隨著全球人口老化、普遍的久坐生活方式及外太空技術的迅速發展，肌肉廢用已成為日益嚴峻及影響廣泛的公共健康問題。 肌肉廢用可引起肌肉萎縮及肌肉收縮功能衰退，最終影響患者的日常活動能力及生活的獨立性。 此外，重新使用廢用肌肉可引起肌纖維破壞及肌肉功能進一步損失，使得肌肉萎縮問題更加惡化。 低幅高頻振動治療屬於非入侵性的生物物理治療方法，通過給予溫和的全身性機械刺激達到治療目的，被証實可有效強化肌肉功能及刺激肌纖維肥大，為進行有關低幅高頻振動應用於廢用性肌肉萎縮治療的復康研究提供了充足證據。 本研究科研假說為低幅高頻振動治療能通過調節肌纖維形態及激活具生肌能力的肌衛星細胞，以改善廢用性萎縮肌肉收縮功能及促進其康復。 本研究共分為三個部分第1部分是對大鼠懸尾模型引發後肢廢用性肌肉萎縮進行驗證（TS模型）第2部分是研究低幅高頻振動治療對肌肉收縮功能的作用第3部分是振動治療對肌纖維型態及肌肉衛星細胞的影響。 / 第1部分的研究中，十二隻6月齡雄性SD大鼠被隨機分成懸尾組 (TS, n=6)及對照組 (Nor, n=6)。 在懸尾二十八天後，大鼠的比目魚肌被收取並進行體外肌肉功能檢測。 結果顯示懸尾組的肌肉質量及肌纖維橫切面積均顯著下降 (p<0.001)，證明懸尾模型能導致廢用性肌肉萎縮。 功能檢測顯示肌肉收縮功能下降，包括抽搐峰力及最大強直力下降（p=0.011及 p<0.001）。 因此，大鼠懸尾模型可用於研究低幅高頻振動治療對肌肉重用康復過程的作用，即本研究的第2及第3部分。 / 為了驗證本研究的科研假說，七十二隻雄性SD大鼠懸尾28天誘導比目魚肌萎縮後被隨機分為振動治療組 (Vib, n=36) 及重用對照組 (Ctrl, n=36)，並於懸尾後的第7、14 及21天取比目魚肌作進一步實驗 (n=6/組/時間點)。 治療組的大鼠於懸尾後接受每星期5天、每天20分鐘的低幅高頻振動治療 (振幅: 0.6g、頻率: 35Hz)直至對應的實驗時間點，而對照組大鼠則如常在籠中活動，其餘條件均相同。 / 第2部分實驗是通過體外肌肉功能檢測系統，分析低幅高頻振動治療對廢用萎縮後重用肌肉收縮功能的作用。 實驗結果顯示，相對於在第7天時的最大強直力，對照組重用肌肉在21天的康復期間肌力增長32% 。 振動治療組中，相對於振動治療7天時的最大強直力，振動治療14天已能夠使重用肌肉得到相近 (34.6%) 力量增長（p=0.033）。 由於兩組在第七天時的最大強直力量並沒有明顯差別，故結果可證明振動治療能提高肌強直力的恢復速度。具體肌肉強直力量(以肌纖維橫切面積常化的肌肉強直力量) 亦能夠證明有關發現。 振動治療組比目魚肌的具體強直力在振動治療14天後大於同期對照組力量 (p=0.001)。 振動治療組的具體強直力在14天時已達到最高並相近於21天時的水平，但對照組於14天至21天時仍有著明顯的上升趨勢，顯示振動治療組的肌肉完全康復速度比對照組的快。 / 第3部分實驗是探討低幅高頻振動治療，對廢用性萎縮肌肉重用過程中的肌纖維肥大及肌衛星細胞激活的作用。 為標記重用過程中激活的肌衛星細胞，本部分的每一隻大鼠處死前14天在皮下植入一顆5-溴氧尿嘧啶核苷 (BrdU) 的緩釋顆粒 (0.22亳克BrdU/ 千克/ 天)。 大鼠比目魚肌在相應實驗時間點離體迅速冷凍後進行低溫橫截切片(厚度: 7微米)。 以肌球蛋白三磷酸腺苷酶染色方法把肌肉切片染色後，即可進行肌纖維的種類及形態學分析。 第21天時，振動治療組的快肌IIB 型纖維橫切面積大於對照組，表明振動治療能刺激快肌IIB 型纖維肥大 (p=0.031)。 此外，快肌IIB 型肌纖維橫切面積與肌強直力是呈正相關的，說明低幅高頻振動治療所加快的肌強直力量康復可能是通過刺激快肌IIB 型肌纖維肥大所致。 振動治療引發的慢肌纖維轉型至快肌纖維的潛能可能被重用所致的快至慢轉型所掩蓋。 從另一角度說明，肌肉重用所導致的快肌纖維轉型至慢肌纖維過程，不受振動治療的影響。 激活的肌衛星細胞則通過5-溴氧尿嘧啶核苷標記方法，以免疫熒光技術進行顯微檢測及分析。 振動治療組肌衛星細胞普遍多於對照組，刺激效果在快肌IIA 型肌纖維中表現更為明顯。 對照組廢用肌肉重用過程中，快肌IIA 型肌纖維中激活的肌衛星細胞數量呈下降趨勢，治療組的卻比對照組高並呈持續上升趨勢。 肌衛星細胞的數量亦發現與肌纖維橫切面積呈正相關。 肌衛星細胞的其中一項主要功能為肌肉修補及康復，有關實驗結果表明，振動治療可能通過激活更多衛星細胞以提高肌肉功能及刺激肌纖維肥大。 / 綜上所述，本研究探討了低震高頻振動治療對廢用性萎縮肌肉的收縮功能、康復過程及其機理的影響。 較佳的肌肉力量產生能力及較大面積的快肌IIB 型纖維，表明了振動治療可促進廢用性萎縮肌肉康復。根據快肌IIA型纖維衛星細胞數量以及活化的衛星細胞同肌纖維橫切面積之間的相關性研究結果，可以推測震動治療促進肌肉修復的可能機理是促進肌衛星細胞的活化。 本研究為低幅高頻振動治療的進一步臨床實驗及未來在快肌纖維相關的肌肉老化問題研究，提供了可靠及充分的依據。 / Muscle disuse becomes a public health issue due to increasing aged population, prevalent sedentary lifestyles and rapidly growing outer space development. It results in muscle atrophy, contractile function loss and ultimately affects the daily life activities. The pathological conditions are even worse off during reloading because of the resulting muscle fiber damages and further functional deterioration. Low-magnitude high-frequency vibration (LMHFV), a biophysical modality providing a mild, non-invasive and systemic mechanical stimulation, has been reported to improve muscle functions and stimulate muscle hypertrophy. In this study, we hypothesized that LMHFV improved the functional outcomes and recovery of disuse-induced atrophied muscle through modulating muscle fiber morphology and activating myogenic satellite cells. The study was divided into three parts: Part 1 for validation of the tail suspension hindlimbs unloading animal model (TS model); Part 2 for testifying the LMHFV effect on functional outcomes; Part 3 for the effects on fiber morphology and satellite cells. / In Part 1 study, twelve 6-month-old male Sprague Dawley (SD) rats were randomly assigned to tail suspension control group (TS, n=6) and normal control group (Nor, n=6). Rats in TS group were tail-suspended for 28 days and of the harvested soleus muscle (Sol) was