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

福尔斯是老年人伤害性死亡和非致命性伤害的主要原因。虽然预防跌倒是一个主要的 VA倡议，目前最好的跌倒预防计划只减少了约30%的福尔斯建议进一步研究 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 有助于平衡和移动限制。我们最近的研究表明，髋外展肌在 平衡和移动功能。髋外展肌受损的老年人表现出髋关节功能下降 外展肌力量、较低的平衡得分和从平衡中恢复时较差的步进力学 扰动我们的初步结果还表明，髋外展肌脂肪浸润的增加可能 有助于不良的肌肉招募，并使改变髋外展肌肌肉与传统的力量 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外展肌。 我们的初步结果表明，老年人谁使用神经肌肉电刺激他们的臀部， 外展肌，结合平衡训练干预;髋外展肌有较大改善 力量、平衡和移动功能。我们的中心假设是，神经肌肉电 在平衡干预期间施加于髋外展肌的刺激将导致：改善平衡， 肌肉和活动功能的改善，以及比单独的平衡干预更少的福尔斯。在这 随机对照试验，我们将确定一个平衡和加强计划的影响， 神经肌肉电刺激对跌倒风险和移动性的影响（目的1），髋外展肌组成的变化， 功能，激活和步态变异性（目的2），以及在6个月和12个月时这些变化的保留情况 后续行动（目标3）。我们期望，这种以病人为导向的转化研究将提供第一个证据 来自一项大型随机对照试验，该试验使用神经肌肉电刺激对初次髋关节进行 外展作为一种有效的辅助传统康复计划，以改善平衡，流动性， 肌肉在老年退伍军人的风险福尔斯。

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.