Effective Attentional Focus Strategies after Anterior Cruciate Ligament Reconstruction:A Commentary

Individuals after anterior cruciate ligament reconstruction (ACLR) have a high rate of reinjury upon return to competitive sports. Deficits in motor control may influence reinjury risk and can be addressed during rehabilitation with motor learning strategies. When instructing patients in performing motor tasks after ACLR, an external focus of attention directed to the intended movement effect has been shown to be more effective in reducing reinjury risk than an internal focus of attention on body movements. While this concept is mostly agreed upon, recent literature has made it clear that the interpretation and implementation of an external focus of attention within ACLR rehabilitation needs to be better described. The purpose of this commentary is to provide a clinical framework for the application of attentional focus strategies and guide clinicians towards effectively utilizing an external focus of attention in rehabilitation after ACLR

Neurocognitive and Neurophysiological Functions Related to ACL Injury:A Framework for Neurocognitive Approaches in Rehabilitation and Return-to-Sports Tests

Context: Only 55% of the athletes return to competitive sports after an anterior cruciate ligament (ACL) injury. Athletes younger than 25 years who return to sports have a second injury rate of 23%. There may be a mismatch between rehabilitation contents and the demands an athlete faces after returning to sports. Current return-to-sports (RTS) tests utilize closed and predictable motor skills; however, demands on the field are different. Neurocognitive functions are essential to manage dynamic sport situations and may fluctuate after peripheral injuries. Most RTS and rehabilitation paradigms appear to lack this aspect, which might be linked to increased risk of second injury. Objective: This systematic and scoping review aims to map existing evidence about neurocognitive and neurophysiological functions in athletes, which could be linked to ACL injury in an integrated fashion and bring an extensive perspective to assessment and rehabilitation approaches. Data Sources: PubMed and Cochrane databases were searched to identify relevant studies published between 2005 and 2020 using the keywords ACL, brain, cortical, neuroplasticity, cognitive, cognition, neurocognition, and athletes. Study Selection: Studies investigating either neurocognitive or neurophysiological functions in athletes and linking these to ACL injury regardless of their design and technique were included. Study Design: Systematic review. Data Extraction: The demographic, temporal, neurological, and behavioral data revealing possible injury-related aspects were extracted and summarized. Results: A total of 16 studies were included in this review. Deficits in different neurocognitive domains and changes in neurophysiological functions could be a predisposing risk factor for, or a consequence caused by, ACL injuries. Conclusion: Clinicians should view ACL injuries not only as a musculoskeletal but also as a neural lesion with neurocognitive and neurophysiological aspects. Rehabilitation and RTS paradigms should consider these changes for assessment and interventions after injury

Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction

No Abstract

Brain Activation During Maximum Concentric and Eccentric Knee Extension Muscle Contractions

Purpose: In spite of mounting evidence indicating that concentric and eccentric knee extensor muscle contractions might have special nervous system control strategies, the differentiation of brain frequencies between concentric and eccentric movements and how the motor cortex programs this contraction has been less studied. In this study, the brain and muscle activation differences during maximum concentric and eccentric contractions were compared. Methods: Nine healthy volunteers performed 20 maximum eccentric and 20 maximum concentric knee extensor contractions. Electroencephalography (EEG) signals from sensorimotor-related cortical areas were recorded simultaneous with the electromyography (EMG) of the knee extensor muscles. In the spectral analysis the performance related power values were calculated for Theta (4-7 Hz) and Alpha (7-12 Hz). Results: The time-domain results revealed, longer time and greater cortical activity is required for the preparation of an eccentric contraction. For the eccentric task, the cortical activity was greater, but the EMG was lower in comparison to the concentric task values. Statistical analysis showed significant higher and lower Theta and Alpha power in both types of contractions compared to the resting state, respectively. Conclusion: These findings suggest that increased Theta power is associated with task complexity and focused attention and decreased Alpha power values with increased information processing in the somatosensory cortex

An ecological dynamics approach to ACL injury risk research:a current opinion

Research of non-contact anterior cruciate ligament (ACL) inj1ury risk aims to identify modifiable risk factors that are linked to the mechanisms of injury. Information from these studies is then used in the development of injury prevention programmes. However, ACL injury risk research often leans towards methods with three limitations: 1) a poor preservation of the athlete-environment relationship that limits the generalisability of results, 2) the use of a strictly biomechanical approach to injury causation that is incomplete for the description of injury mechanisms, 3) and a reductionist analysis that neglects profound information regarding human movement. This current opinion proposes three principles from an ecological dynamics perspective that address these limitations. First, it is argued that, to improve the generalisability of findings, research requires a well-preserved athlete-environment relationship. Second, the merit of including behaviour and the playing situation in the model of injury causation is presented. Third, this paper advocates that research benefits from conducting non-reductionist analysis (i.e., more holistic) that provides profound information regarding human movement. Together, these principles facilitate an ecological dynamics approach to injury risk research that helps to expand our understanding of injury mechanisms and thus contributes to the development of preventative measures