Virtual Reality Mindfulness Meditation in Patients after Anterior Cruciate Ligament Reconstruction

前十字韧带 (ACL) 损伤后与损伤相关的恐惧会显着降低 恢复运动、体力活动减少以及 ACL 再损伤风险增加 功能正常、身体活跃的个体。与伤害相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，目前的康复实践 没有专门解决 ACLR 后患者与损伤相关的恐惧。虚拟现实正念冥想是一种 心理练习涉及将你的注意力集中在当下的经历上，并且已经被 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 疼痛。 ACLR 后的患者表现出与患有抑郁症、焦虑症和慢性病的人相似的较差的大脑活动。 肌肉骨骼疼痛；因此，ACLR 术后的患者也可能从正念冥想中受益。评估 虚拟现实正念冥想对 ACLR 术后患者的影响，我们将确定虚拟现实的效果 现实正念冥想可以 1) 减少自我报告的与受伤相关的恐惧，2) 改善跳跃着陆不良的情况 运动模式，3) 与虚拟现实相比，ACLR 后 9 个月改善女性的大脑活动 现实假组。与伤害相关的恐惧和不良的跳跃着陆运动模式与 ACL 再次损伤的风险。由于之前的文献已经证明了性别差异，因此选择了女性参与这项研究 在大脑活动方面，女性也有较高的 ACL 损伤发生率和 ACL 再次损伤风险。所有患者均在 研究将完成为期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周的虚拟现实假高级康复训练计划。中央 假设接受虚拟现实正念冥想后 9 个月的女性会 表现出减少了与伤害相关的恐惧，改善了跳跃着陆运动模式，并改善了大脑 活动。该提案的研究结果将解决有效心理方面的知识空白 解决与 ACL 再次损伤风险相关的心理和生物因素的干预措施。这个提议 还培养了一名有抱负的独立临床科学家，接受培训以学习神经影像技术和 复杂的运动模式数据收集和分析。通过这次培训，主要研究者将 检查虚拟现实正念冥想减轻伤害相关恐惧、降低 ACL 的功效 在她作为临床科学家的职业生涯中，降低了再损伤风险，并提高了 ACLR 后患者的生活质量。

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.