Postural Control During Single-Leg Landing in Female Athletes After Anterior Cruciate Ligament Reconstruction.

Background: Secondary anterior cruciate ligament (ACL) injury is a complication of ACL reconstruction (ACLR), which may result from altered neuromuscular control affecting anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) required for maintaining balance during movement. However, it remains unclear how APAs and CPAs differ in single-leg landings post-ACLR compared to healthy subjects. Purpose: The purpose of this study was to clarify the differences in muscle activities of APAs and CPAs, lower limb kinematics, and kinetics between athletes with a history of ACLR and healthy athletes during single-leg landing. Study design: Cross-sectional study. Methods: Eighteen female athletes were recruited and divided into ACLR (n = 9) and control groups (n = 9). The experimental task involved a single-leg landing from a 30 cm box. Joint angles and moments were determined using a 3-dimensional motion analysis system, while muscle activity was assessed using surface electromyography. Analysis intervals were divided into two phases: the APA phase (-150 ms to 50 ms) and the CPA phase (50 ms to 250 ms), with initial contact (0 ms) as the reference point. Muscle activity onset time was defined as the time when the baseline exceeded by the sum of mean values and 2 standard deviations. Results: No significant differences were observed in muscle activity or onset time between the ACLR and control groups. However, an increased hip external rotation moment was observed during the CPA phase in the ACLR group. Conclusion: These findings suggest that APAs and CPAs of athletes who returned to sports more than 1 year post-ACLR may be similar. The increased hip external rotation moment in the ACLR group during the CPA phase could represent a specific compensatory strategy to decrease the hip internal rotation angle post-ACLR. Level of Evidence: III.

Virtual reality modulates the control of upper limb motion in one-handed ball catching.

There remains a question about whether and to what extent perception-action coupled response in virtual reality are equal/unequal to those in the real world or physical reality. The purpose of this study was to identify the differences in the environmental effect of virtual presentation on the motor responses of a one-handed ball catching. Thirteen healthy participants were instructed to catch an approaching ball projected at three speeds in a real laboratory room and in a room-sized virtual reality system (CAVE) that simulated those real situations with two- or three-dimensional display settings. The results showed that the arm movement time, which denotes the duration of arm-raising motion (shoulder flexion), was significantly longer in the virtual reality than that in the physical reality at the fast ball speed condition. The shoulder flexion velocities, calculated as the average angular velocity of shoulder flexion over the arm movement time, were significantly lower in the virtual reality than in the physical reality at the medium and fast ball speed conditions. The electromyography onsets, derived from anterior deltoid, biceps brachii, and flexor carpi radialis muscles of the catching arm, appeared before and significantly closer to the initiation of arm raising in the two-dimensional virtual reality than both in the physical reality and in the three-dimensional virtual reality. The findings suggest that simulation of virtual reality may induce a modulation in the motor responses of the catching arm, which is different from natural motion that appeared in the real world. On the contrary, the effect of ball speed generally found in real setting was maintained in the current CAVE experiment.

Perceptual distortion in virtual reality and its impact on dynamic postural control.

BACKGROUND: Voluntary movement such as lifting a foot in preparation to stepping acts as a self-initiated perturbation that disturbs postural equilibrium. To maintain and restore equilibrium, humans utilize early, anticipatory, and compensatory postural adjustments. Despite technological progress in accessible virtual reality (VR) devices, little is known on the usage of VR in control and maintenance of balance while standing. RESEARCH QUESTION: How does VR modulate early, anticipatory, and compensatory postural adjustments during a dynamic task of leg lifting while avoiding an obstacle? METHODS: First, the postural adjustments in a single-leg obstacle avoidance were compared between real and VR settings, where a statistical reanalysis was performed with data subsets that minimize the difference of foot elevation speed. Second, the effect of simple foot elevation was examined to identify the fundamental nature of leg lifting motion as a self-initiated perturbation. Lastly, perceptual distortion in VR was assessed by evaluating how the spatial scale of the virtual scene used in the single-leg obstacle avoidance experiment was recognized by participants. RESULTS: The VR setting reduced the activities of lower leg muscles on the supporting side not only in the compensatory phase but also in the preparatory early and anticipatory phases. On the other hand, simple foot elevation resulted in a significant increase of muscle activities with lifting height only found in the compensatory phase. Furthermore, it is suggested that the VR induced perceptual distortion in estimating the sizes of the virtual objects. SIGNIFICANCE: The findings provide more definitive evidence that VR presentation modulates the components of postural adjustments for maintaining upright stance while being perturbed. One of the potential psychophysical factors is perceptual distortion in VR, and this provides critical information for further development of VR based training system.

