CAN NEUROMUSCULAR TRAINING ALTER MOVEMENT PATTERNS?

描述(申请人提供)：前十字韧带(ACL)损伤很常见，经常导致不稳定、股四头肌无力和骨关节炎。(OA)那些不能很好地独立补偿前交叉韧带缺陷(非铜病)的人所经历的虚弱和不稳定会导致补偿策略，这可能会导致或恶化膝盖骨关节炎。这些糟糕的补偿策略在手术重建后并不能统一解决，那些接受重建的人也有更高的患膝骨性关节炎的风险。这项工作的总体目标是确定在膝骨性关节炎高危人群中，有效的康复计划动态稳定膝关节是否能改善结果，减少前交叉韧带重建后的不良适应。我们过去五年的工作提供了相当多的证据来支持我们的基本假设，即一种名为扰动训练的特殊形式的神经肌肉训练可以使一些不参与训练的人发展正常的运动模式和关节力量，并产生更好的功能结果。我们团队和我们的合作者最近的研究表明，非COP的适应性很强，但结果也不稳定。此外，我们还发现非COP患者存在强烈的性别效应；女性对训练的反应与男性相似，但手术后恢复要慢得多，并继续表现出异常的运动模式和膝关节负荷。女性更有可能是不接受手术的人，也更有可能在手术后出现持续的适应不良模式。这项竞争性更新申请的具体目的是调查：1)对包括扰动训练在内的术前康复的反应是否预测了更好的临床和功能结果以及随着时间的推移骨关节炎的发展；2)女性继续表现出异常负荷、持续的适应不良模式，临床和功能结果比男性更差，并随着时间的推移发展成更多的骨性关节炎；3)术后增加神经肌肉训练计划比标准护理导致更低的负荷、更好的运动模式以及临床和功能结果。从该项目获得的信息将为每年约150,000-175,000名美国人的前交叉韧带断裂并接受重建手术的管理提供有价值的见解。更重要的是，如果扰动训练既可以改善患者的预后，又可以减少重建前交叉韧带手术后的不良适应，这些发现可能适用于有广泛膝关节损伤的个人。

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.