subjected to the in vitro muscle functional assessment. Muscle atrophy in TS group was confirmed by the significant decrease of Sol muscle mass (Mm) and fiber cross-sectional area (FCSA) (both p<0.001). Functionally, weakening of contractile forces including peak of twitch force (Pt) and maximum tetanic force (Po) were observed in TS (p=0.011 and p<0.001 respectively). The established animal model was used to study the effects of LMHFV on muscle reloading recovery in Part 2 and 3. / To testify the hypothesis, a total of 72 male SD rats with Sol atrophy induced by 28-day TS were used for Part two (n=36) and Part three studies (n=36). In each part of the studies, the rats were randomized into LMHFV treatment group (Vib) and reloading control group (Ctrl), from which Sol were harvested at Day 7, 14 and 21 post-TS (n=6/group/timepoint). The LMHFV treatment (0.6g, 35Hz) was applied to Vib group 20min per day and 5 days per week until the endpoint while Ctrl rats were allowed free-cage movement. / In Part 2 study, the effects of LMHFV on contractile functional outcomes of reloading muscle following TS were evaluated by in vitro muscle functional test. In Ctrl group, 32% increase of Po was found at day 21 when compared with that at day 7. A similar recovery level was already achieved in Vib group by 14 days of treatment; when compared with Vib-Day7, a 34.6% increase of Po was found at day 14 (p=0.033). Specific Po (Po normalized by FCSA) in Vib was significantly larger than Ctrl at day 14 (p=0.001). Plateau of specific Po was observed at day 14 in Vib group while significant increase was observed in Ctrl group from day 14 to day 21. These findings suggested the facilitated recovery of force generating capacity in Sol by LMHFV treatment. / In Part 3 study, the effects of LMHFV on muscle fiber hypertrophy and fiber type transition during reloading as well as on muscle satellite cells (SC) activation were assessed. In order to label activated SC, a bromodeoxyuridine (BrdU) time release pellet (0.22mg BrdU/ kg body mass/ day) was subcutaneously implanted to every rat 14 days before execution. In order to evaluate the fiber morphology and fiber type transition, Sol were harvested at corresponding endpoints and cryosectioned (cross-sections at 7μm) for ATPase staining. The bromodeoxyuridine (BrdU)-labeled activated SCs were revealed on the cryosections by immunofluorescence method. Results showed that fast-twitch type IIB muscle fiber hypertrophy was stimulated by LMHFV with type IIB fiber cross-sectional area (FCSA) in Vib group significantly larger than Ctrl at day 21 (p= 0.031). Interestingly, the type IIB FCSA was positively correlated with the Po measured, which suggested the possible contribution of stimulated type IIB muscle fiber hypertrophy for improving contractile force in Vib. The potential slow-to-fast fiber type transition induced by LMHFV might be masked by reloading-induced fast-to-slow transition in Sol. In other words, the normal fiber type transition in Sol during reloading was not affected by LMHFV. In SC activation assessment, more BrdU-labeled SCs were observed in Vib group. Particularly in fast twitch type IIA muscle fibers, the SC counts were increasing throughout the treatment period. It suggested the specific stimulatory effect of LMHFV on activation of fast twitch fiber SCs. Since SC activation is important for muscle recovery, the current finding suggested the possible contribution of increased SC activation