Anticipatory judgements associated with vision of an opponent's end-effector: An approach by motion perturbation and spatial occlusion.

This study was aimed at determining how the visual information of an end-effector (racket) and the intermediate extremity (arm) of a tennis server contribute to the receiver's anticipatory judgement of ball direction. In all, 15 experienced tennis players and 15 novice counterparts viewed a spatially occluded computer graphics animation of a tennis serve (no-occlusion, racket-occlusion, and body-occlusion) and made anticipatory judgements of ball direction on a visual analogue scale (VAS). The patterns of the serve motions were generated by a simulation technique that computationally perturbs the rotation speed of the selected racket-arm joint (forearm pronation and elbow extension) on a captured serve motion. The results suggested that the anticipatory judgements were monotonically attuned with the perturbation rate of the forearm pronation speed excepting under the conditions of the racket-occlusion model. Although such attunements were not observed in the elbow perturbation conditions, the results of correlation analysis indicated that the residual information in the spatially occluded models had a similar effect to the no-occlusion model within the individual experienced participants. The findings support the notion that end-effector (racket) provides deterministic cues for anticipation, as well as imply that players are able to benefit from the relative motion of an intermediate extremity (elbow extension).

Can Slow-Motion Footage of Forehand Strokes Be Used to Immediately Improve Anticipatory Judgments in Tennis?

Slow-motion footage of sports actions is widely used as a visual learning tool in observing the dynamic motor behaviors of athletes. Recent studies on action observation have reported that extending the observation time in slow-motion footage provides benefits of understanding the intention of an opponent's action, at least when observing rapid movements. As such, the use of slow-motion footage may have the potential to improve the anticipatory judgments of an opponent's action outcome without training (or feedback). To verify this possibility, we examined the effects of the replay speed of slow-motion footage on the anticipatory judgments of shot directions and recognition of kinematic positions of opponents' forehand strokes in tennis. Nine skilled and nine novice tennis players were asked to anticipate the direction of their opponent's shots (left or right) and then attempted to recognize proximal (trunk center) and distal (ball) kinematic positions. Computer graphic animations of forehand strokes were used as visual stimuli, which were presented at four different replay speeds (normal, three-quarter, half, and quarter speeds). We failed to show the immediate effect of the use of slow-motion footage on the anticipatory performance of the skilled and novice players, although the anticipatory performance of the skilled players was superior to that of the novice players. Instead, we found an effect of the use of slow-motion footage in terms of promoting recognition of important kinematic cues (trunk center) for effective anticipation by skilled players. Moreover, no significant correlations were observed between the anticipatory judgments and motion recognition in all experimental conditions. These results suggest that even if the use of slow-motion footage enhances the recognition of key kinematic cues, it may not immediately improve anticipatory judgments in tennis.

The role of proximal body information on anticipatory judgment in tennis using graphical information richness.

OBJECTIVE: Recent studies have reported that skilled tennis players are likely to use proximal body information for anticipating the direction of their opponent's forehand shot. However, in these studies, the visual stimuli did not include visual information about the ball. Skilled players may have used proximal information owing to the lack of distal information. To address this issue, we developed a novel methodological approach using computer graphics (CG) images in which the entire body was presented by a combination of point-light display (i.e., poor graphical information, PLD) and polygons (i.e., rich graphical information). Using our novel methodological approach, we examined whether skilled tennis players use proximal body information when anticipating shot directions. METHODS AND RESULTS: Fifteen skilled tennis players and fifteen novice players tried to anticipate shot directions by observing four CG forehand strokes (ALPOL: all body parts were represented with polygon; RAPLD: racket and arm were represented with PLD; BOPLD: body parts without racket and arm were represented with PLD; and ALPLD: all body parts were represented with PLD). Our intention in creating CG models with such combinations (i.e., RAPLD and BOPLD) was that because of the richer graphical information provided by polygons compared to PLD, the participant's anticipatory judgment would be influenced more by body parts expressed with polygons. The results showed that for skilled players, anticipatory judgment was more accurate when they observed RAPLD than when they observed BOPLD and ALPLD. In contrast, for novice players, there were no differences in the accuracy of anticipatory judgments with the four CG models. CONCLUSIONS: Only skilled players made more accurate anticipatory judgments when body regions were expressed with rich graphical information, and the racket and arm were expressed with poor graphical information. These suggest that skilled players used proximal information to effectively anticipate shot directions.

