下体正压跑步机用于膝关节骨关节炎康复
1Department of Rehabilitation,The Fifth Affiliated Hospital of Guangzhou Medical University, 2Experiment Education Model Center of Rehabilitation Medicine,Guangzhou Medical University, 3Department of Physical Medicine and Rehabilitation,Geisinger Health System, 4Department of Rehabilitation Medicine,New York University School of Medicine
Summary
在这里,基于临床医生的观点,我们提出了一个双模型下体正压(LBPP)协议(步行和蹲下模型),除了临床,功能评估方法,包括进一步鼓励膝骨关节炎患者非药物手术干预策略的制定。然而,我们只通过三维步态分析,提出LBPP训练对改善一个患者疼痛和膝关节功能的效果。在今后的研究中,应探讨这种方法的确切和长期影响。
Abstract
在这里,基于临床医生的观点,我们提出了一个双模型下体正压(LBPP)协议(步行和蹲下模型),除了临床,功能评估方法,包括进一步鼓励膝骨关节炎患者非药物手术干预策略的制定。然而,我们只通过三维步态分析,提出LBPP训练对改善一个患者疼痛和膝关节功能的效果。在今后的研究中,应探讨这种方法的确切和长期影响。
Introduction
膝关节骨关节炎(OA)是一种渐进性退行性关节疾病,是世界各地人们疼痛和运动障碍的主要原因1。膝关节OA的特点是骨质和囊肿形成,狭窄的关节间距,和亚孔德拉骨硬化2。这些病理变化使得人们难以进行日常生活的基本活动,如步行、蹲下和上下楼梯3。然而,身体活动被推荐作为一线膝关节OA管理4的重要组成部分。膝关节OA康复的运动干预受多种因素影响:(1)疼痛和膝部结构轻微变化引起的膝关节运动受限;(2)与维持膝关节稳定性有关的肌肉萎缩和肌肉力量下降5;(3)上述原因导致运动减少和身体质量指数(BMI)增加,这进一步增加了膝盖的负担,从而造成恶性循环6。
针对上述问题,体重支持训练系统(BWSTT)已逐步解决骨骼和关节疾病相关的康复问题。近年来,一种新兴的体重支持训练技术被称为下体正压(LBPP)跑步机7。该技术使用腰高充气气球实现正下肢压力,并精确调节气压以调节体重,以实现减肥。该系统还配备了一个跑步平台,可以同时执行跑步机相关的活动,在体重8的控制下。同时,充气外壳中产生的压力对车身提供提升力。由于压力仅略高于大气压力且均匀分布,因此下部身体的力几乎无法察觉。因此,LBPP运行平台提供了更高的舒适度,比传统的BWSTT9更适合长期训练。皮尔等人对32名膝关节OA患者进行了LBPP跑步机干预,结果表明LBPP跑步机能有效缓解膝关节疼痛,改善日常生活功能,并产生大腿肌肉力量增加10.潜在的机制可能与实现有效的膝关节活动有关,同时减少膝关节扭矩11。另一方面,由于膝关节OA患者发病年龄大多在45岁以上,12岁,发病也可能与心肺疾病有关。研究表明,LBPP使人们在心率、血压和耗氧量相对较低的运动中实现步行,实现比全重平式行走更安全、更有效的有氧运动;这种类型的步行是LBPP的另一个优势,相比传统的BWSTT13。
然而,由于该系统在膝关节OA干预中的应用相对较新,目前相对较少的研究极大地限制了该技术在膝关节OA康复中的临床应用。本文提出的LBPP方案旨在探索使用LBPP跑步机的临床非药物和手术膝关节OA治疗。
Protocol
临床项目经广州医科大学第五附属医院医学伦理协会批准,已在中国临床试验注册中心注册(No.ChiCTR1800017677,标题为”膝关节骨关节炎患者下肢运动功能的反重力跑步机的效果和机制” 1. 招聘 在行走、蹲下和/或跪下时,用轻度至中度(Kellgren & Lawrence II 或 III 级)膝盖 OA 的放射学证据招募患者(数字疼痛评分表上的最低等级 3/10 [NPRS]包含之前)。 确保这些患者没有严重的?…
Representative Results
我们展示了一个膝关节OA患者的结果,她是一个60岁的女性(BMI = 22.9),在行走时患有”超过3年的膝骨关节炎”和剧烈疼痛(视觉模拟量表[VAS] = 8/10),并参加了我们为期2周的LBPP训练计划。设施。在整个干预过程中,患者没有服用任何止痛药来缓解膝关节疼痛。图3和表1显示了她膝关节的放射图像和临床功能评估结果。 10 MWT 从培训前的 4.1 s 下降到培训?…
Discussion
我们提出了一种LBPP跑步机干预方案,包括临床评估和治疗模型,用于膝下OA下肢运动功能的恢复。同时,针对临床症状和膝关节OA功能障碍,治疗模式不仅包括LBPP协议中行走的训练部分,还包括一个创新的蹲下训练部分,旨在解决日常功能障碍。大腿肌肉无力和蹲下困难在膝盖OA患者。据我们所知,此协议是首次在膝OA患者中使用非重量技术进行蹲下运动方案。
该协议的设计基于五个要…
Disclosures
The authors have nothing to disclose.
