Preliminary Report on the Train the Brain Project, Part II: Neuroplasticity of Augmented Neuromuscular Training and Improved Injury-Risk Biomechanics

Abstract

Context: Neuromuscular training (NMT) facilitates the acquisition of new movement patterns that reduce ACL injury risk; however, the neural mechanisms underlying these changes are unknown. Objective: Determine the relationship between brain activation and biomechanical changes following NMT with biofeedback. Study Design: Controlled Laboratory Study Setting: Research laboratory Participants: Final analyses included twenty high school female soccer athletes (15.7±0.95 years; 1.68±0.05 m; 59.91±5.62 kg). Main Outcome Measures: Ten participants completed 6 weeks of NMT augmented with real-time biofeedback (aNMT) to reduce knee injury risk movements, and 10 participants completed no training. aNMT was implemented with visual biofeedback that responded in real-time to injury-risk biomechanical variables. A drop vertical jump with 3D motion capture was used to assess injury risk neuromuscular changes before and after the six-week intervention. Pre to post brain activation changes were measured using functional magnetic resonance imaging (fMRI) during unilateral knee and multi-joint motor tasks. Results: Following aNMT, sensory (precuneus), visual-spatial (lingual gyrus), and motor planning (pre-motor) brain activity increased for knee specific movement and sensorimotor cortex activity for multi-joint movement decreased. Knee abduction moment during landing also decreased (4.66±5.45 Nm; p=0.02; g=0.82) in the aNMT group with no change in the control group (p>0.05). The training-induced increased brain activity for isolated knee movement was associated with decreases in knee abduction moment (r=.67, p=.036) and sensorimotor cortex activity for multi-joint movement (r=.87, p=.001). No significant change in brain activity was observed in the control group (p>0.05). Conclusions: The relationship between neural changes observed across tasks and reduced knee abduction suggests that aNMT facilitates recruitment of sensory integration centers to support reduced injury risk mechanics and improve sensorimotor neural efficiency for multi-joint control. Further research is warranted to determine if this training related multimodal neuroplasticity enhances neuromuscular control during more complex sport-specific activities.

Lower extremity Interlimb coordination associated brain activity in young female athletes: A biomechanically instrumented neuroimaging study

“…This study was a secondary data analysis from which the primary study's focus was put on female adolescent athletes due to their high risk for anterior cruciate ligament (ACL) injury (Griffin et al, 2000), theorized to occur because of sensorimotor coordination errors whereby the central nervous system fails to maintain safe knee positioning during dynamic movements with high neurocognitive demands (landing from a jump while distracted by a defender; Swanik, 2015). Thus, the present findings may be an initial step toward identifying a neural marker underlying sensorimotor coordination failures of the lower extremity (e.g., ACL injury) and/or could be used to evaluate the efficacy of training programs designed to optimize brain function to support injury‐resistant movement (Diekfuss et al, 2019, 2020; Grooms et al, 2018, 2022). Though this study is not without limitations, our inferences here to discuss our findings in the context of previous literature are theoretical constructs and sets the stage for targeted research to further deconstruct the neural mechanisms underlying interlimb coordination.…”

Bedeutung der Neuroplastizitätin der Rehabilitation nach VKB-Ruptur

“…neuromuskulärer Übungen zu fördern. In den bisherigen Studien 16 , 26 , 27 zur Untersuchung der Wirkungen eines neuromuskulären Trainings mit visuellem Echtzeit-Biofeedback wurde den Trainierenden während der Trainings ein visueller Stimulus (z. B. Rechteck) auf einem Bildschirm angezeigt.…”

“…Erste Längsschnittstudien 16 , 26 , 27 an kniegesunden sportlichen Personen zeigen, dass ein sechswöchiges neuromuskuläres Training mit visuellem Echtzeit-Biofeedback im Vergleich zu einer passiven Kontrollgruppe die Aktivität des primär motorischen Kortex während der Bewegungsdurchführung (unilaterale Kniebewegungen und Beinpresse) reduziert. Die vermehrt unbewusste und automatisierte Bewegungsdurchführung wurde auf die neuronalen Effekte eines impliziten motorischen Lernens mit externalem Fokus zurückgeführt.…”

Either Autonomy Support or Enhanced Expectancies Delivered Via Virtual-Reality Benefits Frontal-Plane Single-Leg Squatting Kinematics

“…Multiple reasons have been postulated for the poor long term outcomes associated with ACL reconstruction, and among them are traditional injury prevention programs that focus on enhancing peripheral neuromuscular control but fail to replicate the sensorimotor demands of real-time sport participation (DiCesare et al, 2019c). Specifically, there is a need to consider those sensorimotor-related processes that are critical for both maintaining safe knee position and ensuring the retention and transfer of learned injury-resistant biomechanics from the lab and clinic to a sport setting (Diekfuss et al, 2020a; Diekfuss et al, 2021; Diekfuss et al, 2020b; Diekfuss et al, 2019a; Grooms, 2022). The emergence of real-time biofeedback technologies provides an opportunity to capitalize on sensorimotor capacity for adaptation and, thus, fully integrate perceptual and motor factors that can support injury-resistant movement behaviors.…”

“…The emergence of real-time biofeedback technologies provides an opportunity to capitalize on sensorimotor capacity for adaptation and, thus, fully integrate perceptual and motor factors that can support injury-resistant movement behaviors. Real-time biofeedback is capable of modifying peripheral movement patterns via visual, vestibular, and proprioceptive inputs, which may simultaneously enhance functioning for the successful transfer of acquired movement strategies to the sporting environment (e.g., ‘neural efficiency’ to support injury resistant knee motor control) (Diekfuss et al, 2020b; Grooms, 2022).…”