Effects of Electromyostimulation on Knee Extensors and Flexors Strength and Steadiness in Older Adults

It is known that electromyostimulation (EMS) alone or superimposed over voluntary contraction (EV) can effectively improve muscle strength. However, the effect of this type of training on the ability to control force production at submaximal levels is unknown. The authors examined the effects of EV training on steadiness in force production of knee extensors and flexors in older adults. Forty participants, including 20 men and 20 women, 60–77 years of age, were randomly allocated into a control group (CG) and an electromyostimulation superimposed over voluntary contraction (EVG) group. The EVG performed 30 bilateral isometric knee extension and flexion contractions per session, 3 training sessions per week, for 6 weeks. The variations in force production, expressed in absolute (standard deviation [SD]) and relative (coefficient of variation [CV]) terms, were assessed in isometric contractions at 5%, 15% and 25% maximal voluntary contraction (MVC) levels. Results indicated that MVC increased in knee extension and flexion in EVG (p < .05) after the training; steadiness CV also improved at 15% MVC in knee flexion (p < .05) but no significant changes were found in knee extension and steadiness SD. The training-induced changes in MVC were not correlated to steadiness CV that might indicate different mechanisms underlying these adaptations.     

Influence of Restricted Vision and Knee Joint Range of Motion on Gait Properties During Level Walking and Stair Ascent and Descent

Because elderly individuals experience marked declines in various physical functions (e.g., vision, joint function) simultaneously, it is difficult to clarify the individual effects of these functional declines on walking. However, by imposing vision and joint function restrictions on young men, the effects of these functional declines on walking can be clarified. The authors aimed to determine the effect of restricted vision and range of motion (ROM) of the knee joint on gait properties while walking and ascending or descending stairs. Fifteen healthy young adults performed level walking and stair ascent and descent during control, vision restriction, and knee joint ROM restriction conditions. During level walking, walking speed and step width decreased, and double support time increased significantly with vision and knee joint ROM restrictions. Stance time, step width, and walking angle increased only with knee joint ROM restriction. Stance time, swing time, and double support time were significantly longer in level walking, stair descent, and stair ascent, in that order. The effects of vision and knee joint ROM restrictions were significantly larger than the control conditions. In conclusion, vision and knee joint ROM restrictions affect gait during level walking and stair ascent and descent. This effect is marked in stair ascent with knee joint ROM restriction.     

膝关节骨性关节炎治疗中的若干问题分析

膝关节骨性关节炎是很多膝关节紊乱疾病恶化后的最常见结局,我们通过分析系统方法主要基本原则在膝关节骨性关节炎治疗中的指导性作用。揭示在医学科学研究中自觉主动运用系统科学方法,可以拓展研究的新思路,在复杂的临床工作中,为膝关节骨性关节炎的治疗提供最佳方案。     

减少医师自卫医学行为的对策研究

根据自卫医学行为产生的原因,减少自卫医学行为有两个思路,一个是减轻医师的法律责任,另一个是化解医师在法律责任下所面临的风险.根据第二个思路,应该采取下面的措施:建立医师责任保险制度;建立医疗责任保险制度;实施医疗风险管理;提高医师个人的执业素养.     

全膝关节置换术后镇痛策略

安全、有效的术后镇痛是全膝关节置换术（total knee replacement,TKR）后各项功能恢复的有力保证,与术后很长一段地间内患者的生活质量息息相关。目前关于TKR术后镇痛策略有多种形式和方法。外周神经阻滞和硬膜外镇痛（epidural control analgesia,CEA）的效果可靠,而外周神经阻滞的术后并发症更少,更为理想。     

Position of compression garment around the knee affects healthy adults’ knee joint position sense acuity

Athletes use compression garments (CGs) to improve sport performance, accelerate rehabilitation from knee injuries or to enhance joint position sense (JPS). The position of CGs around the knee may affect knee JPS but the data is inconsistent. The purpose of the present study was to determine the effects of CG position on healthy adults’ knee joint position sense acuity. In a counterbalanced, single-blinded study, 16 healthy young adults (8 female, age: 25.5 y) performed an active knee joint position-matching task with and without (CON) a below-knee (BK), above-knee (AK), or whole-knee (WK) CG in a randomized order on the dominant (CompDom) or the non-dominant leg (CompNon-Dom). We also determined the magnitude of tissue compression by measuring anatomical thigh and calf cross sectional area (CSA) in standing using magnetic resonance imaging (MRI). Subjects had less absolute repositioning error (magnitude of error) in BK compared with CON condition. On the other hand, the analysis of the direction of error (constant error) revealed that in each condition subjects tended to underestimate the target position (AK, BK and CON: 75%; WK: 94%). In WK condition there was a significantly larger negative error (−2.7 ± 3.4) as compared with CON (−1.6 ± 3.7) condition. There also was less variable error, in WK compared to BK and CON conditions, indicating less variability in their position sense using a WK CG, regardless of the underestimation. CG reduced thigh CSA by 4.5 cm² or 3% and calf CSA by Δ1.3 cm² or 1%. The position of CG relative to the knee modifies knee JPS. The findings helps us better understand how the application of a WK CG may support athletic activities.     

