Posted January 20, 2023

Dustin R. Grooms, Ph.D., AT, CSCS, Ohio University

Musculoskeletal injury to the anterior cruciate ligament (ACL) often leads to impaired performance, which current surgical reconstruction and physical therapy may not always fully restore. These injuries are common in the civilian and military populations, with high rates of reinjury and long recovery times. Current rehabilitation methods tend to focus on mechanical milestones relating to knee motion and load, but data on the impact of the central nervous system on recovery are limited. Dr. Dustin Grooms and key co-investigators, Dr. Janet Simon and Dr. Brian Clark, from Ohio University are quantifying brain activity in high-risk and ACL injury-repaired individuals to help identify the regions affected and develop new rehabilitation strategies.

Dr. Grooms was awarded a fiscal year 2017 Peer Reviewed Orthopaedic Research Program (PRORP) Applied Research Award to determine the neuroplasticity associated with ACL injury/therapy, and what functional correlates exist to be viable targets for intervention. In other words, this study is assessing how certain regions in the brain change after ACL injury across the typical 6-month window of physical therapy, using new functional evaluations to target the brain changes that may limit performance and recovery. The overall goal of the project is to add to the body of knowledge regarding cognitive-visual-motor integration after injury. The team is also incorporating virtual reality (VR) during the recovery process to stimulate a complex environment to help reduce reinjury. This VR environment is designed to promote proper motor control and minimize the cognitive resources to control the knee.

Dr. Grooms’ PRORP-funded project has produced several publications on topics quantifying neural activity for knee motor control, identifying brain activity in persons with high versus low risk of ACL injury, and investigating how cognitive motor interference and virtual reality affects motor function in athletes and Reserve Officers’ Training Corps (ROTC) research volunteers. His team has used functional MRI (fMRI) to identify specific neural paradigms to quantify lower extremity neuromuscular function (Figure 1).¹ This technique has now been incorporated into evaluating female high school athletes with high versus low risk of ACL injury by assessing the motor control brain activity between the two groups. Their findings suggest that elevated brain activity in specific regions of the brain is associated with a higher risk of injury.² Additionally, Dr. Grooms’ team evaluated cognitive motor interference in ROTC members at a simulated shooting range and found that adding visual cognitive challenges delayed shot initiation and completion times (Figures 2 and 3).³ In the ROTC cohort, they also used virtual reality to improve the detection of injury risk neuromuscular control.⁴ The improved understanding of neuromuscular function combined with virtual reality and other cognitive motor interference tasks could be adapted to aid in optimizing tactical performance in the battlefield. Dr. Grooms and his team have also developed tests for athletic return to activity that incorporates cognitive-motor interference, and they are finding that adding a visual-cognitive challenge to impaired hop performance tests is highly reliable.⁵

Throughout his past and current work, Dr. Grooms has been able to demonstrate the importance of cognitive function in physical rehabilitation. He has now demonstrated the benefits of incorporating environment and cognitive load in training tools for increased performance and injury prevention.

References:

¹Grooms DR, Criss R, Simon JE, et al. 2021. Neural correlates of knee extension and flexion force control: A kinetically instrumented neuroimaging study. Frontiers in Human Neuroscience 14, 622637. https://doi.org/10.3389/fnhum.2020.622637

²Grooms DR, Diekfuss JA, Criss CR, et al. 2022. Preliminary brain-behavioral neural correlates of anterior cruciate ligament injury risk landing biomechanics using a novel bilateral leg press neuroimaging paradigm. PLOS One 17(8):e0272578. https://doi.org/10.1371/journal.pone.0272578

³Buckley S, Chaput M, Simon JE, et al. 2022. Cognitive load impairs time to initiate and complete shooting tasks in ROTC members. Military Medicine 187(7-8), e898–e905. https://doi.org/10.1093/milmed/usab276

⁴Brazalovich P, Simon JE, Criss CR, et al. 2022. The effects of virtual reality immersion on drop landing mechanics. Sports Biomechanics. Published online February 9. https://www.tandfonline.com/doi/full/10.1080/14763141.2022.2035427

⁵Farraye BT, Chaput M, Simon JE, et al. 2022. Development and reliability of a visual-cognitive medial side hop for return to sport testing. Physical Therapy in Sport 57:40-45. https://doi.org/10.1016/j.ptsp.2022.07.004

Links:
Public and Technical Abstracts: Rehabilitation 2.0: Addressing Neuroplasticity in the Musculoskeletal Rehabilitation Model