Vibroacoustic therapy is a recently recognized technology that uses sound in the audible range to produce mechanical vibrations that are applied directly to the body. The technology uses speakers or transducers placed within mats, mattresses, chairs, recliners, tables, or soft furniture to provide a physiologic and auditory experience. Benefits include pain management, anxiety relief, symptom reduction, physical therapy, and health improvement.
Three general designs of vibroacoustic technology have been developed over the past 30 years, with unique capabilities and purposes. The designs differ in the type of vibration-generating systems used; the frequencies selected for stimulus; the extent to which sound vibrations are processed, measured and monitored' and the qualities and patterns of resonance in the vibrating surfaces.
Interest in incorporating vibroacoustics in patient care practices may be attributable to the nonpharmacologic and noninvasive nature of the technology. Because some models of vibroacoustic technology can be administered easily in nursing care, this may have also led to broad use of vibroacoustic in medical and wellness practices.
Research and/or development of vibroacoustic use include applications to manage pain; reduced symptoms for patients in chemotherapy; reduce stress; distract patients during biopsies, aspirations, and other procedures; increase range of motion (ROM) and muscle tone and in physical therapy or rehabilitative therapy following knee replacement; help prepare patients for surgery or those who are recovering; and provide sensory stimulation for people who are hearing impaired and developmentally disabled. Vibroacoustics can also increase quality of life and be used to manage behavior in psychiatric settings, geriatric facilities, child life centers, and palliative care facilities.
Sound Vibration Processing
Sound vibration-processing techniques are used in some vibroacoustic designs to create patterns of sound that affect the experience of felt vibrations. Pulsed sound originated from VibroAcoustic technology while the physioacoustic method developed pulsation, scanning and directionality.
These techniques may be generated during treatment but may also be used as compositional techniques in prerecorded music. Pulsed sound blends two relatively close frequencies, for example, 70 Hz and 70.5 Hz. Together, they produce a fast-pulsed sound. Musicians would say the frequencies in this example are "out of tune" with on another. Sound is most often pulsed in vibroacoustics at a slow rate of speed. It is believed that pulsed sounds create a more pleasant sensation for patients and add a relaxing element to treatment.
Research by Tony Wigram, associate professor at the Institute for Music and Music Therapy, Aalborg, Denmark, compared pulsed sound lengths of 6, 10 and 14 seconds, peak to peak, and a pure sinusoidal tone. Subjects in this study expressed personal preferences for more slowly pulsed sound waves but study data did not confirm that slower-pulsed sounds induced greater relaxation. Pulsation varies the volume of low-frequency sound within a certain time sequence.
Based on the theory that continual vibration may cause numbness in the body, alternating periods of more and less intense vibration in pulsation are believed to alleviate stimulation fatigue, or overstimulation, and to increase treatment effectiveness. Experimentation with SLF designs indicated that prolonged stimulation may cause muscle contractions that can be avoided via pulsation and that pulsation can induce greater muscle relaxation. Scanning was originally developed to increase muscle relaxation through the physioacoustic method. The theory behind scanning is that each muscle resonates to a specific and unique frequency.
Frequencies are scanned above and below approximate known resonant frequencies of target muscle(s). Physioacoustic explanations indicate that approximate resonant frequencies have been determined in physiotherapy and research at Stockholm's Karolinska Institute in Sweden has supported this principle.5 Within the scanned frequency spectrum the target muscle(s) will, at some time, resonate with the frequency with which it has an innate resonance and receive benefit from this stimulation.
Scanning is designed so that the desired frequency will be stimulated dozens of times in a single vibroacoustic session. Each time the muscle responds, greater relaxation is believed to occur. This theory is based on the physics principle of sympathetic resonance and is believed to work with body tissues as well. The principle of directionality refers to movement of sound vibrations from one speaker or transducer to another. The movement is felt as a wave of vibration up or down the body and can enhance the vibroacoustic experience.
Music in Vibroacoustics
While specific frequencies and vibration processing techniques have proven to be effective in vibroacoustics, music may also hold essential value. Research has shown that live and recorded music can be used in treating illness and maintaining health.
Chesky, Michel, and Kondraske presented the Two-Pronged Approach conceptual model of vibroacoustics, highlighting the powerful synergy created from integration of physiologic sound vibration and psychological stimulation from music listening.11 Vibration and music together may be more powerful than either element independently and may be especially useful in certain instances.
An important aspect of music in vibroacoustics may be the broad range of frequencies within music. The effects achieved with SLF techniques may occur naturally in the wider range of frequencies in music. There are also potential benefits or problems from the overtone frequencies within music as opposed to the pure sine waves used in some methods.
Most vibroacoustic technologies use music either in addition to low frequencies for listening benefit or as the primary stimulus. A patient's enjoyment of music may play a key role in motivating the use of vibroacoustics. The majority of patients are interested in using vibroacoustics because it is a treatment modality that is pleasing and comforting, unlike many invasive and potentially unpleasant medical procedures.
Recorded music has been designed specifically to enhance vibroacoustic effects and some commercial recordings also work well. The MVT has the ability to process frequencies within any music selection, thus offering unlimited music selection options and allowing patients to choose their own music for effective treatment.
Physical Therapy
Vibroacoustics has a long history of experimentation in physical therapy. Treatment benefits include reduction of muscle tones, increased ROM, reduction of muscle spasticity, and sensory stimulation for patients with severe disabilities.
Skille began his research with children who were severely mentally and physically handicapped. By 2001, Skille and other therapists has gathered data from more than 40,000 hours of treatment. Many of the results found were related to benefits derived from reduced muscle tension.
Research on muscle spasticity on patients with cerebral palsy found that SLF treatment could reduced high muscle tone and accompanying movement restriction caused by increased rigidity and stiffness in these patients. ROM was also increased with treatment and relaxation induced by vibroacoustic treatment resulted in reduced muscle spasms.
SLF is also considered to be a viable treatment for fixed deformities for certain patients with cerebral palsy and may curb the development of fixed deformities. People with Rett syndrome also benefit from relaxed muscle tone and experience improvement in muscle control with vibroacoustic treatment.
Vibroacoustics for increasing ROM has expanded into other medical areas. Research at Duke University Medical Center, Durham, North Carolina, using SLF Physioacoustic treatment for patients, over age 55, during physical therapy following total knee replacements showed greater passive ROM. Of 9 patients who were given the experimental treatment, 66 percent were able to achieve a 90-degree bend compared to 44 percent of the 9 control subjects.
Surgery and Other Medical Procedures
Vibroacoustic research and experimentation in surgical units and procedures areas has recently been undertaken with SLF and FFM systems. A study with 33 patients who underwent knee replacements or revisions produced a 21-percent reduction of tension after patients received SLF physioacoustic treatment postsurgically. Subjects in the experimental group went home an average of one half-day earlier, used fewer mg of pain medication, and expressed more satisfaction with the care they received than did control group subjects.
Heart surgeons have used SLF physioacoustic therapy during cardiac surgery recovery. Ina study using SLF treatment, patients' use of sedative and pain medication decreased and average ventilator time was reduced from 17 hours to 7 hours. Time spent in the cardiac surgical unit decreased from averages of 36 hours to 18 hours and overall hospital stay was reduced to an average of 5 days from a 9-day average.
Vibroacoustics has reduced patients' anxiety during medical procedures. Vibrotactile and auditory music reduced agitation and physiologic instability following suctioning in infants with bronchiopulmonary dysplasia.32 Anecdotal reports from the Tampa Children's' Hospital at St. Joseph's, Tampa, Florida, from 1990 to 1997, using a specially designed vibroacoustic examination table for a various procedures noted that infants increased time spent in a quiet, alert state and had higher oxygen saturation levels.
Research at Dallas Children's' Hospital, Texas, is underway to determine the effectiveness of vibroacoustics for distraction during biopsies, aspirations, portable catheter maintenance, and other procedures. Nursing staff members have reported seeing lowered anxiety levels in patients during these procedures when vibroacoustic treatment was used.
Research is being conducted to compare vibroacoustics with other distraction mediums and to quantify the degree of anxiety reduction. Research is also ongoing at the Women's' Diagnostic Center in Jupiter, Florida, where FFM treatment is used before breast-cancer biopsies. Experimental variables include anxiety levels and amounts of Valium requested and/or used.
Pain Management
Vibroacoustic therapy has produced significant gains in pain relief and management. Dr. Patrick's NIH program evaluation produced a 63-percentreduction of perceived pain and he has suggested that this pain relief is relaxation-induced. Patients in chemotherapy with FFM vibroacoustics have experienced 61-percent reductions of pain, probably via the same mechanism.
QMV technology was used for pain reduction with patients who have rheumatoid arthritis. Patients who listened to music while experiencing music vibration had a 64-percent reduction in pain while patients receiving only music had a24-percet reduction in pain and a placebo group experienced a 2-percent increase in pain.
Research has also been conducted with SLF technologies producing pain relief for 25 patients in a hospice. Patients who received vibroacoustic treatment used significantly less medication in 48 hours, experienced less discomfort, and reported lower pain intensity than did controls. Twenty (20) women at Duke University Medical Center who had surgery for ovarian, endometrial, or cervical cancer experienced significant pain reduction with treatment.
The nonpharmacologic nature of vibroacoustics makes this treatment an important pain management tool. While it may not work in every instance, it is a promising complementary method that may reduced the need for pain medication and provide a pleasant alternative to medication. The ease of use and implementation of the FFM models makes vibroacoustics a promising nursing care practice.
Conclusions
Vibroacoustic technology is an effective treatment for relaxation, anxiety reduction, muscle-tension reduction, and pain management. Vibroacoustics has potential for treating disorders and for use during medical procedures. The method is effective for a wide variety of medical and wellness programs and has promise for others. The technology of vibroacoustics has evolved to provide greater understanding of how it works but continued development of technology and research on effective protocols and dosages is necessary to meet this technology's full potential.
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