonabalanceboard.JournalofBiomechanics.2013;46:2593-

602.

25. LiuM,LiuY,HeY,WangQ,WengC,ZhangL.Effectofwhole-bodyvibration

exerciseonmobility,balanceabilityandgeneralhealthstatusinfrailelderly

patients:apilotrandomizedcontrolledtrial.JournalofClinicalRehabilitation.

2014;28(1):59-68.

26. BogaertsA,VerschuerenS,DelecluseC,ClaessensAL,BoonenS.Effectsofwhole

bodyvibrationtrainingonposturalcontrolinolderindividuals:a1year

randomizedcontrolledtrial.InternationalJournalofGait&Posture.

2007;26(2):309-16.

27. LathamN,LiuC.AdverseEventsReportedinProgressiveResistanceStrength

TrainingTrialsinOlderAdults:2SidesofaCoin.ArchivesofPhysicalMedicine

andRehabilitation.2010;91:1471-3.

28. AmickR,ChaparroA,PattersonJ,JorgensenM.Test-Retestreliabilityofthe

SWAYbalancemobileapplication.JournalofMobileTechnologyinMedicine.

2015;4(2):40-7.

29. SWAY.Balance.SWAYMedicalGroup.http://swaymedical.com/.Accessed

August17,2014.

30. RehabMeasures.Instruments.RehabMeasures.http://rehabmeasures.org/.

AccessedJanuary19,2016.

31. ArnoldBL,SchmitzRJ.ExaminationofBalanceMeasuresProducedbytheBiodex

StabilitySystem.NATAJournals.1998;33(4):323-7.

32. PickerillML,HarterRA.ValidityandReliabilityofLimits-of-StabilityTesting:A

Comparisonof2PosturalStabilityEvaluationDevices.NATAJournals.

2011;46(6):600-6.

33. ParracaJA,OlivaresPR,Carbonell-BaezaA,AparicioVA,AdsuarJC,GusiN.Test-

RetestreliabilityofBiodexBalanceSDonphysicallyactiveoldpeople.Journalof

HumanSport&Exercise.2011;6(2):444-51.


34. RehabMeasures:Activities-SpecificBalanceConfidenceScale.

http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=949.

PublishedMarch22,2013.AccessedMay4,2016.

35. CardinaleM,MaffiulettiN,MicallefJ,PlaceN,SaugyJ.Neuromuscularfatigue

inducedbywhole-bodyvibrationexercise.EuropeanJournalofApplied

Physiology.2103;113:1625-34.

36. BassM,BrownL,TingL,TurnerL.InfluenceofYardWorkandWeightTrainingon

BoneMineralDensityAmongOlderU.S.Women.JournalofWomen&Aging.

2002;14(3):139-48.

37. MartinF,NewhamD,PollackR,ProvanS.Theeffectsofwhole-bodyvibrationon

balance,jointpositionsenseandcutaneoussensation.EuropeanJournalof

AppliedPhysiology.2011;111:3069-77.

38. PingY,XiaohuaW.Riskfactorsforaccidentalfallsintheelderlyandintervention

strategy.JournalofMedicalCollegesofPLA.2012;27:299-305.

39. SwanenburgJ,deBruinE,UebelhartD,MulderT.Fallspredictioninelderly

people:A1-yearprospectivestudy.InternationalJournalofGait&Posture.

2010;31:317-21.

THE EFFECT OF COUNTER-CLOCKWISE VIBRATION PLATFORM ...

Documents

Transcript of THE EFFECT OF COUNTER-CLOCKWISE VIBRATION PLATFORM ...