The effects of vibroacoustic therapy on clinical and non-clinical populations

290 Pages·1.041 MB·English

by  Wigram A.L.

T HE EF FECT S O F
VI BRO ACO USTI C THERAPY
O N CLI NI CAL AND
NO N-CLINI CAL POPULAT I O NS
ANTHONY LEWIS WIGRAM
THESIS SUBMITTED FOR THE
DEGREE OF
DOCTOR OF PHILOSOPHY
ST. GEORGES HOSPITAL MEDICAL SCHOOL
LONDON UNIVERSITY
1
A BSTRAC T
Vibroacoustic and vibrotactile devices that transmit sound as vibration to the body
have developed over the last 15 years, and have been reported anecdotally to
produce relaxation and reductions in muscle tone, blood pressure and heart rate.
Vibroacoustic (VA) therapy is used in clinical treatment and involves a stimulus that
is a combination of sedative music and pulsed, sinusoidal low frequency tones
between 20Hz and 70Hz, played through a bed or chair containing large speakers.
There is limited evidence to support the efficacy of VA therapy in the clinical
situations in which it is used. The studies in this thesis investigated the clinical effect
of VA therapy, and the effect of elements of the stimulus on non-clinical subjects.
A study on 10 multiply handicapped adults with high muscle tone and spasm
compared the effect of eight trials of VA therapy with a similar number of trials of
relaxing music. A significantly greater range of movement was recorded after VA
therapy than relaxing music. No significant difference was found in changes in
blood pressure or heart rate.
Comparing the effect of VA therapy with music and movement-based physiotherapy
(MMBP) and relaxing music alone on 27 subjects with high muscle tone and
spasticity revealed no significant difference in range of movement between VA
therapy and MMBP, but a significant difference comparing the combined results of
MMBP and VA therapy with relaxing music alone. Additional trials found significant
differences between VA therapy and music alone.
2
A study on non-clinical subjects (n=39), and a second study (n=52) measured
perceived location of bodily vibrations in response to sinusoidal tones between
20Hz and 70Hz through a VA bed. Reports indicated some that frequencies caused
sensations of resonant vibration consistently in the same places in the body.
A second study on non-clinical subjects (n=60) in three groups found that VA
therapy had a significantly greater effect in reducing arousal when compared with
relaxing music, and a control, and heart rate when VA therapy was compared with a
control. No significant differences were found between the groups in changes in
blood pressure.
A third study (n=60) found no significant differences between four groups when
evaluating the effect of varying rate of amplitude modulation of a 40Hz sinusoidal
tone and a constant tone.
These studies have clarified the efficacy of VA therapy as an intervention for clinical
populations, and the effect of the stimulus on normal subjects. Questions remain
about the nature of the stimulus that is used, and its effect on behaviour.
3
A CKNOWLEDGEMENT S
I would like to acknowledge the contribution many people have made both towards
the research field in which I have chosen to work and also to the work undertaken
for this thesis and the preparation of this dissertation.
Firstly, I would like to thank Rektor Olav Skille, who has inspired me since 1985 with
his pioneering work in the field of vibroacoustics. He made it possible for me to
begin clinically working with this equipment, and has been supportive and helpful in
so many ways.
Secondly, I would like to thank Dr Robert West, my Supervisor. He has been very
helpful and supportive, as well as guiding me through the complex process of
undertaking new research. He also made it possible for me to study at London
University, helped me through a qualifying degree in psychology, and has taken a
great interest in the whole field.
I would like to acknowledge the support of Horizon NHS Trust who made some
financial contribution towards my fees and have allowed me a great deal of
flexibility in both developing the clinical application of the VA therapy and also
allowing me the research time necessary to undertake studies and to write. In
particular, the support of Mr Tom Freeman, the Chief Executive, and Ms Jane Hine,
