Uncertainty in the knee impairment assessment - Research Paper Example

Uncertainty in the knee impairment assessment. The knee joint kinematics could be seriously affected by different reasons. In most of these cases a clear isolation of the specific reason is seldom possible due to the absence of the sufficient results to consolidate the argument (Murray et al, 1985). One such case is the reason for the weakness of the muscle during the aging process. This situation often results in lowered postural stability leading to reduction in independence and higher risk of falling. The quadriceps are vital muscle group required to support all the activities for daily life (ADL). The reduction in the strength of quadriceps is required for decreased ADL performance and an increased frequency of fall in elders. Further, earlier studies have shown that the impairment of muscles could also lead to proprioceptive acuity (Aniss et al, 1990). The detailed study have been undertaken to compare the quadriceps strength, activation proprioceptive acuity, postural stability and the performance of functional activities in young, middle-aged and elderly subjects (Hurley et al, 1998). The results from this study showed revealed that proprioception and functional performance on different age groups revealed that the strength of the quadriceps was negatively correlated with the age. While all the age groups displayed identical postural stability in bipedal stance with their eyes open, both the middle and elderly age groups were unable to maintain monopedal stance at least for 15 seconds (Hurley et al, 1998). On postural stability, the monopedal stance has significant age influence over the bipedal stance. Hurlet et al (1998) have confirmed that deterioration of muscle strength, proprioceptive acuity and postural stability with the age is the prime reason for the increased duration of the ADL and adversely effects the individual functional performance with elderly population. Certain ailments like osteoarthritis (OA) also lead to the malfunctioning of the quadriceps, which in long term result in reduced mobility and increased socio-economic burden. In majority of the cases relief is sought by taking simple analgesia drugs or non-steroidal anti-inflammatory drugs in order get rid of the pain generated during this period (McAlindon et al, 1993). This approach is reported to have serious side effects culminating in the huge amount of hidden costs related to the knee osteoarthritis (OA). At a later stage the increased pain would usually force the patient to an orthopedic consultant, who would then have to handle the most enhanced form of disability, and hence result in poor or unsatisfactory medical support. Thus, under these circumstances a set of exercise regime is considered to effectively strengthen the quadriceps muscle group and hence is proposed as a potential prelude to the clinical implementation. Also, other than the muscle strength deterioration, it is also observed that the quadriceps sensory dysfunction lead to the decline in the proprioceptive acuity (Marks et al, 1993). Thus detailed research activity have been undertaken to investigate the impact of well planned exercise regime on the increasing the quadriceps strength and proprioceptive acuity and reducing the disability levels in the persons affected with knee osteoarthritis. The research was initiated on a sample of 110 patients but due to problems from undergoing a planned physiotherapy sessions a few of them were forced to withdraw and the sample was reduced to 60 (Hurley and Scott, 1998). This group was subjected to a well planned rehabilitation sessions of 5 week duration. And based on the knee data of the patients sampled, the weakest knee was considered for the future assessment. The brief exercise sessions clearly demonstrated considerable improvement, like strength gain of quadriceps, among the sample, which is comparable with the prolonged exercise regimes (Hurley and Scott, 1998). Van der Esch (2207) had undertaken detailed study to assess the impact of knee joint proprioception on the aggravation of the muscle weakness, which ultimately impairs the free movement of individuals. The functional ability study was conducted on a sample consisting of 63 patients involving 48 males and 15 females (van der Esch et al, 2007). This exercise consisted of two standardized tests to determine the physical performance namely 100 m walking test and Get up and Go test (Hurley et al, 1997). In addition, they were required to give a completed self-report questionnaire to understand the various details of the physical functioning of