Optimization of the Anterior Cruciate Ligament Injury Prevention Paradigm: Novel Feedback Techniques to Enhance Motor Learning and Reduce Injury Risk

Benjaminse, Anne; Gokeler, Alli; Dowling, Ariel V.; Faigenbaum, Avery D.; Ford, Kevin R.; Hewett, Timothy E.; Oñate, James A.; Otten, Bert; Myer, Gregory D.

doi:10.2519/jospt.2015.4986

Cited by 140 publications

(136 citation statements)

References 96 publications

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“…sports-related skills). 15 An external focus is induced when an athlete's attention is directed toward the outcomes or effects of the movement, whereas an internal focus is based on the movement itself. In our study, the external foci were the SquatGuide and TheraBand CLX apparatus.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Hip Abduction Elastic-Resisted Neuromuscular Feedback on Frontal Plane Knee Kinematics in Female Volleyball Athletes

Voight

Page

Chidester

et al. 2017

JPHR

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Background: In female athletes, the knee is one of the most commonly injured areas of the body. Uncontrolled frontal plane knee motion or "valgus collapse" has been identified as a risk factor for knee injury. This movement pattern has been observed in cases of anterior cruciate ligament (ACL) tears in athletes and it has also been linked to the development of patellofemoral pain syndrome. While often seen during a body-weight squatting maneuver, the valgus collapse is magnified when the athlete either lands from a jump or attempts to accelerate into a jump. Knee injury prevention programs that emphasize knee separation have shown the ability to reduce the effect of the loss of valgus control and are associated with a decrease in knee injury risk. Purpose: The purpose of this study is to examine the impact of hip elastic-resisted neuromuscular feedback on frontal plane knee abduction during a counter jump maneuver. Design: Randomized, controlled repeated measure. Methods: In total, 20 female volleyball athletes (mean age, 16.4 6 1.6 years; age range, 15-18 years) were included in this study under the following condition: athletes should have had a pain-free dysfunctional squatting pattern with no signs of structural dysfunction. During a drop-jump test, the distance between the hips, knees, and ankles was measured via video analysis software. The separation distance between the knees (mid-patella width) and ankles (lateral malleolus width) was normalized by the hip separation (greater trochanter width) distance and measured at pre-landing, landing, and takeoff. Athletes were randomized into either a control group or a neuromuscular intervention group; a SquatGuide was used and variable resistance was manually applied to the distal femur to resist hip abduction by means of an elastic band. Before a volleyball practice session, the athletes in the neuromuscular intervention group performed 30 repetitions of a deep squat with variable resistance manually applied around the distal thighs; the SquatGuide was used to provide feedback on proper lower-quarter positioning. During this period, the control group did not participate in any activity. The jump landing characteristics of both groups were immediately re-examined before practice and again at 60 min at the conclusion of practice. Results: The means and standard deviations for the absolute distances (measures in centimeters) of knee and ankle separation and for the normalized knee and ankle separation were calculated. There was no correlation between the distance in the knee and ankle separation for each of the jump-land sequences. After squat training, statistically significant increases were found in the absolute distance (P < .001) and the normalized knee and ankle separation distance (P < .001) for all phases of the jump-land sequence, both immediately following the training and at 60 min after training.

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Section: Discussionmentioning

confidence: 99%

The Impact of Hip Abduction Elastic-Resisted Neuromuscular Feedback on Frontal Plane Knee Kinematics in Female Volleyball Athletes

Voight

Page

Chidester

et al. 2017

JPHR

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“…11 The lack of timely and accurate feedback potentially contributes to the poor implementation of these programs. Multiple studies support the importance of providing timely feedback during neuromuscular training programs, 12,13 as it may enhance motor skill development and improve joint position sense. 13 Recent developments in gaming technology have facilitated the use of real-time joint kinematic tracking as a feedback tool.…”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies support the importance of providing timely feedback during neuromuscular training programs, 12,13 as it may enhance motor skill development and improve joint position sense. 13 Recent developments in gaming technology have facilitated the use of real-time joint kinematic tracking as a feedback tool. Such feedback has resulted in both immediate 14 and…”

Section: Introductionmentioning

confidence: 99%

“…Benjaminse et al, 13 argue that this method of feedback may interfere with the natural coordination of the movement and automaticity of the skill. Virtual Reality (VR) may be provide a solution to this issue by offering individuals the chance to intensively train meaningful tasks with externally focused feedback, within relatively realistic 3-dimensional (3D) environments.…”

