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)许多患有慢性ACL缺陷的患者在ACL断裂后数年出现膝关节OA的证据。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，并减少ACL重建后的适应不良，在人群中的发展膝关节OA的风险很大。将80名计划进行手术的ACL断裂患者随机分配到一组，该组包括一种称为扰动训练的神经肌肉训练形式，或标准组。将在手术前后使用运动分析和X线摄影对其进行评价，将使用运动学、动力学、胫骨平移的体内测量和基于EMG的关节压缩模型进行比较。本随机试验旨在证明，在术前康复（包括扰动训练）后，非copers将：1）表现出具有动态稳定性的运动和肌肉放电模式，2）这些变化在重建后将持续存在，3）训练诱导的运动和肌肉放电模式变化将在重建后产生更好的功能结局。来自该项目的信息将提供有价值的见解，以管理约100，000名美国人谁打破他们的ACL的，每年进行重建手术。更重要的是，如果术前扰动训练可以促进改善患者预后和减少ACL重建手术后的适应不良，这些发现可能适用于各种膝关节损伤的患者。

DESCRIPTION (provided by applicant): Anterior cruciate ligament (ACL) injury is prevalent and often leads to instability, quadriceps muscle weakness and osteoarthritis. (OA) Many of those with chronic ACL deficiency have evidence of knee OA years after ACL rupture. 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 maladaptations after ACL reconstruction in a population at great risk for the development of knee OA. Eighty individuals with ACL rupture who are scheduled for surgery will be randomly assigned to a group that includes a form of neuromuscular training called perturbation training, or a standard group. They will be evaluated before and after surgery using motion analysis and radiography, in vivo measures of kinematics, kinetics, tibial translation and EMG based models of joint compression will be used for comparison. This randomized trial is designed to demonstrate that, after preoperative rehabilitation that includes perturbation training, non-copers will: 1) demonstrate movement and muscle firing patterns that are characteristic of those with dynamic stability, 2) these changes will persist after reconstruction and 3) training induced changes in movement and muscle firing patterns will result in better functional outcomes after reconstruction. The information derived from this project will provide valuable insight into the management of the approximately 100,000 Americans who rupture their ACL's each year and undergo reconstructive surgery. More importantly, if pre-operative perturbation training can facilitate both improved patient outcomes and a reduction in maladaptions following reconstructive ACL surgery, these findings may have applications for individuals with an extensive range of knee injuries.