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Conditioning Brain Responses to Improve Quadriceps Function in an Individual With Anterior Cruciate Ligament Reconstruction
- Source :
- Sports Health: A Multidisciplinary Approach. 11:306-315
- Publication Year :
- 2019
- Publisher :
- SAGE Publications, 2019.
-
Abstract
- Background: Persistent quadriceps weakness and activation failure are common in individuals with anterior cruciate ligament (ACL) reconstruction. A growing body of evidence indicates that this chronic quadriceps dysfunction could be partly mediated due to reduced corticospinal excitability. However, current rehabilitation approaches do not directly target corticospinal deficits, which may be critical for restoring optimal clinical outcomes after the surgery. This case study tested the feasibility of operant conditioning of torque responses evoked by transcranial magnetic stimulation (TMS) to improve quadriceps function after ACL reconstruction. Hypothesis: Operant conditioning of motor evoked torque responses would improve quadriceps strength, voluntary activation, and corticospinal excitability. Study Design: Case study and research report. Level of Evidence: Level 5. Methods: A 24-year-old male with an ACL reconstruction (6 months postsurgery) trained for 20 sessions (2-3 times per week for 8 weeks) to increase his TMS-induced motor evoked torque response (MEP torque) of the quadriceps muscles using operant conditioning principles. Knee extensor strength, voluntary quadriceps muscle activation, and quadriceps corticospinal excitability were evaluated at 3 time points: preintervention (pre), 4 weeks (mid), and immediately after the intervention (post). Results: The participant was able to successfully condition (ie, increase) the quadriceps MEP torque after 1 training session, and the conditioned MEP torque gradually increased over the course of 20 training sessions to reach about 500% of the initial value at the end of training. The participant’s control MEP torque values and corticospinal excitability, which were measured outside of the conditioning paradigm, also increased with training. These changes were paralleled by improvements in knee extensor strength and voluntary quadriceps muscle activation. Conclusion: This study shows that operant conditioning of MEP torque is a feasible approach to improving quadriceps corticospinal excitability and quadriceps function after ACL reconstruction and encourages further testing in a larger cohort of ACL-reconstructed individuals. Clinical Relevance: Operant conditioning may serve as a potential therapeutic adjuvant for ACL rehabilitation.
- Subjects :
- Male
medicine.medical_specialty
Anterior cruciate ligament reconstruction
Anterior cruciate ligament
medicine.medical_treatment
Football
Pyramidal Tracts
Focus Topic: ACL
Physical Therapy, Sports Therapy and Rehabilitation
Quadriceps Muscle
Young Adult
03 medical and health sciences
0302 clinical medicine
Physical medicine and rehabilitation
medicine
Humans
Knee
Orthopedics and Sports Medicine
Muscle Strength
Patient Reported Outcome Measures
Functional rehabilitation
Anterior Cruciate Ligament Reconstruction
business.industry
Anterior Cruciate Ligament Injuries
030229 sport sciences
Evoked Potentials, Motor
Transcranial Magnetic Stimulation
medicine.anatomical_structure
Torque
Conditioning, Operant
Feasibility Studies
Knee injuries
business
030217 neurology & neurosurgery
Quadriceps weakness
Subjects
Details
- ISSN :
- 19410921 and 19417381
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- Sports Health: A Multidisciplinary Approach
- Accession number :
- edsair.doi.dedup.....ac073a1c68352f8a17101963b02e37f8