Evaluating the Spectrum of Cognitive-Motor Relationships During Dual-Task Jump Landing

Neurophysiology of ACL Injury

The neurophysiology of ACL injury extends beyond the mechanical rupture of the ligament to encompass profound alterations in the central and peripheral nervous systems, impacting sensorimotor integration and neuromuscular control. The ACL, densely populated with mechanoreceptors, plays a critical role in joint proprioception, dynamically regulating knee stability through complex neural circuits that connect to the spinal cord and brain. When disrupted by injury, these neural pathways contribute to delayed muscular activation, altered motor planning, and compromised joint stability. Such neuromechanical deficits increase the likelihood of reinjury and highlight the need for comprehensive neuroplastic rehabilitation. Neuroplastic therapy, employing tools like external focus strategies, stroboscopic glasses, smartboards, and virtual reality, aims to restore and enhance neural connectivity, sensory integration, and motor coordination. These advanced tools target distinct phases of motor learning, promoting automaticity and resilience in movement patterns. By integrating visual-cognitive, proprioceptive, and reflexive controls, this therapeutic approach not only accelerates recovery but also optimizes performance and reduces the risk of re-injury, representing a paradigm shift in ACL rehabilitation.

Adding secondary cognitive tasks to drop vertical jumps alters the landing mechanics of athletes with anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) reinjury rates among athletes remain very high despite screening protocols designed to assess readiness for return to sport. To better identify biomechanical risk factors for ACL injury, combining neurocognitive challenges and high-impact tasks would more closely resemble sporting demands. We investigated the influence of secondary cognitive tasks on landing mechanics during bilateral drop vertical jumps (DVJs) among athletes following ACL reconstruction and whether sex affected these results. We also assessed whether adding secondary cognitive tasks to DVJs influenced loading asymmetries. Forty individuals (20 males) performed three DVJ conditions: (1) without secondary cognitive tasks (DVJ), (2) with secondary cognitive tasks targeting fast decision-making and inhibitory control of the motor action (DVJmot), and (3) with secondary cognitive tasks targeting fast decision-making, inhibitory control, attention, and short-term memory (DVJcogmot). We collected movement mechanics time-series data during the first 100 ms of landing using a motion capture system and force plates and compared outcomes between the three DVJs using functional t-tests. Secondary cognitive tasks altered trunk, hip, knee, and ankle landing mechanics (adjusted p-values < 0.05), representing more upright and stiffer landings. Loading asymmetries were increased by unloading the injured limb (adjusted p-values < 0.05). We found no differences between DVJmot and DVJcogmot or between males and females. Adding secondary cognitive tasks to DVJs better identifies landing mechanics associated with an increased ACL injury risk and inadequate rehabilitation. Future research should focus on optimizing the challenge point of the cognitive and motor tasks and how to best integrate them in RTS testing.

Cognitive-Motor Dual-Task Performance of the Landing Error Scoring System

CONTEXT

The Landing Error Scoring System (LESS) is a common assessment used to determine biomechanical landing errors. However, this assessment is completed as a single motor task, which does not require additional attentional resources. It is unclear if the LESS can be used to detect cognitive-motor interference (ie, dual-task cost) in biomechanical errors associated with lower extremity injury.

OBJECTIVE

To determine if the LESS is a suitable clinical assessment of dual-task performance in uninjured women and to evaluate whether specific landing criteria are more affected by an additional cognitive load than others.

DESIGN

Cross-sectional study.

SETTING

University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 20 uninjured, physically active female participants (age = 22.4 ± 2.5 years, height = 1.68 ± 0.07 m, mass = 67.0 ± 13.8 kg, Tegner Activity Scale = 5.9 ± 1.1).

INTERVENTION(S)

Participants performed the LESS under 3 different conditions: baseline landing with no cognitive distraction (Single), a visual-based dual task (Visual), and a number-based dual task (Number).

MAIN OUTCOME MEASURES(S)

Mean sagittal-plane, frontal-plane, and total LESS scores were compared between conditions using a 1-way repeated-measures analysis of variance with Tukey post hoc correction. A Cohen d effect size with a 95% confidence interval was used to determine the magnitude of differences. The frequency of errors for each LESS item under the 3 conditions was compared using χ2 analysis.

