Dual-Tasking Effects on Dynamic Postural Stability in Athletes With and Without Anterior Cruciate Ligament Reconstruction

Purpose:To compare the effect of dual tasking on postural stability between patients with anterior cruciate ligament reconstruction (ACL-R) and healthy controls.Methods:Single-limb postural stability was assessed in 17 athletes with ACL-R and 17 healthy matched athletes while standing on a Biodex Balance System platform in 4 conditions: stability level of 8 (ie, more-stable support surface) with eyes open, stability level of 8 with eyes closed, stability level of 6 (ie, less-stable support surface) with eyes open, and stability level of 6 with eyes closed. Postural-stability tasks were performed with and without auditory Stroop task. The anteroposterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI) as measures of postural performance, as well as reaction time and error ratio as measures of cognitive performance, were recorded.Results:Dual-tasking effect on postural stability was not significantly different between the groups in 3 postural conditions. Only in level 6 with eyes open, for APSI and OSI, patients with ACL-R showed lower postural stability under the dual-task condition. However, patients showed poorer performance on both reaction time and error ratio in all postural conditions.Conclusions:The patients with ACL-R appeared to sacrifice their cognitive performance to optimize their performance on postural stability. This posture-first strategy was reflected by a more pronounced effect of dual tasking on the auditory Stroop task than the postural-stability task. In situations where maintenance of posture is challenging, giving priority to the postural task at the expense of cognitive performance can ensure safety from balance loss.

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Postural Stability and Responses to Vibrations in Patients After Anterior Cruciate Ligament Surgical Reconstruction

Physiological Research ◽

10.33549/physiolres.933437 ◽

2016 ◽

pp. S409-S416 ◽

Cited By ~ 3

Author(s):

Z. HIRJAKOVÁ ◽

H. ŠINGLIAROVÁ ◽

D. BZDÚŠKOVÁ ◽

J. KIMIJANOVÁ ◽

K. BUČKOVÁ ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Postural Stability ◽

Cruciate Ligament ◽

Quadriceps Femoris ◽

Triceps Surae ◽

Surgical Reconstruction ◽

Eyes Closed ◽

Postural Changes ◽

Eyes Open ◽

Anterior Cruciate

The aim of the study was to evaluate the effect of surgical reconstruction of anterior cruciate ligament (ACL) on postural stability and responses to lower limb (LL) muscles vibrations. Centre of pressure (CoP) was measured in 17 subjects during stance on firm/foam surface with eyes open/closed and during unilateral vibrations of LL muscles (m. triceps surae – TS, m. quadriceps femoris – Q, m. quadriceps femoris and hamstrings simultaneously – QH). The measurements were performed: 1) preoperatively, 2) six weeks and 3) three months after the reconstruction. Decreased postural stability was documented six weeks after the reconstruction compared to preoperative measurement. Three months after the reconstruction significant improvement was observed during stance on foam surface with eyes closed. Preoperatively, altered reactions of LL with ACL lesion compared to intact LL were manifested by slower response in first 3 s of TS vibration and by increased CoP shift in last 5 s of QH vibration. After the reconstruction, we observed slower CoP reaction and decreased CoP shift during TS vibration of LL with ACL lesion compared to preoperative level. Posturography during quiet stance and during TS vibration reliably detect postural changes due to ACL reconstruction and can be potentially useful in clinical practice.

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Do Athletes With a Reconstructed Anterior Cruciate Ligament Respond Differently Than Controls to Visual Challenges When Dynamic Postural Stability is Assessed?

