Establishing Cognitive-Motor Function as a Missing Therapeutic Target after Anterior Cruciate Ligament Reconstruction

建立认知运动功能作为前十字韧带重建后缺失的治疗目标

• 批准号: 10301013
• 负责人: Scott M. Monfort
• 金额: $ 14.32万
• 依托单位: MONTANA STATE UNIVERSITY - BOZEMAN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10301013
• 关键词: 19 year old; 3-Dimensional; Adolescent; Age; Athletic Injuries; Biomechanics; Body mass index; Brain Concussion; Child; Chronic Disease; Clinic; Clinical; Cognition; Cognitive; Complex; Decision Making; Degenerative polyarthritis; Dependence; Emergency department visit; Ensure; Environment; Equilibrium; Fibrinogen; Fright; Functional disorder; Goals; Health; Impairment; Incidence; Individual; Injury; Knee; Knowledge; Laboratories; Literature; Longevity; Measures; Methods; Mission; Motion; Motor; Movement; National Institute of Child Health and Human Development; Obesity; Operative Surgical Procedures; Outcomes Research; Patient Outcomes Assessments; Patient Self-Report; Patients; Performance; Physical activity; Prevention strategy; Psychological Factors; Public Health; Quality of life; Readiness; Recording of previous events; Rehabilitation Outcome; Rehabilitation therapy; Research; Risk; Risk Factors; Severities; Short-Term Memory; Sports; Task Performances; Testing; Time; Training; Treatment outcome; United States; Validation; Visual Accommodation; Visual attention; Work; Youth; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; anterior cruciate ligament rupture; attentional control; base; biomechanical test; career; clinical decision-making; clinical translation; clinically relevant; cognitive function; cognitive load; cognitive process; cognitive task; cognitive testing; comorbidity; cost; cost effective; design; experience; functional restoration; heart disease risk; high school; improved; injury prevention; innovation; insight; knee mechanics; laboratory equipment; motor control; motor deficit; motor impairment; multitask; musculoskeletal injury; neuromuscular; neurophysiology; new therapeutic target; prevent; processing speed; psychologic; quadriceps muscle; return to sport; screening; sex; therapeutic target

The spectrum of cognitive-motor impairments following anterior cruciate ligament reconstruction (ACLR) is poorly defined. This knowledge gap is an important problem because recent evidence indicates that the current dependence on isolated motor tests for ACLR clinical decision making is insufficient to ensure restored function in complex sports environments or prevent a second injury. Under existing tests, the interaction between cognition and motor control is routinely missed and deficits are allowed to remain despite passing discharge criteria. Mounting evidence demonstrates that the interaction of cognitive and motor function is impaired after musculoskeletal injury, including ACL tears. There is a critical need for studies that establish the scope and severity of cognitive-motor impairments in ACLR patients to provide novel therapeutic targets. The long-term goal of this research is to improve ACLR rehabilitation outcomes. The objective of this R03 is to demonstrate the spectrum of cognitive-motor impairments with rigorous lab-based metrics following ACLR. Clinical translation will be achieved by validating cost-effective and simple tests for cognitive-motor performance against lab-based measures. The central hypotheses are that 1) simultaneous cognitive tasks will reveal neuromuscular impairments following ACLR, 2) clinical surrogate tests will be related to lab-based metrics, and 3) worse cognitive-motor impairments will predict poorer patient-reported outcomes of knee function and psychological factors. The study objective will be achieved through two specific aims: 1) elucidate the spectrum of dual-task impairments that persist following ACLR, and 2) demonstrate the clinical relevance of dual-task impairments following ACLR. For the first aim, 3D biomechanical analyses will be done for jumping tasks with an innovative approach of systematically adding simultaneous cognitive tasks (i.e., dual tasks) that target specific cognitive processes (e.g., decision making). Clinical cognitive-motor dual-task tests will also be validated. Greater increases in frontal plane knee motion (ACL injury risk factor) when visually- demanding cognitive tasks are added will support the primary hypothesis for the first aim. Strong correlations between dual-task impairments in clinic-based tests and dual-task impairments in frontal plane knee motion from lab-based tests will support the second hypothesis. Greater dual-task impairments on lab-based tests associating with worse patient-reported outcomes of knee function and psychological factors will support the hypothesis of the second aim. The approach is innovative because it will systematically introduce different types of cognitive challenges designed around the neurophysiological changes associated with ACL injury that go unquantified in current treatment. The research is significant because it will identify novel therapeutic targets for ACLR rehabilitation by determining the most salient cognitive-motor impairments and their clinical relevance. Ultimately, such knowledge has the potential to inform rehabilitation and injury prevention strategies for ACL tears that will help reduce the growing problem of sports injuries in the U.S.

