After reconstruction of the anterior cruciate ligament (ACL) afferent proprioceptive information from the knee joint may be altered. In order to examine changes in central activation patterns, spectral features of the electroencephalography (EEG) were measured. Patients after ACL reconstruction and healthy controls carried out an knee-angle reproduction task in a groups x limbs x trials design. Cortical activity was recorded using international standards. FFT were conducted to determine power at Theta, Alpha-1, Alpha-2 and Beta-1. Statistics show significantly larger aberrations in the reconstructed limbs compared with the controls whereas there are no differences between the uninvolved land controls. Brain activity demonstrates significantly higher frontal Theta-power (F3, F4, F8) in both limbs of the ACL group vs the controls and a significantly higher Alpha-2 power was shown in the ACL-reconstructed limb compared with controls at parietal positions (P3, P4). No such differences were found between the uninvolved side and the controls. The EEG was able to measure a change in joint position sense at the cortical level after the reconstruction of the ACL. The results of these findings might indicate differences in focused attention with involvement of the anterior cingulate cortex (frontal Theta) and sensory processing in the parietal somatosensory cortex (Alpha-2).
Athletes who wish to resume high-level activities after an injury to the anterior cruciate ligament (ACL) are often advised to undergo surgical reconstruction. Nevertheless, ACL reconstruction (ACLR) does not equate to normal function of the knee or reduced risk of subsequent injuries. In fact, recent evidence has shown that only around half of post-ACLR patients can expect to return to competitive level of sports. A rising concern is the high rate of second ACL injuries, particularly in young athletes, with up to 20% of those returning to sport in the first year from surgery experiencing a second ACL rupture. Aside from the increased risk of second injury, patients after ACLR have an increased risk of developing early onset of osteoarthritis. Given the recent findings, it is imperative that rehabilitation after ACLR is scrutinized so the second injury preventative strategies can be optimized. Unfortunately, current ACLR rehabilitation programs may not be optimally effective in addressing deficits related to the initial injury and the subsequent surgical intervention. Motor learning to (re-)acquire motor skills and neuroplastic capacities are not sufficiently incorporated during traditional rehabilitation, attesting to the high re-injury rates. The purpose of this article is to present novel clinically integrated motor learning principles to support neuroplasticity that can improve patient functional performance and reduce the risk of second ACL injury. The following key concepts to enhance rehabilitation and prepare the patient for re-integration to sports after an ACL injury that is as safe as possible are presented: (1) external focus of attention, (2) implicit learning, (3) differential learning, (4) self-controlled learning and contextual interference. The novel motor learning principles presented in this manuscript may optimize future rehabilitation programs to reduce second ACL injury risk and early development of osteoarthritis by targeting changes in neural networks.
A skilled player in goal-directed sports performance has the ability to process internal and external information in an effective manner and decide which pieces of information are important and which are irrelevant. Focused attention and somatosensory information processing play a crucial role in this process. Electroencephalographic (EEG) recordings are able to demonstrate cortical changes in conjunction with this concept and were examined during a golf putting performance in an expert-novice paradigm. The success in putting (score) and performance-related cortical activity were recorded with an EEG during a 5 x 4 min putting series. Subjects were asked to putt balls for four min at their own pace. The EEG data was divided into different frequencies: Theta (4.75-6.75 Hz), Alpha-1 (7-9.5 Hz), Alpha-2 (9.75-12.5 Hz) and Beta-1 (12.75-18.5 Hz) and performance related power values were calculated. Statistical analysis shows significant better performance in the expert golfers (P < 0.001). This was associated with higher fronto-midline Theta power (P < 0.05) and higher parietal Alpha-2 power values (P < 0.05) compared to the novices in golf putting. Frontal Theta and parietal Alpha-2 spectral power in the ongoing EEG demonstrate differences due to skill level. Furthermore the findings suggest that with increasing skill level, golfers have developed task solving strategies including focussed attention and an economy in parietal sensory information processing which lead to more successful performance. In a theoretical framework both cortical parameters may play a role in the concept of the working memory.
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