Mental Imagery for Anterior Cruciate Ligament Reconstruction
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Marquette University
Disqualifiers: Neurological condition, Substance abuse, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The goal of this clinical trial is to understand if people recovering from anterior cruciate ligament reconstruction (ACLR) surgery will complete mental imagery training and if this will improve their injured leg's strength. The main questions are:
* Will people complete a five-day mental imagery exercise schedule while in physical therapy for ACLR?
* Does mental imagery exercise help raise leg strength during ACLR recovery? Researchers will also compare if different mental imagery exercises involving leg extension or squats will change leg strength.
Participants will be asked to:
* Participate in two testing sessions to make measurements of leg function
* Complete about 10 minutes of mental imagery exercises once per day for five days at home and write down whether they complete the exercises.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the treatment Mental Imagery Closed Chain, Mental Imagery Open Chain for Anterior Cruciate Ligament Reconstruction?
Research suggests that mental imagery, when combined with standard physical therapy, can help reduce fear of reinjury and pain perception in patients recovering from anterior cruciate ligament reconstruction. Additionally, mental imagery has been shown to increase muscle activation and may aid in the recovery of muscle strength, making it a potentially useful addition to rehabilitation programs.
12345Is mental imagery safe for use in humans?
Mental imagery, used alongside physical therapy, has been shown to be safe and can help reduce anxiety, tension, and pain, while promoting healing in patients recovering from anterior cruciate ligament reconstruction.
12345How does mental imagery treatment differ from other treatments for ACL reconstruction?
Mental imagery treatment is unique because it focuses on the psychological aspects of recovery, helping to reduce fear of reinjury and pain perception, which are often overlooked in traditional physical therapy. This treatment involves visualizing performing skills in the mind, which can aid in reducing anxiety and promoting healing, unlike standard physical rehabilitation that primarily addresses physical recovery.
12678Eligibility Criteria
This trial is for individuals who have had anterior cruciate ligament reconstruction (ACLR) surgery, are cleared and currently in physical therapy. It's not suitable for those with neurological issues affecting muscle strength, substance abuse history within 5 years, uncontrolled medical conditions, inability to follow simple commands, or if they're over 9 months post-surgery.Inclusion Criteria
I am approved to join physical therapy.
I am currently in physical therapy for ACL reconstruction.
I have had ACL reconstruction surgery.
Exclusion Criteria
History of substance abuse in the last 5 years
I have lower back or hip pain that affects my ability to move my legs.
I have a neurological condition that affects my muscle strength.
+3 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1-2 weeks
Baseline Testing
Participants undergo initial testing sessions to measure leg function, including knee range of motion and knee extension strength
1 day
1 visit (in-person)
Mental Imagery Intervention
Participants complete mental imagery exercises for 10 minutes once per day for five days at home, focusing on either open or closed chain exercises
5 days
5 sessions (home-based)
Post-Intervention Testing
Participants undergo post-intervention testing sessions to measure changes in leg function, including knee range of motion and knee extension strength
1 day
1 visit (in-person)
Follow-up
Participants are monitored for any long-term effects or changes in leg strength and function after the intervention
4 weeks
Participant Groups
The study tests whether mental imagery exercises can boost leg strength during ACL recovery. Participants will do daily mental imagery related to leg movements for five days and track their completion while attending two sessions measuring leg function.
2Treatment groups
Experimental Treatment
Group I: Mental Imagery Open ChainExperimental Treatment1 Intervention
Participants will receive a paper packet with instructions to imagine themselves performing seated maximal leg extension exercises. They will be instructed to imagine the feeling of the exercise for 5 seconds, rest for 5 seconds, and repeat this 50 times with a 2-minute rest period after the 25th repetition. They will also be asked to keep track of the exercises with tallies on a table within the packet and also to record on this table if they did not complete the exercises for that day. The participant is asked to perform the exercises on five consecutive days.
Group II: Mental Imagery Closed ChainExperimental Treatment1 Intervention
Participants will receive a paper packet with instructions to imagine themselves performing maximal standing squat exercises. They will be instructed to imagine the feeling of the exercise for 5 seconds, rest for 5 seconds, and repeat this 50 times with a 2-minute rest period after the 25th repetition. They will also be asked to keep track of the exercises with tallies on a table within the packet and also to record on this table if they did not complete the exercises for that day. The participant is asked to perform the exercises on five consecutive days.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Marquette UniversityMilwaukee, WI
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Who Is Running the Clinical Trial?
