Think outside the box: Incorporating secondary cognitive tasks into return to sport testing after ACL reconstruction

Abstract

The optimal set of return to sport (RTS) tests after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) remains elusive. Many athletes fail to pass current RTS test batteries, fail to RTS, or sustain secondary ACL injuries if they do RTS. The purpose of this review is to summarize current literature regarding functional RTS testing after ACLR and to encourage clinicians to have patients “think” (add a secondary cognitive task) outside the “box” (in reference to the box used during the drop vertical jump task) when performing functional RTS tests. We review important criteria for functional tests in RTS testing, including task-specificity and measurability. Firstly, tests should replicate the sport-specific demands the athlete will encounter when they RTS. Many ACL injuries occur when the athlete is performing a dual cognitive-motor task (e.g., attending to an opponent while performing a cutting maneuver). However, most functional RTS tests do not incorporate a secondary cognitive load. Secondly, tests should be measurable, both through the athlete’s ability to complete the task safely (through biomechanical analyses) and efficiently (through measures of performance). We highlight and critically examine three examples of functional tests that are commonly used for RTS testing: the drop vertical jump, single-leg hop tests, and cutting tasks. We discuss how biomechanics and performance can be measured during these tasks, including the relationship these variables may have with injury. We then discuss how cognitive demands can be added to these tasks, and how these demands influence both biomechanics and performance. Lastly, we provide clinicians with practical recommendations on how to implement secondary cognitive tasks into functional testing and how to assess athletes’ biomechanics and performance.

Enhancing Return to Alpine Skiing: Integrating Perceptual-Motor-Cognitive Considerations in Testing and Progressions: A Clinical Commentary

“…Chabaan and colleagues developed a creative instrument in order to create both motor and cognitive tasks during functional testing (drop jumps, single limb jump tests, cutting) that can be easily applied and measured based on low or high tech resources within clinic. 68 A calculation for dual task cost was also proposed during specific motor tasks in order to quantify the motor performance and movement quality with or without cognitive load, in order to compare healthy and surgical limb. This concept of a dual-task cost application can also be provided to snow specific settings.…”

“…It is stressed that until guidelines are established for return to participation with dual-task testing, caution is urged for athletes that have large dual task costs with traditional testing battery under perceptual-cognitive-motor load. 68 The athlete must also safely perform all training progressions with added perceptual-cognitive-motor elements, if possible, under the supervision of coaching and medical professionals in order to return to snow. Quantification of readiness for a professional athlete would be prior level of performance (no more than a 10% degradation in dual task cost) during time trials in a simulated environment comparable to that of a professional event with appropriate motor control.…”

Bedeutung der Neuroplastizitätin der Rehabilitation nach VKB-Ruptur

“…Experten für motorisches Lernen im Kontext muskuloskelettaler Verletzungen betonen die Relevanz für die Integration eines perzeptuell-kognitiven Trainings in die Rehabilitation sowie die „Return to Sport“- und „Return to Play“-Diagnostik, um insbesondere VKB-rekonstruierte Mannschaftsballsportler auf die motor-kognitiven Anforderungen komplexer Spielsituationen vorzubereiten und das Wiederverletzungsrisiko zu reduzieren 9 , 23 , 36 .…”

“…B. Landing Error Scoring System (LESS), Single Leg Hop for Distance (SLHD) oder der Cutting Movement Assessment Score (CMAS) 9 . Mittels frei zugänglicher Anwendungen, wie z.…”