NMES for Older Individuals After Total Knee Arthroplasty

由于疾病或受伤而导致的肌肉力量下降通常会导致老年人丧失功能和独立性。失能老年人肌肉力量和功能的恢复是康复中的一个重大挑战。肌无力的病因与损伤或年龄是充分阐明。旨在最大限度地提高年轻人的力量增益的训练计划在老年人中可能不是最佳的，因为年轻人与老年人的虚弱原因和肌肉形态可能不同。这项工作的总体目标是确定基于生理和形态的康复计划是否比传统康复更有效地对抗老年人肌肉力量和功能的变化。神经肌肉电刺激（NMES）可用于改善受伤或手术后的力量和功能。本研究为探索NMES在老年人中的应用提供了动力。我们认为，使用NMES来增强全膝关节置换术（TKA）后骨关节炎老年患者的传统康复计划，将比仅使用传统康复获得更大的力量和功能增益。接受TKA的骨关节炎老年患者是测试康复计划有效性的理想受试者，这些患者几乎总是表现出明显的股四头肌无力，对传统的身体康复有抵抗力。 在美国，每年有超过300，000例TKA用于治疗老年人的膝关节骨关节炎。神经肌肉电刺激（NMES）可用于改善受伤或手术后的力量和功能。本研究为探索NMES在老年患者中的应用提供了动力。我们认为，与仅使用传统康复方法相比，使用NMES加强全膝关节置换术（TKA）后骨关节炎老年患者的传统康复方案将获得更大的力量和功能增益。接受TKA的骨关节炎老年患者是测试康复计划有效性的理想受试者，这些患者几乎总是表现出明显的股四头肌无力，对传统的身体康复有抵抗力。在美国，每年有超过300，000例TKA用于治疗老年人的膝关节骨关节炎。因此，老年患者TKA术后的康复治疗是一个重要而具有挑战性的问题。本提案的具体目的是：1）评估高水平神经肌肉电刺激作为持续强化早期康复的辅助手段在恢复股四头肌力量和改善初次TKA后的功能结局方面的有效性，以及2）确定改善股四头肌力量和功能结局的生理和形态学基础。

Reduced muscle strength from illness or injuries often leads to loss of function and independence in the elderly. The recovery of muscle strength and function in disabled elderly individuals is a major challenge in rehabilitation. The etiology of the muscle weakness with injury or age is fully elucidated. Training programs designed to maximize strength gains in young individuals may not be optimal in the elderly because the cause of the weakness and the morphology of the muscle may be different for young vs. old people. The overall goal of this work is to determine if physiologically and morphologically based rehabilitation programs are more effective than traditional rehabilitation to counter changes in muscle strength and function in older individuals. Neuromuscular electrical stimulation (NMES) may be used to improve strength and function following injury or surgery. This study provides motivation for exploring the use of NMES with the elderly. We posit that using NMES to augment a traditional rehabilitation program for elderly patients with osteoarthritis following total knee arthroplasties (TKA) will result in greater strength and functional gains than using only traditional rehabilitation. Elderly patients with osteoarthritis who undergo TKAs serve as ideal subjects for testing the effectiveness of rehabilitation programs become those patients almost always exhibit marked quadriceps weakness that is resistant to traditional physical rehabilitation. More than 300,000 TKAs are performed each year in the United States to treat osteoarthritis of the knee in older individuals. Neuromuscular electrical stimulation (NMES) may be used to improve strength and function following injury or surgery. This study provides motivation for exploring the use of NMES with the elderly, We posit that using NMES to augment a traditional rehabilitation program for elderly patients with osteoarthritis following total knee arthroplasties (TKA) will result in greater strength and functional gains than using only traditional rehabilitation. Elderly patients with osteoarthritis who undergo TKAs serve as ideal subjects for testing the effectiveness of rehabilitation programs become those patients almost always exhibit marked quadriceps weakness that is resistant to traditional physical rehabilitation. More than 300,000 TKAs are performed each year in the United States to treat osteoarthritis of the knee in older individuals. So, the successful rehabilitation of elder patients following TKA is an important and challenging problem. The specific aims of this proposal are: 1) To assess the effectiveness of high-level neuromuscular electrical stimulation is an adjunct to ongoing intensive, early rehabilitation in restoring quadriceps strength and improving the functional outcome after primary TKA, and 2) To identify the physiological and morphological bases for improvements in quadriceps strength and functional outcome.