前交叉韧带重建后（ACLR）的认知运动障碍的光谱是 定义不佳。该知识差距是一个重要的问题，因为最近的证据表明 当前对ACLR临床决策的孤立运动测试的依赖不足以确保恢复 在复杂的运动环境中起作用或防止第二次伤害。在现有测试下，互动 在认知和运动控制之间通常会错过，尽管通过 出院标准。越来越多的证据表明，认知和运动功能的相互作用是 肌肉骨骼损伤后受损，包括ACL眼泪。建立研究的迫切需要 ACLR患者的认知运动障碍的范围和严重程度提供了新的治疗靶标。 这项研究的长期目标是改善ACLR康复结果。此R03的目的是 为了证明ACLR后具有严格的基于实验室的指标的认知运动障碍的范围。 临床翻译将通过验证认知运动的成本效益和简单测试来实现 针对基于实验室的措施的绩效。中心假设是1）同时认知任务 将显示ACLR后的神经肌肉损伤，2）临床替代测试将与基于实验室的替代测试有关 指标和3）较差的认知运动障碍将预测患者报告的膝盖预后较差 功能和心理因素。研究目标将通过两个具体目的来实现：1）阐明 ACLR之后持续存在的双任务障碍的频谱，2）证明了临床相关性 ACLR后的双重任务损伤。对于第一个目标，将对3D生物力学分析进行 通过系统地添加同时认知任务的创新方法跳跃任务（即双重 任务）针对特定认知过程（例如决策）的任务。临床认知运动双任务测试 也将得到验证。当视觉上时，额骨膝关节运动的增加（ACL损伤风险因素）会增加 添加苛刻的认知任务将支持第一个目标的主要假设。牢固的相关性 在基于诊所的测试中的双重任务障碍与额叶膝盖运动中的双任务障碍之间 从基于实验室的测试中将支持第二个假设。在基于实验室的测试中更大的双任务障碍 与膝盖功能和心理因素的患者报告结果更糟糕的结合将支持 第二个目标的假设。这种方法具有创新性，因为它将系统地引入不同 围绕与ACL损伤相关的神经生理变化设计的认知挑战类型 在当前治疗中，这种情况没有量化。这项研究很重要，因为它将识别出新颖的治疗性 通过确定最显着的认知运动障碍及其临床来确定ACLR康复的目标 关联。最终，这种知识有可能告知康复和预防伤害 ACL眼泪的策略将有助于减少美国日益增长的运动损伤问题

项目成果

Development and Reliability of a Visual-Cognitive Reactive Triple Hop Test.

视觉认知反应三跳测试的开发和可靠性。

• DOI: 10.1123/jsr.2022-0398
• 发表时间: 2023
• 期刊: Journal of sport rehabilitation
• 影响因子: 1.7
• 作者: Farraye,ByrnadeenT;Simon,JanetE;Chaput,Meredith;Kim,HoWon;Monfort,ScottM;Grooms,DustinR
• 通讯作者: Grooms,DustinR

Development and reliability of a visual-cognitive medial side hop for return to sport testing.

用于返回运动测试的视觉认知内侧跳的开发和可靠性。

• DOI: 10.1016/j.ptsp.2022.07.004
• 发表时间: 2022
• 期刊: Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine
• 作者: Farraye,ByrnadeenT;Chaput,Meredith;Simon,JanetE;Kim,HoWon;Grooms,DustinR;Monfort,ScottM
• 通讯作者: Monfort,ScottM