ارزیابی تأثیر یک نوع ارتز جدید زانو بر فعالیت الکترومایوگرافی عضلات فلکسور و اکستانسور زانو در افراد مبتلا به استئوآرتریت زانو در هنگام راه رفتن

نوع مقاله: مقاله پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد فیزیوتراپی، گروه فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی اصفهان، ایران

2 استادیار گروه فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی اصفهان، ایران

3 دانشیار، گروه ارتوپد فنی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شیراز، ایران

چکیده

مقدمه و اهداف
امروزه استئوآرتریت یکی از شایع‌ترین علل ناتوانی در افراد مسن می‌باشد. بیماران مبتلا به استئوآرتریت سمت داخلی زانو اغلب بی‌ثباتی زانو، احساس چین­خوردگی و خالی شدن زانو هنگام راه رفتن را تجربه می‌کنند که منجر به افزایش فعالیت عضلات می‌ شود. هدف از مطالعه حاضر، بررسی اثر ارتز جدید زانو بر فعالیت عضلات اندام تحتانی، در حین راه رفتن در افراد مبتلا به استئوآرتریت زانو می­باشد.
مواد و روش­ ها
تعداد 10 نفر از بیماران مبتلا به استئوآرتریت زانو با میانگین سنی (6/5±1/56 سال) در مطالعه حاضر شرکت کردند. شرکت­کنندگان 7 مرتبه با ارتز و 7 مرتبه بدون ارتز با سرعت دلخواه راه رفتند. فعالیت عضلات اندام تحتانی با استفاده از دستگاه الکترومایوگرافی سطحی ثبت گردید. برای تجزیه و تحلیل داده­ها از آزمون آماری تی-زوجی با سطح معناداری 05/0 استفاده شد.
یافته ­ها
میانگین و انحراف استانداردشدت درد (05/0=(P و فعالیت عضلات در وضعیت راه رفتن با ارتز نسبت به وضعیت بدون ارتز به صورت معناداری کاهش یافت. اگرچه مدت زمان اجرای تست حرکت عملکردی (88/0=(P و سرعت راه رفتن (34/0=(P با ارتز و بدون ارتز تفاوت معناداری نشان ندادند.
نتیجه­گیری
به نظر می­رسد که ارتز جدید زانو در نتیجه ایجاد ثبات مکانیکی در زانو، شدت درد و میزان فعالیت عضلات را در افراد مبتلا به استئوآرتریت زانو کاهش می­دهد.
 

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Effects of the New Type of Knee Orthosis on EMG Activity of Knee Extensor and Flexor Muscles in People with Knee Osteoarthritis during Walking

نویسندگان [English]

  • Soheila Yazdani 1
  • Hamid Azadeh 2
  • Mohammad Taghi Karimi 3
1 MSc in Physiotherapy Student, Department of Physiotherapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Physiotherapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
3 Associate Professor, Department of Ortosis and Prosthesis, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
چکیده [English]

Background and Aim: Osteoarthritis is one of the most common causes of disability in the elderly. Patients with medial knee osteoarthritis frequently experience knee instability, the sensation of buckling, and giving way that increase muscle activity. The objective of the present study was to assess the effect of a new type of knee orthosis on the muscle activity of the lower limb muscles in medial knee osteoarthritis patients during gait.
Materials and Methods: A total of 10 patients with knee Osteoarthritis (mean age 56.1± 5.6 years) participated in the current research project. The participants walked at their self-selected speed to perform 7 trials with knee orthosis and 7 trials without knee orthosis. The activity of the lower limb muscles was recorded using the surface electromyographic system. The paired t-tests with a significance level of 0.05 were run for the final analysis.
Results:The mean and standard deviation values of the root-mean-square and pain severity (P= 0/05) decreased significantly while walking with the orthosis compared to those without orthosis condition, although differences were not significant for walking speed (P= 0/34) and time taken to perform the timed up and go test (P= 0/8) during gait with and without the orthosis.
Conclusion: According to the results of the current study, it seems that the new design of the knee orthosis has a significant effect on severity of pain and reduction of the muscle activation in individuals with knee osteoarthritis due to mechanical stabilization of the knee offered by the brace.

کلیدواژه‌ها [English]

