Virtual Reality Mindfulness Meditation in Patients after Anterior Cruciate Ligament Reconstruction

前交叉韧带（ACL）损伤后与损伤相关的恐惧显著有助于降低 恢复运动，减少体力活动参与，增加ACL再损伤风险， 功能正常的、身体活跃的个体。与受伤有关的恐惧也与跳跃着陆不佳有关 ACL重建（ACLR）后患者的运动模式。不幸的是，目前的康复措施 没有专门针对ACLR后患者的损伤相关恐惧。虚拟现实正念冥想是一种 一种心理练习，包括将你的思想集中在你现在的经历上， 用于治疗抑郁、焦虑和慢性肌肉骨骼疼痛。此外，正念冥想 导致抑郁症、焦虑症和慢性肌肉骨骼疾病患者的大脑活动发生积极变化。 痛苦ACLR后的患者表现出与抑郁、焦虑和慢性抑郁症患者相似的大脑活动不良。 肌肉骨骼疼痛;因此，ACLR后的患者也可以从正念冥想中受益。评价 虚拟现实正念冥想对ACLR后患者的影响，我们将确定虚拟现实的效果。 现实正念冥想：1）减少自我报告的与伤害有关的恐惧，2）改善跳跃着陆不良 运动模式，3）与虚拟相比，ACLR后9个月的女性大脑活动改善 现实骗局小组与受伤有关的恐惧和不良的跳跃-着陆运动模式与以下因素有关： ACL再损伤风险。由于先前的文献已经证明了性别差异，因此选择女性进行本研究 在大脑活动中，女性也有较高的ACL损伤发生率和ACL再损伤风险。中所有患者 研究将完成一个为期8周的高级康复训练计划，以改善下半身肌肉 力量，力量和灵活性。干预组的患者将完成为期8周的虚拟现实 正念冥想+高级康复训练计划。假手术组的患者将 完成为期8周的虚拟现实假手术+高级康复训练计划。中央 假设是，接受虚拟现实正念冥想的ACLR后9个月的女性将 表现出减少与受伤有关的恐惧，改善跳跃着陆运动模式，并改善大脑 活动这项提案的结果将解决有效心理治疗知识的空白。 干预措施，以解决与ACL再损伤风险相关的心理和生物因素。这项建议 还定位一个有抱负的独立临床科学家培训，学习神经成像技术， 复杂的运动模式数据收集和分析。通过此次培训，主要研究者将 检查虚拟现实正念冥想的有效性，以减轻与伤害有关的恐惧，减少ACL 在她作为临床科学家的整个职业生涯中，她一直致力于提高ACLR后患者的再损伤风险和生活质量。

Injury-related fear after anterior cruciate ligament (ACL) injury significantly contributes to decreased return to sport, decreased physical activity engagement, and increased ACL reinjury risk in previously high functioning, physically active individuals. Injury-related fear is also associated with poor jump-landing movement patterns in patients after ACL reconstruction (ACLR). Unfortunately, current rehabilitation practices do not specifically address injury-related fear in patients after ACLR. Virtual reality mindfulness meditation is a mental practice that involves focusing your mind on your experiences in the present moment and has been used to address depression, anxiety, and chronic musculoskeletal pain. Additionally, mindfulness meditation has led to positive changes in brain activity in individuals with depression, anxiety, and chronic musculoskeletal pain. Patients after ACLR exhibit poor brain activity similar to individuals with depression, anxiety, and chronic musculoskeletal pain; thus, patients after ACLR may also benefit from mindfulness meditation. To evaluate the effect of virtual reality mindfulness meditation on patients after ACLR, we will determine the effect of virtual reality mindfulness meditation to 1) decrease self-reported injury-related fear, 2) improve poor jump-landing movement patterns, and 3) improve brain activity in women 9-months post-ACLR when compared to a virtual reality sham group. Injury-related fear and poor jump-landing movement patterns have been associated with ACL reinjury risk. Women were selected for this study as previous literature has demonstrated sex differences in brain activity and women also have a higher incidence of ACL injury and ACL reinjury risk. All patients in the study will complete an 8-week advanced rehabilitation training program to improve lower-body muscle strength, power, and flexibility. Patients in the intervention group will complete 8-weeks of virtual reality mindfulness meditation + the advanced rehabilitation training program. Patients in the sham group will complete 8-weeks of the virtual reality sham + the advanced rehabilitation training program. The central hypothesis is that women 9-months post ACLR who undergo virtual reality mindfulness meditation will demonstrate decreased injury-related fear, improved jump-landing movement patterns, and improved brain activity. The findings from this proposal will address a gap in knowledge about effective psychological interventions to address psychological and biological factors associated with ACL reinjury risk. This proposal also positions an aspiring independent clinician scientist training to learn neuroimaging techniques and complex movement pattern data collection and analyses. With this training, the primary investigator will examine the efficacy of virtual reality mindfulness meditation to mitigate injury-related fear, decrease ACL reinjury risk, and improve quality of life in patients after ACLR throughout her career as a clinician scientist.