to muscle fiber hypertrophy in response to LMHFV treatment. It was in fact evident from the positive association between SC counts and muscle FCSA found in this study. / In conclusion, LMHFV was beneficial to muscle disuse recovery, as indicated from higher force generating capacity and larger fast twitch type IIB fiber FCSA. The possible mechanism was to stimulate myogenic SC activation for muscle repair, as evident from the elevated fast twitch type IIA fiber SC counts and the association of activated SC counts to fiber FCSA. This study suggests the beneficial effects of LMHFV on muscle disuse rehabilitation and also justifies the future clinical trials on rehabilitation of bed-rest patients. The profound effects of LMHFV specifically on fast-twitch fibers provided solid basis for further study on treating the loss of fast-twitch type II fibers in muscle aging (i.e. sarcopenia). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Sun, Keng Ting. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 113-130). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese. / Thesis/Assessment Committee --- p.ii / Abstract --- p.iii / 論文摘要 --- p.vii / Publications --- p.x / Acknowledgement --- p.xi / List of Abbreviations --- p.xiii / Figure Index --- p.xvi / Table Index --- p.xvii / Chapter Chapter 1 --- Introduction and Literature Review --- p.1 / Chapter 1.1 --- Skeletal Muscle --- p.1 / Chapter 1.1.1 --- Muscle Structure and Organization --- p.1 / Chapter 1.1.2 --- Muscle Diversity --- p.5 / Chapter 1.1.3 --- Muscle Contraction and Relaxation --- p.7 / Chapter 1.1.4 --- Muscle Plasticity --- p.10 / Chapter 1.1.5 --- Muscle Mechanosensitivity and Mechanotransduction --- p.13 / Chapter 1.1.6 --- Muscle Satellite Cells --- p.16 / Chapter 1.2 --- Muscle Disuse and Rehabilitation --- p.17 / Chapter 1.2.1 --- Epidemiology and Impact of Muscle Disuse --- p.17 / Chapter 1.2.2 --- Effects of Disuse on Muscle Structure and Contractile Function --- p.18 / Chapter 1.2.3 --- Rehabilitation of Disused Muscle --- p.21 / Chapter 1.2.4 --- Countermeasures for Muscle Disuse --- p.22 / Chapter 1.2.5 --- Muscle Disuse Animal Models - Tail Suspension Hindlimbs Unloading Model --- p.23 / Chapter 1.3 --- Low-Magnitude High-Frequency Vibration Intervention --- p.24 / Chapter 1.3.1 --- Stimulatory Effects of Vibration on Muscle --- p.25 / Chapter 1.4 --- Hypothesis and Objectives --- p.27 / Chapter Chapter 2 --- Materials and Methods --- p.30 / Chapter 2.1 --- Study Design --- p.30 / Chapter 2.1.1 --- Part 1: Validation of Tail-Suspension Model --- p.32 / Chapter 2.1.2 --- Part 2: Effect of LMHFV on Functional Recovery after Tail Suspension --- p.32 / Chapter 2.1.3 --- Part 3: Effect of LMHFV on Muscle Recovery in Cellular and Histological Aspects --- p.33 / Chapter 2.2 --- Tail Suspension- Hind Limbs Unloading Model and Reloading --- p.33 / Chapter 2.3 --- Low-Magnitude High-Frequency Vibration (LMHFV) Treatment --- p.36 / Chapter 2.4 --- Part 1 and Part 2 Studies --- p.39 / Chapter 2.4.1 --- Isolation of Soleus Muscle for Functional Assessment --- p.39 / Chapter 2.4.2 --- In vitro Muscle Functional Test --- p.42 / Chapter 2.5 --- Part 3 Study --- p.50 / Chapter 2.5.1 --- Implantation of Bromodeoxyuridine (BrdU) Pellet for Satellite Cell Labeling --- p.50 / Chapter 2.5.2 --- Preparation of Soleus Muscle (Sol) for Histological and Cellular Studies --- p.51 / Chapter 2.5.3 --- Preparation of Muscle Cryosections --- p.51 / Chapter 2.5.4 --- Muscle Fiber