Journal of Applied Biomechanics ◽

10.1123/jab.2021-0302 ◽

2021 ◽

Vol 37 (6) ◽

pp. 611-618

Author(s):

Nathan J. Robey ◽

Kurt O. Buchholz ◽

Shane P. Murphy ◽

Jeremy D. Smith ◽

Gary D. Heise

Keyword(s):

Anterior Cruciate Ligament ◽

Visual Information ◽

Postural Stability ◽

Cruciate Ligament ◽

Stability Index ◽

Acl Injury ◽

Increased Risk ◽

Eyes Open ◽

Anterior Cruciate ◽

Dynamic Postural Stability

Individuals returning to sport after anterior cruciate ligament reconstruction (ACLR) are at an increased risk of sustaining a subsequent ACL injury. It is suspected that increased reliance on visual information to maintain stability may factor into this increased risk. The connection between visual reliance and ACLR is not well understood during dynamic tasks. Examination of the proposed visual reliance may help improve returning to sport standards and reduce subsequent ACL injury risk. A total of 12 ACLR individuals and 12 age- and sex-matched controls completed several trials of a normalized dynamic hop task on both limbs under 3 different visual conditions (eyes open, low visual disruption, and high visual disruption). Stroboscopic eyewear were worn by each participant to disrupt vision during testing. Ground reaction force data were collected during landing. Dynamic postural stability was assessed using 2 separate calculations: dynamic postural stability index and time to stability. No significant statistical interactions or group differences were observed. The stroboscopic eyewear did increase the medial–lateral stability index from the eyes open to the low visual disruption condition (P < .05). These findings suggest that ACLR individuals do not rely on visual information more than controls during a dynamic hop task.

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The Effects of Instruction Exercises on Performance and Kinetic Factors Associated With Lower-Extremity Injury in Landing After Volleyball Blocks

Journal of Sport Rehabilitation ◽

10.1123/jsr.2018-0163 ◽

2020 ◽

Vol 29 (1) ◽

pp. 51-64

Author(s):

Anis Rostami ◽

Amir Letafatkar ◽

Alli Gokeler ◽

Mehdi Khaleghi Tazji

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Injury ◽

Postural Stability ◽

Cruciate Ligament ◽

Stability Index ◽

Lower Extremity Injury ◽

Ligament Injury ◽

Hop Test ◽

Anterior Cruciate ◽

Dynamic Postural Stability

Context: Female volleyball players are more predisposed to anterior cruciate ligament injury in comparison with their male counterparts. Recent research on anterior cruciate ligament injury prevention strategies has shown the positive results of adopting the external focus (EF) of attention in sports. Objective: To determine the effect of 6-week EF instruction exercises on performance and kinetic factors associated with lower-extremity injury in landing after the volleyball blocks of female athletes. Design: Pretest and posttest control study. Setting: University research laboratory. Participants: Thirty-two female volleyball players (18–24 y old) from the same team randomly divided into experimental (n = 16) and control (n = 16) groups. Intervention: The experimental group performed a 6-week exercise program with EF instructions. The control group continued its regular volleyball team schedule. Main Outcome Measures: To assess function, single-leg triple hop test for distance was used. A force plate was used to evaluate kinetic variables including vertical ground reaction forces, the rate of loading, and dynamic postural stability index. All data were assessed at baseline and after the intervention. Results: There was a significant increase in single-leg triple hop test (P < .05) and in the first and second peak ground reaction force, rate of loadings, dynamic postural stability index (P < .05). Conclusion: According to the results of this study, anterior cruciate ligament injury prevention programs should incorporate EF instruction exercises to enhance the kinetics and to increase athletes’ functional performance.

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Examining the Relationship Between a Neuromuscular Control Baseline Battery for Sport-Related Concussion and Anterior Cruciate Ligament Injury Risk

Neurology ◽

10.1212/01.wnl.0000801936.89376.f8 ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S21.2-S22

Author(s):

Ryan Moran

Keyword(s):

