Focal Muscle Vibration for Stroke Rehabilitation: A Review of Vibration Parameters and Protocols

Round 1

Reviewer 1 Report

N/A

Author Response

Thank you for your time and effort to review our manuscript. Your support are greatly appreciated!

Reviewer 2 Report

The work includes an important issue which is post-stroke rehabilitation. The material is carefully analyzed. A valuable set of muscles that have undergone FMV.I like the authors' critical view of the limitations of the study.

Minor revision:

 In table 2, in the vibration protocol item, it should be noted how long the procedures were performed. The authors refer to it as one session (I mean how many days or weeks). The note applies to tests P1-P7.

 

Author Response

Thank you for your time and effort to review our manuscript. Your support are greatly appreciated. Below please see our responses to your specific comments:

The work includes an important issue which is post-stroke rehabilitation. The material is carefully analyzed. A valuable set of muscles that have undergone FMV.I like the authors' critical view of the limitations of the study.

Thank you for the comments. We appreciated your positive comments.

Minor revision:

In table 2, in the vibration protocol item, it should be noted how long the procedures were performed. The authors refer to it as one session (I mean how many days or weeks). The note applies to tests P1-P7.

Thank you for the comments. We have revised Table 2 based on your suggestion. For those studies they only performed a one-time single focal vibration. We had made that clear in Table 2.

Reviewer 3 Report

This manuscript presents a review of focal muscle vibration applied to reduce spasticity after stroke. The summary clearly describes the protocols and their general results. 

 

The primary concern is that the manuscript is primarily limited to summarizing all of the studies and misses an opportunity to synthesize these results in a manner that allows something new to be learned from the cohort of studies as a group. The primary takeaway that more research is needed seems thin. For example, I appreciated Figure 2 in how it showed the amplitudes and frequencies that were implemented together. While vibration parameters were applied, it would be useful to know if there were themes between parameters and responses. Similarly, the distribution of targeted muscles is shown in Figure 3. These seem to be study specific and suggest that different researchers expected a different mechanism, suggesting that it may be more complex than simply the activation of Ia afferents. Presumably some of these studies were targeting golgi tendon organs. Several of the studies reported some electrophysiology. Are these results consistent across studies and do they impact perceived mechanism? Given the potential mechanisms, what is know about how these pathways are impacted poststroke and how is the underlying neural circuitry impacted? Additional synthesis is the primary need for this manuscript so that it gives additional insight into what has been learned by this cohort of studies that is beyond the sum of the individual studies. 

 

The remaining comments are primarily about the presentation and are mostly minor.

1) The content in your first paragraph is all correct. It would benefit from focusing on the specific poststroke limitations though since hemiparesis has multiple effects. 

2) Line 47/48 - Physical therapy and occupational therapy are two separate interventions. Adding an 'and' between the two words should clarify the sentence.     

3) Line 49 - Are the described limitations relevant to all of those approaches or they intervention specific? I appreciate the desire for brevity, but it currently lacks precision. Are these limitations primarily limited to spasticity reduction or motor relearning in general? Has FMV actually shown better responses than the previously described interventions or is the primary benefit that it can be implemented outside clinical contexts?

4) Line 57 - I think there's a typo. The sentence currently reads that it results in muscle contraction and relaxation. Presumably, the word antagonist is missing before relaxation.  

5) Line 79 - are these studies since the previously described review (reference 28)?

6) is the list narrowing in Line 117 describing the inclusion/exclusion criteria in 2.2?

7) Hemiparetic may be more accurate than hemiplegic. Hemiparetic refers to weakness on one side of the body while hemiplegic implies fully paralyzed. (this is entirely my personal preference and not required by any means). 

8) Table 1 does a nice job summarizing the studies. There are a lot of abbreviations. It would be helpful to also define them the first time they are used. Otherwise, it's difficult going back and forth between the table and the abbreviations. Again, this is a personal preference. 

9) Table 1, P17 lists Triceps Brachialis. I think this is a typo. 

10) I don't think the paragraph in Lines 208-222 adds much since the results are not specific to stroke and seem to have substantially different parameters. 

Author Response

Thank you for your time and effort to review our manuscript. Your insight and support are greatly appreciated. Please see the attached file for our detailed responses to your comments.

Please note that the citation numbers in the responses to comments are different with the numbers in the paper. We just tried to make it easier for you to read.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

While the revisions do begin to summarize themes, in my opinion, there is a missed opportunity here for digging into what 'did or did not work' between the different studies and their different targets to really understand if/when this intervention may be effective. 

 

Similarly, it seems like there is an opportunity for the authors to expand on the understandings about potential mechanisms beyond what the individual papers report considering the diverse array of agonist/antagonist targets and relative firing rates between different sensory inputs.