Lower Kinetic Chain, Meet the Thinking Brain: A Scoping Review of Cognitive Function and Lower Extremity Injury Risk
The classic model of non-contact ACL injury includes environmental, anatomical, hormonal and biomechanical risk factors which directly impact either the amount of stress placed on the ligament or the relative capacity of ligament to withstand the forces placed on it. However, cognition also clearly...
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| Language: | English |
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North American Sports Medicine Institute
2022-08-01
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| Series: | International Journal of Sports Physical Therapy |
| Online Access: | https://ijspt.scholasticahq.com/article/36814-lower-kinetic-chain-meet-the-thinking-brain-a-scoping-review-of-cognitive-function-and-lower-extremity-injury-risk |
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| author | Michaela A. Reyes Mark O. Probasco Trina N. Worby Dylan E. Loertscher Lyndsey K. Soderbeck Wendy E. Huddleston |
| author_facet | Michaela A. Reyes Mark O. Probasco Trina N. Worby Dylan E. Loertscher Lyndsey K. Soderbeck Wendy E. Huddleston |
| author_sort | Michaela A. Reyes |
| collection | DOAJ |
| description | The classic model of non-contact ACL injury includes environmental, anatomical, hormonal and biomechanical risk factors which directly impact either the amount of stress placed on the ligament or the relative capacity of ligament to withstand the forces placed on it. However, cognition also clearly plays a role in successful athletic performance, yet diminished cognitive function is rarely considered a risk factor for injury.
# Objective
To examine the existing literature to determine the extent to which cognitive function (both cognitive ability and task cognitive load) influences non-contact lower extremity injury risk in male and female athletes with a broad variety of athletic expertise.
# Study Design
Scoping Review
# Methods
An electronic search was conducted of CINAHL, SPORTDiscus, Google Scholar, and MEDLINE using the PRISMA method. Search terms included Boolean combinations of “cognition”, “concussion”, “ImPACT”, “cognitive deficit”, “mild traumatic brain injury (mTBI)”, and “neuropsychological function” as cognitive descriptors and the terms “injury risk” and “lower extremity injury” as injury descriptors. Inclusion criteria included papers written in English published between 2000-2021. Exclusion criteria included neurological and cognitively atypical populations, except for concussion (included). Included articles were appraised using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
# Results
Fifty-six studies utilizing across the spectrum of levels of evidence met inclusion criteria. Forty-one articles had good, fourteen had fair, and one had poor methodological quality. Studies examined baseline cognitive function in healthy athletes (n=7); performance during dual-task paradigms (n=13); and the impact of concussion on dual-task performance (n=4), LE injury risk (n=22), or post-concussion testing (n=10). Six articles examining cognitive function and all dual-task studies (including concussion studies) found altered biomechanics associated with injury or increased processing demands. Studies related to concussion and injury incidence consistently found an increased risk of LE injury following concussion. Half of the studies that examined concussion and post-concussion cognitive testing demonstrated significant effects.
# Discussion
Consistent across participant demographics, tasks, and dependent measures, fifty-one of fifty-six assessed articles concluded that decreased cognitive ability or increased cognitive load led to risky LE mechanics or a direct increase in non-contact LE injury risk.
# Conclusion
The robustness of results across gender, performance level, sport, cognitive ability, task cognitive load suggest that the inclusion of cognitive training in the design of optimal LE injury prevention programs warrants further study.