Acknowledgements
这项研究由广州医科大学资助(助学金号2018A053)。
Materials
| AlterG Anti-Gravity Treadmill M320 | AlterG Inc, Fremont, CA, USA | 1 | LBBP training |
| BTS Smart DX system | Bioengineering Technology System, Milan, Italy | 2 | Temporospatial data collection |
| BTS FREEEMG | Bioengineering Technology System, Milan, Italy | 3 | Surface EMG data collection |
| BTS SMART-Clinic software | Bioengineering Technology System, Milan, Italy | 4 | Data processing |
References
- McAlindon, T. E., et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 22, 363-388 (2014).
- Luyten, F. P., Denti, M., Filardo, G., Kon, E., Engebretsen, L. Definition and classification of early osteoarthritis of the knee. Knee Surgery Sports Traumatology Arthroscopy. 20, 401-406 (2012).
- Lankhorst, G. J., Van de Stadt, R. J., Van der Korst, J. K. The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee. Scandinavian Journal of Rehabilitation Medicine. 17, 167-172 (1985).
- Waugh, E., et al. Physical activity intervention in primary care and rheumatology for the management of knee osteoarthritis: A review. Arthritis Care & Research. 71 (2), 189-197 (2019).
- Segal, N. A., et al. Effect of quadriceps strength and proprioception on risk for knee osteoarthritis. Medicine & Science in Sports & Exercise. 42, 2081 (2010).
- Linda, F., et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Annals of the Rheumatic Diseases. 72, 1125-1135 (2013).
- Watanabe, S., Someya, F. Effect of Body Weight-supported Walking on Exercise Capacity and Walking Speed in Patients with Knee Osteoarthritis: A Randomized Controlled Trial. Journal of the Japanese Physical Therapy Association. 16, 28-35 (2013).
- Takacs, J., Anderson, J. E., Leiter, J. R., MacDonald, P. B., Peeler, J. D. Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis?. Clinical Interventions in Aging. 8, 983-991 (2013).
- Ruckstuhl, H., Kho, J., Weed, M., Wilkinson, M. W., Hargens, A. R. Comparing two devices of suspended treadmill walking by varying body unloading and Froude number. Gait & Posture. 30, 446-451 (2009).
- Peeler, J., Christian, M., Cooper, J., Leiter, J., MacDonald, P. Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength. Clinical Journal of Sport Medicine. 25, 518-523 (2015).
- Patil, S., et al. Anti-gravity treadmills are effective in reducing knee forces. Journal of Orthopaedic Research. 31, 672-679 (2013).
- Nicolas-Alonso, L. F., Gomez-Gil, J. Brain computer interfaces, a review. Sensors (Basel). 12, 1211-1279 (2012).
- Webber, S. C., Horvey, K. J., Yurach Pikaluk, M. T., Butcher, J. S. Cardiovascular responses in older adults with total knee arthroplasty at rest and with exercise on a positive pressure treadmill. European Journal of Applied Physiology. 114, 653-662 (2014).
- Dolphin, N. W., Crue, B. L. Pain: Clinical Manual For Nursing Practice. Clinical Journal of Pain. 5, 363 (1989).
- Lavernia, C., D’Apuzzo, M., Rossi, M. D., Lee, D. Accuracy of Knee Range of Motion Assessment After Total Knee Arthroplasty. The Journal of Arthroplasty. 23, 85-91 (2008).
- Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., Stitt, L. W. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. Journal of Rheumatology. 15, 1833-1840 (1988).
- Collins, N. J., Misra, D., Felson, D. T., Crossley, K. M., Roos, E. M. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) Knee O. Arthritis Care & Research. 63, S208-S228 (2011).
- Rabin, R., De-Charro, F. EQ-5D: a measure of health status from the EuroQol Group. Annals of Medicine. 33, 337-343 (2001).
- Wirz, M., et al. Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial. Archives of Physical Medicine and Rehabilitation. 86, 672-680 (2005).
- Shumway-Cook, A., Baldwin, M., Polissar, N. L., Gruber, W. Predicting the probability for falls in community-dwelling older adults. Physical Therapy. 77, 812-819 (1997).
- Iii, R. B. D. A gait analysis data collection and reduction technique. Human Movement Science. 10, 575-587 (1991).
- Peeler, J., Ripat, J. The effect of low-load exercise on joint pain, function, and activities of daily living in patients with knee osteoarthritis. Knee. 25 (1), 135-145 (2018).
- Escamilla, R. F. Knee biomechanics of the dynamic squat exercise. Medicine & Science in Sports & Exercise. 33, 127-141 (2001).
- Linschoten, R. V., et al. The PEX study – Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749]. BMC Musculoskeletal Disorders. 7, 31 (2006).
Cite This Article
Liang, J., Guo, Y., Zheng, Y., Lang, S., Chen, H., You, Y., O’Young, B., Ou, H., Lin, Q. The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation. J. Vis. Exp. (149), e59829, doi:10.3791/59829 (2019).