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

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.