RESULTS

Participants exhibited greater sagittal-plane (P = .02, d = 0.91; 95% confidence interval, 0.26-1.56) and total (P = .008, d = 1.03; 95% confidence interval, 0.37-1.69) errors during the Visual condition than during the Single condition. The frequency of errors observed for each LESS item did not differ between conditions (all P > .05).

CONCLUSIONS

The LESS was able to detect a dual-task cost in landing errors during both the Visual conditions. We recommend developing clinically oriented solutions to incorporate similar dual-task paradigms in traditional injury risk-reduction programs.

Think fast, stay healthy? A narrative review of neurocognitive performance and lower extremity injury

BACKGROUND

Lower extremity (LE) injury has been problematic in athletic populations. While previous research has identified biomechanical and neuromuscular risk factors, more recent efforts have determined that neurocognitive performance (NP) may influence LE injury risk.

OBJECTIVES

To describe the present findings pertaining to the relationship between NP and LE injury. This review described potential cerebral neural mechanisms underpinning LE injury with a particular emphasis on the role of vision in sensorimotor integration. Lastly, newer technology such as stroboscopic eyewear, smartboards, and virtual/augmented reality were discussed for their utility in assessing and training NP.

METHODS

Narrative review that described NP and LE injury, as well as plausible mechanisms and training interventions.

RESULTS

NP appears to influence both LE biomechanics and LE injury risk. Athletes with worse NP demonstrated decreased knee flexion and increased frontal plane knee loading compared to better performing athletes. Most studies determined an association between NP and LE injury risk. Visual motor reaction time, processing speed, and working memory appear to be useful NP measures for identifying athletes at risk for LE injury. Various brain regions including the precuneus and lingual gyrus may be implicated as neural signatures for LE injury. While recently developed technology offer promise, far-transfer effects to LE injury risk reduction have yet to be substantially investigated.

CONCLUSIONS

NP should be considered an important component for identifying LE injury risk. Sports scientists and clinicians may consider a variety of assessments and interventions to quantify and train NP in conjunction with previously established protocols.

Effects of adding dual-task or sport-specific task constrains to jump-landing tests on biomechanical parameters related to injury risk factors in team sports: a systematic review

Background

Jumping and landing tests are frequently used as a tool to assess muscle function. However, they are performed in a controlled and predictable environment. The physical tests commonly used as part of the criteria for return to sport after injury are often performed with little or no cognitive load and low coordinative demand compared to game-specific actions. The aim of this systematic review was to examine the influence of performing a dual task (DT) or sport-specific task constrains during jump-landing tests on biomechanical variables related to lower limb injury risk in team sports.

Methods

This systematic review followed the specific methodological guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted in the databases Medline (PubMed), Web of Science, Cochrane Plus, and SportDiscus for studies published from 2013 until June 30, 2023. To be eligible, studies had to include: (1) kinematic and/or kinetic assessment of injury risk factors in the lower extremity; (2) a comparison between a simple jump or landing test and a DT jump or landing test which included cognitive information. The risk of bias in the selected articles was analyzed using the recommendations of the Cochrane Collaboration.

Results

Of the 656 records identified, 13 met the established criteria. Additionally, two more articles were manually included after screening references from the included articles and previous related systematic reviews. Regarding the Risk of bias assessment, 12 studies did not surpass a score of 3 points (out of a total of 7). Only three studies exceeded a score of 3 points, with one article achieving a total score of 6. From the included studies, comparative conditions included actions influenced by the inclusion of a sports ball (n = 6), performing tasks in virtual environments or with virtual feedback (n = 2), participation in cognitive tasks (n = 6), and tasks involving dual processes (n = 7). The execution of decision-making (DM) during the jump-landing action resulted in biomechanical changes such as lower peak angles of hip flexion and knee flexion, along with increased vertical ground reaction force, knee abduction, and tibial internal rotation. Regarding limitations, discrepancies arise in defining what constitutes DT. As a result, it is possible that not all studies included in this review fit all conceptual definitions of DT. The inclusion of DT or constraints in jump-landing tests significantly alters biomechanical variables related to lower extremity injury risk in team sports. In future research, it would be beneficial to incorporate tasks into jumping tests that simulate the specific cognitive demands of team sports. This systematic review was registered in PROSPERO (registration number: CRD42023462102) and this research received no external funding.