Typing - ATPase Staining Assay --- p.54 / Chapter 2.5.5 --- Activated Satellite Cell Profiling - Immunofluorescence Imaging --- p.55 / Chapter 2.6 --- Statistical Analysis --- p.57 / Chapter Chapter 3 --- Results --- p.58 / Chapter 3.1 --- Part 1: Validation of Tail Suspension Model --- p.58 / Chapter 3.1.1 --- Morphological Assessment --- p.58 / Chapter 3.1.2 --- Functional Assessment --- p.58 / Chapter 3.2 --- Part 2: Effects of LMHFV on Functional Recovery from Tail Suspension --- p.61 / Chapter 3.2.1 --- Morphological Assessment --- p.61 / Chapter 3.2.2 --- Functional Assessment --- p.63 / Chapter 3.3 --- Part 3: Effects of LMHFV on Muscle Recovery in Cellular and Histological Aspects --- p.72 / Chapter 3.3.1 --- Muscle Fiber Typing - ATPase Staining --- p.72 / Chapter 3.3.2 --- Satellite Cells Proliferation --- p.78 / Chapter 3.4 --- Correlation of outcomes from part II and part III studies --- p.83 / Chapter Chapter 4 --- Discussion --- p.90 / Chapter 4.1 --- Beneficial Effects of LMHFV in Disuse-induced Atrophied Soleus Muscle Recovery --- p.92 / Chapter 4.2 --- Facilitated Recovery of Force Generating Capacity by LMHFV Treatment --- p.93 / Chapter 4.3 --- Biphasic Effects of LMHFV in Muscle Contraction and Relaxation Time --- p.95 / Chapter 4.4 --- Specific Hypertrophy on Type IIB Muscle Fiber Stimulated by LMHFV --- p.96 / Chapter 4.5 --- Physiological Fiber Type Adaptation Maintained in LMHFV Treatment --- p.98 / Chapter 4.6 --- Promoted SC Activation by LMHFV and its Possible Roles in Histological Improvement --- p.99 / Chapter 4.6.1 --- Possible Regulatory Mechanisms of LMHFV in Promoting SC Activation --- p.100 / Chapter 4.7 --- Disuse-induced Muscle Atrophy Successfully Developed by Tail Suspension Model --- p.102 / Chapter 4.8 --- Limitations --- p.103 / Chapter 4.8.1 --- In vitro measurement of isolated muscle contractile functions --- p.103 / Chapter 4.8.2 --- Overestimation of satellite cell (SC) counts --- p.104 / Chapter 4.9 --- Future studies --- p.105 / Chapter 4.9.1 --- Effects of LMHFV on Fast muscle --- p.106 / Chapter 4.9.2 --- Parameters of LMHFV treatment --- p.107 / Chapter 4.9.3 --- Clinical Trials --- p.107 / Chapter Chapter 5 --- Conclusions --- p.110 / Bibliography --- p.113

跌倒和肌肉減少症是威脅老年人身體健康和生命安全的兩個重要問題。肌肉減少症所致的肌肉力量減弱和平衡能力下降是導致老年人跌倒的最主要原因。老年人跌倒最普遍和最嚴重的後果是脆性骨折。跌倒所致的脆性骨折是常見老年病，同時也是導致老年人生活品質下降和死亡的最主要原因之一。高頻低幅振動(LMHFV)是一種非侵入性生物物理干預手段，通過給予全身物理震動刺激，可有效提高肌肉功能和改善骨質。由此推測高頻低幅振動治療有望應用於預防跌倒/骨折及延緩肌肉減少。 / 本研究的目的在於，採用臨床隨機對照研究方法，通過對社區老年人進行高頻低幅振動治療，探索高頻低幅振動治療在預防跌倒/骨折、降低骨折發生率以及延緩肌肉量下降的作用。本研究假設高頻低幅振動治療可有效提高肌肉力量和改善骨質，從而降低骨折風險、跌倒率以及骨折發生率。本研究將分成兩部分進行以驗證此假說。 / 第一部分研究中，710名60歲或以上的社區老年人按社區中心為單位隨機分成振動治療組和對照組。振動治療組給予35Hz，0.3g的振動治療，並以每天20分鐘，每週5 天，持續18 個月；對照組則如常生活而不予振動治療。18個月治療過程中，振動治療組的跌倒率低於對照組46% (p=0.001)。同時，治療組的在平衡力測試中的反應時間、移動速度，和最遠移動距離也都有明顯改善 (所有指標 p<0.001）。在高頻低幅振動治療停止一年後，振動治療組的主導腿和非主導腿肌肉力量仍高於接受振動治療前 (p=0.029, p=0.002)。在平衡力測試中，治療組的反應時間、移動速度以及最遠移動距離也明顯優於對照組 (p=0.001，p=0.014，p=0.007)。在停止治療的一年期間，兩組受試者的肌肉力量，平衡能力以及生活品質均有下降的趨勢，但兩組的下降率並無明顯的差異。 / 第二部分的設計是基於第一部分的研究成果，目的在於更深入研究高頻低幅振動治療對肌肉功能、肌肉量以及肌肉質素的影響。60名社區老人隨機分成對照組和振動治療組。振動治療組給予35Hz，0.3g的高頻低幅振動治療，並以每天20分鐘，每週5天，持續9個月; 對照組則如常生活而不予振動治療。9個月後，治療組的主導腿和非主導腿的肌肉力量明顯高於對照組 (p<0.001，p=0.003)。在用以評估肌肉力量以及平衡力的計時起立坐下測試中，振動治療組用以完成連串起立及坐下動作的時間明顯低於對照組 (p=0.009)。振動治療組的下肢功能尺度問卷評估結果也明顯優於對照組 (p=0.002)。雖然兩組間的身體成份及肌電圖測試結果並無明顯差異，但治療組的肌肉量和肌電圖平均頻率均有上升的趨勢。而且，在兩部分實驗中，受試者對高頻低幅振動治療均有良好的耐受性，目前並沒有發現對受試者身體產生不利影響。因此，高頻低幅振動治療可安全地應用於社區老年人。 / 總括而言研究結果證明高頻低幅振動治療可明顯降低老年人跌倒發生率。9至18個月的振動治療可明顯改善老年人下肢功能和平衡力。