Role of muscle strength affecting dynamic balance ability for subjects with knee osteoarthritis...
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Transcript of Role of muscle strength affecting dynamic balance ability for subjects with knee osteoarthritis...
Role of muscle strength affecting Role of muscle strength affecting dynamic balance ability for dynamic balance ability for
subjects with knee osteoarthritis subjects with knee osteoarthritis
Reporter: Chao-jung HsiehSupervisor: Sai-wei Yang
Date: 2007/10/29
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OutlineOutline
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• Introduction Knee osteoarthritis Literature review
• Materials and methods Participants Experimental procedure
IntroductionIntroductionKnee osteoarthritis (OA) is one of major problems in the elderly
Knee OA, rather than any other joint, is more likely to cause disability Davis 1998
In Taiwan, the prevalence of OA ranges from 5.1% to 6.3% Chou et al 1994
It is defined as a degenerative condition that lead to joint symptoms and signs which is associated with defective integrity of articular cartilage, in addition to related changes in the underlying bone and at the joint margins
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Classification of osteoarthritis• The Kellgren-Lawrence scale
The severity of articular cartilage changes of OA by radiographs
Patellofemoral joint space narrowing
Presence of osteophytes
Kellgren-Lawrence Scale 0 No osteophytes
1 Doubtful osteophytes
2 Minimal osteophytes, possible narrowing, cysts, and sclerosis
3 Moderate or definite osteophytes with moderate joint space narrowing
4 Severe with large osteophytes and definite joint space narrowing
Knee OsteoarthritisKnee Osteoarthritis
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71% ~ 91% of total joint load is transmitted through the medial compartment of knee joint
Maly 2002
The symptoms include:Joint stiffnessPainDeterioration of coordination
BalanceBalance
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• Static balance• Dynamic balance
DeOreo 1980
• Evaluation / Training of dynamic balance is effective for improving the postural control ability
Shumway-Cook 2000
Steadiness- trajectory of center of pressure Symmetry- ratio of weight-bearingDynamic stability- functional tests
Niam 1999
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Postural controlPostural control• Difficulty in squatting, kneeling, and rising from a chair • Avoidance of pain associated with limb loading and decline in postural control ability Bennell 2003; Na 2003
Postural controlPostural control
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• Individuals with knee OA demonstrate Significantly more postural sway than the age-matched group Wegener 1997; Kul-Panza 2006 Balance deficits in clinical tests Hinman 2002
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Muscle controlMuscle control• Effective control of balance rely not only accurate sensory input but also a timely response of strong muscles• Subjects with knee OA revealed
Quadriceps are weak with delayed activation when walking
Birmingham 2001
The lower extremity muscular strength is reduced
Kaufman 2001
Increased hamstring muscle activation while executing activities of daily life Hortobagyi 2005
•Knee and hip weakness are related to poor balance and a
greater risk of falling
Robbins 1989
PurposePurpose
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• To investigate the relationship between muscle strength and dynamic balance among subjects with knee OA • To determine the role that severity of knee pain play in the ability to maintain balance
Materials and methodsMaterials and methods
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• ParticipantsThirty subjects with bilateral knee osteoarthritis, as well as a group of thirty controls
• Eligibility criteria Age over 40 years oldNo other disease of lower extremity
• Exclusion criteriaReceiving any surgeries of lower extremityHaving severe medical illnesses that affected the subject’s ability to perform sustained activities
Experimental procedureExperimental procedure
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• Basic data measurements• Dynamic balance• Muscular strength• Knee pain
Basic data measurementsBasic data measurements
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• Descriptive data AgeGender Height Weight Physical activity levelHealth condition
• Berg Balance Score (BBS)
Dynamic balanceDynamic balance
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• Dynamic perturbation system (Stewart platform) Sinusoidal angular rotation with 10°at 0.3Hz/0.6Hz Antonio 2000; Yang 2001
• The footscan system (Rsscan International Co., Belgium)
Dynamic balanceDynamic balance
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• Center of pressure (CoP)Total travelled wayEllipse areaMaximal AP/ML distanceRatio of weight bearing
Pitch Row
Muscular strengthMuscular strength
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• Isokinetic dynamometer• Frontal plane
Hip abduction/adductionAnkle eversion/inversion
• Sagittal planeKnee flexion/extensionAnkle plantar-flexion/ dorsi-flexion
• Electromyography
Muscular strengthMuscular strength
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• Peak torque• Power
• Latency of muscle firingWhipple 1987; Toole 2000; Carmeli 2002
N-M
Time
Hocherman 1984
Knee painKnee pain
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• Visual analogue scale (VAS) • Lequesne index • Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
ReferencesReferences
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• Whipple RH, Wolfson LI, Amerman PM(1987)The relationship of knee and ankle weakness to falls in nursing home residents: An isokinetic study. JAGS. 35:13-20• Wegener L, Carolyn K, Nichols D(1997)Static and dynamic balance responses in persons with bilateral knee osteoarthritis. JOSPT. 25:13-18• Jadelis K, Miller ME, Ettinger WH and Messier SP(2001)Strength, balance, and the modifying of obesity and knee pain. J Am Geriatr Soc. 49:884-891• Yelin EH, Felts WR. (1990) A summary of the impact of musculoskeletal conditions in the United States. Arthritis Rheum, 33:750-5• Birmingham TB, Kramer JF, Kirkley A, et al.(2001)Knee brace for medial compartment osteoarthritis: effect on proprioception and postural control. Rheumatology, 40:285-289• Kul-Panza E, Berker N(2006) Pedobarographic findings in patients with knee osteoarthritis . Am J Phys Med Rehab,85:228-233• Jadelis K, Miller ME, Ettinger WH, et al.(2001) Strength, balance and the modifying effects of obesity and knee pain: results from the Observational Arthritis Study in Seniors (OASIS). J Am Geriatr Soc,49:884-891
Center of pressureCenter of pressure
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• Center of pressure (CoP)Trajectory of body center of mass over the supportMovements of CoP are indicators of stability
Alexander 1994