STUDY OF FALLING IN PATIENTS WITH MUSCLE WEAKNESS DUE TO MYOSITIS

肌炎引起的肌无力患者跌倒的研究

• 批准号: 3792241
• 负责人: F L BUCZEK
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3792241
• 关键词: accidental falls; biomechanics; body movement; disease /disorder proneness /risk; gait; human subject; inclusion body; muscle function; myositis; patient monitoring device; questionnaires

Falling can be a serious problem, especially for the elderly and those with musculoskeletal problems. During gait, falling may result from "slips", a condition that occurs during stance phase when friction is inadequate to meet slip-resistance needs, or "trips," when there is inadequate ground clearance during swing phase. To determine possible mechanisms for falls in patients with decreased strength and normal joints, we have begun studies in patients with muscle disease. Measurements of required slip-resistance and ground clearance were made in a patient with Inclusion Body Myositis (IBM) and a high incidence of falls, using two strain gauge force plates and a passive infra-red motion analysis system. Manual muscle testing was performed to measure relative muscle strength, and a questionnaire was used to gather facts pertinent to falls. Marked differences were seen between the right and left legs. Ground clearances for the right toe and heel did not seem to put this patients at risk for tripping. Required slip-resistance at heel-strike was abnormally high at 0.66 +/- 0.03 (n=6), consistently above normal values (less than 0.25) and architectural guidelines (0.50). This put the patient at risk for slipping on the right foot. Although questionnaire responses did not identify slipping as a precursor to falls, knowledge of the increased risk was considered useful for patient safety. For the left leg, abduction was pronounced during swing, which terminated with a prolonged medial sweep of the foot over the final 40% of swing. Ground clearance of the left heel was below 1 cm during this sweep, increasing the likelihood of tripping. In this situation, the patient could fall because weak hip and knee musculature may not be strong enough to stabilize the body. Indeed, the patient did identify tripping on the left side as a precursor to falls. We conclude that detailed biomechanical analyses identify gait characteristics that put patients at risk for falling, and may facilitate directed clinical interventions to prevent falls. We are expanding the scope of this study to other IBM patients.

跌倒可能是一个严重的问题，尤其是对于老年人和 有肌肉骨骼问题。行走过程中，跌倒可能是由于 “滑倒”，一种在站立阶段摩擦力过大时发生的情况 不足以满足防滑需求，或“跳闸”，当有 摆动阶段离地间隙不足。以确定可能的 力量下降且正常的患者跌倒的机制 我们已经开始对肌肉疾病患者进行研究。 测量了所需的防滑性和离地间隙 患有包涵体肌炎 (IBM) 且发病率高的患者 跌落，使用两个应变仪测力台和一个被动红外 运动分析系统。进行徒手肌肉测试以测量 相对肌肉力量，并使用问卷来收集事实 与跌倒有关。 右腿和左腿之间存在明显差异。地面 右脚趾和脚后跟的间隙似乎并没有使该患者 有绊倒的危险。足跟着地时所需的防滑性为 异常高为 0.66 +/- 0.03 (n=6)，始终高于正常值 （小于 0.25）和架构指南（0.50）。这把 患者有右脚滑倒的危险。虽然问卷 答复并未将滑倒视为跌倒的先兆，知识 增加的风险被认为对患者安全有用。对于 左腿，在摆动过程中明显外展，最后以 在最后 40% 的挥杆过程中，脚的内侧扫动时间较长。地面 在此扫掠过程中，左脚跟的间隙低于 1 厘米，增加 绊倒的可能性。在这种情况下，患者可能会摔倒 因为薄弱的臀部和膝盖肌肉组织可能不够强壮 稳定身体。事实上，患者确实发现了绊倒的情况 左侧是跌倒的前兆。我们得出结论，详细 生物力学分析确定患者的步态特征 有跌倒风险，可能有助于定向临床干预 以防止跌倒。我们正在将这项研究的范围扩大到其他 IBM 患者。