| Summary: | 碩士 === 國立陽明大學 === 醫學工程研究所 === 98 === Background: Injury to the anterior cruciate ligament (ACL) results in mechanical and functional instability. The rehabilitation after ACL reconstruction (ACLR) usually emphasizes the recovery of symmetry in muscle strengths and functional abilities of bilateral lower extremities. The coordination of kinesthetic perception with associated musculature through ligaments plays an important role in the control of knee joint motion. The characteristics of closed kinetic chain (CKC) exercises include the higher compression on the tibiofemoral joint and the higher co-contraction between hamstrings and quadriceps muscles, which provide knee stability and proprioceptive stimulation, and thus are recommended to patients with ACLR. For a better effect of the CKC exercise, appropriate dynamic movement control of the legs and core stability are essential. The biofeedback apparatus represents visual feedback of muscular activation, knee joint angle and center of pressure trajectory. Purpose: The purpose of this study was to examine the effect of CKC exercise with integrated biofeedback on muscle strength and functional recovery after ACLR. Material and method: Eight ACLR patients with patellar tendon graft participated in this study and were assigned to the control group and feedback group. Both groups completed the CKC exercise training program once or twice a week for 2 months after surgery, but only the subjects in the feedback group used the integrated biofeedback. A self-developed LabVIEWR program with data acquisition system integrated the signals of the Wii FitR balance board, EMG sensor and accelerometer, which provide visual feedback. The outcome measurements were consisted of isokinetic muscle strength and two functional tests, step-up-and-over test and forward lunge test. Results: At 4-month after surgery, limb symmetry index of quadriceps (QQR, percentage of uninjured leg) in feedback group improved in isokinetic strength at angular velocity of 60°/s and 180°/s recovered nearly to the pre-operational level, but decreased in control group when compared to the pre-operational level. The results also showed increase the hamstring: quadriceps (H/Q) ratio for bilateral limbs when compared to the pre-operational level in feedback group. With regard to the forward lunge test, the more improvement in the distances and force impulses (average impulse in the contact time) for both legs at 3 months after surgery in feedback group. In the step up-over test, the more increase in the lift-up index (maximum vertical force during lifting) and the better eccentric control for affected limb in feedback group. Conclusion: Using the integrated biofeedback to assist CKC exercise training could benefit the symmetry of muscle strength between legs (QQR), H/Q ratio, and the dynamic functional performances. The integrated biofeedback training can be utilized as one of the training tool for early stage of ACLR.
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