Injuries to the anterior cruciate ligament (ACL) are among the most common injuries evaluated by sports physicians and most frequently occur by noncontact mechanisms. The risk of injury to the ACL is influenced by many factors: anatomical, hormonal, and biomechanical. In addition, recent studies, observed that the cognitive aspect could also be an important factor in increasing the risk of this injury. Among the tests proposed to assess the risk of ACL injury, the most common are "Drop Jump Test" and "Single Leg Squat," which assess the dynamic position of the knee during sports movements. Cognitive performance, on the other hand, was mainly assessed by pen-and-paper or computer-based tests. Given the multifactorial nature of the injury, however, assessing individual risk factors seems to be ineffective in determining injury susceptibility. Therefore, the aim of this thesis work is first to validate a new cognitive-motor ecological protocol that allows the combination of motor tasks with specific cognitive exercises and, subsequently, to apply this protocol to sports subjects undergoing functional testing so as to observe whether there was a correlation between cognitive test results and biomechanical risk variables associated with injury. The first phase of the analysis sees 12 subjects asked to perform 6 cognitive tests in 2 experimental sessions so as to demonstrate the repeatability of the cognitive tests over time using a test-retest approach. Once the cognitive-motor protocol composed of the cognitive tests that showed moderate to excellent repeatability was defined, it was applied to evaluate 10 sports subjects. The latter first performed the cognitive exercises defined in the protocol and then performed a functional test that consisted of jumping from a box, landing on the force platforms and jumping again to the right or left according to the indication given by one of the two traffic lights placed in front of the subject. In this thesis work, the condition that required more cognitive load was considered. The subject's movement during the jumps was recorded using an optoelectronic system, reconstructed using the SmartTracker program and then analyzed using Visual 3D software, which allowed the extraction of the dominant limb biomechanical variables associated with the risk of cruciate ligament injury: vertical ground reaction force, knee flexion angle, knee abduction angle and their respective moments. Since injuries occur most frequently in the landing phase from a jump, the analysis was done considering a time window from the moment the subject places his or her feet on the force pads (appearance of GRF) until 100 ms later. The objective, in this second phase of the research, was to find a correlation between the results made in the cognitive tests and the biomechanical risk variables, so by means of a multiple linear regression model with stepwise method, the results of the cognitive tests, were used as predictors for the biomechanical risk variables. Only the biomechanical variables related to jumping dynamics presented a correlation with 2 cognitive tests performed by the subject, specifically as the scores obtained in these two tests decreased, the value of the biomechanical variables increased; thus, potentially increasing the relative risk of ACL injury. Therefore, for subjects who demonstrated lower cognitive-motor performance, the risk of injury could be found in the dynamics of impact rather than joint angles. Both tests correlated with biomechanical variables, develop as a cognitive domain the attentional focus, which has been shown to be crucial during sports practice where the environment is highly dynamic. The main novelty of this study is the combination of cognitive and motor aspects in finding a correlation between them. In fact, the cognitive-motor protocol has interactive exercises that require motor effort, and the functional tests require cognitive load. In conclusion, therefore, the present validated cognitive-motor protocol could be applied in sports in the prevention of ACL injuries, in those sports that involve frequent jumps and changes of direction associated with an ever-changing cognitive load.
