Neuroplastic Mechanisms Underlying Augmented Neuromuscular Training
Condition: Anterior Cruciate Ligament Injuries
MeSH terms: Anterior Cruciate Ligament Injuries
Study type: Interventional

Summary: 
      The purpose of this proposal is to determine the neural mechanisms of augmented neuromuscular
      training (aNMT). Participants will complete a 6-week course of neuromuscular training with
      either aNMT biofeedback or sham biofeedback. An MRI will be performed before and after the
      training program.
    

Detailed description: 
      Anterior cruciate ligament (ACL) injury is a common and debilitating knee injury affecting
      over 350,000 children or young adults each year, drastically reducing their chances for an
      active and healthy life. Annual direct costs exceed $13 billion, and the long-term indirect
      costs far exceed that figure, as ACL injury is also linked to accelerated development of
      disabling osteoarthritis within a few years after injury. The National Public Health Agenda
      for Osteoarthritis recommends expanding and refining evidence-based ACL injury prevention to
      reduce this burden. The investigators have identified modifiable risk factors that predict
      ACL injury in young female athletes. This neuromuscular training targets those factors and
      shows statistical efficacy in high-risk athletes, but meaningful transfer of low-risk
      mechanics to the field of play has been limited, as current approaches are not yet decreasing
      national ACL injury rates in young female athletes. The key gap is how to target mechanisms
      that allow transfer of risk-reducing motor control strategies from the intervention to the
      athletic field. The mechanisms that ultimately make such transfer possible are neural, but
      thus far injury prevention training focusing on neuromuscular control has not utilized neural
      outcomes. The investigators published and new preliminary data on neuroplasticity related to
      injury and neuromuscular training demonstrate the proficiency to capture these neural
      outcomes and future capability to target these neural mechanisms to improve the rate of motor
      transfer. The data support this proposal's central hypothesis that increased sensory, visual
      and motor planning activity to improve motor cortex efficiency is the neural mechanism of
      adaptation transfer to realistic scenarios. The ability to target the neural mechanisms to
      increase risk-reducing motor transfer from the clinic to the world could revolutionize ACL
      injury prevention. The transformative, positive impact of such innovative strategies will
      enhance the delivery of biofeedback to optimize training and increase the potential for sport
      transfer. This contribution will be significant for ACL injury prevention and associated
      long-term sequelae in young females. This unique opportunity to enhance ACL injury prevention
      by targeting neural mechanisms of neuromuscular adaptation and transfer will reduce the
      incidence of injuries that cause costly and long-term disabling osteoarthritis.

      Participants from the parent study "Real-time Sensorimotor Feedback for Injury Prevention
      Assessed in Virtual Reality" will be eligible to participate in this study. In the parent
      study, participants are randomized to receive augmented neuromuscular training (aNMT) or sham
      biofeedback training. Enrolled participants will complete MRI testing before and after the
      study training program. The entire MRI protocol will include high resolution T1-weighted 3D
      images, a 61 direction diffusion tensor imaging sequence, resting state functional magnetic
      resonance imaging (fMRI), and task-based fMRI. The fMRI tasks will be focused on motor
      function, participants will be asked to complete lower extremity movements including knee
      flexion and extension and a combined hip and knee flexion and extension.
    

Intervention name(s): aNMT Biofeedback; Sham Biofeedback
Intervention type(s): Other; Other
Intervention description(s): aNMT biofeedback is created by calculating kinematic and kinetic data in real-time from the athlete's own movements. These values determine realtime transformations of the stimulus shape the athlete views via augmented-reality (AR) glasses during movement performance. The athlete's task is to move so as to create ("animate") a particular stimulus shape that corresponds to desired values of the biomechanical parameters targeted by the intervention. The aNMT biofeedback occurs during neuromuscular training sessions. The neuromuscular training is a 12-week, pre-season training program occurring over 6 weeks.; Sham biofeedback provides a similar phenomenological experience to aNMT biofeedback for athletes-both groups experience a shape that changes with their movements-but the sham biofeedback will not provide usable information to modify movement parameters during critical movement phases. The sham biofeedback occurs during neuromuscular training sessions. The neuromuscular training is a 12-week, pre-season training program occurring over 6 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention