Reyes Michaela A, Probasco Mark O, Worby Trina N, Loertscher Dylan E, Soderbeck Lyndsey K, Huddleston Wendy E
Rehabilitation Sciences & Technology, University of Wisconsin - Milwaukee.
Int J Sports Phys Ther. 2022 Aug 1;17(5):787-815. doi: 10.26603/001c.36814. eCollection 2022.
The classic model of non-contact ACL injury includes environmental, anatomical, hormonal and biomechanical risk factors which directly impact either the amount of stress placed on the ligament or the relative capacity of ligament to withstand the forces placed on it. However, cognition also clearly plays a role in successful athletic performance, yet diminished cognitive function is rarely considered a risk factor for injury.
To examine the existing literature to determine the extent to which cognitive function (both cognitive ability and task cognitive load) influences non-contact lower extremity injury risk in male and female athletes with a broad variety of athletic expertise.
Scoping Review.
An electronic search was conducted of CINAHL, SPORTDiscus, Google Scholar, and MEDLINE using the PRISMA method. Search terms included Boolean combinations of "cognition", "concussion", "ImPACT", "cognitive deficit", "mild traumatic brain injury (mTBI)", and "neuropsychological function" as cognitive descriptors and the terms "injury risk" and "lower extremity injury" as injury descriptors. Inclusion criteria included papers written in English published between 2000-2021. Exclusion criteria included neurological and cognitively atypical populations, except for concussion (included). Included articles were appraised using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Fifty-six studies utilizing across the spectrum of levels of evidence met inclusion criteria. Forty-one articles had good, fourteen had fair, and one had poor methodological quality. Studies examined baseline cognitive function in healthy athletes (n=7); performance during dual-task paradigms (n=13); and the impact of concussion on dual-task performance (n=4), LE injury risk (n=22), or post-concussion testing (n=10). Six articles examining cognitive function and all dual-task studies (including concussion studies) found altered biomechanics associated with injury or increased processing demands. Studies related to concussion and injury incidence consistently found an increased risk of LE injury following concussion. Half of the studies that examined concussion and post-concussion cognitive testing demonstrated significant effects.
Consistent across participant demographics, tasks, and dependent measures, fifty-one of fifty-six assessed articles concluded that decreased cognitive ability or increased cognitive load led to risky LE mechanics or a direct increase in non-contact LE injury risk.
The robustness of results across gender, performance level, sport, cognitive ability, task cognitive load suggest that the inclusion of cognitive training in the design of optimal LE injury prevention programs warrants further study. Level of Evidence: Ia.
非接触性前交叉韧带损伤的经典模型包括环境、解剖、激素和生物力学风险因素，这些因素直接影响施加在韧带上的应力大小或韧带承受施加于其上的力的相对能力。然而，认知在成功的运动表现中显然也起着作用，但认知功能下降很少被视为损伤的风险因素。
研究现有文献，以确定认知功能（包括认知能力和任务认知负荷）在多大程度上影响具有广泛运动专长的男女运动员的非接触性下肢损伤风险。
范围综述。
使用PRISMA方法对CINAHL、SPORTDiscus、谷歌学术和MEDLINE进行电子检索。检索词包括“认知”、“脑震荡”、“ImPACT”、“认知缺陷”、“轻度创伤性脑损伤（mTBI）”和“神经心理功能”作为认知描述词，以及“损伤风险”和“下肢损伤”作为损伤描述词的布尔组合。纳入标准包括2000年至2021年期间发表的英文论文。排除标准包括神经和认知非典型人群，但脑震荡（包括在内）除外。使用观察性队列和横断面研究的质量评估工具对纳入的文章进行评估。
56项利用各种证据水平的研究符合纳入标准。41篇文章质量良好，14篇中等，1篇方法学质量较差。研究检查了健康运动员的基线认知功能（n = 7）；双任务范式中的表现（n = 13）；以及脑震荡对双任务表现（n = 4）、下肢损伤风险（n = 22）或脑震荡后测试（n = 10）的影响。6篇研究认知功能和所有双任务研究（包括脑震荡研究）发现与损伤相关的生物力学改变或处理需求增加。与脑震荡和损伤发生率相关的研究一致发现脑震荡后下肢损伤风险增加。一半研究脑震荡和脑震荡后认知测试的研究显示出显著影响。
在参与者人口统计学、任务和相关测量方面保持一致，56篇评估文章中有51篇得出结论，认知能力下降或认知负荷增加会导致危险的下肢力学或直接增加非接触性下肢损伤风险。
跨性别、表现水平、运动项目、认知能力、任务认知负荷的结果稳健性表明，在最佳下肢损伤预防计划设计中纳入认知训练值得进一步研究。证据水平：Ia。