  • knee osteoarthritis
  • knee orthosis
  • gait analysis
  • surface Electromyography
  1. Liddle AD, Pegg EC, Pandit H. Knee replacement for osteoarthritis. Maturitas. 2013;75(2):131-6.##
  2. Karimi MT, Esrafilian A, Eshraghi A. Design and Evaluation of a New Type of Knee Orthosis to Align the Mediolateral Angle of the Knee Joint with Osteoarthritis. advances in orthopedics. 2012;201. ##
  3. McWilliams D, Leeb B, Muthuri S, Doherty M, Zhang W. Occupational risk factors for osteoarthritis of the knee: a meta-analysis. Osteoarthritis and Cartilage. 2011;19(7):829-39. ##
  4. Raja K, Dewan N. Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review. American journal of physical medicine & rehabilitation. 2011;90(3):247-62. ##
  5. Hinman RS, Bardin L, Simic M, Bennell KL. Medial arch supports do not significantly alter the knee adduction moment in people with knee osteoarthritis. Osteoarthritis and Cartilage. 2012##
  6. Fantini Pagani CH, Willwacher S, Kleis B, Brüggemann G-P. Influence of a valgus knee brace on muscle activation and co-contraction in patients with medial knee osteoarthritis. Journal of Electromyography and Kinesiology. 2012;23(2):490-500. ##
  7. Ramsey DK, Snyder Mackler L, Lewek M, Newcomb W, Rudolph KS. Effect of anatomic realignment on muscle function during gait in patients with medial compartment knee osteoarthritis. Arthritis Care & Research. 2007;57(3):389-97. ##
  8. Luksurapan W, Boonhong J. Effects of phonophoresis of piroxicam and ultrasound on symptomatic knee osteoarthritis. Archives of physical medicine and rehabilitation. 2012;94:250-5. ##
  9. Laufer Y, Dar G. Effectiveness of thermal and athermal short-wave diathermy for the management of knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis and Cartilage. 2012;20(9):957-66. ##
  10. Ramsey DK, Briem K, Axe MJ, Snyder-Mackler L. A mechanical theory for the effectiveness of bracing for medial compartment osteoarthritis of the knee. J Bone Joint Surg Am. 2007;89(11):2398-407. ##
  11. Toriyama M, Deie M, Shimada N, Otani T, Shidahara H, Maejima H, et al. Effects of unloading bracing on knee and hip joints for patients with medial compartment knee osteoarthritis. Clinical Biomechanics. 2011;26(5):497-503. ##
  12. Rudolph KS, Schmitt LC, Lewek MD. Age-related changes in strength, joint laxity, and walking patterns: are they related to knee osteoarthritis? Physical therapy. 2007;87(11):1422-32. ##
  13. Karimi M, Saljoghian P, Fatoye F. The Effectiveness of a Newly Designed Orthosis on Knee Contact Forces in Subjects with Knee Osteoarthritis. Ortopedia, Traumatologia, Rehabilitacja. 2015;17(3):259-63. ##
  14.  Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K. development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria committee of the American rheumatism association. Arthritis Rheum. 1986;29(8):1039-49. ##
  15. Kellgren J, Lawrence J. Radiological assessment of osteo-arthrosis. Annals of the rheumatic diseases. 1957;16(4):494-502. ##
  16. Rutherford DJ, Hubley-Kozey CL, Stanish WD. Changes in knee joint muscle activation patterns during walking associated with increased structural severity in knee osteoarthritis. Journal of Electromyography and Kinesiology. 2013;23(3):704-11. ##
  17. Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clinical Biomechanics. 2009;24(10):833-41. ##
  18. Schmitt LC, Rudolph KS. Influences on knee movement strategies during walking in persons with medial knee osteoarthritis. Arthritis Care & Research. 2007;57(6):1018-26. ##
  19. Lewek MD, Rudolph KS, Snyder-Mackler L. Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis. Osteoarthritis and Cartilage. 2004;12(9):745-51. ##
  20. Rutherford DJ, Hubley-Kozey CL, Stanish WD, Dunbar MJ. Neuromuscular alterations exist with knee osteoarthritis presence and severity despite walking velocity similarities. Clinical Biomechanics. 2011;26(4):377-83. ##
  21. Astephen Wilson J, Deluzio K, Dunbar M, Caldwell G, Hubley-Kozey C. The association between knee joint biomechanics and neuromuscular control and moderate knee osteoarthritis radiographic and pain severity. Osteoarthritis and Cartilage. 2011;19(2):186-93. ##
  22. Hubley-Kozey C, Deluzio K, Dunbar M. Muscle co-activation patterns during walking in those with severe knee osteoarthritis. Clinical Biomechanics. 2008;23(1):71-80. ##
  23. Hubley-Kozey C, Deluzio K, Landry S, McNutt J, Stanish W. Neuromuscular alterations during walking in persons with moderate knee osteoarthritis. Journal of Electromyography and Kinesiology. 2006;16(4):365-78. ##
  24. Hubley-Kozey CL, Hill NA, Rutherford DJ, Dunbar MJ, Stanish WD. Co-activation differences in lower limb muscles between asymptomatic controls and those with varying degrees of knee osteoarthritis during walking. Clinical Biomechanics. 2009;24(5):407-14. ##
  25. Zeni JA, Rudolph K, Higginson JS. Alterations in quadriceps and hamstrings coordination in persons with medial compartment knee osteoarthritis. Journal of Electromyography and Kinesiology. 2010;20(1):148-54. ##
  26. Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ, Hubley-Kozey CL. Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels. Journal of Biomechanics. 2008;41(4):868-76. ##
  27. Lynn SK, Costigan PA. Effect of foot rotation on knee kinetics and hamstring activation in older adults with and without signs of knee osteoarthritis. Clinical Biomechanics. 2008;23(6):779-86. ##
  28. Hinman RS, Bennell KL, Metcalf BR, Crossley KM. Delayed onset of quadriceps activity and altered knee joint kinematics during stair stepping in individuals with knee osteoarthritis. Archives of physical medicine and rehabilitation. 2002;83(8):1080-6. ##
  29. Draper E, Cable J, Sanchez-Ballester J, Hunt N, Robinson J, Strachan R. Improvement in function after valgus bracing of the knee. Bone & Joint Journal. 2000;82(7):1001-5. ##
  30. Pollo FE, Otis JC, Backus SI, Warren RF, Wickiewicz TL. Reduction of medial compartment loads with valgus bracing of the osteoarthritic knee. The American Journal of Sports Medicine. 2002;30(3):414-21. ##
  31. Knopf E. Analysis of biomechanical effectiveness of valgus-inducing knee brace for osteoarthritis of knee. journal of rehabilitation research and develpment. 2010;47(5):419-29. ##
  32. Reeves N, Bowling F. Conservative biomechanical strategies for knee osteoarthritis. Nature Reviews Rheumatology. 2011;7(2):113-22. ##
  33. Arnold CM, Faulkner RA. The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis. BMC geriatrics. 2007;7(1):17. ##
  34. bohannon RW. Reference values for the timed up and go test: a descriptive meta-analysis. Journal of Geriatric Physical Therapy. 2006;29(2):64-8. ##
  35. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. journal of the American geriatrics Society. 1991;39(2):142-8##.