Le lesioni al legamento crociato anteriore (LCA) sono tra le più comuni valutate dai medici sportivi e più frequentemente avvengono per meccanismi di non contatto. Il rischio di lesione all’ACL è influenzato da molti fattori: anatomici, ormonali e biomeccanici. In aggiunta, recenti studi, hanno osservato che anche l’aspetto cognitivo potesse essere un importante fattore nell’aumento del rischio di questa lesione. Tra i test proposti per valutare il rischio di lesione all’ACL i più comuni sono “Drop Test” e “Piegamento singolo su una gamba” che valutano la posizione dinamica del ginocchio durante movimenti sportivi. La performance cognitiva, invece, è stata valutata principalmente con test carta e penna o al computer. Data la natura multifattoriale della lesione, però, valutare i singoli fattori di rischio sembra non essere efficace nel determinare la predisposizione alla lesione. Pertanto l’obiettivo di questo lavoro di tesi è innanzitutto di validare un nuovo protocollo cognitivo-motorio ecologico che permetta la combinazione di task motori con esercizi cognitivi specifici e, in seguito, di applicare questo protocollo a soggetti sportivi sottoposti a test funzionali in modo da osservare se ci fosse una correlazione tra i risultati dei test cognitivi e le variabili biomeccaniche di rischio associate alla lesione. La prima fase dell’analisi vede 12 soggetti chiamati a svolgere 6 test cognitivi in 2 sessioni sperimentali in modo da dimostrare la ripetibilità dei test cognitivi nel tempo con un approccio test/re-test. Una volta definito il protocollo cognitivo-motorio composto dai test cognitivi che hanno mostrato una ripetibilità da moderata a eccellente, esso è stato applicato per valutare 10 soggetti sportivi. Questi ultimi hanno primo svolto gli esercizi cognitivi definiti nel protocollo e poi hanno eseguito un test funzionale che consisteva nel saltare da un box, atterrare sulle pedane di forza e saltare nuovamente a destra o sinistra secondo l’indicazione data da uno dei due semafori posti davanti al soggetto. In questo lavoro di tesi è stata considerata la condizione che richiedeva un maggiore carico cognitivo. Il movimento del soggetto durante i salti è stato registrato mediante sistema optoelettronico, ricostruito con il programma SMARTRACKER e analizzato poi attraverso il software Visual 3D che ha permesso di estrarre le variabili biomeccaniche dell’arto dominante associate al rischio di lesione del legamento crociato: forza verticale di reazione al terreno, angolo di flessione del ginocchio, angolo di abduzione del ginocchio e i rispettivi momenti. Dato che gli infortuni si verificano più frequentemente in fase di atterraggio da un salto, l’analisi è stata fatta considerando una finestra temporale dal momento in cui il soggetto appoggia i piedi sulle pedane di forza (comparsa della GRF) fino ai 100 millisecondi successivi. L’obiettivo, in questa seconda fase della ricerca, era trovare una correlazione tra i risultati fatti nei test cognitivi e le variabili biomeccaniche di rischio, quindi mediante un modello di regressione lineare multipla con metodo graduale, i risultati dei test cognitivi, sono stati utilizzati come predittori per le variabili biomeccaniche di rischio. Solamente le variabili biomeccaniche legate alla dinamica del salto presentavano una correlazione con 2 test cognitivi svolti dal soggetto, in particolare al diminuire dei punteggi ottenuti in questi due test aumentava il valore delle variabili biomeccaniche; quindi, potenzialmente aumentava il rischio relativo di lesione al legamento crociato anteriore. Pertanto, per i soggetti che hanno dimostrato minori performance cognitivo-motorie, il rischio d’infortunio potrebbe essere da ricercare nella dinamica dell’impatto piuttosto che negli angoli articolari. Entrambi i test correlati con le variabili biomeccaniche, sviluppano come dominio cognitivo il focus attentivo, che si è dimostrato essere fondamentale durante la pratica sportiva dove l’ambiente è altamente dinamico. La novità principale di questo studio è la combinazione di aspetti cognitivi e motori nella ricerca di una correlazione tra essi. Infatti, il protocollo cognitivo-motorio ha esercizi interattivi che richiedono uno sforzo motorio, e i test funzionali richiedono un carico cognitivo. In conclusione, quindi, il presente protocollo cognitivo-motorio validato potrebbe essere applicato in ambito sportivo nella prevenzione d’infortuni all’ACL, in quegli sport che prevedono frequenti salti e cambi di direzione associati a un carico cognitivo sempre variabile.
Sviluppo di un protocollo cognitivo-motorio per la valutazione del rischio biomeccanico relativo alla lesione del Legamento Crociato Anteriore durante attività sportiva.