Associations Between Cognitive Function and ACL Injury-Related Biomechanics: A Systematic Review

CONTEXT

Does lower baseline cognitive function predispose athletes to ACL injury risk, especially when performing unplanned or dual-task movements?

OBJECTIVE

To evaluate the association between cognitive function and biomechanics related to ACL injuries during cognitively challenging sports movements.

DATA SOURCES

PubMed (MEDLINE), Web of Science, Scopus, and SciELO databases were searched; additional hand searching was also conducted.

STUDY SELECTION

The following inclusion criteria had to be met: participants completed (1) a neurocognitive test, (2) a cognitively challenging sport-related task involving lower limbs, and (3) a biomechanical analysis. The following criteria determined exclusion from the review: studies involving participants with (1) recent or current musculoskeletal injuries; (2) recent or current concussion; (3) ACL surgical reconstruction, reviews of the literature, commentary or opinion articles, and case studies.

STUDY DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement and registered at the International Prospective Register of Systematic Reviews (PROSPERO).

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Two of authors independently extracted data and assessed the methodological quality of the articles with the Downs and Black and ROBINS-I checklists, to assess methodological quality and risk of bias, respectively.

RESULTS

Six studies with different methodologies and confounding factors were included in this review. Of these 6 studies, 3 were ranked as high-quality, 3 demonstrated a low risk of bias, 2 a moderate risk, and 1 a severe risk. Five studies found a cognitive-motor relationship, with worse cognitive performance associated with increased injury risk, with 1 study reporting the opposite directionality for 1 variable. One study did not identify any interaction between cognitive function and biomechanical outcomes.

CONCLUSION

Worse cognitive performance is associated with an increased injury risk profile during cognitively challenging movements.

Changes in dual-task cognitive performance elicited by physical exertion vary with motor task

Background

Integrated movement and cognitive load paradigms are used to expose impairments associated with concussion and musculoskeletal injury. There is currently little information on the discriminatory nature of dual-task complexity and the relative influence of physical exertion on cognitive outcomes.

Purpose

Assess cognitive performance while under motor conditions of increasing complexity before and after a standardized exercise protocol.

Methods

34 participants were recruited (17 male and 17 female; 24 ± 1.4 yrs). A modified Eriksen flanker test was used to assess cognitive performance under four conditions (seated, single-leg stance, walking, and lateral stepping) before and after a 20-min moderate-to vigorous intensity treadmill protocol. The flanker test consisted of 20 sets of 5-arrow configurations, appearing in random order. To complete the response to cognitive stimulus, participants held a smartphone horizontally and were instructed to respond as quickly and as accurately as possible by tilting the device in the direction corresponding to the orientation of the middle arrow. The metrics used for analysis included average reaction time (ms), inverse efficiency index (average reaction time penalized for incorrect responses), and conflict effect (the average time cost of responding to an incongruent repetition vs. a congruent repetition). Mixed effects (condition by time) RMANOVAs were conducted to examine the effects of motor task complexity and physical exertion on cognitive performance.

Results

There was a condition by time interaction for inverse efficiency index (p < 0.001), in which participants displayed higher cognitive efficiency for the pre-activity lateral stepping condition compared to the other three conditions (Cohen's d = 1.3–1.6). For reaction time and conflict effect, there were main effects for condition (p = 0.004 and 0.006, respectively), in which performance during lateral stepping was improved in relation to the seated condition (reaction time Cohen's d = 0.68; conflict effect Cohen's d = 0.64).

Conclusion

Participants tended to display better dual-task cognitive performance under more stimulating or complex motor tasks before physical exertion, likely associated with the inverted-U arousal-performance relationship. When using dual-task assessments, clinicians should be mindful of the accompanying motor task and baseline exertion levels and their potential to disrupt or optimize cognitive performance.