Section: Introductionmentioning

confidence: 99%

“…Virtual Reality (VR) may be provide a solution to this issue by offering individuals the chance to intensively train meaningful tasks with externally focused feedback, within relatively realistic 3-dimensional (3D) environments. 13,16 In the rehabilitation settings VR results in high degrees of motivation and involvement. 17,18 While still confined to laboratory settings, innovation in portable VR headset technology is making it possible for VR to be considered as a supplement for current on-field programs.…”

Section: Introductionmentioning

confidence: 99%

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Validity and Reliability of a Virtual Reality Game in Evaluating the Projected Frontal Plane Knee Angle When Landing From a Drop Vertical Jump

Mills¹,

Idris²,

Pham³

et al. 2018

Journal of Sport Rehabilitation

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Objectives: To determine the validity and reliability of the peak frontal plane knee angle evaluated by a virtual reality (VR) netball game when landing from a drop vertical jump (DVJ). Study Design: LaboratoryMethods: Forty participants performed 3 DVJs evaluated by 3-dimensional (3D) motion analysis and 3 DVJs evaluated by the VR game. Limits of agreement for the peak projected frontal plane knee angle and peak knee abduction were determined. Participants were given a consensus category of "Above threshold" or "Below threshold" based on a pre-specified threshold angle of 9˚ during landing. Classification agreement was determined using kappa coefficient and accuracy was determined using specificity and sensitivity. Ten participants returned 1-week later to determine intra-rater reliability, standard error of the measure and typical error. Results:The mean difference in detected frontal plane knee angle was 3.39˚ (1.03˚, 5.74˚).Limits of agreement were -10.27˚ (-14.36˚, -6.19˚) Conclusion:The VR game reliably evaluated a projected frontal plane knee angle. While the knee angle detected by the VR game is strongly related peak knee abduction, the accuracy of detecting the exact angle was limited. A threshold approach may be a more accurate approach for gaming technology to evaluate frontal plane knee angles when landing from a jump.

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Visual cognition associated with knee proprioception, time to stability, and sensory integration neural activity after ACL reconstruction

Chaput

Oñate

Simon

et al. 2021

Journal Orthopaedic Research

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Visual cognitive ability has previously been associated with anterior cruciate ligament injury and injury risk biomechanics in healthy athletes. Neuroimaging reports have identified increased neural activity in regions corresponding to visual-spatial processing, sensory integration, and visual cognition in individuals after anterior cruciate ligament reconstruction (ACLR), indicating potential neural compensatory strategies for motor control. However, it remains unclear whether there is a relationship between visual cognition, neural activity, and metrics of neuromuscular ability after ACLR. The purpose of this study was to (1) evaluate the relationship between visual cognitive function and measurements of neuromuscular control (proprioception and time to stability [TTS]), isokinetic strength, and subjective function, and (2) examine the neural correlates of visual cognition between ACLR (n = 16; time since surgery 41.4 ± 33.0 months) and demographically similar controls (n = 15). Visual cognition was assessed by the ImPACT visual motor and visual memory subscales. Outcome variables of proprioception to target knee angle 20°, landing TTS, strength, and subjective function were compared between groups, and visual cognition was correlated within groups to determine the relationship between visual cognition and outcome variables controlled for time from surgery (ACLR group). The control group had better IKDC scores and strength. Visual memory and visual motor ability were negatively associated with proprioception error (r = −0.63) and TTS (r = −0.61), respectively, in the ACLR group but not controls. Visual cognition was associated with increased neural activity in the precuneus and posterior cingulate cortex in the ACLR group but not control participants. These data suggest the neural strategy in which ACLR participants maintain proprioception and stability varies, and may depend on visual cognition and sensory integration neural activity.

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Optimization of the Anterior Cruciate Ligament Injury Prevention Paradigm: Novel Feedback Techniques to Enhance Motor Learning and Reduce Injury Risk

Cited by 140 publications

References 96 publications

The Impact of Hip Abduction Elastic-Resisted Neuromuscular Feedback on Frontal Plane Knee Kinematics in Female Volleyball Athletes

The Impact of Hip Abduction Elastic-Resisted Neuromuscular Feedback on Frontal Plane Knee Kinematics in Female Volleyball Athletes

Validity and Reliability of a Virtual Reality Game in Evaluating the Projected Frontal Plane Knee Angle When Landing From a Drop Vertical Jump

Visual cognition associated with knee proprioception, time to stability, and sensory integration neural activity after ACL reconstruction

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