Neuroplastic Mechanisms for Acquisition and Transfer of Injury-Resistant Movement Patterns Assessed in VR Simulated Sport

项目概要/摘要 前交叉韧带（ACL）损伤是一种常见的活动相关性膝关节损伤，具有相当大的负面影响 对个人和社会。每年直接成本超过130亿美元，长期间接成本远远超过 这一数字，因为ACL损伤也与几年内致残性骨关节炎的加速发展有关。 受伤后的几年国家骨关节炎公共卫生议程建议扩大和加强 以证据为基础的ACL损伤预防，以减少这种负担。我们已经确定了可以改变的运动模式 增加年轻女运动员ACL损伤风险。而神经肌肉训练的目标是那些受伤的风险 运动模式，并显示在高风险的运动员，低风险的有意义的转移统计功效 力学到游戏领域已经受到限制。目前的方法无法确保抗损伤 运动模式转移到体育运动是显而易见的，因为全国ACL损伤并没有减少 尽管标准的神经肌肉训练对改变年轻女运动员的生物力学有效， 实验室确保将有效的伤害预防转移到体育运动的关键知识差距是了解 神经系统参与的机制，以获得和转移抗损伤的运动模式， 运动场的干预或实验室。因此，本提案的总体目标是确定 神经机制的基础上转移的抗损伤运动模式，以现实的运动场景。 我们已发表和最近的初步数据涉及与损伤风险相关的神经可塑性以及以下内容 神经肌肉训练证明了一种特定的神经机制， 移动模式这些初步的数据支持了这一提议的核心假设，即大脑中的变化 活动的基础收购和转移的抗损伤运动模式，以现实的运动场景。 重要的是，这项工作表明神经可塑性可以通过增强的生物反馈和其他临床治疗来靶向。 优化运动的脑激活模式的方法 收购和转让。针对损伤危险因素减少的神经机制的能力可以 彻底改变ACL损伤预防策略。一旦实现本申请的目标，我们将 能够增强具有所识别的神经治疗靶点的神经肌肉训练的功效。这 对提高ACL损伤预防训练的可移植性，降低损伤发生率具有重要意义 从而避免相关的长期负面健康后果。这对年轻人来说尤其重要。 女性运动员是非接触性感觉运动错误相关ACL损伤风险最高的人群。 这是一个独特的机会，通过靶向神经肌肉的神经机制， 适应和转移强调了该辅助项目为母公司U 01提供的特殊机会 NIH投资。

Project Summary/Abstract Anterior cruciate ligament (ACL) injury is a common activity-related knee injury with a substantial negative impact on individuals and society. Annual direct costs exceed $13 billion, and the long-term indirect costs far exceed that figure, as ACL injury is also linked to the accelerated development of disabling osteoarthritis within a few years after injury. The National Public Health Agenda for Osteoarthritis recommends expanding and enhancing evidence-based ACL injury prevention to reduce this burden. We have identified modifiable movement patterns that increase ACL injury risk in young female athletes. While neuromuscular training targets those injury risk movement patterns and shows statistical efficacy in high-risk athletes, a meaningful transfer of low-risk mechanics to the field of play has been limited. This inability of current approaches to ensure injury-resistant movement pattern transfer to sport is readily apparent as there has not been a decrease in national ACL injury rates in young female athlete despite efficacy of standard neuromuscular training to modify biomechanics in the lab. The key knowledge gap to ensure effective injury prevention transfer to sport is understanding the mechanisms the nervous system engages to acquire and transfer injury-resistant movement patterns from the intervention or laboratory to the athletic field. Thus, the overall objective of this proposal is to determine the neural mechanisms underpinning the transfer of injury-resistant movement patterns to realistic sport scenarios. Our published and recent preliminary data on the neuroplasticity related to injury risk and following neuromuscular training demonstrate a specific neural mechanism underlies the transfer of injury-resistant movement patterns. These preliminary data support this proposal's central hypothesis that changes in brain activity underlie the acquisition and transfer of injury-resistant movement patterns to realistic sport scenarios. Importantly this work indicates the neuroplasticity can be targeted by augmented biofeedback and other clinical methods to optimize brain activation patterns for movement that promote injury-resistant movement pattern acquisition and transfer. The ability to target the neural mechanisms of injury risk factor reduction could revolutionize ACL injury prevention strategies. Once the objectives of this application are achieved, we will be able to enhance the efficacy of neuromuscular training with the identified neuro-therapeutic targets. This contribution will be significant to improve ACL injury prevention training transferability to reduce injury incidence and thus avoid the associated long-term negative health consequences. This is especially relevant to young female athletes as they are the population at highest risk for non-contact sensorimotor error related ACL injury. This unique opportunity to enhance ACL injury prevention by targeting neural mechanisms of neuromuscular adaptation and transfer highlights the exceptional opportunity afforded by this ancillary project to the parent U01 NIH investment.