Level of Evidence: Ia |
| format | Article |
| id | doaj-art-fcdedfe277fc40baa781766bed60f159 |
| institution | Kabale University |
| issn | 2159-2896 |
| language | English |
| publishDate | 2022-08-01 |
| publisher | North American Sports Medicine Institute |
| record_format | Article |
| series | International Journal of Sports Physical Therapy |
| spelling | doaj-art-fcdedfe277fc40baa781766bed60f1592025-02-11T20:27:33ZengNorth American Sports Medicine InstituteInternational Journal of Sports Physical Therapy2159-28962022-08-01175Lower Kinetic Chain, Meet the Thinking Brain: A Scoping Review of Cognitive Function and Lower Extremity Injury RiskMichaela A. ReyesMark O. ProbascoTrina N. WorbyDylan E. LoertscherLyndsey K. SoderbeckWendy E. HuddlestonThe classic model of non-contact ACL injury includes environmental, anatomical, hormonal and biomechanical risk factors which directly impact either the amount of stress placed on the ligament or the relative capacity of ligament to withstand the forces placed on it. However, cognition also clearly plays a role in successful athletic performance, yet diminished cognitive function is rarely considered a risk factor for injury. # Objective To examine the existing literature to determine the extent to which cognitive function (both cognitive ability and task cognitive load) influences non-contact lower extremity injury risk in male and female athletes with a broad variety of athletic expertise. # Study Design Scoping Review # Methods An electronic search was conducted of CINAHL, SPORTDiscus, Google Scholar, and MEDLINE using the PRISMA method. Search terms included Boolean combinations of “cognition”, “concussion”, “ImPACT”, “cognitive deficit”, “mild traumatic brain injury (mTBI)”, and “neuropsychological function” as cognitive descriptors and the terms “injury risk” and “lower extremity injury” as injury descriptors. Inclusion criteria included papers written in English published between 2000-2021. Exclusion criteria included neurological and cognitively atypical populations, except for concussion (included). Included articles were appraised using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. # Results Fifty-six studies utilizing across the spectrum of levels of evidence met inclusion criteria. Forty-one articles had good, fourteen had fair, and one had poor methodological quality. Studies examined baseline cognitive function in healthy athletes (n=7); performance during dual-task paradigms (n=13); and the impact of concussion on dual-task performance (n=4), LE injury risk (n=22), or post-concussion testing (n=10). Six articles examining cognitive function and all dual-task studies (including concussion studies) found altered biomechanics associated with injury or increased processing demands. Studies related to concussion and injury incidence consistently found an increased risk of LE injury following concussion. Half of the studies that examined concussion and post-concussion cognitive testing demonstrated significant effects. # Discussion Consistent across participant demographics, tasks, and dependent measures, fifty-one of fifty-six assessed articles concluded that decreased cognitive ability or increased cognitive load led to risky LE mechanics or a direct increase in non-contact LE injury risk. # Conclusion The robustness of results across gender, performance level, sport, cognitive ability, task cognitive load suggest that the inclusion of cognitive training in the design of optimal LE injury prevention programs warrants further study. Level of Evidence: Iahttps://ijspt.scholasticahq.com/article/36814-lower-kinetic-chain-meet-the-thinking-brain-a-scoping-review-of-cognitive-function-and-lower-extremity-injury-risk |
| spellingShingle | Michaela A. Reyes Mark O. Probasco Trina N. Worby Dylan E. Loertscher Lyndsey K. Soderbeck Wendy E. Huddleston Lower Kinetic Chain, Meet the Thinking Brain: A Scoping Review of Cognitive Function and Lower Extremity Injury Risk International Journal of Sports Physical Therapy |
| title | Lower Kinetic Chain, Meet the Thinking Brain: A Scoping Review of Cognitive Function and Lower Extremity Injury Risk |
| title_full | Lower Kinetic Chain, Meet the Thinking Brain: A Scoping Review of Cognitive Function and Lower Extremity Injury Risk |
| title_fullStr | Lower Kinetic Chain, Meet the Thinking Brain: A Scoping Review of Cognitive Function and Lower Extremity Injury Risk |
| title_full_unstemmed | Lower Kinetic Chain, Meet the Thinking Brain: A Scoping Review of Cognitive Function and Lower Extremity Injury Risk |
| title_short | Lower Kinetic Chain, Meet the Thinking Brain: A Scoping Review of Cognitive Function and Lower Extremity Injury Risk |
| title_sort | lower kinetic chain meet the thinking brain a scoping review of cognitive function and lower extremity injury risk |
| url | https://ijspt.scholasticahq.com/article/36814-lower-kinetic-chain-meet-the-thinking-brain-a-scoping-review-of-cognitive-function-and-lower-extremity-injury-risk |
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