Visual-motor training after ACL to retrain the brain and stabilize neuroplasticity

Anterior cruciate ligament (ACL) is an injury to the knee that may come about as a result of vigorous sports or accidents. The most common way of treating ACL is the surgical reconstruction of the knee.

Patients who have gone through surgical treatment of knee injuries have on various occasions showed problems in their cognitive function. They tend to take a long time to regain full use of their knees especially when it comes to sporting activities.

Research has shown that this has got to do with brain plasticity in relation to the reconstructive surgery. In this article, we are going to explore visual motor training as a means of treatment after ACL surgery as we also look at how the knee injury affects brains plasticity.

How do ACL and brain plasticity relate?

Brain plasticity is the ability of the brain to change and form new neural connections over one’s lifetime. Different situations may cause more brain plasticity than others. For instance, when one part of the brain becomes inactive due to injury or otherwise, the part that is still functional may take over the functions of the region that cannot work.

Injury to the body especially when it touches nerves may sometimes cause a breakdown in communication between that part and the central nervous system. This is what happens with ACL, the neuron transmissions from the hurt knee are either weak or unavailable for some time. During the breakdown, the brain reorganizes itself and removes that area from its system.

Therefore when corrective surgery is administered, the knee function is no longer included in the brain’s “list” of cognitive functions. It, therefore, follows that when the patient is recovering, they can no longer trust their knee to move as before, but rather they end up having to use their vision to “see” their movement.

The part of the sensorimotor function that deals with visual feedback fails and as a result doesn’t give feedback. A person recovering from ACL may, therefore, be operating as a person walking in the dark in a place they are not familiar with. They may walk as if they are not sure of their steps as if they are learning to walk.

What is visual motor-training and how does it help post ACL reconstructive surgery?

One of the ways that is used to cause a distraction in visual training is the use of blindfolds or closed eyes. This enables the patient to stop concentrating on what they see but instead use their other senses when moving. This method is however mostly used in a controlled environment rather than in chaotic sporting environments.

Combining stroboscopic and visual obstruction techniques to help with relearning motor skills is one of the ways that help decrease the dependence on one’s sight when they are using their knees. All these techniques added together make up visual motor training, and they aim to stimulate the central nervous system and make it start to allow vestibular and somatosensory input from the affected knee area and in turn reduce the need for continual visual feedback.

Visual feedback may not go away, and it is, therefore, essential to find a way of controlling how much of it happens and pairing visual training with other techniques like neuromuscular training that will help the patient to participate in sports being cognizant of their environment while at the same time managing to achieve knee control.

Final thoughts

Assuming that the patient suffers from post ACL motor impairment and does not have any other cognitive disability, visual motor training will go a long way in helping them regain “trust” in their knee function.
However, should the patient suffer from neuroplasticity issues stemming from other aspects, the training may not offer a complete treatment plan for their ACL recovery issues.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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