Patel Harsh H, Berlinberg Elyse J, Nwachukwu Benedict, Williams Riley J, Mandelbaum Bert, Sonkin Konstantin, Forsythe Brian
Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, Illinois.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York.
Arthrosc Sports Med Rehabil. 2022 Dec 28;5(1):e207-e216. doi: 10.1016/j.asmr.2022.11.015. eCollection 2023 Feb.
Persistent quadriceps weakness is a problematic sequela of anterior cruciate ligament reconstruction (ACLR). The purposes of this review are to summarize neuroplastic changes after ACL reconstruction; provide an overview of a promising interventions, motor imagery (MI), and its utility in muscle activation; and propose a framework using a brain-computer interface (BCI) to augment quadriceps activation. A literature review of neuroplastic changes, MI training, and BCI-MI technology in postoperative neuromuscular rehabilitation was conducted in PubMed, Embase, and Scopus. Combinations of the following search terms were used to identify articles: "quadriceps muscle," "neurofeedback," "biofeedback," "muscle activation," "motor learning," "anterior cruciate ligament," and "cortical plasticity." We found that 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 using 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. 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 after ACLR and may offer an innovative, multidisciplinary approach to orthopaedic care.
V, expert opinion.
股四头肌持续无力是前交叉韧带重建术（ACLR）后一个棘手的后遗症。本综述的目的是总结前交叉韧带重建术后的神经可塑性变化；概述一种有前景的干预措施——运动想象（MI）及其在肌肉激活中的作用；并提出一个使用脑机接口（BCI）增强股四头肌激活的框架。在PubMed、Embase和Scopus数据库中对术后神经肌肉康复中的神经可塑性变化、运动想象训练和脑机接口 - 运动想象技术进行了文献综述。使用以下搜索词的组合来识别文章：“股四头肌”、“神经反馈”、“生物反馈”、“肌肉激活”、“运动学习”、“前交叉韧带”和“皮质可塑性”。我们发现，前交叉韧带重建术会破坏来自股四头肌的感觉输入，这导致对电化学神经元信号的敏感性降低，调节股四头肌控制的神经元的中枢抑制增加以及反射性运动活动减弱。运动想象训练包括在不实际进行肌肉活动的情况下想象一个动作。运动想象训练期间想象的运动输出会增加从初级运动皮层发出的皮质脊髓束的敏感性和传导性，这有助于“锻炼”大脑与目标肌肉组织之间的连接。使用脑机接口 - 运动想象技术的运动康复研究表明，运动皮层、皮质脊髓束、脊髓运动神经元的兴奋性增加，以及抑制性中间神经元的去抑制作用增强。该技术已在中风患者萎缩的神经肌肉通路恢复中得到验证并成功应用，但尚未在外周神经肌肉损伤（如前交叉韧带损伤和重建）中进行研究。精心设计的临床研究可以评估脑机接口对临床结果和恢复时间的影响。股四头肌无力与特定皮质脊髓通路和脑区的神经可塑性变化有关。脑机接口 - 运动想象在促进前交叉韧带重建术后萎缩的神经肌肉通路恢复方面显示出强大潜力，并可能为骨科护理提供一种创新的多学科方法。
V，专家意见。