Control of vertical posture while elevating one foot to avoid a real or virtual obstacle.

The purpose of this study is to investigate the control of vertical posture during obstacle avoidance in a real versus a virtual reality (VR) environment. Ten healthy participants stood upright and lifted one leg to avoid colliding with a real obstacle sliding on the floor toward a participant and with its virtual image. Virtual obstacles were delivered by a head mounted display (HMD) or a 3D projector. The acceleration of the foot, center of pressure, and electrical activity of the leg and trunk muscles were measured and analyzed during the time intervals typical for early postural adjustments (EPAs), anticipatory postural adjustments (APAs), and compensatory postural adjustments (CPAs). The results showed that the peak acceleration of foot elevation in the HMD condition decreased significantly when compared with that of the real and 3D projector conditions. Reduced activity of the leg and trunk muscles was seen when dealing with virtual obstacles (HMD and 3D projector) as compared with that seen when dealing with real obstacles. These effects were more pronounced during APAs and CPAs. The onsets of muscle activities in the supporting limb were seen during EPAs and APAs. The observed modulation of muscle activity and altered patterns of movement seen while avoiding a virtual obstacle should be considered when designing virtual rehabilitation protocols.

Fan-precooling effect on heat strain while wearing protective clothing.

This study compared heat strain during walking while wearing impermeable protective suits between fan-precooling and nonprecooling conditions. Six males engaged in 60 min of walking at a moderate speed (∼2.5 km/h) in a hot environment (37 °C, 40% relative humidity). Fanning using a fan (4.5 m/s) and spraying water over the body before wearing the suits produced significantly lower rectal temperature before the walking (37.3 ± 0.1 °C vs. 37.0 ± 0.1 °C, P < 0.05). In addition, whilst walking, rectal temperature was significantly lower in the precooling condition (maximum difference: 0.4 °C at 15 min of walking; 38.0 ± 0.1 °C vs. 37.8 ± 0.1 °C at the end of walking, P < 0.05). Although skin temperature decreased during fanning, no difference was observed during walking. Heart rate was lower in the precooling condition during the early stages of walking. Thermal and fatigue perceptions whilst walking did not differ between the conditions. Body weight loss was significantly lower in the precooling condition. These results may indicate that fan precooling attenuates exertional heat strain while wearing impermeable protective clothing. The fan-cooling method is practical, convenient, and yields lower heat strain during prolonged moderate exertion.

Relationship between static anterior laxity using the KT-1000 and dynamic tibial rotation during motion in patients with anatomical anterior cruciate ligament reconstruction.

The anterior cruciate ligament (ACL) plays an important role in controlling knee joint stability, not only by limiting tibial anterior translation but also by controlling knee axial rotation. The aim of ACL reconstruction is to reduce excessive anterior joint laxity, hoping to restore normal tibiofemoral kinematics including knee axial rotation. The purpose of this study was to investigate the relationship between static anterior instability and tibial rotation during several activities in an anterior cruciate ligament reconstructed knee. Seven patients with unilateral ACL injury performed plain walking, running, landing and side step cutting tasks after ACL reconstruction with a mean follow-up of 14 months. The kinematic data for the 4 motions was measured using a motion analysis system and the point cluster technique. The evaluation period was defined to be from the first contact to removal of the tested leg from the ground. Maximum tibial internal rotation during tasks was calculated using the point cluster technique (PCT). Passive anterior tibial translation was measured using a KT-1000 arthrometer. Regression analysis was used to determine the correlation of the maximum internal rotation with the side-to-side difference of static anterior tibial translation measured using a KT-1000 arthrometer. During side step cutting maneuvers, maximum tibial internal rotation significantly showed negative correlation with static anterior tibial translation (p<0.05, r=0.83). The anterior laxity contributed to the normal knee rotation kinematics. The normal anterior tibial translation obtained by ACL reconstruction is thought to be the key factor in successful restoration of normal knee kinematics.

