Neuromuscular Electrical Stimulation for Achilles Tendon Rupture Rehabilitation

摘要 跟腱断裂(ATR)是一种影响活跃个人的常见损伤，在过去增加了10倍 几十年了。小腿功能缺陷包括脚跟抬高高度降低、脚跟抬高做功、向心力下降 力量，降低足底屈曲力量，并降低脚踝的发电能力。这些赤字 受伤后仍能坚持14年之久。长期功能缺陷的原因仍不清楚，而且 被认为是多因素的。ATR后肌腱-肌肉单位的结构变化与畸形密切相关 在足屈功能上。具体地说，ATR导致肌腱长期伸长，肌腱面积增加， 改变了机械性能，减少了小腿肌肉体积。这些结构性变化迅速发展到 恢复的头几周，在受伤后的几个月里进展缓慢，此后变化很小。这个 肌肉和肌腱异常的快速发展初期与无负重期或 目前康复方案中的部分负重。在这项研究中，我们建议使用神经肌肉电 刺激(NMES)在第一阶段为愈合的肌腱提供肌肉活动和机械刺激 数周的回升，将最初的较大跌幅降至最低。NME可以对以下几个因素产生积极影响 从ATR中恢复，并已成功地作为膝关节手术康复方案的一部分 保持肌肉的体积和力量。因此，NMES可以延缓前几周的肌肉萎缩。 ATR修复术后恢复。早期控制负荷改善跟腱的力学性能 在破裂之后。此外，NMES显著降低了深静脉血栓形成的风险，深静脉血栓是一种可能的并发症 在从ATR恢复的过程中。 这项研究的目的是开发和评估NMES手术治疗的康复方案 跟腱断裂。本研究分为两个目的。目标1将确定NMES的参数 基于肌腱力学性能测量的协议。目标2将评估可行性和 NMES方案作为自我干预方案的初步疗效。 ATR后的功能障碍是常见的，并在损伤后很长时间内持续存在。大多数不正常的 肌肉和肌腱特性的变化发生在恢复的第一周。本协议的目的是 是补充肌肉活动，修复后对肌腱进行6周的机械刺激。这个 所提出的方案的基本概念是刺激小腿肌肉的一小部分来诱导 在该区域显著收缩，同时对肌腱施加适度的负荷。我们将对效果进行评估 建议的方案在预测较长期结果的早期功能结果中的应用。NMES是一种 在理疗和康复中心广泛使用的技术。因此，拟议的议定书 可以很容易地采用和纳入ATR的常规护理。

Summary Achilles tendon rupture (ATR), a common injury that affects active individuals, has increased 10-fold in the past few decades. Lower-leg functional deficits include decreased heel-rise height, heel-rise work, concentric strength power, reduced plantar flexion strength, and decreased ability of the ankle to generate power. These deficits persist as far out as 14 years after injury. The cause of long-term functional deficits remains unclear and is thought to be multifactorial. Structural changes in the tendon-muscle unit after ATR are strongly related to deficits in plantarflexion function. Specifically, ATR results in long-term tendon elongation, increased tendon area, altered mechanical properties, and reduced calf muscle volume. These structural changes rapidly develop over the first weeks of recovery, slowly progress for a few months after injury, and change very little thereafter. The rapid initial development of muscle and tendon abnormalities coincides with the period of no weight bearing or partial weight bearing of current rehabilitation protocols. In this study, we propose to use neuromuscular electrical stimulation (NMES) to provide muscle activity and mechanical stimulus to the healing tendon during the first weeks of recovery to minimize the large initial decline. NMES can positively impact several of the factors affecting recovery from ATR, and has been successfully applied as part of rehabilitation protocols for knee surgery to preserve muscle volume and strength. Therefore, NMES can attenuate muscle atrophy during the first weeks of recovery after ATR repair surgery. Early controlled loading improves mechanical properties of the Achilles tendon after rupture. Additionally, NMES significantly reduces the risk of deep vein thrombosis, a possible complication during the recovery from ATR. The objective of this study is to develop and evaluate a NMES rehabilitation protocol for surgically-treated Achilles tendon ruptures. This study is divided into two aims. Aim 1 will determine parameters of the NMES protocol based on measurements of tendon mechanical properties. Aim 2 will evaluate the feasibility and preliminary efficacy of NMES protocol as a self-applied intervention. Functional deficits after ATR are common and persist long after the injury. The majority of the abnormal changes in muscle and tendon properties occur during the first weeks of recovery. The purpose of this protocol is to supplement muscle activity and provide mechanical stimulation to the tendon for 6 weeks after repair. The fundamental concept of the proposed protocol is to stimulate small portions of the calf muscles to induce significant contraction in that region, while applying moderate loading to the tendon. We will evaluate the effect of proposed protocol in early functional outcomes that are predictive of longer-term outcomes. NMES is a technology widely available in physical therapy and rehabilitation centers. Consequently, the proposed protocol can be easily adopted and incorporated as part of routine care for ATR.