The Effect of Combined Exercise and NMES on Strength, Proprioception and Reaction Time in Scapholunate Instability

Summary

In our study, which we conducted to investigate the effect of exercise training combined with neuromuscular electrical stimulation on muscle strength, proprioceptive sensation, reaction time and functionality in patients with scapholunate (SL) instability, individuals with SL instability who meet the inclusion criteria and volunteer to participate in the study will participate. After the approval of the ethics committee, it is planned to include as many individuals with SL instability as the number to be obtained following the power analysis to be performed as a result of the pilot study. The pain of the subjects will be evaluated with the VAS pain scale during rest-activity-exercise. All participants will be evaluated with the isokinetic cybex device for isokinetic muscle strength of the wrist, grip strength with the JAMAR hand held dynometer, NEH evaluation: goniometer, proprioceptive sensation with ACUMAR and isokinetic device, reaction time with blazepod trainer, wrist pain transfer with a digital scale, assessment of upper extremity functional status: pwre (patient rated wrist evaluation), modified mayo wrist score, DASH, EL20 questionnaire, SF-12 questionnaires.

In this randomized controlled study, the first group will receive NMES and exercise training 3 days a week for a total of 8 weeks and the other group will receive only exercise training. The evaluations will be done at the beginning and twice in total after the 8-week rehabilitation program. The exercises given to the patients in both groups will be similar for 8 weeks and they will receive a total of 24 sessions of exercise programs with 15 repetitions per day, 3 days a week, accompanied by a physiotherapist. Both groups will also be given home exercises to continue at home. NMES and exercise trainings will be applied in such a way that activation of SL-friendly extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), flexor carpi radialis (FCR), and abductor pollicis longus (APL) muscles will be followed by inhibition of non-friendly extensor carpi ulnaris (ECU).

After the completion of the thesis, it is planned to add to the literature by examining the effects of exercise training combined with NMES on muscle strength, proprioceptive sensation, reaction time and functionality in individuals diagnosed with SL instability and the superiorities, if any, between the methods.

Conditions

• Scapholunate Interosseous Ligament Injury
• Scapholunate Dissociation
• Scaphoid-Lunate Instability

Interventions

OTHER

Exercise Training

Individuals in the NMES group will have a total of 24 sessions of NMES application with 15 repetitions 3 days a week for 8 weeks and then exercise programs will be performed face-to-face. They will also be given home exercises to continue at home. In the NMES group, NMES training will be performed for extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), abductor pollicis longus (APL), flexor carpi radialis (FCR) muscles. The pencil electrode will be used to stimulate the ECRL, ECRB, FCR and APL muscles in such a way that 30+30+30=90 contractions will be obtained from each muscle. According to the morphologic characteristics of each muscle, different current and will be applied. P11th program to ECRL and APL : 65 Hz. 200 μs, P13th program to ECRB and FCR 50 Hz, 200 μs will be applied. Exercises includes intrinsic and extrinsic muscle strengthening, stabilization exercises and dart exercises, wrist neuromuscular exercises and perturbation exercises.

OTHER

Exercise Training (Control Group)

Patients in the control group will have face-to-face exercise programs with a physiotherapist for a total of 24 sessions of 15 repetitions 3 days a week for 8 weeks. Exercises will be performed 3 days a week with a physiotherapist. On the other days, patients will be asked to perform 3 sets of 15 repetitions every day as home exercises. Exercise training includes intrinsic and extrinsic muscle strengthening, wrist stabilization exercises, dart exercises, wrist neuromuscular exercises using different materials, reactive muscle control, perturbation exercises. Exercises will be at the limit of pain. Until the 6th month, overloading, strong gripping, weight transfer, rotations and lifting heavy objects should be avoided. Rehabilitation with functional range of motion is important. Exercises will be performed with a physiotherapist 3 days a week. On the other days, patients will be asked to perform 3 sets of 15 repetitions every day as home exercises.

DEVICE

Neuromuscular Electrical Stimulation

Neuromuscular Electrical Stimulation

Sponsors & Collaborators

• Hacettepe University

  lead OTHER

Principal Investigators

• Semra Topuz, Prof.Dr. · Hacettepe University

• Arzu Dağ, Ph.D Student · Hacettepe University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

45 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-09-08

Primary Completion

2024-12-20

Completion

2025-08-09

Countries

• Turkey (Türkiye)

Study Locations