Sensorimotor control after anterior cruciate ligament injury: towards a precision medicine approach
Anterior cruciate ligament (ACL) injury in the knee is common. It is treated either with physiotherapy alone or combined with surgical reconstruction. It is not known which treatment is best for the person, especially in the long term. Research shows that regardless of treatment, the injury has consequences. The project concerns movement control after ACL injury also in relation to brain mechanisms.
The project goal is to evaluate the movement control of persons after injury of the ACL and how to assess, partly with functional movement tests using detailed movement analysis in high-tech laboratories. We record movements, forces and muscle activation and also in combination with brain imaging methods such as electroencephalography and functional magnetic imaging (fMRI) in partnership with Umeå Centre for Functional Brain Imaging, UFBI. We also aim to interpret movement and brain data using Artificial Intelligence (AI) and develop new sensor technology for motion recording outside the lab.
Background: Injury of the anterior cruciate ligament (ACL) in the knee leads to chronic instability, osteoarthritis, low physical activity, poorer quality of life and a high risk of new injury. Several factors are considered crucial for new injury/osteoarthritis risk; what movement control you have, fear of new injury, so-called fear of movement and that the brain's control of movements seems impaired after injury. However, there is no clear-cut way to measure knee function and movement control, nor evidence for the best treatment. Fear of movement likely affects movement control, but today it cannot easily be measured objectively. We develop new tests and analyses for complicated movement control, joint proprioception (position perception), brain influence and fear of movement.
Our interdisciplinary research evaluates in various sub-studies: 1) knee function over time during rehabilitation following ACL injury in comparison with knee healthy ones; 2) the impact of injury on joint proprioception and brain processes; 3) fear of movement physiologically and how it affects movement control and brain activity in knee injured persons; 4) which attention focus (internally on one's own body, or externally) has the best effect on knee control and the brain.
Methods: We have unique methodologies to register in parallel with advanced movement analysis including muscle activity also record brain activation with different methods. Fear of movement is examined in provocative balance tests also recording heart rate variability, facial muscle activity etc. Data is analysed using innovative statistical and machine learning methods. In addition, we strive for individualized registration and training after ACL injury via the development of artificial intelligent (AI) body-worn sensors that enable feedback on training e.g., at home.
Significance: The project generates methods for evaluation of movement control as well as knowledge of how it is affected by cognition and brain plasticity, and should contribute to more targeted rehabilitation for return to sport or physical activity with reduced risk of injury. The end goal is clinical individualized treatment after injury, in accordance with precision medicine.