Anterior Cruciate Ligament ◽

Lower Extremity ◽

Cruciate Ligament ◽

Neuromuscular Control ◽

Ligament Injury ◽

Jump Landing ◽

Eyes Closed ◽

Eyes Open ◽

Anterior Cruciate ◽

The Relationship

ObjectiveTo examine the relationship between the m-CTSIB and Landing Error Scoring System in a sample of collegiate female athletes.BackgroundRecent literature has linked concussion and neuromuscular deficits in the lower extremity after injury. Neuromuscular control is frequently assessed using balance measures for concussion, but also dynamically to identify anterior cruciate ligament injury (ACL) risk via jump-landing movement screening.Design/MethodsThirty-nine healthy, collegiate female soccer (n = 22) and volleyball (n = 17) athletes completed the modified-Clinical Test of Sensory Interaction of Balance (m-CTSIB) and the Landing Error Scoring System (LESS). Measures consisted of total m-CTSIB sway index scores on individual conditions (firm surface eyes open [condition 1] and eyes closed [2], foam surface eyes open [3] and eyes closed [4]), m-CTSIB overall score, and total LESS errors. LESS scores were also categorized into a low (0–4 errors) and high (5 + errors) risk to determine if athletes with worse neuromuscular control on the LESS has worse balance on the m-CTSIB. A Spearman's rank-order correlation was conducted to determine the strength of the relationship between LESS and m-CTSIB performance. A series of Mann-Whitney U test were performed to determine differences between low and high LESS performance on m-CTSIB performance.ResultsThere was a weak, negative correlation between LESS and m-CTSIB performance (rs(37) = −0.153, p = 0.35). Further, there were no differences between the low and high risk LESS groups on sway index scores on conditions 1 (U = 158.5, p = 0.39), 2 (U = 156.0, p = 0.36), 3 (U = 165.5, p = 0.51), or 4 (U = 128.5, p = 0.08), as well as overall m-CTSIB scores (U = 150.5, p = 0.28).ConclusionsThere appears to be a lack of relationship between the LESS and m-CTSIB tests, revealing the independence of static and dynamic lower extremity neuromuscular function. Athletes who may be more at risk for ACL injury due to abnormal jump-landing biomechanics, do not differ from low-risk athletes on baseline balance assessment.

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Measures of Agility and Single-Legged Balance as Clinical Assessments in Patients With Anterior Cruciate Ligament Reconstruction and Healthy Individuals

Journal of Athletic Training ◽

10.4085/1062-6050-266-18 ◽

2019 ◽

Vol 54 (12) ◽

pp. 1260-1268

Author(s):

Aleah N. Kirsch ◽

Stephan G. Bodkin ◽

Susan A. Saliba ◽

Joseph M. Hart

Keyword(s):

Ligament Reconstruction ◽

Center Of Pressure ◽

Cruciate Ligament ◽

T Test ◽

Control Group ◽

Clinical Assessments ◽

Eyes Closed ◽

Knee Position ◽

Eyes Open ◽

Anterior Cruciate

Context Current clinical assessments used for patients with anterior cruciate ligament reconstruction (ACLR) may not enable clinicians to properly identify functional deficits that have been found in laboratory studies. Establishing muscular-function assessments, through agility and balance tasks, that can properly differentiate individuals with ACLR from healthy, active individuals may permit clinicians to detect deficits that increase the risk for poor outcomes. Objective To compare lower extremity agility and balance between patients with ACLR and participants serving as healthy controls. Design Case-control study. Setting Controlled laboratory. Patients or Other Participants A total of 47 volunteers in 2 groups, ACLR (9 males, 11 females; age = 23.28 ± 5.61 years, height = 173.52 ± 8.89 cm, mass = 70.67 ± 8.89 kg) and control (13 males, 12 females; age = 23.00 ± 6.44, height = 172.50 ± 9.24, mass = 69.81 ± 10.87 kg). Main Outcome Measure(s) Participants performed 3 timed agility tasks: Agility T Test, 17-hop test, and mat-hopping test. Balance was assessed in single-legged (SL) stance in 3 positions (straight knee, bent knee, squat) on 2 surfaces (firm, foam) with the participants' eyes open or closed for 10-second trials. Agility tasks were measured for time to completion. Eyes-open balance tasks were measured using center-of-pressure average velocity, and eyes-closed balance tasks were measured using the Balance Error Scoring System. Results For the Agility T Test, the ACLR group had slower times than the control group (P = .05). Times on the Agility T Test demonstrated moderate to strong positive relationships for unipedal measures of agility. The ACLR group had greater center-of-pressure average velocity in the SL bent-knee position than the control group. No differences were found between groups for the SL straight-knee and SL-squat balance tasks (P > .05). No differences in errors were present between groups for the eyes-closed balance tasks (P > .05). Conclusions The ACLR group demonstrated slower bipedal agility times and decreased postural stability when assessed in an SL bent-knee position compared with the control group.