Perceptual response and information pick-up strategies within a family of sports.

The purpose of this study was to determine whether and how the perceptual response of athletes differed depending on their sporting expertise. This was achieved by comparing the responses of tennis and soft tennis players. Twelve experienced tennis players and 12 experienced soft tennis players viewed computer graphic serve motions simulated by a motion perturbation technique, and then scaled their anticipatory judgments regarding the direction, speed, and spin of the ball on a visual analogue scale. Experiment 1 evaluated the player's judgments in response to test motions rendered with a complete polygon model. The results revealed significantly different anticipatory judgments between the player groups when an elbow rotation perturbation was applied to the test serve motion. Experiment 2 used spatially occluded models in order to investigate the effectiveness of local information in making anticipatory judgments. The results suggested that the isolation of visual information had less effect on the judgment of the tennis players than on that of the soft tennis players. In conclusion, the domain of sporting expertise, including those of closely related sports, cannot only differentiate the anticipatory judgment of a ball's future flight path, but also affect the utilization strategy for the local kinematic information.

Estimation of tibiofemoral static zero position during dynamic drop landing.

OBJECTIVE: The objective is to assess the in vivo knee secondary motions intrinsic to flexion in isolation from actual displacements during a landing activity. For this purpose a "static zero position", which denotes the normal tibiofemoral position to the static flexion angle, was introduced to describe the intrinsic secondary motion. METHODS: The three-dimensional motion data of the healthy knee were collected from 13 male and 13 female young adults by using an auto motion analysis system and point cluster technique. First, the relationship between flexion and secondary motion in the static state was determined during a single-leg quasistatic squat. The static zero position during a single-leg drop landing was then calculated by substituting the flexion angle into the flexion-secondary relational expression obtained. RESULTS: After the foot-ground contact, the estimated static zero positions shifted monotonically in valgus, internal rotation, and anterior translation in the case of both the male and female groups. For the time-course change, noticeable differences between the actual displacement and estimated static zero position were found from the foot-ground contact up to 25ms after the contact for the valgus/varus and external/internal rotation, and between 20 and 35ms after the contact for the anterior/posterior translation. SUMMARY: The static zero position demonstrated relatively modest but not negligible shift in comparison with the actual displacement. The intrinsic tibiofemoral motion, or baseline shift, would be worth taking into account when examining the fundamental function and injury mechanics of the knee during an impulsive activity.

Two different protocols for knee joint motion analyses in the stance phase of gait: correlation of the rigid marker set and the point cluster technique.

Objective. There are no reports comparing the protocols provided by rigid marker set (RMS) and point cluster technique (PCT), which are similar in terms of estimating anatomical landmarks based on markers attached to a segment. The purpose of this study was to clarify the correlation of the two different protocols, which are protocols for knee motion in gait, and identify whether measurement errors arose at particular periods during the stance phase. Methods. The study subjects were 10 healthy adults. All estimated anatomical landmarks were which their positions, calculated by each protocol of the PCT and RMS, were compared using Pearson's product correlation coefficients. To examine the reliability of the angle changes of the knee joint measured by RMS and the PCT, the coefficient of multiple correlations (CMCs) was used. Results. Although the estimates of the anatomical landmarks showed high correlations of >0.90 (P < 0.01) for the Y- and Z-coordinates, the correlations were low for the X-coordinates at all anatomical landmarks. The CMC was 0.94 for flexion/extension, 0.74 for abduction/adduction, and 0.71 for external/internal rotation. Conclusion. Flexion/extension and abduction/adduction of the knee by two different protocols had comparatively little error and good reliability after 30% of the stance phase.

Recognition of tennis serve performed by a digital player: comparison among polygon, shadow, and stick-figure models.