General Manager, New Services Division, was crucial in allowing me to work on
this research.
4
I would like to acknowledge the support and consistent help of Dr Barbara Kugler,
Director of the Harper House Children's Service. She has supported me through
study for the qualifying degree in psychology and allowed me the time necessary to
undertake the research and write the thesis.
I particularly want to draw attention in an acknowledgement to my colleagues in the
Vibroacoustic Therapy Unit at Harperbury Hospital. Mrs Jenny McNaught and Mrs
June Cain came to work in the Department and helped me with the research, and
also particularly to develop the clinical service of vibroacoustic therapy which is now
an established part of the Horizon Trust Services. They have been very supportive
and helpful in working with me with some of the more difficult patients in the trials.
Gina Basi, an American student gave valuable assistance with trials.
I would like to acknowledge the support of colleagues internationally who have
assisted me by stimulating and broadening my own perspective and enhancing this
thesis:
Dr Cheryl Maranto, Dr Kenneth Bruscia, Dr Bruce Saperston,
Mrs Penny Rogers, Dr David Aldridge, Dr Kris Chesky,
Dr Don Michel, Mr Petri Lehikoinen, Mr Raul Vatsar.
I want to acknowledge particularly the friendship, support, professional
collaboration and enthusiasm of Mrs Lyn Weekes - Head 2 Physiotherapist, Horizon
5
NHS Trust. We have worked together on many of the clinical developments and
vibroacoustic therapy at Harperbury Hospital since 1987.
Financial support enabling me to develop vibroacoustic therapy research and the
clinical service has been generously provided by the Spastics Society, the Oak
Tree Trust, the Platinum Trust and a personal fund raising effort in memory of
Humphrey Mews by Mrs Anna Clemence-Mews.
Finally, I want to say a very special thank you and acknowledgement to my wife and
family, who have stood by me all through the period of time I was studying for the
qualifying degree in psychology, trying to research at the same time, and trying to
hold a full time job in Harperbury Hospital. Jenny, Robert, Michael and David have
always been a strong foundation on which I have been able to undertake this
research, and without them, it would not have been possible.
I dedicate this work to all my patients.
6
TABLE OF CONTENTS
TITLE PAGE
ABSTRACT
ACKNOWLEDGMENTS AND DEDICATION
TABLE OF CONTENTS
LIST OF TABLES
FIGURES
C H APTER ONE
M U SIC THERAPY AND MUSIC IN MEDICIN E
1.1 ORIGIN OF STUDY
1.2 MUSIC THERAPY
1.3 MUSIC AND MEDICINE
1.4 OVERVIEW OF THESIS
C H APTER TWO
E F FECTS OF MUSIC, VIBRATION AND INFRASOUN D
2.1 PHYSIOLOGICAL RESPONSES TO MUSIC
2.2 RESEARCH IN VIBRATION
2.3 INFRASOUND AND LOW FREQUENCY SOUND
7
2.4 THE EFFECT OF INFRASOUND ON HUMANS
2.5 MUSIC AS VIBRATION
C H APTER THREE
T H E DEVELOPMENT OF VIBROACOUSTIC AND
V I BROTACTILE THERAP Y
3.1 ORIGINS
3.2 HISTORICAL DEVELOPMENT
3.3 CURRENT APPLICATIONS:
3.3.1 Pain disorders
3.3.2 Muscular conditions
3.3.3 Pulmonary disorders
3.3.4 General physical ailments
3.3.5 Psychological disorders
3.4 TREATMENT PROCEDURE
3.5 CONTRA-INDICATIONS
3.6 CONCLUSION
C H APTER FOUR
T H E EFFECT OF VIBROACOUSTIC
( V A) THERAPY ON MULTIPLY HANDICAPPED ADULTS
W I TH HIGH MUSCLE TONE AND SPASTICIT Y
4.1 INTRODUCTION:
8
4.1.1. Whole Body Vibration
4.1.2. Low Frequency Vibration
4.1.3. Cerebral Palsy and Spasticity
4.2 EXPERIMENTAL HYPOTHESIS
4.3 METHOD:
4.3.1 Overview
4.3.2 Subjects
4.3.3 Material
4.3.4 Measures
4.3.5 Procedure
4.4 RESULTS
4.5 DISCUSSION
C H APTER FIVE
T H E EFFECT OF VIBROACOUSTIC (VA) THERAPY COMPARED
W I TH MUSIC AND MOVEMENT-BASED PHYSIOTHERAPY ON
M U LTIPLY HANDICAPPED PATIENTS WITH HIGH MUSCLE
T O NE AND SPASTICITY .
5.1 INTRODUCTION
5.2 EXPERIMENTAL HYPOTHESIS
5.3 METHODS
5.3.1 Overview
9
5.3.2 Subjects
5.3.3 Materials
5.3.4 Measures
5.3.5 Procedure
5.4 RESULTS
5.5 DISCUSSION
C H APTER SIX
T W O EXPERIMENTS TO EVALUATE THE SENSATION
O F VIBRATION FROM LOW FREQUENCY TONES
IN THE HUMAN BODY .
6.1 INTRODUCTION
6.2 E X PERIMENT ONE : Experimental Hypothesis
6.3 EXPERIMENT 1: METHODS -
6.3.1 Overview
6.3.2 Subjects
6.3.3 Materials
6.3.4 Measures
6.3.5 Procedure
6.4 EXPERIMENT ONE: RESULTS
6.5 EXPERIMENT ONE: DISCUSSION
10