CAN NEUROMUSCULAR TRAINING ALTER MOVEMENT PATTERNS?

描述（由申请人提供）：前交叉韧带（ACL）损伤是常见的，经常导致不稳定，股四头肌无力和骨关节炎。（OA）那些不能很好地补偿前交叉韧带缺陷（非铜）的人所经历的虚弱和不稳定，会导致代偿策略沉淀或恶化膝关节OA。这些不良的代偿策略在手术重建后并不能统一解决，并且那些接受重建的患者也增加了患膝关节OA的风险。本研究的总体目标是确定动态稳定膝关节的有效康复方案是否能改善前交叉韧带重建后的预后，并减少发生膝关节OA的高危人群的不良适应。我们过去五年的工作已经提供了相当多的证据来支持我们的主要假设，即一种称为扰动训练的特殊形式的神经肌肉训练可以让一些非copd患者发展正常的运动模式和关节力量，并产生更好的功能结果。我们的团队和合作者最近的研究显示了非应对者的适应性，但也显示了不同的结果。此外，我们还发现，在非铜矿患者中存在强烈的性别效应；女性对训练的反应与男性相似，但手术后恢复得慢得多，并且继续表现出异常的运动模式和膝关节负荷。女性更有可能不适应，更有可能在手术后出现持续的适应不良模式。这项竞争性更新应用的具体目的是研究：1)对术前康复的反应性，包括扰动训练，预测更好的临床和功能结果以及OA的发展；2)随着时间的推移，女性继续表现出异常负荷，持续的适应不良模式，临床和功能结果较差，患OA的几率高于男性；3)与标准治疗相比，术后神经肌肉训练项目可以降低负荷，改善运动模式和临床及功能结果。从该项目中获得的信息将为每年大约15万至17.5万名美国前交叉韧带破裂并接受重建手术的患者的管理提供有价值的见解。更重要的是，如果扰动训练既能改善患者的预后，又能减少前交叉韧带重建手术后的畸形适应，那么这些发现可能适用于范围广泛的膝关节损伤患者。

DESCRIPTION (provided by applicant): Anterior cruciate ligament (ACL) injury is prevalent and often leads to instability, quadriceps muscle weakness and osteoarthritis. (OA) Weakness and instability experienced by those who do not compensate well for ACL deficiency (non-copers) independently lead to compensation strategies that could precipitate or worsen knee OA. These poor compensation strategies do not uniformly resolve after surgical reconstruction and those who undergo reconstruction also have an increased risk of developing knee OA. The overall goal of this work is to determine whether effective rehabilitation programs to dynamically stabilize the knee improve outcome and reduce mal adaptations after ACL reconstruction in a population at great risk for the development of knee OA. Our work of the past five years has provided considerable evidence in support of our primary hypothesis that a specialized form of neuromuscular training called perturbation training can allow some non-copers to develop normal movement patterns and joint forces and result in better functional outcomes. Recent work from our group and our collaborators has shown the adaptability of non-copers, but also variable outcomes. Additionally, we have uncovered a strong gender effect in non-copers; women respond similarly to men to training, but recover much more slowly after surgery and continue to demonstrate aberrant movement patterns and knee joint loads. Women are more likely to be non-copers and more likely to have persistent maladaptive patterns after surgery. The specific aims of this competitive renewal application are to investigate whether:1) Responsiveness to preoperative rehabilitation that includes perturbation training predicts better clinical and functional outcome and the development of OA over time; 2) Women continue to demonstrate aberrant loads, persistent maladaptive patterns, have poorer clinical and functional outcome and develop more OA over time than men; and 3) The addition of a post-operative neuromuscular training program results in lower loading, better movement patterns and clinical and functional outcomes than standard care. The information derived from this project will provide valuable insight into the management of the approximately 150,000-175,000 Americans who rupture their ACL's each year and undergo reconstructive surgery. More importantly, if perturbation training can facilitate both improved patient outcomes and a reduction in mal adaptions following reconstructive ACL surgery, these findings may have applications for individuals with an extensive range of knee injuries. PUBLIC HEALTH RELEVANCE: Anterior Cruciate ligament injury and surgery are common; recovery is not simple and disability, particularly from knee osteoarthritis happens often in the years following the injury. The proposed studies will identify clinical markers and biomechanical abnormalities, particularly in women, a group at high risk for ACL rupture and knee OA, that contribute to the high rate of knee osteoarthritis following ACL rupture and reconstruction and provide clinicians with practical, useful and evidence-based treatment options that may normalize movement patterns, function and forces before and after ACL reconstruction for the nearly 100,000- 175,000 Americans who undergo ACL reconstruction each year.