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Real-time biofeedback integrated into neuromuscular training reduces high-risk knee biomechanics and increases functional brain connectivity: A preliminary longitudinal investigation |
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| Authors: | Jed A. Diekfuss Dustin R. Grooms Scott Bonnette Christopher A. DiCesare Staci Thomas Ryan P. MacPherson Jonathan D. Ellis Adam W. Kiefer Michael A. Riley Daniel K. Schneider Brooke Gadd Katie Kitchen Kim D. Barber Foss Jonathan A. Dudley Weihong Yuan Gregory D. Myer |
| Affiliation: | 1. The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA;2. Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA;3. The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA;4. The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA College of Medicine, University of Cincinnati, Cincinnati, OH, USA;5. The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Department of Exercise Science and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Center for Cognition, Action & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA;6. Center for Cognition, Action & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA;7. Department of Radiology, University of Michigan, Ann Arbor, MI, USA;8. Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA;9. College of Medicine, University of Cincinnati, Cincinnati, OH, USA Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA;10. The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA College of Medicine, University of Cincinnati, Cincinnati, OH, USA Department of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA The Micheli Center for Sports Injury Prevention, Waltham, MA, USA |
| Abstract: | Prospective evidence indicates that functional biomechanics and brain connectivity may predispose an athlete to an anterior cruciate ligament injury, revealing novel neural linkages for targeted neuromuscular training interventions. The purpose of this study was to determine the efficacy of a real-time biofeedback system for altering knee biomechanics and brain functional connectivity. Seventeen healthy, young, physically active female athletes completed 6 weeks of augmented neuromuscular training (aNMT) utilizing real-time, interactive visual biofeedback and 13 served as untrained controls. A drop vertical jump and resting state functional magnetic resonance imaging were separately completed at pre- and posttest time points to assess sensorimotor adaptation. The aNMT group had a significant reduction in peak knee abduction moment (pKAM) compared to controls (p = .03, d = 0.71). The aNMT group also exhibited a significant increase in functional connectivity between the right supplementary motor area and the left thalamus (p = .0473 after false discovery rate correction). Greater percent change in pKAM was also related to increased connectivity between the right cerebellum and right thalamus for the aNMT group (p = .0292 after false discovery rate correction, r2 = .62). No significant changes were observed for the controls (ps > .05). Our data provide preliminary evidence of potential neural mechanisms for aNMT-induced motor adaptations that reduce injury risk. Future research is warranted to understand the role of neuromuscular training alone and how each component of aNMT influences biomechanics and functional connectivity. |
| Keywords: | anterior cruciate ligament central nervous system coordination motion analysis resting-state fMRI |