在完成為期18個月高頻低幅振動治療後的1年，肌肉功能仍高於對照組，表明高頻低幅振動治療具有長期療效。因此，高頻低幅振動治療應在社區推廣作為老年人跌倒的預防方案之一。 / Fall and sarcopenia are two major problems among elderly. Poor muscle strength and balancing ability resulted from sarcopenia are the major causes of fall incidences. Fragility fracture is one of the most common and serious consequences of falls, which accounts for most of the deaths, as well as morbidity and poor quality of life. Low magnitude high frequency vibration (LMHFV) treatment is a non-invasive biophysical modality to provide a whole-body mechanical stimulation, which was previously shown to improve muscle performance and bone quality implying the potential application for fall/fracture prevention and reducing muscle loss. / The objectives of this study were to conduct prospective randomized controlled clinical trials to investigate the effect of LMHFV treatment on fall/fracture prevention, fracture risks and muscle loss among community elderly. It was hypothesized that LMHFV treatment could enhance muscle performance and bone quality, thus reducing the fracture risks, fall incidence and fracture rate. Two parts of studies were designed to testify the hypotheses. / In the Part I study, a total of 710 community elderly who were aged 60 years or above were recruited and randomized into vibration or control group on center-basis. The subjects in vibration group received LMHFV treatment (35Hz, 0.3g) 20min/day and 5days/week for 18 months, while control group remained sedentary. During the 18-month study period, the vibration group had reported 46% lower fall incidence rate when compared with control group (p=0.001). Significant improvements were found in reaction time, movement velocity and maximum excursion of balancing ability assessment, and also the quadriceps muscle strength (p<0.001 to all). After ceasing the LMHFV for 1 year, the muscle strength of dominant and non-dominant legs in vibration group were still significantly better than the baseline assessed before intervention (p=0.029 and 0.002 respectively), as compared with the control. In balancing ability test, the reaction time, movement velocity and maximum excursion of vibration group also remained significantly improved, as compared with the control group (p=0.001, 0.014 and 0.007 respectively). During the 1 year post-intervention period, both groups had shown a decreasing trend of muscle strength, balancing ability and quality of life but the rate of changes were not significantly different between two groups. / With reference to the results of Part I study, the Part II study was designed to investigate further the effects of LMHFV on muscle performance, mass and quality. 60 community elderly were recruited and randomized into either vibration or control group. Vibration group subjects received LMHFV treatment (35Hz, 0.3g) 20min/day, 5days/week for 9 months, while control group remained sedentary. Significant enhancement of dominant and non-dominant leg muscle strength was observed in the vibration group after 9 months LMHFV (p<0.001 and =0.003 respectively). In the chair rising test assessing muscle power and balancing ability, vibration group showed significantly shorter time needed for sit-to-stand cycles than the control (p=0.009). Significant increase of the lower extremity functional scale was also observed in the vibration group (p=0.002). No significant findings were found in the body composition and vibromyography (VMG) assessment, however, a trend of increasing