Joost Dekker PhD Department of Psychiatry & Department of Rehabilitation Medicine VU University...
25
Joost Dekker PhD Department of Psychiatry & Department of Rehabilitation Medicine VU University Medical Center, Amsterdam, Netherlands Knikkende knieën Over instabiliteit en loopvaardigheid bij artrose van de knie 1
-
Upload
brent-patrick -
Category
Documents
-
view
218 -
download
2
Transcript of Joost Dekker PhD Department of Psychiatry & Department of Rehabilitation Medicine VU University...
Joost Dekker PhDDepartment of Psychiatry & Department of Rehabilitation MedicineVU University Medical Center, Amsterdam, Netherlands
Knikkende knieënOver instabiliteit en loopvaardigheid bij
artrose van de knie
1
Osteoarthritis
• Prevalence symptomatic OA in among adults aged ≥45 years– Knee 16.7% – Hip 9.2%
• Top 10 of most disabling diseases in European region
• Most important cause of pain and disability in the
elderly
Jordan et al, 2007
WHO, 2008
Conaghan et al, 2008
• Impairments of cartilage and bone– Findings on X-rays, MRI
• Physical impairments– Muscle weakness, instability
• Sensory impairments– Pain, stiffness, instability
• Activity limitations– Walking, rising
• Problems in participation– Work
Osteoarthritis – multiple levels
3
• Impairments of cartilage and bone– Findings on X-rays, MRI
• Physical impairments– Muscle weakness, instability
• Sensory impairments– Pain, stiffness, instability
• Activity limitations– Walking, rising
• Problems in participation– Work
Osteoarthritis – multiple levels
4
Instability
• Sudden loss of postural support across the knee at a time a weight bearing
• Self report – Sensation of buckling, shifting, or giving way of the knee– Sensory impairment
• Observed measure– To be developed– Physical impairment
5
Felson et al, 2007
6
Instability
• In knee OA– 60 – 80 %
• Instability is associated with activity limitations– Walking speed, self reported walking limitations
7
Fitzgerald et al, 2004
Schmitt et al, 2008
van der Esch et al, 2012
Knoop et al, 2012
Nguyen et al, 2014
Instability
• In knee OA– 60 – 80 %
• Instability is associated with activity limitations
• … and with falls
8
Fitzgerald et al, 2004
Schmitt et al, 2008
van der Esch et al, 2012
Knoop et al, 2012
Nguyen et al, 2014
9
Instability
• Reduced muscle strength is associated with instability• Quadriceps and hamstring muscles are stabilizers of the knee
10
Knoop et al, 2012
11
van der Esch et al, 2006
Proprioception - perception of position and movement
12
muscle strength Nm/kg
2,52,01,51,0,50,0
wal
k-tim
e (1
00 m
) se
c.
220
200
180
160
140
120
100
80
60
40
proprioception
poor
accurate
muscle strength Nm/kg
2,52,01,51,0,50,0
GU
G-ti
me
sec.
50
40
30
20
10
0
proprioception
poor
accurate
muscle strength Nm/kg
2,52,01,51,0,50,0
WO
MAC
-PF
scor
e
60
50
40
30
20
10
0
proprioception
poor
accurate
Muscle strength, proprioception and activity limitations
van der Esch et al, 2007
Replication Holla et al, 201213
14
Pain
15
Felson et al, 2007
Arthrogenic muscle inhibition
16
Stokes and Young, 1984
Tactile stimulation
• Lack (-/-) tactile stimulation – Instability ?
17
Arthrogenic muscle inhibition
18
Rice and McNair, 2010
Tactile stimulation
• Lack tactile stimulation (-/-) – Instability ?
• Additional tactile stimulation (+/+) – Soft brace
19
Additional tactile stimulation
20
Pegoretti et al, 2015
21
Instability in knee OA
• Highly prevalent– 60 – 80 %
• Activity limitations (walking), falls
• Muscle strength
• Proprioception• Pain• Tactile stimulation
22
Instability in knee OA
• Highly prevalent– 60 – 80 %
• Activity limitations (walking), falls
• Muscle strength
• Proprioception• Pain• Tactile stimulation
23
Exercise therapy
Soft brace
25
