Department of Physiotherapy, University of Valencia, Valencia, Spain.
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Haemophilia. 2019 Mar;25(2):e69-e77. doi: 10.1111/hae.13697. Epub 2019 Feb 12.
Effects of haemophilic arthropathy on neuromuscular control during gait are currently unknown.
(a) To assess how haemophilic arthropathy affects the complexity of neuromuscular control during gait; (b) To investigate the relationship between complexity of neuromuscular control and joint impairment.
Thirteen control subjects (CG) walked overground at their preferred and a slow velocity and thirteen people with haemophilic arthropathy (PWHA) walking at their preferred velocity. Surface electromyography (EMG) was collected from eleven leg muscles. Electromyography variance explained by muscle synergies (sets of co-activated muscles that can be recruited by a single signal) was calculated by the total variance accounted (tVAF). Three measures were used to evaluate complexity of neuromuscular control: (a) the number of synergies required for tVAF > 90%, (b) tVAF as a function of the number of muscle synergies, and (c) the dynamic motor control index (Walk-DMC). Impairment of ankle and knee joints was determined by the Haemophilia Joint Health Score (HJHS).
The same number of the muscle synergies was found for each group (P > 0.05). For both walking velocities tested, tVAF1 was higher in PHWA (P < 0.05). The Walk-DMC of PWHA was lower than that of the CG for both walking velocities (P < 0.05). For PWHA, no significant correlation was found between HJHS (sum knee and ankle) and Walk-DMC index (r = -0.32, P = 0.28).
These results indicate differences between PWHA and CG in the neuromuscular control of gait. The Walk-DMC and tVAF1 may be useful measures to assess changes in neuromuscular control in response to treatment.
目前尚不清楚血友病性关节病对步态期间神经肌肉控制的影响。
(a)评估血友病性关节病如何影响步态期间神经肌肉控制的复杂性；(b)研究神经肌肉控制复杂性与关节损伤之间的关系。
13 名健康对照组（CG）在地面上以他们的偏好速度和慢速度行走，13 名血友病性关节病患者（PWHA）以他们的偏好速度行走。从 11 条腿部肌肉采集表面肌电图（EMG）。通过总方差解释（tVAF）计算由肌肉协同作用解释的肌电图方差（一组可被单个信号募集的共同激活肌肉）。使用三种方法来评估神经肌肉控制的复杂性：(a)tVAF>90%所需的协同作用数量，(b)tVAF 作为肌肉协同作用数量的函数，以及 (c)动态运动控制指数（Walk-DMC）。踝关节和膝关节的损伤程度通过血友病关节健康评分（HJHS）确定。
每组发现的肌肉协同作用数量相同（P>0.05）。对于测试的两种步行速度，PWHA 的 tVAF1 更高（P<0.05）。对于两种步行速度，PWHA 的 Walk-DMC 均低于 CG（P<0.05）。对于 PWHA，HJHS（膝关节和踝关节总和）与 Walk-DMC 指数之间没有显著相关性（r=-0.32，P=0.28）。
这些结果表明 PWHA 和 CG 在步态的神经肌肉控制方面存在差异。Walk-DMC 和 tVAF1 可能是评估治疗后神经肌肉控制变化的有用指标。
