Reducing Fall Risk with the use of Neuromuscular Electrical Stimulation to Maximize the Hip Abductor Muscles in Older Veterans

通过使用神经肌肉电刺激最大化老年退伍军人的髋关节外展肌来降低跌倒风险

• 批准号: 10311867
• 负责人: Odessa Addison
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10311867
• 关键词: Address; Adipose tissue; Age; Area; Balance training; Cessation of life; Clinical Treatment; Data; Educational Intervention; Elderly; Electrodes; Equilibrium; Exercise; Exhibits; Fall prevention; Fascia lata structure; Fatty acid glycerol esters; Future; Gait; Health; Healthcare; Hip region structure; Hospitalization; Impairment; Incidence; Infiltration; Intervention; Intramuscular; Isometric Exercise; Lower Extremity; Mechanics; Methods; Mission; Muscle; Muscle Contraction; Muscle function; Muscular Atrophy; Physical Performance; Prevention program; Publishing; Randomized Controlled Trials; Rehabilitation therapy; Research; Role; Step Tests; Surface; Testing; Time; Training; Translational Research; Trauma; Veterans; Work; X-Ray Computed Tomography; cost; cost effective; exercise training; fall risk; falls; follow-up; functional outcomes; improved; multimodality; muscle form; muscle strength; neuromuscular stimulation; novel; patient oriented; patient safety; performance tests; primary outcome; programs; recruit; response; tool

Falls are a leading cause of injurious death and non-fatal injuries in older adults. While fall prevention is a major VA initiative, the current best fall preventions program only reduces falls by ~30% suggesting further research and interventions are needed to reduce fall risk. Decreased lower extremity muscle mass and strength contribute to balance and mobility limitations. Our recent studies show the hip abductors have a unique role in balance and mobility function. Older adults with impaired hip abductor muscles demonstrate decreased hip abductor strength, lower balance scores, and poor stepping mechanics when recovering from a balance perturbation. Our preliminary results also show increased fatty infiltration of the hip abductor muscles may contribute to poor muscle recruitment and make changing the hip abductor muscles with a traditional strength intervention difficult. Neuromuscular electrical stimulation is one method to improve muscles in older adults, though it is not traditionally used on the hip abductors. Our preliminary results demonstrate that older adults who use neuromuscular electrical stimulation on their hip abductors, in conjunction with a balance training intervention; demonstrate larger improvements in hip abductor strength, balance, and mobility function. Our central hypothesis is that the addition of neuromuscular electrical stimulation applied to the hip abductors during a balance intervention will result in: improved balance, larger improvements in muscle and mobility function, and fewer falls than a balance intervention alone. In this randomized control trial, we will determine the effects of a balance and strengthening program with and without neuromuscular electrical stimulation on fall risk and mobility (aim 1), changes in hip abductor composition, function, activation and gait variability (aim 2), and the retention of these changes at a six and twelve-month follow up (aim 3). We anticipate that this patient-oriented translational research will provide the first evidence from a large randomized control trial for the use of neuromuscular electrical stimulation applied to the primary hip abductors as an efficacious adjunct to traditional rehabilitation programs to improve balance, mobility, and muscle in older Veterans at risk for falls.

跌倒是老年人伤害性死亡和非致命性伤害的主要原因。虽然预防跌倒是重中之重 VA 倡议，目前最好的跌倒预防计划仅将跌倒次数减少约 30%，建议进一步研究 需要采取干预措施来降低跌倒风险。下肢肌肉质量和力量下降 导致平衡和活动受限。我们最近的研究表明髋关节外展肌在 平衡和活动功能。髋关节外展肌受损的老年人表现出髋关节下降 外展肌力量减弱，平衡得分较低，从平衡状态恢复时的迈步动作较差 扰动。我们的初步结果还表明，髋关节外展肌的脂肪浸润增加可能 导致肌肉募集不良，并以传统力量改变髋部外展肌 干预困难。神经肌肉电刺激是改善老年人肌肉的一种方法， 尽管它传统上不用于髋关节外展肌。 我们的初步结果表明，对臀部使用神经肌肉电刺激的老年人 绑架者，结合平衡训练干预；展示髋关节外展肌的更大改善 力量、平衡和活动功能。我们的中心假设是添加神经肌肉电 在平衡干预期间对髋关节外展肌施加刺激将导致： 改善平衡、更大 与单独的平衡干预相比，肌肉和活动功能得到改善，跌倒次数也减少。在这个 随机对照试验，我们将确定有或没有的平衡和强化计划的效果 神经肌肉电刺激对跌倒风险和活动能力的影响（目标 1）、髋关节外展肌成分的变化、 功能、激活和步态变异性（目标 2），以及这些变化在六个月和十二个月时的保留情况 跟进（目标 3）。我们预计这项以患者为导向的转化研究将提供第一个证据 来自一项针对初级髋关节使用神经肌肉电刺激的大型随机对照试验 绑架者作为传统康复计划的有效辅助手段，以改善平衡、活动能力和 有跌倒风险的老年退伍军人的肌肉。