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Effects of 7-Day Ketone Ingestion and a Physiological Workload on Postural Stability, Cognitive, and Muscular Exertion Measures in Professional Firefighters

Safety ◽

10.3390/safety5010015 ◽

2019 ◽

Vol 5 (1) ◽

pp. 15

Author(s):

Harish Chander ◽

Matthew McAllister ◽

Angelia Holland ◽

Hunter Waldman ◽

Benjamin Krings ◽

...

Keyword(s):

Cognitive Performance ◽

Muscle Activity ◽

Postural Stability ◽

Experimental Testing ◽

Peak Oxygen Consumption ◽

Plantar Flexors ◽

Eyes Closed ◽

Performance Reduction ◽

Eyes Open ◽

The Impact

Background: Postural stability and cognitive performance are challenged in firefighters. The purpose of this investigation was to examine the impact of 7-day ketone supplementation on postural stability, cognitive performance, and muscular activation before and after a physiological workload. Methods: Nine professional firefighters completed two experimental sessions (pre- and post-workload) in a counterbalanced, double-blind design. Participants ingested either a ketone salt (KS) or placebo (PLA) daily for seven days, and had an eighth ingestion 30 min prior to testing. Each experimental testing consisted of maximal voluntary contractions (MVIC) for four muscles (knee flexors—BF, extensor—VM, ankle dorsiflexors—TA, and plantar flexors—MG) using electromyography and postural stability testing (eyes open (EO), eyes closed (EC), and eyes open-dual-task using a FitLight™ system (EOT)), before (pre-workload) and after (post-workload) a simulated physiological workload. The workload consisted of 35 min steady state exercise at 60% of peak oxygen consumption wearing firefighter personal protective equipment (PPE). Results: Significant differences were limited to time effects (pre-workload vs. post-workload), with no differences between groups (KS vs. PLA). Significantly lower muscle activity in VM, TA, and MG during MVIC, greater postural sway and muscle activity in BF during EC and EOT, and slower response time during EOT were evident post-workload. Conclusions: A 7-day ketone supplementation does not impact postural stability, muscle activity, and cognitive tasks, but a fatiguing workload causes significant performance reduction.

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THE EFFECTS OF NEUROMUSCULAR ELECTRICAL STIMULATION IN ASSOCIATION WITH WHEY PROTEIN SUPPLEMENTATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Acta Ortopédica Brasileira ◽

10.1590/1413-785220212906237983 ◽

2021 ◽

Vol 29 (6) ◽

pp. 316-322

Author(s):

GABRIELA OTÍLIA MENDONÇA ◽

MARIA LUIZA BIANCHINI SEVERINO ◽

KELLE MOREIRA DE OLIVEIRA ◽

MARCELO LIMA DE OLIVEIRA ◽

GIOVANE GALDINO DE SOUZA ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Electrical Stimulation ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Neuromuscular Electrical Stimulation ◽