Morichini, Nicolò;LANZANI, VALENTINA
2022/2023
Abstract
Injuries to the anterior cruciate ligament (ACL) are among the most common injuries evaluated by sports physicians and most frequently occur by noncontact mechanisms. The risk of injury to the ACL is influenced by many factors: anatomical, hormonal, and biomechanical. In addition, recent studies, observed that the cognitive aspect could also be an important factor in increasing the risk of this injury. Among the tests proposed to assess the risk of ACL injury, the most common are "Drop Jump Test" and "Single Leg Squat," which assess the dynamic position of the knee during sports movements. Cognitive performance, on the other hand, was mainly assessed by pen-and-paper or computer-based tests. Given the multifactorial nature of the injury, however, assessing individual risk factors seems to be ineffective in determining injury susceptibility. Therefore, the aim of this thesis work is first to validate a new cognitive-motor ecological protocol that allows the combination of motor tasks with specific cognitive exercises and, subsequently, to apply this protocol to sports subjects undergoing functional testing so as to observe whether there was a correlation between cognitive test results and biomechanical risk variables associated with injury. The first phase of the analysis sees 12 subjects asked to perform 6 cognitive tests in 2 experimental sessions so as to demonstrate the repeatability of the cognitive tests over time using a test-retest approach. Once the cognitive-motor protocol composed of the cognitive tests that showed moderate to excellent repeatability was defined, it was applied to evaluate 10 sports subjects. The latter first performed the cognitive exercises defined in the protocol and then performed a functional test that consisted of jumping from a box, landing on the force platforms and jumping again to the right or left according to the indication given by one of the two traffic lights placed in front of the subject. In this thesis work, the condition that required more cognitive load was considered. The subject's movement during the jumps was recorded using an optoelectronic system, reconstructed using the SmartTracker program and then analyzed using Visual 3D software, which allowed the extraction of the dominant limb biomechanical variables associated with the risk of cruciate ligament injury: vertical ground reaction force, knee flexion angle, knee abduction angle and their respective moments. Since injuries occur most frequently in the landing phase from a jump, the analysis was done considering a time window from the moment the subject places his or her feet on the force pads (appearance of GRF) until 100 ms later. The objective, in this second phase of the research, was to find a correlation between the results made in the cognitive tests and the biomechanical risk variables, so by means of a multiple linear regression model with stepwise method, the results of the cognitive tests, were used as predictors for the biomechanical risk variables. Only the biomechanical variables related to jumping dynamics presented a correlation with 2 cognitive tests performed by the subject, specifically as the scores obtained in these two tests decreased, the value of the biomechanical variables increased; thus, potentially increasing the relative risk of ACL injury. Therefore, for subjects who demonstrated lower cognitive-motor performance, the risk of injury could be found in the dynamics of impact rather than joint angles. Both tests correlated with biomechanical variables, develop as a cognitive domain the attentional focus, which has been shown to be crucial during sports practice where the environment is highly dynamic. The main novelty of this study is the combination of cognitive and motor aspects in finding a correlation between them. In fact, the cognitive-motor protocol has interactive exercises that require motor effort, and the functional tests require cognitive load. In conclusion, therefore, the present validated cognitive-motor protocol could be applied in sports in the prevention of ACL injuries, in those sports that involve frequent jumps and changes of direction associated with an ever-changing cognitive load.File | Dimensione | Formato | |
---|---|---|---|
Executive_Summary_Tesi_MotCog_Lanzani_Morichini.pdf
accessibile in internet per tutti
Descrizione: Executive Summary
Dimensione
804.03 kB
Formato
Adobe PDF
|
804.03 kB | Adobe PDF | Visualizza/Apri |
Tesi_MotCog_Lanzani_Morichini.pdf
accessibile in internet per tutti
Descrizione: Tesi
Dimensione
2.89 MB
Formato
Adobe PDF
|
2.89 MB | Adobe PDF | Visualizza/Apri |
I documenti in POLITesi sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
https://hdl.handle.net/10589/210493