Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
FisioBrain, Arezzo, Italy.
Sports Med. 2024 Oct;54(10):2531-2556. doi: 10.1007/s40279-024-02085-2. Epub 2024 Aug 17.
Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive-motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.
The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.
Scoping review.
We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.
Only primary studies published in English were included without time limitations.
Qualitative analysis of the included studies was performed.
We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual-cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.
Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual-cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.
IV. The protocol was a priori registered on Open Science Framework ( https://osf.io/p4j95/ ).
前交叉韧带（ACL）损伤的个体在需要神经肌肉控制的任务中表现出视觉认知缺陷。在本文中，我们提供了 ACL 损伤后在一系列临床适用的认知运动任务中视觉依赖增加的证据。这些信息对于加强针对适应性神经可塑性的治疗干预的科学依据至关重要，并且可能转化为 ACL 损伤后重返运动（RTS）结果的改善。
本研究的目的是：（1）确定在 ACL 缺失（ACL-D）或 ACL 重建（ACL-R）后的常见康复评估中是否存在视觉依赖；（2）描述在这些任务中如何评估视觉依赖；（3）提供信息帮助临床医生和患者理解认知负荷在视觉依赖评估和干预中的临床相关性。
范围综述。
我们检索了 MEDLINE、EMBASE、CINAHL、SCOPUS 和 PEDro 数据库。
仅纳入无时间限制的发表在英语中的原始研究。
对纳入的研究进行定性分析。
我们综合了 23 项研究的结果。共有 7 项研究（31%）纳入了 ACL-D 患者，15 项研究（65%）纳入了 ACL-R 患者，1 项研究（4%）纳入了 ACL-D 和 ACL-R 患者。确定了任务评估、任务评估设置、视觉条件、结果测量以及视觉依赖增加的情况。与 ACL-R 患者相比，大多数研究表明 ACL-D 患者在闭眼条件下的姿势稳定性比未受伤对照组差。最常报告的破坏视觉的方法是完全视觉阻断（即闭眼或蒙住眼睛）（52%）。与对照组相比，在 ACL-R 患者中加入视觉认知挑战会导致明显更差的姿势稳定性。
最常通过单腿站立评估视觉依赖，完全视觉阻断。与未受伤对照组相比，大多数 ACL-D 患者的研究表明，他们在闭眼状态下的姿势稳定性较差，这表明视觉依赖增加。与 ACL-D 患者相比，接受 ACL-R 治疗的患者的视觉依赖证据较少。发现添加视觉认知负荷更能有效地诱导接受 ACL-R 治疗的个体的姿势稳定性缺陷。
IV。该方案是在开放科学框架（https://osf.io/p4j95/）上预先注册的。