Electromyographic Activity ◽

Eyes Closed ◽

Eyes Open ◽

Anterior Cruciate

ABSTRACT Objective: To analyze the effects of neuromuscular electrical stimulation of the femoral quadriceps associated or not with whey protein supplementation on the electromyographic activity and body mass distribution in volunteers undergoing anterior cruciate ligament reconstruction. Methods: 24 volunteers were randomly divided into three groups: basal control, whey protein in association with neuromuscular electrical stimulation, and neuromuscular electrical stimulation alone. Results: In the postoperative evaluation, during the mini squat, the basal group showed a decrease in the electromyographic activity of the vastus medialis (p = 0.005, eyes open; p = 0.003, eyes closed), vastus lateralis (p = 0.005, eyes open; p = 0.020; eyes closed) and rectus femoris (p = 0.075, eyes open; p = 0.074, eyes closed) and of body mass distribution in the injured limb (p < 0.001, eyes open; p < 0.001, eyes closed), and in the healthy limb (p < 0.001, eyes open; p < 0.001, eyes closed). Conclusion: The early use of neuromuscular electrical stimulation of the quadriceps femoris maintained the electromyographic activity of the vastus medialis and vastus lateralis muscles and prevented asymmetries in body mass distribution 15 days after anterior cruciate ligament reconstruction. Level of Evidence I, High quality randomized trial.

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Core Stabilization Training After Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00150 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0015 ◽

Cited By ~ 2

Author(s):

Özge Çınar Medeni ◽

Kezban Bayramlar ◽

Gül Baltacı ◽

İbrahim Yanmış

Keyword(s):

Postural Stability ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Strength Ratio ◽

Cruciate Ligament Reconstruction ◽

Core Stabilization ◽

Eyes Closed ◽

Anterior Cruciate ◽

Knee Muscle ◽

Knee Muscle Strength

Objectives: The aim of this study was to compare the effects of core stabilization exercises and conventional rehabilitation exercises after anterior cruciate ligament reconstruction in terms of knee joint laxity, knee muscle strength, postural stability and functional tests. Methods: Twenty eight patients reconstructed with hamstring tendon were included. Thirteen patients evaluated after a conventional rehabilitation and fifteen after a core stabilization programme. Single-limb postural stability assessment, isokinetic knee muscle strength test, instrumented ligament laxity test, functional hop tests were done to both groups after 16th week. Single-limb postural stability was assessed with stabilometer in both eyes open and eyes-closed conditions. Healthy legs were evaluated as internal controls. Results: Knee flexor and extensor strength indices were not different between groups (p>.05). H/Q strength ratio was different at 180 °/s (p<.05). Knee laxity was not different between groups (p<.05). There was no significant difference in hop distance and hop index between groups (p>.05). Conventional training group had deficit in overall stability score in eyes closed condition (p>.05), but core stabilization group did not have any postural stability deficit (p>.05). Conclusion: Better H/Q strength ratio was seen in core stabilization group. Core stabilization exercises improved postural stability more than classic rehabilitation.

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Gait Stability Measurement by Using Average Entropy

Entropy ◽

10.3390/e23040412 ◽

2021 ◽

Vol 23 (4) ◽

pp. 412

Author(s):

Han-Ping Huang ◽

Chang Francis Hsu ◽

Yi-Chih Mao ◽

Long Hsu ◽

Sien Chi

Keyword(s):

Postural Stability ◽

Multiscale Entropy ◽

Gait Stability ◽

Eyes Closed ◽

Stride Interval ◽

Step Interval ◽

Stability Measurement ◽

Eyes Open ◽

Two Measures ◽

Better Than

Gait stability has been measured by using many entropy-based methods. However, the relation between the entropy values and gait stability is worth further investigation. A research reported that average entropy (AE), a measure of disorder, could measure the static standing postural stability better than multiscale entropy and entropy of entropy (EoE), two measures of complexity. This study tested the validity of AE in gait stability measurement from the viewpoint of the disorder. For comparison, another five disorders, the EoE, and two traditional metrics methods were, respectively, used to measure the degrees of disorder and complexity of 10 step interval (SPI) and 79 stride interval (SI) time series, individually. As a result, every one of the 10 participants exhibited a relatively high AE value of the SPI when walking with eyes closed and a relatively low AE value when walking with eyes open. Most of the AE values of the SI of the 53 diseased subjects were greater than those of the 26 healthy subjects. A maximal overall accuracy of AE in differentiating the healthy from the diseased was 91.1%. Similar features also exists on those 5 disorder measurements but do not exist on the EoE values. Nevertheless, the EoE versus AE plot of the SI also exhibits an inverted U relation, consistent with the hypothesis for physiologic signals.

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