The objective of this study was to assess the cognitive effect of human character models on the observer's ability to extract relevant information from computer graphics animation of tennis serve motions. Three digital human models (polygon, shadow, and stick-figure) were used to display the computationally simulated serve motions, which were perturbed at the racket-arm by modulating the speed (slower or faster) of one of the joint rotations (wrist, elbow, or shoulder). Twenty-one experienced tennis players and 21 novices made discrimination responses about the modulated joint and also specified the perceived swing speeds on a visual analogue scale. The result showed that the discrimination accuracies of the experienced players were both above and below chance level depending on the modulated joint whereas those of the novices mostly remained at chance or guessing levels. As far as the experienced players were concerned, the polygon model decreased the discrimination accuracy as compared with the stick-figure model. This suggests that the complicated pictorial information may have a distracting effect on the recognition of the observed action. On the other hand, the perceived swing speed of the perturbed motion relative to the control was lower for the stick-figure model than for the polygon model regardless of the skill level. This result suggests that the simplified visual information can bias the perception of the motion speed toward slower. It was also shown that the increasing the joint rotation speed increased the perceived swing speed, although the resulting racket velocity had little correlation with this speed sensation. Collectively, observer's recognition of the motion pattern and perception of the motion speed can be affected by the pictorial information of the human model as well as by the perturbation processing applied to the observed motion.

Evaluation of tibial rotational stability of single-bundle vs. anatomical double-bundle anterior cruciate ligament reconstruction during a high-demand activity - a quasi-randomized trial.

The purpose of this study was to compare the tibial rotational stability of anatomical double-bundle anterior cruciate ligament reconstructed knees with single-bundle anterior cruciate ligament reconstructed knees during a high-demand activity. Total of 66 subjects, (22 with double-bundle anterior cruciate ligament reconstruction, 22 with single-bundle anterior cruciate ligament reconstruction, and 22 healthy control individuals) were examined in this study. Using a 9-camera motion analysis system, motion subjects were recorded performing during a drop landing and cutting. Using the point cluster technique, the internal-external tibial rotation of both knees was calculated. The mean maximum range of motion for each knee was evaluated for 3 groups (double-bundle group, single-bundle group, and control group). Clinical assessment, including Tegner score, Lysholm score, and knee arthrometric measurement, revealed restoration of the reconstructed knee stability with no differences between the two anterior cruciate ligament reconstruction groups. The results showed that both groups resulted in tibial rotation values that were significantly smaller than those in the intact legs and those in the healthy controls. There were no significant differences in tibial rotation between the DB group and the SB group. Therefore anatomical double-bundle reconstruction restores normal tibial rotation no more than single-bundle reconstruction during this high-demand dynamic activity. These results suggest a trend towards dynamic overcorrection after the ACL reconstruction.

Relationship between three-dimensional kinematics of knee and trunk motion during shuttle run cutting.

Female athletes are considered to exhibit knee and trunk motion that is characteristic of anterior cruciate ligament (ACL) injury. The aim of this study was to examine the in vivo motion of the trunk and knee during a cutting manoeuvre and determine the relationship between them. All participants (10 male and 10 female college athletes) performed a shuttle run cutting task with the left limb. Trunk inclination (forward and lateral) and knee joint angles (flexion/extension, abduction/adduction, and internal/external tibial rotation) were calculated. Differences between the sexes and associations between knee motion and trunk inclination were examined. An increase in trunk forward inclination was strongly correlated with an increase in knee flexion angle and moderately correlated with a decrease in the excursion of internal tibial rotation. An increase in right trunk lateral inclination was moderately correlated with an increase in excursion of internal tibial rotation. The results also showed differences between the sexes in trunk forward inclination, lateral inclination, and knee flexion angle, but no such differences in knee abduction or internal tibial rotation. Trunk inclination is related to knee flexion and excursion of internal tibial rotation. Female athletes demonstrate a low trunk forward inclination and knee flexion angle, a posture that resembles that of ACL injury.

Effects of jump and balance training on knee kinematics and electromyography of female basketball athletes during a single limb drop landing: pre-post intervention study.

