Vpliv transkutane električne živčne stimulacije na artrogeno inhibicijo štiri glave stegenske mišice : diplomsko delo

Navodnik, Simon (author), Rugelj, Darja (mentor), Weber, Daša (co-mentor)

Uvod: Artrogena inhibicija štiri glave stegenske mišice je zaščitni mehanizem pri okvarah kolenskega sklepa. Opisuje nezmožnost popolne aktivacije mišice zaradi zmanjšanega priliva iz motoričnega sistema. Dolgotrajna inhibicija pa lahko postane omejitveni dejavnik v rehabilitaciji, saj je lahko vzrok za dolgotrajno šibkost mišice. Predvideva se, da je transkutana električna živčna stimulacija učinkovita dezinhibitorna intervencija, ki bi naj dezinhibirala vzdražnost motoričnih nevronov štiri glave stegenske mišice. Namen: Namen diplomskega dela je bil ugotoviti učinke transkutane električne živčne stimulacije na artrogeno mišično inhibicijo štiri glave stegenske mišice. Metode dela: Uporabili smo deskriptivno metodo s pregledom literature. Literaturo smo iskali v elektronskih podatkovnih zbirkah PubMed, PEDro in ScienceDirect preko oddaljenega dostopa. Pri iskanju smo uporabili naslednje ključne besede: »arthrogenous muscle inhibition« or »muscle inhibition« and »transcutaneous electrical nerve stimulation« and »knee« or »quadriceps«. Vključili smo članke, objavljene po letu 2000. Rezultati: V analizo smo vključili pet raziskav. V dveh raziskavah je bila artrogena mišična inhibicija prisotna zaradi tibiofemoralne osteoartroze, v eni raziskavi zaradi pretrganja sprednje križne vezi, v preostalih dveh pa je bila inhibicija posledica eksperimentalno povzročene bolečine oz. otekline v kolenskem sklepu. V treh raziskavah so merili takojšne učinke TENS-a pri enkratni uporabi, v dveh raziskavah pa so merili vpliv TENS-a v kombinaciji z vadbo po večtedenski uporabi. Pri štirih raziskavah so izmerili statistično pomembno zmanjšanje artrogene inhibicije štiri glave stegenske mišice po uporabi TENS-a v primerjavi s kontrolno skupino. Samo v eni raziskavi, kjer so pacienti s pretrgano sprednjo križno vezjo opravili dvotedenski terapevtski program, ni bilo razlike v primerjavi s kontrolno skupino, artrogena mišična inhibicija se je podobno zmanjšala v obeh skupinah. Razprava in zaključek: Rezultati sistematičnega pregleda literature nakazujejo, da je TENS za zmanjšanje artrogene mišične inhibicije pri različnih okvarah kolenskega sklepa uspešen tako po enkratni aplikaciji kot po večtedenskem terapevtskem programu, kjer je kombiniran s terapevtsko vadbo. Za doseganje najboljših možnih izidov pri rehabilitaciji pacientov z okvarami kolenskega sklepa bi bilo smiselno izvesti še nadaljnje raziskave, kjer bi se morali osredotočiti na optimalno trajanje terapevtskega programa, ki vključuje uporabo TENS-a.

• Language: Slovenian
• Keywords: artrogena mišična inhibicija, transkutana električna živčna stimulacija, kolenski sklep, centralna aktivacija
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-112616
• COBISS.SI-ID: 5720171
• Publication date in RUL: 26.10.2019

Secondary language

• Language: English
• Title: Effects of transcutaneous electric nerve stimulation on arthrogenic muscle inhibition of quadriceps : diploma work

Abstract

Introduction: Quadriceps arthrogenic muscle inhibition is a protective mechanism in knee joint pathology. It describes the inability to fully activate the muscle due to the reduced input from the motor system. Long-term inhibition can become a limiting factor in rehabilitation as it may be a cause of long-term muscle weakness. One of the major disinhibitory interventions is thought to be transcutaneous electrical nerve stimulation, which is expected to disinhibit the quadriceps motor neuron pool excitability. Purpose: The purpose of diploma work was to determine the effects of transcutaneous electrical nerve stimulation on quadriceps arthrogenic muscle inhibition. Methods: We used a descriptive method with a literature review. We searched the literature in the electronic databases PubMed, PEDro, and ScienceDirect via remote access. We searched for the following keywords: »arthrogenous muscle inhibition« or »muscle inhibition« and »transcutaneous electrical nerve stimulation« and »knee« or »quadriceps«. We only included articles after year 2000. Results: We included 5 studies in the analysis. In two studies, arthrogenic muscle inhibition was present due to tibiofemoral osteoarthritis, in one study due to anterior cruciate ligament rupture, and in the other two the inhibition was due to experimentally induced pain and swelling in the knee joint. Three studies measured the immediate effects of single-use TENS, and two studies measured effects of TENS in combination with exercise after several weeks of use. Four studies measured a statistically significant decrease in quadriceps arthrogenic inhibition after TENS compared to the control group. In only one study, where patients with a torn anterior cruciate ligament underwent a two-week therapy program, there was no difference in muscle inhibition compared to the control group. Discussion and conclusion: Results of a systematic review of the literature suggest that TENS is successful for reducing arthrogenic muscle inhibition in various pathologies in knee joint. TENS has positive effects on inhibition both after a single application and after a several-week therapeutic program where it is combined with therapeutic exercise. In order to achieve the best possible outcomes in the rehabilitation of patients with knee pathologies, further research should be conducted.

• Keywords: arthrogenic muscle inhibition, transcutaneous electrical nerve stimulation, knee joint, central activation