2023 ISAKOS Biennial Congress ePoster
Neurobiofeedback for Quadriceps Activation Following Anterior Cruciate Ligament Reconstruction: A Narrative Review of Neuroplastic Adaptations Following Injury and Utility of Brain-Computer Interface Technology for Rehabilitation
Harsh Patel, BS, New Brunswick, New Jersey UNITED STATES
Elyse Berlinberg, BS, New York, NY UNITED STATES
Vahram Gamsarian, BE, Chicago, IL UNITED STATES
Vikranth R Mirle, BS, Chicago, IL UNITED STATES
Konstantin Sonkin, PhD, Tel Aviv ISRAEL
Benedict U. Nwachukwu, MD, MBA, Chicago, IL UNITED STATES
Riley J. Williams, MD, New York, NY UNITED STATES
Bert Roland Mandelbaum, MD, DHL(Hon), Santa Monica, California UNITED STATES
Brian Forsythe, MD, Chicago, IL UNITED STATES
Rush University Medical Center, Chicago, Illinois, UNITED STATES
FDA Status Not Applicable
Summary
Brain computer interface technology shows strong potential for facilitating recovery of atrophied neuromuscular pathways following ACLR and may offer an innovative, multidisciplinary approach to Orthopaedic care.
ePosters will be available shortly before Congress
Abstract
Purpose
Persistent quadriceps weakness is a problematic sequela of anterior cruciate ligament reconstruction (ACLR). While traditional physiotherapy remains the mainstay approach, growing evidence suggests substantial benefits of utilizing quadriceps neurobiofeedback techniques.
Methods
A narrative review of neuroplastic changes, motor imaging (MI) training, and brain- computer interface (BCI)-MI technology in postoperative neuromuscular rehabilitation was conducted.
Results
ACLR disrupts sensory input from the quadriceps, which results in reduced sensitivity to electrochemical neuronal signals, an increase in central inhibition of neurons regulating quadriceps control, and dampening of reflexive motor activity. MI training consists of visualizing an action, without physically engaging in muscle activity. Imagined motor output during MI training increases the sensitivity and conductivity of corticospinal tracts emerging from the primary motor cortex, which helps “exercise” the connections between the brain and target muscle tissues. Motor rehabilitation studies utilizing BCI-MI technology have demonstrated increased excitability of the motor cortex, corticospinal tract, spinal motor neurons, and disinhibition of inhibitory interneurons. This technology has been validated and successfully applied in the recovery of atrophied neuromuscular pathways in stroke patients but has yet to be investigated in peripheral neuromuscular insults, such as ACL injury and reconstruction. Well-designed clinical studies may assess the impact of BCI on clinical outcomes and recovery time.
Conclusions
Quadriceps weakness is associated with neuroplastic changes within specific corticospinal pathways and brain areas. BCI-MI shows strong potential for facilitating recovery of atrophied neuromuscular pathways following ACLR and may offer an innovative, multidisciplinary approach to Orthopaedic care.