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 跟腱断裂 (ATR) 是一种影响活跃个体的常见损伤，在过去已增加了 10 倍 几十年。小腿功能缺陷包括脚跟抬高高度、脚跟抬高工作、同心力量下降 力量，跖屈力量下降，脚踝产生力量的能力下降。这些赤字 受伤后可持续长达 14 年。长期功能缺陷的原因仍不清楚， 认为是多因素的。 ATR 后肌腱肌肉单位的结构变化与缺陷密切相关 在跖屈功能中。具体来说，ATR 会导致肌腱长期伸长、肌腱面积增加、 改变机械性能，并减少小腿肌肉体积。这些结构性变化迅速发展 恢复的最初几周，受伤后几个月缓慢进展，此后变化很小。这 肌肉和肌腱异常的快速初始发育与不负重或不负重的时期相一致 当前康复方案的部分负重。在这项研究中，我们建议使用神经肌肉电 刺激 (NMES) 在第一阶段为愈合肌腱提供肌肉活动和机械刺激 数周的复苏，以尽量减少最初的大幅下降。 NMES 可以对影响的几个因素产生积极影响 从 ATR 中恢复，并已成功应用于膝关节手术康复方案的一部分 保持肌肉体积和力量。因此，NMES 可以在最初几周内减轻肌肉萎缩 ATR修复手术后的恢复情况。早期控制负荷可改善跟腱的机械性能 破裂后。此外，NMES 还可显着降低深静脉血栓形成（一种可能的并发症）的风险 从 ATR 恢复期间。 本研究的目的是为手术治疗的患者制定和评估 NMES 康复方案 跟腱断裂。这项研究分为两个目标。目标 1 将确定 NMES 的参数 基于肌腱机械性能测量的协议。目标 2 将评估可行性并 NMES 方案作为自我应用干预措施的初步功效。 ATR 后的功能缺陷很常见，并且在受伤后仍持续很长时间。大部分不正常 肌肉和肌腱特性的变化发生在恢复的最初几周内。本协议的目的 是在修复后6周内补充肌肉活动并为肌腱提供机械刺激。这 拟议协议的基本概念是刺激小腿肌肉的一小部分以诱导 该区域显着收缩，同时对肌腱施加适度的负荷。我们将评估效果 预测长期结果的早期功能结果中拟议的方案。 NMES 是一个 物理治疗和康复中心广泛采用的技术。因此，拟议的协议 可以轻松采用并纳入 ATR 常规护理的一部分。