胫骨近端截骨治疗膝关节骨关节炎疗效的影响因素分析

胫骨近端内侧截骨撑开植骨术是治疗膝关节骨关节炎合并膝内翻畸形的有效方法,本文总结分析了患者的年龄、体重指数、术前膝关节间隙改变程度及术后膝关节外翻角度等因素对胫骨近端内侧截骨撑开植骨术的临床结果的影响,并提出相应的处理策略。     

Effects of antagonistic and synergistic muscles’ co-activation on mechanics of activated spastic semitendinosus in children with cerebral palsy

ObjectivesMost activities involve co-activation of several muscles and epimuscular myofascial force transmission (EMFT) can affect their mechanics. This can be relevant for spastic muscles of cerebral palsy (CP) patients. Isometric spastic semitendinosus (ST) forces vs. knee angle (KA-F_ST) data were collected intra-operatively to test the following hypotheses: (i) Inter-antagonistic EMFT elevates F_ST, (ii) changes the shape of KA-F_ST characteristics, (iii) reduces the muscle’s joint range of force exertion (Range-F_ST) and (iv) combined inter-antagonistic and synergistic EMFT further changes those effects.Methods11 limbs of 6 patients with CP (mean (SD) = 7.7 (4.7) years; GMFCS levels = II–IV) were tested in 3 conditions from 120° to full extension: ST activated (I) exclusively, (II) simultaneously with an antagonist, and (III) with added activation of synergists.ResultsCondition II increased F_ST (e.g., peak force = 87.6 N (30.5 N)) significantly (by 33.6%), but condition III caused no further change. No condition changed the muscle’s wide Range-F_ST (100.7° (15.9°)) significantly. Therefore, only the first hypothesis was confirmed.ConclusionsCo-activating its antagonist elevates forces of activated spastic ST substantially, but does not change its joint range of force exertion. Added activation of its synergists causes no further effects. Therefore, EMFT effects in CP can be relevant and need to be tested in other knee flexors.     

Relationships among pain intensity,pain-related distress,and psychological distress in pre-surgical total knee arthroplasty patients: a secondary analysis

The current study aimed to examine the relationships between movement and resting pain intensity, pain-related distress, and psychological distress in participants scheduled for total knee arthroplasty (TKA). This study examined the impact of anxiety, depression, and pain catastrophizing on the relationship between pain intensity and pain-related distress. Data analyzed for the current study (N = 346) were collected at baseline as part of a larger Randomized Controlled Trial investigating the efficacy of TENS for TKA (TANK Study). Participants provided demographic information, pain intensity and pain-related distress, and completed validated measures of depression, anxiety, and pain catastrophizing. Only 58% of the sample reported resting pain >0 while 92% of the sample reported movement pain >0. Both movement and resting pain intensity correlated significantly with distress (r_s = .86, p < .01 and .79, p < .01, respectively). About three quarters to two thirds of the sample (78% for resting pain and 65% for movement pain) reported different pain intensity and pain-related distress. Both pain intensity and pain-related distress demonstrated significant relationships with anxiety, depression, and catastrophizing. Of participants reporting pain, those reporting higher anxiety reported higher levels of distress compared to pain intensity. These findings suggest that anxious patients may be particularly distressed by movement pain preceding TKA. Future research is needed to investigate the utility of brief psychological interventions for pre-surgical TKA patients.     

高频超声对膝关节病变的观察

通过超声对髌上囊、股骨髁间软骨情况、胭窝滑囊、髌腱等膝部结构的观察,评价超声对膝关节病变的辅助诊断、观察疗效的价值。通过高频超声对膝关节肿胀、疼痛病例纽与对照组、病例组治疗前后髌上囊液体、滑膜、股骨髁间软骨、胭窝滑囊积液情况以及髌腱厚度及回声进行对比观察。病例组髌上囊液体及滑膜增厚,股骨髁间软骨多有不同程度改变,胭窝滑...