their body with emphasis on the knee. The knee joint proprioception was measured as the threshold to detect the knee joint motion and it was expressed as the Joint Motion Detection Threshold (JMDT) (van der Esch, 2007). A statistical correlation done on the personal information collected relating the JMDT values that represented the proprioception with the muscle strength and functional ability. The authors also constructed a multi-regression model to analyze the relationship that existed across muscle strength, functional ability and knee proprioception. Based on this initial attempt to investigate the direct bearing of proprioception on the muscle strength and functional ability, authors have inferred that even when proprioception acuity reduces the functional ability can be maintained only if the muscle strength can be compensated for this degeneration. Thus, function ability would be seriously affected only when the both the proprioceptive inaccuracy and muscle weakness would be present. One of the serious limitations in that the study was the absence of clear demarcation across adequate and poor proprioception (van der Esch, 2007). A similar set of exercises were undertaken by Hurley and Scott (1998) to assess the impact of brief exercise regime on the strength gain of the quadriceps muscles and proprioceptive acuity and reduced disability in patients suffering from osteoarthritis (OA). Nearly, 111 patients from the rheumatology department was chosen for this exercise. The quadriceps strength was determined based on the maximum voluntary contraction exerted by the patient. The proprioceptive acuity was determined on the Knee Joint Position Sense and the functional performance was evaluated based on the combined performance of four different tests like walking a straight stretch of specified length, standing up from chair and initiating walking, ascending and descending of stairs. The performance of these was represented as Aggregate Functional Performance Time (AFPT). The rehabilitation process involved mild exercise session of 30 minutes conducted twice a week across five continuous weeks. The patients were discharged from the hospital after 10 exercise sessions with clear instructions to follow the schedule from home. The detailed investigations into the efficacy of rehabilitation showed that simple clinically practicable exercise schedule helped to achieve quadriceps strength increase often better than the prolonged and continuous exercise (Hurley and Scott, 1998). Another study to investigate the association of sensorimotor function with knee joint kinematics during locomotion in knee osteoarthritis was undertaken by Bennel et al (2004). A sample of 220 patients suffering from knee osteoarthritis aged above 50 was used for this exercise which reports that sensorimotor dysfunction of the quadriceps is the major contributing factor to the the altered knee joint kinematics during gait in patients with knee OA. Thus the research results discussed here shows the varying reasons being reported to address the knee movement dysfunction. Thus it is confirmed from the results that significant uncertainty exist in the knee impairment assessment. References Aniss AM, Diener H-C, Hore J, Burke D, Gandevia S. (1990), Behaviour of human muscle receptors when reliant on proprioceptive feedback during standing. J Neurophysiol, 64, pp 661-70. Bennell K.L., Hinman R.S., Metcalf B.R (2004), Association of sensorimotor function with knee joint kinematics during locomotion in knee osteoarthritis, Am J Phys Med Rehabil, 83, pp 455-463. Hurley, M.V. and Scott, D.L. (1998) , Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime, British Journal of Rheumatology, 37, pp 1181-1187. Hurley, M.V., Rees, J. and Newham, D.J., (1998), Quadriceps function, proprioceptive acuity and functional performance in healthy young, middle-aged and elderly subjects, Age and Ageing, 27, pp 55-62. Marks, R., Qinney, H. and and Wessel, J (1993), Proprioceptive sensibility in women with normal and osteoarthritic knee joint, Clin Rheumatol, 12, pp 170 - 175. McAlindon, T.E., Cooper, C. and Kirwan, J.R. and Dieppe, P.A. (1993) Determinants of disability in osteoarthritis of the knee, Ann Rheum Dis, 52, pp 252-262. Murray MP, Duthie EH, Gambert SR, Sepic SB, Mollinger, LA. (1985) Age-related difference in knee muscle strength in normal women. J Gerontol, 40: pp 275-80. van der Esch, M., Steultjens, M, Harlaar, J, Knol, D., Lems, W. and Dekker, J, (2007), Joint proprioception, Muscle Strength and Functional ability in patients with Osteoarthritis of Knee, Arthritis and Rheumatism, 57(3),pp 787 -793. Read More