lean mass and VMG mean frequency were observed. Also, minimal adverse effects were documented in both parts of study; all subjects were well-tolerated for LMHFV treatment. LMHFV is therefore safe and applicable to elderly in the community setting. / LMHFV was demonstrated to reduce fall incidences significantly. Significant effects on improving lower limbs function and balancing ability were observed as early as 9 months after treatment. Enhancement of muscle performance still remained significant 1 year after completion of 18-month LMHFV treatment, indicating strong residual effects of LMHFV. Use of LMHFV in the community as an effective fall prevention program is recommended. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Chi Yu. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 154-167). / Abstracts also in Chinese.

Introduction. Painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes that interferes with daily living and causes severe pain. Pharmacotherapy is the accepted treatment strategy, however, this strategy is associated with high cost, minimal reductions in pain, and adverse side effects. Thus, a critical need exists to develop alternative treatment strategies. Purpose. To determine if a 12-week whole-body vibration (WBV) intervention reduces pain in adults with DPN. Methods. Twenty-one adults with physician confirmed painful DPN volunteered to take part in a 26-week time series design study. Pain was assessed with the Brief Pain Inventory Short Form [BPI-sf] and a 0-10 numeric rating scale [NRS]. The BPI-sf contains two indices that respectively measure how pain interferes with daily living and severity. The intervention began after a 12-week control period. At week 13, participants were asked to stand on a WBV machine 3 d/week for 4, 3-min bouts at 30-50 Hz with 1-min rest intervals between bouts. Pain levels were reported using the NRS before and after each bout. Results. Comparing post- to pre-intervention, BPI-sf pain interference scores decreased from 5.61±1.40 to 2.39±1.82 (p≤0.001). BPI-sf pain severity scores decreased from 5.1±0.64 to 3.1±1.87 (p≤0.01). Analyses of the NRS scores indicate that pain decreased each week following WBV and that between weeks, pain continued to decrease. Conclusion. These findings demonstrate that whole-body vibration was effective at reducing pain in a sample of adults with painful DPN. / Graduation date: 2012

The pain relieving efficacy of music listening combined with vibrotactile cutaneous stimulation was determined. Music with mechanical vibration (30min. session; average amplitude of 26μm; frequency range of 60-600Hz.) was applied to subjects with rheumatoid arthritis using the Music Vibration Table (MVT). Scores from pain relief visual analogue scales (VAS) and McGill Pain Questionnaires (MPQ) were compared to groups with music alone and placebo. ANOVA and post hoc analysis indicated that VAS scores from music with vibration were significantly greater than music alone or placebo. MPQ scores also indicated larger percentages of change in pain perception for the music with vibration condition. However, subjects receiving music alone showed a large percentage of change on the affective dimension of the MPQ. This investigation supports the application of music with a controlled, measurable music vibration for the relief of pain. The results of this study warrant further evaluation and development of treatment protocols using music and music vibration.

