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Schnurrer-Luke-Vrbanić, Tea; Ravlić-Gulan, Jagoda
Medicina Fluminensis, 09/2020, Volume: 56, Issue: 3Journal Article, Paper
Cilj: Istražiti jesu li nakon ozljede prednjeg križnog ligamenta koljena aktivni mehanizmi stabilizacije zgloba, potaknuti vježbama propriocepcije i ravnoteže tijekom programa rehabilitacije, dovoljni za uspostavljanje normalne funkcije zgloba, praćenjem živčano-mišićne kontrole na nestabilnoj podlozi u ranim razdobljima od ozljede, odnosno operacije rekonstrukcije prednjeg križnog ligamenta (od 1 mjesec do 1 godine). Ispitanici i metode: U kliničko istraživanje bilo je uključeno 53 ispitanika s ozljedom prednjeg križnog ligamenta (PKL) koljena, liječenih konzervativno/operacijski. Svi su nakon ozljede/operacije proveli rehabilitacijski program s naglaskom na vježbama na nestabilnoj podlozi za poticanje živčano-mišićne koordinacije i ravnoteže. Statičku i dinamičku stabilnost pratili smo i mjerili aparatom SportKAT 2000. Usporedbu rezultata vršili smo prema usporedbenoj skupini zdravih ispitanika i/ili prema zdravom ekstremitetu istog ispitanika. Rezultati: Koristeći se Sport KAT metodom, pronašli smo disfunkciju neuromišićne kontrole u održavanju statičke i dinamičke stabilnosti zgloba i ravnoteže u promatranim skupinama pacijenata određivanjem statičkih i dinamičkih ravnotežnih indeksa. Vježbe živčano-mišićne koordinacije, kao dio rehabilitacijskog protokola nakon ozljede PKL-a koljena, vrlo brzo dovode do poboljšanja obaju ravnotežnih indeksa (p < 0,001), u obje skupine pacijenata. No, ako se navedene vježbe svakodnevno ne izvode, dinamički ravnotežni indeks pogoršava se u neoperiranoj skupini, dok se nakon operacijske stabilizacije zgloba uspostavlja „normalizacija” ravnoteže (p < 0,001). Zaključak: S ciljem rehabilitacije neurosenzoričkih i propriocepcijskih oštećenja nastalih nakon ozljede PKL-a koljena liječenih konzervativno/operacijski, potrebno je koristiti vježbe koje stimuliraju dinamičke stabilizatore zgloba, preko mehanizama neuromišićne ko-kontrakcije tijekom održavanja ravnoteže. Spomenuto predstavlja znanstveni doprinos ovog rada s naglašavanjem važnosti živčano-mišićne koordinacije u rehabilitaciji donjeg ekstremiteta pri održavanju stabilnosti zglobova. Aim: To evaluate if the restoration of neuromuscular coordination in knee ACL-injured patients could be estimated by the stimulation of neuromuscular control during the rehabilitation or if operative stabilisation should be performed previously. The study had to examine a short-term and long-term efficiency by monitoring the indicators of joint functionality in the early stages, from one month to one year after the injury/operation. Patients and methods: We analysed 53 ACL-injured patients treated operatively and non-operatively. All the patients underwent a functional rehabilitation programme with balance exercises. The measuring of static and dynamic balance on SportKAT 2000 device was performed, and the results were compared with the healthy subjects and the healthy limb of the same subject. Results: Measuring the static and dynamic balance indexes, a dysfunction of neuromuscular control was found in the maintenance of balance in the patient groups. Exercises that included stimulation of the neuromuscular coordination, as a part of the rehabilitation procedure following ACL injuries, soon lead to an improvement of both balance indexes (p<0,001) in both groups, however, no long term impact was noted in non-operatively treated group. Namely, if the above exercises are not conducted on a regular daily basis, the balance indexes will deteriorate. Contrary, after the operative joint stabilization the balance indexes tend to improve to the ‘normal’ balance (p<0,001). Conclusion: In order to restore dynamic stabilization of the joint in ACL injured patients, exercises stimulating the neuromuscular mechanisms are necessary. This suggests the importance of neuromuscular coordination in the rehabilitation of the lower extremity while maintaining joint stability, which represents the scientific contribution of this paper.
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