CAN NEUROMUSCULAR TRAINING ALTER MOVEMENT PATTERNS?

描述（由申请人提供）：前交叉韧带（ACL）损伤很常见，通常会导致不稳定、股四头肌无力和骨关节炎。(OA)那些不能很好地补偿ACL缺陷的患者（非copers）所经历的虚弱和不稳定独立地导致可能加速或恶化膝关节OA的补偿策略。这些不良的补偿策略在手术重建后并不一致，并且接受重建的患者发生膝关节OA的风险也增加。这项工作的总体目标是确定是否有效的康复计划，以动态稳定膝关节改善结果和减少不良适应后，ACL重建的人群在发展为膝关节骨性关节炎的风险很大。我们过去五年的工作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copers发展正常的运动模式和联合力量，并产生更好的功能结果。我们小组和合作者最近的工作显示了非copers的适应性，但也有不同的结果。此外，我们还发现了非copers中强烈的性别效应;女性对训练的反应与男性相似，但手术后恢复慢得多，并继续表现出异常的运动模式和膝关节负荷。女性更有可能是非copers和更有可能有持续的适应不良模式手术后。本竞争性更新申请的具体目的是研究：1）对术前康复（包括扰动训练）的反应是否预测了更好的临床和功能结局以及随时间推移的OA发展; 2）女性继续表现出异常负荷、持续适应不良模式，临床和功能结局较差，随时间推移比男性发展更多OA;和3）增加术后神经肌肉训练计划导致比标准护理更低的负荷、更好的运动模式以及临床和功能结果。来自该项目的信息将为每年约150，000 - 175，000名ACL断裂并接受重建手术的美国人的管理提供有价值的见解。更重要的是，如果扰动训练可以促进改善患者的预后和减少重建ACL手术后的适应不良，这些发现可能适用于广泛的膝关节损伤的个人。

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.