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Sensorimotor Neuroplasticity after ACL Reconstruction: Insights into Neuromodulation in Orthopedic Clinical Rehabilitation

Sherman, David Alexander
http://orcid.org/0000-0002-3027-9124
http://rave.ohiolink.edu/etdc/view?acc_num=toledo1651586669680026

Abstract Details

2022, Doctor of Philosophy, University of Toledo, Exercise Science.
Joint injury is the most common cause of pain and disability in young adults, contributing to physical in-activity and disenfranchisement with exercise. One such injury, anterior cruciate ligament injury and surgical reconstruction (ACLR), alters neural afferent activity originating from the periarticular tissue. Since movement is dependent upon sensory input, sensory and processing dysfunctions contribute to changes in movement capability, such as thigh muscle weakness and balance impairments. Although subtle, these cascade into withdrawal from physical activity and contribute to joint degeneration (knee osteoarthritis). Therapies, such as strength training in physical rehabilitation, often do not consider whether augmenting sensory input can improve movement. Fortunately, novel applications of widely available modalities, such as visual biofeedback, electrical stimulation (TENS), and goal-oriented attention show preliminary alignment with modifiable neural impairments following ACL injury. In manuscript 1, we compare brain activity between individuals with ACLR and uninjured controls during single-limb balance and determine the influence of neuromodulatory interventions (External focus of attention [EF] and TENS) on cortical activity and balance performance. Our results demonstrate that (1) individuals with ACLR exhibit lower somatosensory processing and greater motor inhibition compared to controls and (2) visual biofeedback resulted in favorable reductions in motor-planning and increases in somatosensory and motor activity. In manuscript 2, we compare cortical motor planning activity and response selection performance between individuals with ACLR and uninjured controls during a reaction time and response selection task. Here, the ACLR group demonstrated (1) greater motor planning and response inhibition during the task, and (2) more errant performance suggesting poorer decision making in the presence of widespread cortical inhibition. In manuscript 3, we compare quadriceps corticomuscular coherence (CMC) and force steadiness between individuals with ACLR and uninjured controls during a force tracing task. We found individuals with ACLR presented with lower quadriceps gamma band CMC and worse quadriceps force steadiness suggesting lower cortical drive and impaired ability to modulate quadriceps neuromuscular control compared to matched controls. Notably, CMC differences were present only in the gamma frequency band, suggesting impairments may be specific to multisensory integration and force modulation. Collectively, these findings detail bilateral sensory processing, motor planning, and motor drive impairments during single limb balance, choice reaction tasks, and quadriceps isometric activation at high volitional efforts (i.e., 50% maximum voluntary contraction). Further, these findings support previous works showing moderate neuromodulatory benefits when using real-time visual biofeedback.
Grant Norte (Advisor)
Matt Stock (Committee Member)
Jochen Baumeister (Committee Member)
Amanda Murray (Committee Member)
David Bazett-Jones (Committee Member)
276 p.
Health; Medicine; Neurosciences; Physical Therapy; Rehabilitation; Sports Medicine
ACL reconstruction; Balance; EEG; motor control; TENS; Focus of Attention; Biofeedback; Motor Planning; LRP; Reaction Time; Force tracing; corticomuscular coherence; quadriceps

Recommended Citations

Citations

  • Sherman, D. A. (2022). Sensorimotor Neuroplasticity after ACL Reconstruction: Insights into Neuromodulation in Orthopedic Clinical Rehabilitation [Doctoral dissertation, University of Toledo]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1651586669680026

    APA Style (7th edition)

  • Sherman, David. Sensorimotor Neuroplasticity after ACL Reconstruction: Insights into Neuromodulation in Orthopedic Clinical Rehabilitation. 2022. University of Toledo, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=toledo1651586669680026.

    MLA Style (8th edition)

  • Sherman, David. "Sensorimotor Neuroplasticity after ACL Reconstruction: Insights into Neuromodulation in Orthopedic Clinical Rehabilitation." Doctoral dissertation, University of Toledo, 2022. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1651586669680026

    Chicago Manual of Style (17th edition)

toledo1651586669680026
116
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This open access ETD is published by University of Toledo and OhioLINK.