Neuromuscular Electrical Stimulation for Achilles Tendon Rupture Rehabilitation

总结 跟腱断裂（ATR）是一种常见的伤害，影响活跃的个人，在过去增加了10倍 几十年小腿功能缺陷包括足跟抬高高度降低、足跟抬高功、向心力 力量，降低的跖屈强度，以及踝关节产生力量的能力降低。这些赤字 在受伤后14年内仍然存在。长期功能缺陷的原因尚不清楚， 被认为是多因素的。ATR后肌腱-肌肉单位的结构变化与缺陷密切相关 跖屈功能。具体来说，ATR导致长期肌腱伸长，肌腱面积增加， 机械性能改变，小腿肌肉体积减少。这些结构变化迅速发展， 恢复的最初几周，在受伤后的几个月里缓慢进展，此后变化很小。的 肌肉和肌腱异常的快速初始发展与无负重期一致， 目前康复方案的部分负重。在这项研究中，我们建议使用神经肌肉电 在第一次肌电刺激期间，可以使用肌肉刺激（NMES）来向愈合肌腱提供肌肉活动和机械刺激。 几周的恢复，以尽量减少大的初始下降。NMES可以积极影响影响的几个因素， 从ATR中恢复，并已成功应用于膝关节手术的康复方案， 保持肌肉体积和力量。因此，NMES可以在第一周期间减轻肌肉萎缩。 ATR修复手术后恢复。早期控制负荷改善跟腱的力学性能 破裂后。此外，NMES显著降低了深静脉血栓形成（一种可能的并发症）的风险 在从ATR恢复期间。 本研究的目的是开发和评估NMES康复方案， 跟腱断裂。本研究分为两个目的。目标1将确定国家监测和评价系统的参数 协议的基础上测量肌腱的机械性能。目标2将评估可行性， NMES方案作为自我应用干预的初步疗效。 ATR后的功能缺陷是常见的，并在损伤后持续很长时间。大多数不正常的 肌肉和肌腱特性的变化发生在恢复的最初几周。本方案的目的 是在修复后6周内补充肌肉活动并为肌腱提供机械刺激。的 所提出的方案的基本概念是刺激小腿肌肉的小部分以诱导 该区域显著收缩，同时向肌腱施加适度载荷。我们将评估效果 在早期功能结局中，建议的方案可以预测长期结局。NMES是一个 技术广泛应用于物理治疗和康复中心。因此，拟议的议定书 可以很容易地采用和纳入ATR的常规护理的一部分。

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.