PRESERVING MOBILITY OF JRA CHILDREN USING NOCTURNAL TES

使用夜间 TES 保持 JRA 儿童的活动能力

• 批准号: 6375115
• 负责人: JOHN R MCGUIRE
• 金额: $ 9.63万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-09-20 至 2003-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6375115
• 关键词: adolescence (12-20); arthritis therapy; bioenergetics; biomechanics; child (0-11); child with disability; clinical research; electrostimulus; functional ability; gait; human subject; human therapy evaluation; juvenile rheumatoid arthritis; knee; limb movement; medical rehabilitation related tag; muscle strength; physical therapy; questionnaires; rehabilitation; sleep; ultrasonography

Therapeutic electrical stimulation (TES) is a modified form of traditional electrical stimulation which involves the use of low-intensity, sub- threshold electrical stimulation applied during sleep. TES is well tolerated and has been used since 1988 in Canada for children with a variety of neuromuscular conditions. The efficacy of TES has not yet been examined in the child with juvenile rheumatoid arthritis (JRA). The purpose of this R29 proposal is to develop and test this innovative use of low-level muscle electrical stimulation as an adjunctive therapy to minimize or prevent movement limitations in the child with juvenile rheumatoid arthritis. Twenty JRA children with bilateral knee joint involvement will be studied during six months while using nocturnal TES as an adjunct to a physical therapy home program. This low-level subthreshold stimulation is done while the child is sleeping six nights a week. This study is very realistic for the child with juvenile rheumatoid arthritis as it done during sleep, the technology is noninvasive, easy to learn and does not add to "the burden of care." The electrical stimulation will be done unilaterally to allow the other leg to serve as a control. The child will be monitored in three major ways: clinical exam, quantitative muscle strength and muscle bulk, and functional assessments. The monthly clinical exam will document bilateral lower extremity A/PROM, MMT of key functional lower extremity muscle groups, leg length, thigh circumference and the Kraus-Weber flexibility test score. The quantitative muscle strength will be assessed by monthly isometric knee extensor torque measurements. The functional assessment will include monthly Childhood Health Assessment Questionnaire (CHAQ), and a modified Pediatric Evaluation of Disability Inventory (PEDI). At the beginning and end of the 6 month period, a gait analysis study including physiologic cost index as well as ultrasound measurement of quadriceps muscle thickness will be done. Our hypothesis is that nocturnal therapeutic electrical stimulation will minimize quadriceps weakness and/or atrophy thereby reducing the potential impairments of muscle weakness, knee flexion contracture and gait deviations which may contribute to long-term disability in the JRA population. If the efficacy of this intervention in preserving mobility is demonstrated, future research would explore the underlying neuromuscular and neuroendocrine mechanisms responsible for the clinical effect.

治疗性电刺激 (TES) 是传统电刺激的改良形式 电刺激，涉及使用低强度、亚 睡眠期间施加的阈值电刺激。 TES还不错 加拿大自 1988 年起就开始使用这种药物治疗患有以下疾病的儿童： 各种神经肌肉疾病。 TES的疗效尚未得到证实 对患有幼年类风湿性关节炎（JRA）的儿童进行检查。这 此 R29 提案的目的是开发和测试这种创新用途 低水平肌肉电刺激作为辅助治疗 尽量减少或防止青少年儿童的运动限制 类风湿关节炎。双侧膝关节JRA儿童20例 将在六个月内研究参与情况，同时使用夜间 TES 作为 物理治疗家庭计划的辅助手段。这个低水平的亚阈值 刺激是在孩子每周六个晚上睡觉时进行的。这 研究对于患有幼年类风湿性关节炎的孩子来说非常现实 正如在睡眠期间所做的那样，该技术是非侵入性的，易于学习和使用 不会增加“护理负担”。电刺激将是 单侧完成，以允许另一条腿作为控制。孩子 将通过三种主要方式进行监测：临床检查、定量肌肉 力量和肌肉体积以及功能评估。每月临床 检查将记录双侧下肢 A/PROM、关键功能性 MMT 下肢肌肉群、腿长、大腿围和 克劳斯-韦伯灵活性测试分数。定量的肌肉力量将 通过每月等距膝关节伸肌扭矩测量进行评估。这 功能评估将包括每月的儿童健康评估 问卷 (CHAQ) 和改良的儿科残疾评估 库存（PEDI）。在 6 个月期间的开始和结束时，步态 分析研究，包括生理成本指数以及超声检查 将测量股四头肌厚度。我们的假设是 夜间治疗性电刺激将最大限度地减少股四头肌 虚弱和/或萎缩，从而减少潜在的损害 肌肉无力、膝关节屈曲挛缩和步态偏差，这些可能 导致 JRA 人群长期残疾。如果功效 这种干预措施在保持流动性方面的作用得到了证明，未来 研究将探索潜在的神经肌肉和神经内分泌 负责临床效果的机制。