PRESERVING MOBILITY OF JRA CHILDREN USING NOCTURNAL TES

治疗性电刺激是传统电刺激的一种改进形式 涉及使用低强度、亚强度的电刺激 睡眠时施加阈值电刺激。TES很好 可耐受，自1988年以来一直在加拿大用于患有 各种神经肌肉疾病。工商业污水附加费的效果尚未得到证实。 对幼年类风湿性关节炎(JRA)儿童进行了检查。这个 本R29提案的目的是开发和测试这一创新使用 低水平肌肉电刺激作为一种辅助治疗 最大限度地减少或防止青少年儿童的行动限制 类风湿关节炎。20例双侧膝关节强直的儿童 将在六个月内研究参与情况，同时使用夜间TES作为 一个家庭理疗项目的辅导员。这个低水平的亚阈值 刺激是在孩子一周睡六个晚上的时候进行的。这 对幼年类风湿性关节炎儿童的研究非常现实 正如它在睡眠中所做的那样，这项技术是非侵入性的，易于学习和 并不会增加“护理的负担”。电刺激将是 单方面进行，以允许另一条腿作为控制。这个孩子 将通过三种主要方式进行监测：临床检查、量化肌肉 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、MMT的关键功能 下肢肌群、腿长、大腿围和 克劳斯-韦伯柔韧性测试分数。定量的肌肉力量将 通过每月等长膝关节伸肌扭矩测量进行评估。这个 功能评估将包括每月儿童健康评估 调查问卷(CHAQ)和改良的儿科残疾评估 库存(Pedi)。在6个月的开始和结束时，步态 包括生理成本指数和超声的分析研究 将进行股四头肌厚度的测量。我们的假设是 夜间治疗性电刺激会使股四头肌最小化 虚弱和/或萎缩，从而减少潜在的损害 肌肉无力、膝关节屈曲痉挛和步态偏差 对日尔曼步枪协会人口的长期残疾作出贡献。如果它的疗效 这种干预措施在保持机动性方面的作用是证明的，未来 研究将探索潜在的神经肌肉和神经内分泌 影响临床疗效的机制。

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.