Orientador: Donizeti Cesar Honorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T00:41:21Z (GMT). No. of bitstreams: 1 Silva_AdrianaTeresa_M.pdf: 5979152 bytes, checksum: 4f4aa8d6d612af76e9680bc18aff0911 (MD5) Previous issue date: 2013 / Resumo: O Acidente Vascular Cerebral (AVC) é um problema de saúde pública relevante em virtude de sua alta frequência e de grande impacto na população. Classificam-se, como uma das quatro causas mais comuns de morte no mundo, sendo considerada uma doença incapacitante, e que limita a qualidade de vida. Objetivo deste estudo foi investigar o efeito imediato da vibração de corpo inteiro na função motora de pacientes acometidos por AVC. Trata-se de um ensaio clínico randomizado, nos quais foram alocados quarenta e três indivíduos (33 grupo intervenção - GI - e 10 grupo controle - GC) com sequela de hemiparesia decorrente de AVC. Aplicou-se no GI uma sessão de terapia vibratória (frequência - 50 Hz e amplitude - 2 mm) por 4 série de 1 minuto com descanso de 1 minuto entre as séries, em 3 posições: apoio bipodal com joelho fletido a 30º e a 90º, apoio unipodal sobre o membro parético. Os testes aplicados para análise foram: o teste de caminhada de 6 minutos (TC6M), teste de escada (TSE), teste de time get-up-and-go (TGUG) e a avaliação eletromiográfica (EMG). A EMG foi aplicada na contração isométrica voluntária simultaneamente para os músculos tibial anterior e retofemural ambos do lado acometido e não acometido (TAA e TANA; RFA e RFNA) respectivamente. Aplicou-se para análise estatística o teste t independente para comparar as características basais dos grupos, teste t pareado e o teste de ANCOVA para verificar o efeito da intervenção no grupo e no tempo. Os resultados demonstram que não há evidência de efeitos na interação grupo e tempo para as variáveis RFA, RFNA, TAA, TANA e TSE (p?0,05). Há evidências de efeito na interação grupo para as variáveis TC6M e para TGUG (p<0,05). Conclui-se que o efeito imediato da vibração de corpo inteiro não contribuiu para melhora da função motora em pacientes acometidos por Acidente Vascular Cerebral / Abstract: Stroke is a relevant public health problem, due to its high frequency and strong impact on the population. It is classified as one of the four most common causes of death worldwide and is considered to be a disabling disease, which limits the patients' quality of life. The aim of this paper was to investigate the immediate effects of whole body vibration on the motor function of patients affected by stroke. This is a randomized clinical trial, where forty-three hemiparetic subjects, due to stroke sequel, were allocated (33 for the intervention group - IG - and 10 for the control group - CG). For the IG subjects a vibratory therapy (50 Hz frequency and 2 mm amplitude) session was applied consisting of four series of stimulation of 1-minute each with a 1-minute resting interval among all series, in three different positions: bipodal landing position with knees bent at 30º then at 90º and finally, unipodal landing position on the hemiparetic limb. The tests used for the analysis were the 6 minute walking test (6MWT), stair climbing test (SCT), time get-up-and-go test (TGUGT) and electromyographic evaluation (EMG). The latter was applied simultaneously, at isometric voluntary contraction, of tibialis anterior and rectus femorais muscles', both affected and unaffected sides (TAA and TAU ; RFA and RFU) respectively. For statistical analysis, the independent t test was applied to compare the baseline characteristics of the groups and the paired t test as well as ANCOVA to determine the effect of the intervention in both the groups and time. The results show no evidence of effects in group and time interaction for the RFA, RFU, TAA, TAU and SCT variables (p?0.05). There is evidence of effect on the group interaction for the 6MWT and TGUGT variables (p<0.05). It was concluded that, the immediate effects of whole body vibration have not contributed for the improvement of stroke-patients' functional motor / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas