Neuromuscular Electrical Stimulation for Achilles Tendon Rupture Rehabilitation

神经肌肉电刺激用于跟腱断裂康复

• 批准号: 10400154
• 负责人: Daniel Humberto Cortes Correales
• 金额: $ 16.85万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10400154
• 关键词: Adherence; Adopted; Adverse effects; Affect; Animals; Ankle; Area; Attenuated; Caliber; Collagen; Complication; Data; Deep Vein Thrombosis; Future; Goals; Heel; Height; Human; Individual; Injury; Intervention; Knee; Leg; Measurement; Measures; Mechanical Stimulation; Muscle; Muscle Contraction; Muscle Development; Muscular Atrophy; Neuropeptides; Operative Surgical Procedures; Outcome; Patients; Periodicity; Physical Rehabilitation; Physical therapy; Property; Protocols documentation; Randomized; Recovery; Rehabilitation Centers; Rehabilitation therapy; Risk; Rupture; Sensory; Skeletal Muscle; Techniques; Technology; Tendon structure; Up-Regulation; Weight-Bearing state; Work; achilles tendon; base; design; effectiveness evaluation; functional outcomes; gene repair; group intervention; healing; improved; mechanical properties; mechanical stimulus; neuromuscular function; neuromuscular stimulation; novel; outcome prediction; preservation; prospective; repaired; routine care; tendon rupture; ultrasound

Summary Achilles tendon rupture (ATR), a common injury that affects active individuals, has increased 10-fold in the past few decades. Lower-leg functional deficits include decreased heel-rise height, heel-rise work, concentric strength power, reduced plantar flexion strength, and decreased ability of the ankle to generate power. These deficits persist as far out as 14 years after injury. The cause of long-term functional deficits remains unclear and is thought to be multifactorial. Structural changes in the tendon-muscle unit after ATR are strongly related to deficits in plantarflexion function. Specifically, ATR results in long-term tendon elongation, increased tendon area, altered mechanical properties, and reduced calf muscle volume. These structural changes rapidly develop over the first weeks of recovery, slowly progress for a few months after injury, and change very little thereafter. The rapid initial development of muscle and tendon abnormalities coincides with the period of no weight bearing or partial weight bearing of current rehabilitation protocols. In this study, we propose to use neuromuscular electrical stimulation (NMES) to provide muscle activity and mechanical stimulus to the healing tendon during the first weeks of recovery to minimize the large initial decline. NMES can positively impact several of the factors affecting recovery from ATR, and has been successfully applied as part of rehabilitation protocols for knee surgery to preserve muscle volume and strength. Therefore, NMES can attenuate muscle atrophy during the first weeks of recovery after ATR repair surgery. Early controlled loading improves mechanical properties of the Achilles tendon after rupture. Additionally, NMES significantly reduces the risk of deep vein thrombosis, a possible complication during the recovery from ATR. The objective of this study is to develop and evaluate a NMES rehabilitation protocol for surgically-treated Achilles tendon ruptures. This study is divided into two aims. Aim 1 will determine parameters of the NMES protocol based on measurements of tendon mechanical properties. Aim 2 will evaluate the feasibility and preliminary efficacy of NMES protocol as a self-applied intervention. Functional deficits after ATR are common and persist long after the injury. The majority of the abnormal changes in muscle and tendon properties occur during the first weeks of recovery. The purpose of this protocol is to supplement muscle activity and provide mechanical stimulation to the tendon for 6 weeks after repair. The fundamental concept of the proposed protocol is to stimulate small portions of the calf muscles to induce significant contraction in that region, while applying moderate loading to the tendon. We will evaluate the effect of proposed protocol in early functional outcomes that are predictive of longer-term outcomes. NMES is a technology widely available in physical therapy and rehabilitation centers. Consequently, the proposed protocol can be easily adopted and incorporated as part of routine care for ATR.

概括 阿喀琉斯肌腱破裂（ATR）是一种影响活跃个体的常见伤害，过去已经增加了10倍 几十年。低腿功能不足包括脚跟高度降低，鞋跟工程，同心力量 功率，降低足底屈曲强度以及踝关节产生动力的能力。这些赤字 受伤后14年持续存在。长期功能缺陷的原因尚不清楚，是 被认为是多因素。 ATR后肌腱肌肉单元的结构变化与缺陷密切相关 在Plantarflexion函数中。具体而言，ATR导致长期肌腱伸长，肌腱面积增加， 机械性能改变并减少了小腿肌肉体积。这些结构性变化迅速发展 恢复的头几周，受伤后几个月缓慢进展，此后几乎没有改变。这 肌肉和肌腱异常的快速初始发展与无体重轴承或 当前康复方案的部分负重轴承。在这项研究中，我们建议使用神经肌肉电气 刺激（NME）在第一次提供肌肉活性和机械刺激 恢复数周以最大程度地减少最初的下降。 NME可以积极影响影响的几个因素 从ATR中恢复，并已成功应用，作为膝盖手术康复方案的一部分 保持肌肉体积和力量。因此，NME可以在最初几周衰减肌肉萎缩 ATR修复手术后的恢复。早期控制的负载改善了跟腱的机械性能 破裂后。此外，NME大大降低了深静脉血​​栓形成的风险，可能并发症 在从ATR恢复期间。 这项研究的目的是开发和评估用于手术治疗的NMES康复方案 跟腱破裂。这项研究分为两个目标。 AIM 1将确定NME的参数 协议基于肌腱机械性能的测量。 AIM 2将评估可行性和 NMES方案作为自我应用的干预措施的初步疗效。 ATR后的功能缺陷很常见，受伤后很长时间持续存在。大多数异常 肌肉和肌腱特性的变化发生在恢复的头几周。该协议的目的 是补充肌肉活动，并在修复后6周为肌腱提供机械刺激。这 该规程的基本概念是刺激小腿肌肉的一小部分以诱导 在该区域的大量收缩，同时将中等负荷施加到肌腱上。我们将评估效果 在早期功能结果中提出的方案，这些方案可预测长期结局。 NME是一个 在物理治疗和康复中心广泛使用的技术。因此，提出的协议 可以轻松地采用并将其作为ATR常规护理的一部分。