Marquette UniversityLead Sponsor
References
Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial. [2022]Imagery can improve functional outcomes post-anterior cruciate ligament repair (ACLR). Research is needed to investigate potential mechanisms for this effect. The aim of this study was to (a) evaluate the effectiveness of an imagery intervention to improve functional outcomes post-ACLR, and (b) explore potential mechanisms. A randomized-controlled pilot trial was conducted. Participants were randomized to guided imagery and standard rehabilitation or standard rehabilitation alone (control). The primary outcome was knee strength 6-month post-operatively. Secondary outcomes were knee laxity at 6-months, and change in psychological (self-efficacy) and neurohormonal (adrenaline, noradrenaline, dopamine) variables. Participants (n=21; 62% male) were 34.86 (SD 8.84) years. Following the intervention, no statistical differences between groups for knee strength extension at 180°/s (t=-0.43, P=0.67), or at 60°/s (t=-0.72, P=0.48) were found. A statistically significant effect was found for knee laxity, F=4.67, P
Reducing Fear of Reinjury and Pain Perception in Athletes With First-Time Anterior Cruciate Ligament Reconstructions by Implementing Imagery Training. [2019]Clinical Scenario: The anterior cruciate ligament is one of the major stabilizing ligaments of the knee joint by preventing anterior translation of the femur in the closed kinetic chain. A ruptured anterior cruciate ligament may require reconstructive surgery for patients who wish to return to physical activity. For the most part, surgeries are successful at repairing the ruptured ligament and restoring ligamentous function; the percentage of athletes that return to a competitive level of physical activity is only 44%, and 24% of patients report a main factor of preventing their return is fear of reinjury and pain. Most physiotherapy and rehabilitation research has focused on the physical treatment and is limited on the psychological aspects of recovery. Imagery has been suggested to be effective at reducing anxiety, tension, and pain, while promoting and encouraging healing after an injury. Imagery is defined as a process of performing a skill in one's mind using the senses (touch, feel, smell, vision, etc) without any overt actions. Clinical Question: In athletes who are first-time anterior cruciate ligament reconstruction patients, does imagery training in combination with standard physical therapy reduce the fear of reinjury and pain perception? Summary of Key Findings: Previous research has primarily looked at the physical treatment aspect, and few studies have focused on the psychological factors affecting recovery. Researchers concluded that fear of reinjury was the unique predictor of return to sport even in a sample of participants that reported very little or almost no pain at all. Imagery as a therapy is an effective intervention in reducing fear of reinjury and confidence building. Furthermore, mental imagery is suggested to assist with a reduction in anxiety, pain, and tension, while promoting healing. Clinical Bottom Line: Based on the strength of recommendation taxonomy, there is a combination of level A and B evidence proposing that imagery, in combination with traditional physical therapy, can be effective at reducing psychological distress such as fear of reinjury and pain perception in first-time anterior cruciate ligament reconstruction patients.
Effects of Mental Imagery on Muscular Strength in Healthy and Patient Participants: A Systematic Review. [2019]The aims of the present review were to (i) provide a critical overview of the current literature on the effects of mental imagery on muscular strength in healthy participants and patients with immobilization of the upper extremity (i.e., hand) and anterior cruciate ligament (ACL), (ii) identify potential moderators and mediators of the "mental imagery-strength performance" relationship and (iii) determine the relative contribution of electromyography (EMG) and brain activities, neural and physiological adaptations in the mental imagery-strength performance relationship. This paper also discusses the theoretical and practical implications of the contemporary literature and suggests possible directions for future research. Overall, the results reveal that the combination of mental imagery and physical practice is more efficient than, or at least comparable to, physical execution with respect to strength performance. Imagery prevention intervention was also effective in reducing of strength loss after short-term muscle immobilization and ACL. The present review also indicates advantageous effects of internal imagery (range from 2.6 to 136.3%) for strength performance compared with external imagery (range from 4.8 to 23.2%). Typically, mental imagery with muscular activity was higher in active than passive muscles, and imagining "lifting a heavy object" resulted in more EMG activity compared with imagining "lifting a lighter object". Thus, in samples of students, novices, or youth male and female athletes, internal mental imagery has a greater effect on muscle strength than external mental imagery does. Imagery ability, motivation, and self-efficacy have been shown to be the variables mediating the effect of mental imagery on strength performance. Finally, the greater effects of internal imagery than those of external imagery could be explained in terms of neural adaptations, stronger brain activation, higher muscle excitation, greater somatic and sensorimotor activation and physiological responses such as blood pressure, heart rate, and respiration rate.