BACKGROUND: Some research studies have investigated the effects of anterior cruciate ligament (ACL) injury prevention programs on knee kinematics during landing tasks; however the results were different among the studies. Even though tibial rotation is usually observed at the time of ACL injury, the effects of training programs for knee kinematics in the horizontal plane have not yet been analyzed. The purpose of this study was to determine the effects of a jump and balance training program on knee kinematics including tibial rotation as well as on electromyography of the quadriceps and hamstrings in female athletes. METHODS: Eight female basketball athletes participated in the experiment. All subjects performed a single limb landing at three different times: the initial test, five weeks later, and one week after completing training. The jump and balance training program lasted for five weeks. Knee kinematics and simultaneous electromyography of the rectus femoris and Hamstrings before training were compared with those measured after completing the training program. RESULTS: After training, regarding the position of the knee at foot contact, the knee flexion angle for the Post-training trial (mean (SE): 24.4 (2.1) deg) was significantly larger than that for the Pre-training trial (19.3 (2.5) deg) (p < 0.01). The absolute change during landing in knee flexion for the Post-training trial (40.2 (1.9) deg) was significantly larger than that for the Pre-training trial (34.3 (2.5) deg) (p < 0.001). Tibial rotation and the knee varus/valgus angle were not significantly different after training. A significant increase was also found in the activity of the hamstrings 50 ms before foot contact (p < 0.05). CONCLUSIONS: The jump and balance training program successfully increased knee flexion and hamstring activity of female athletes during landing, and has the possibility of producing partial effects to avoid the characteristic knee position observed in ACL injury, thereby preventing injury. However, the expected changes in frontal and transverse kinematics of the knee were not observed.

Knee kinematics and kinetics during shuttle run cutting: comparison of the assessments performed with and without the point cluster technique.

The differences between the assessments performed with and without the point cluster technique (PCT) for knee joint motions during the high-risk movements associated with non-contact anterior cruciate ligament (ACL) injuries have not been reported. This study aims to examine the differences between PCT and non-PCT assessments for knee joint angles and moments during shuttle run cutting. Fourteen high school athletes performed a maximal effort shuttle run cutting task. Motion data were collected by an 8-camera motion analysis system at 200 Hz, and ground reaction force data were recorded using a force plate at 1000 Hz. In both PCT and non-PCT approaches, the knee joint angles were calculated using Euler angle rotations, and the knee joint moments were obtained by solving the Newton-Euler equations using an inverse dynamics technique. For the extension/flexion angle, good agreement was measured between PCT and non-PCT assessments. The abduction angle obtained in the non-PCT assessment was smaller than that obtained with the PCT. An internal rotation angle was obtained in the PCT assessment, whereas a small external rotation angle was obtained in the non-PCT assessment. For the knee joint moments, good agreement between PCT and non-PCT assessments was observed for all the components. The differences in the knee joint angles were attributed in part to the differences in the position of the medial femoral epicondyle. The results suggest that the ACL injury risk during shuttle run cutting is estimated lower in the non-PCT assessment than in the PCT assessment.

A study of kinematic cues and anticipatory performance in tennis using computational manipulation and computer graphics.

Computer graphics of digital human models can be used to display human motions as visual stimuli. This study presents our technique for manipulating human motion with a forward kinematics calculation without violating anatomical constraints. A motion modulation of the upper extremity was conducted by proportionally modulating the anatomical joint angular velocity calculated by motion analysis. The effect of this manipulation was examined in a tennis situation--that is, the receiver's performance of predicting ball direction when viewing a digital model of the server's motion derived by modulating the angular velocities of the forearm or that of the elbow during the forward swing. The results showed that the faster the server's forearm pronated, the more the receiver's anticipation of the ball direction tended to the left side of the serve box. In contrast, the faster the server's elbow extended, the more the receiver's anticipation of the ball direction tended to the right. This suggests that tennis players are sensitive to the motion modulation of their opponent's racket-arm.

Quantitative relation between server motion and receiver anticipation in tennis: implications of responses to computer-simulated motions.

The purpose of this study was to determine the quantitative relationships between the server's motion and the receiver's anticipation using a computer graphic animation of tennis serves. The test motions were determined by capturing the motion of a model player and estimating the computational perturbations caused by modulating the rotation of the player's elbow and forearm joints. Eight experienced and eight novice players rated their anticipation of the speed, direction, and spin of the ball on a visual analogue scale. The experienced players significantly altered some of their anticipatory judgment depending on the percentage of both the forearm and elbow modulations, while the novice players indicated no significant changes. Multiple regression analyses, including that of the racket's kinematic parameters immediately before racket-ball impact as independent variables, showed that the experienced players demonstrated a higher coefficient of determination than the novice players in their anticipatory judgment of the ball direction. The results have implications on the understanding of the functional relation between a player's motion and the opponent's anticipatory judgment during real play.