R15HD118518

Determining the effects of non-invasive brain stimulation to improve quadriceps muscle function after ACL reconstruction.

- Project summary/abstract

Quadricep muscle impairments persist for years after anterior cruciate ligament reconstruction (ACLR).

They are linked to poor long-term outcomes including the early onset of post-traumatic knee osteoarthritis (PTOA), which is thought to result from altered movement patterns (i.e. walking and running) and persistent quadriceps muscle impairments.

Despite use of evidence-based postoperative rehabilitation protocols, the prevalence of PTOA following ACLR remains at approximately 40% after a mean follow-up of 15 years.

Thus, approximately 100,000 individuals who undergo ACLR each year will develop PTOA between the ages of 30 and 40 years, imposing a substantial burden on the U.S. healthcare system and significantly impacting quality of life.

Recent evidence suggests that lower neural drive, (i.e., lower corticospinal excitability (CSE)), is associated with pronounced quadriceps muscle performance deficits, which are more severe in females recovering from ACLR than in males.

Current postoperative rehabilitation protocols do not target lower neural drive, which can be achieved through non-invasive brain stimulation.

Thus, the long-term goal of this research is to improve the effectiveness of ACLR rehabilitation.

The objective of this R15 project is to determine if neural drive is the critical missing link in ACLR rehabilitation.

To meet this objective, we will administer anodal transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation known to increase CSE.

We will then assess whether it improves three measures of quadriceps muscle performance (in Aim 1) and two measures of CSE (in Aim 2).

In Aim 3, we will determine the relationship between observed changes in quadriceps muscle performance and CSE in female participants recovering from ACLR.

These aims will be achieved using a randomized, triple-blinded clinical trial with 42 female individuals after ACLR between the ages of 18 and 35 years.

All participants will receive six sessions of active or sham anodal tDCS while they perform isolated quadriceps exercises on an isokinetic dynamometer.

The two measures of CSE (i.e. active motor threshold and the slope of transcranial magnetic stimulation (TMS) induced recruitment curves) will be determined using surface electromyography on the vastus medialis and TMS.

Three measures of quadriceps performance (i.e. peak torque normalized to body weight, rate of torque development (RTD) from 0-100ms and 100-200ms, and torque steadiness) will be determined following standard isometric muscle testing on an isokinetic dynamometer with the hips flexed to 90° and the knees flexed to 60°.

Statistical analyses will include repeated measures analyses of variance (Aims 1 & 2) and Pearson correlations (Aim 3).

Findings from this study will determine if a form of non-invasive brain stimulation improves quadriceps muscle performance, setting the stage for new post-ACLR rehabilitation protocols.

Additionally, follow-up research will assess whether the restoration of neural drive corrects altered movement patterns, and in the long-term, ultimately reduces risk of PTOA.

Arcadia University

TO CONDUCT AND SUPPORT LABORATORY RESEARCH, CLINICAL TRIALS, AND STUDIES WITH PEOPLE THAT EXPLORE HEALTH PROCESSES. NICHD RESEARCHERS EXAMINE GROWTH AND DEVELOPMENT, BIOLOGIC AND REPRODUCTIVE FUNCTIONS, BEHAVIOR PATTERNS, AND POPULATION DYNAMICS TO PROTECT AND MAINTAIN THE HEALTH OF ALL PEOPLE. TO EXAMINE THE IMPACT OF DISABILITIES, DISEASES, AND DEFECTS ON THE LIVES OF INDIVIDUALS. WITH THIS INFORMATION, THE NICHD HOPES TO RESTORE, INCREASE, AND MAXIMIZE THE CAPABILITIES OF PEOPLE AFFECTED BY DISEASE AND INJURY. TO SPONSOR TRAINING PROGRAMS FOR SCIENTISTS, DOCTORS, AND RESEARCHERS TO ENSURE THAT NICHD RESEARCH CAN CONTINUE. BY TRAINING THESE PROFESSIONALS IN THE LATEST RESEARCH METHODS AND TECHNOLOGIES, THE NICHD WILL BE ABLE TO CONDUCT ITS RESEARCH AND MAKE HEALTH RESEARCH PROGRESS UNTIL ALL CHILDREN, ADULTS, FAMILIES, AND POPULATIONS ENJOY GOOD HEALTH. THE MISSION OF THE NICHD IS TO ENSURE THAT EVERY PERSON IS BORN HEALTHY AND WANTED, THAT WOMEN SUFFER NO HARMFUL EFFECTS FROM REPRODUCTIVE PROCESSES, AND THAT ALL CHILDREN HAVE THE CHANCE TO ACHIEVE THEIR FULL POTENTIAL FOR HEALTHY AND PRODUCTIVE LIVES, FREE FROM DISEASE OR DISABILITY, AND TO ENSURE THE HEALTH, PRODUCTIVITY, INDEPENDENCE, AND WELL-BEING OF ALL PEOPLE THROUGH OPTIMAL REHABILITATION.

93.865 - Child Health and Human Development Extramural Research

National Institute of Child Health and Human Development (NICHD) [HHS - NIH]

Pennsylvania United States

State-Wide

Research Enhancement Award Program (REAP) for Health Professional Schools and Graduate Schools (R15 Clinical Trial Required) (PAR-21-357)