Increased muscle activation following motor imagery during the rehabilitation of the anterior cruciate ligament. [2022]Motor imagery (MI) is the mental representation of an action without any concomitant movement. MI has been used frequently after peripheral injuries to decrease pain and facilitate rehabilitation. However, little is known about the effects of MI on muscle activation underlying the motor recovery. This study aimed to assess the therapeutic effects of MI on the activation of lower limb muscles, as well as on the time course of functional recovery and pain after surgery of the anterior cruciate ligament (ACL). Twelve patients with a torn ACL were randomly assigned to a MI or control group, who both received a series of physiotherapy. Electromyographic activity of the quadriceps, pain, anthropometrical data, and lower limb motor ability were measured throughout a 12-session therapy. The data provided evidence that MI elicited greater muscle activation, even though imagery practice did not result in pain decrease. Muscle activation increase might originate from a redistribution of the central neuronal activity, as there was no anthropometric change in lower limb muscles after imagery practice. This study confirmed the effectiveness of integrating MI in a rehabilitation process by facilitating muscular properties recovery following motor impairment. MI may thus be considered a reliable adjunct therapy to help injured patients to recover motor functions after reconstructive surgery of ACL.
The Effectiveness and Recommendation of Motor Imagery Techniques for Rehabilitation after Anterior Cruciate Ligament Reconstruction: A Systematic Review. [2021]Motor imagery (MI) reported positive effects in some musculoskeletal rehabilitation processes. The main objective of this study was to analyze the effectiveness of MI interventions after anterior cruciate ligament (ACL) reconstruction. A systematic review was conducted from November 2018 to December 2019 in PubMed, Scopus, Web of Science, The Cochrane Library, and Physiotherapy Evidence Database (PEDro). The methodological quality, degree of recommendation, and levels of evidence were analyzed. A total of six studies were included. Selected studies showed unequal results (positive and negative) regarding pain, anxiety, fear of re-injury, function, and activities of daily living. Regarding the range of motion, anthropometric measurements, and quality of life, the results were not conclusive. Muscle activation, strength, knee laxity, time to remove external support, and neurobiological factors showed some favorable results. Nevertheless, the results were based on a limited number of studies, small sample sizes, and a moderate-weak degree of recommendation. In conclusion, our review showed a broader view of the current evidence, including a qualitative assessment to implement MI after ACL surgery. There was no clear evidence that MI added to physiotherapy was an effective intervention after ACL surgery, although some studies showed positive results in clinical outcomes. More adequately-powered long-term randomized controlled trials are necessary.
Magnetic resonance imaging of reconstructed anterior cruciate ligament. [2022]After anterior cruciate ligament reconstruction with autologous patellar tendon, 23 patients who had clinically stable knees were studied prospectively with sequential magnetic resonance imaging 1, 2, 3, 6, and 12 months after surgery. The images of the anterior cruciate ligament were obtained with a 1.5 tesla magnetic resonance scanner in the oblique sagittal, coronal, and oblique axial planes. The cross-sectional area and signal intensity on the reconstructed anterior cruciate ligament were measured in an oblique axial image. The usefulness of the oblique axial image in evaluating the integrity of the reconstructed anterior cruciate ligament was seen. The result showed that the diameter of the graft increased by 70% of its initial size and the signal intensity of the reconstructed graft also showed a tendency to increase. In three patients, there was discontinuity in the graft direction on the oblique sagittal image, but on the oblique axial image there was no evidence of reconstructed anterior cruciate ligament rupture in the sequential images. This shows the value of the oblique axial image in evaluating the integrity of the reconstructed anterior cruciate ligament. Also, sufficient notchplasty in anterior cruciate ligament reconstruction may be needed to prevent graft impingement.
Two-year postoperative MRI appearances of anterior cruciate ligament hamstrings autografts are not correlated with functional outcomes, anterior laxity, or patient age. [2021]MRI has been suggested as an objective method of assessing anterior crucate ligament (ACL) graft "ligamentization" after reconstruction. It has been proposed that the MRI appearances could be used as an indicator of graft maturity and used as part of a return-to-sport assessment. The aim of this study was to evaluate the correlation between MRI graft signal and postoperative functional scores, anterior knee laxity, and patient age at operation.
Effect of personality traits on rehabilitation effect after anterior cruciate ligament reconstruction: An observational study. [2022]Anterior cruciate ligament (ACL) reconstruction requires an extended period of postoperative rehabilitation. Psychological factors can affect recovery after surgery. Study of psychological factors is still limited to self-motivation, fear and pain. Study of personality traits associated with early rehabilitation outcome after ACL reconstruction is scarce.