Conditioning Brain Responses to Improve Thigh Muscle Function After Anterior Cruciate Ligament Reconstruction

Not Applicable

Recruiting

Interventions: Behavioral: Operant Conditioning
Behavioral: Control
Device: Single Pulse Transcranial Magnetic Stimulation

Brief Summary: The purpose of this study is to examine if thigh muscle weakness and the lack of muscle activation that accompanies ACL injury can be improved through a form of mental coaching and encouragement, known as operant conditioning.

Detailed Description: Thigh muscle weakness is a common result after anterior cruciate ligament (ACL) injury and reconstruction surgery. Therefore, reducing thigh muscle weakness after ACL injury and reconstructive surgery is important as the quadriceps muscles act as shock absorbers that protect the knee joint. If significant weakness is present in the quadriceps, the knee is exposed to increased forces and often results in degeneration of the structures in the joint leading to osteoarthritis. Thus, it is important to investigate activation and strength rehabilitation methods for the quadriceps muscles. This research study is being done to learn if thigh muscle weakness and the lack of muscle activation that accompanies ACL injury can be improved by conditioning brain responses (elicited by non-invasive transcranial magnetic stimulation) using a form of training called as operant conditioning.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

have suffered a previous ACL injury;
have undergone previous major surgery to either knee;
have a history of recent significant knee injury (other than ACL) or lower-extremity fracture;
have a history of uncontrolled diabetes or hypertension;
be pregnant or plan to become pregnant;
have metal implants in the head;
have electronic devices in their ear or heart (e.g., cochlear implants or cardiac pacemakers);
have unexplained recurrent headaches;
have a recent history of seizures;
be taking drugs that reduce seizure threshold;
have a history of repeated fainting spells;

Arm && Interventions

Group	Intervention	Description
Control	Single Pulse Transcranial Magnetic Stimulation	Participants will receive single pulse transcranial magnetic stimulation 2-3 times a week for about 8 weeks without operant conditioning training.
Operant Conditioning	Operant Conditioning	Participants will receive operant conditioning training and single pulse transcranial magnetic stimulation 2-3 times a week for about 8 weeks.
Operant Conditioning	Single Pulse Transcranial Magnetic Stimulation	Participants will receive operant conditioning training and single pulse transcranial magnetic stimulation 2-3 times a week for about 8 weeks.
Control	Control	Participants will receive single pulse transcranial magnetic stimulation 2-3 times a week for about 8 weeks without operant conditioning training.

Primary Outcome Measures

Name	Time	Method
Changes in Quadriceps muscle strength	Approximately 8 weeks after the start of intervention	Quadriceps strength will be measured using an isokinetic dynamometer. Improvements in quadriceps strength from baseline to the end of intervention will be assessed and compared between groups.

Secondary Outcome Measures

Name	Time	Method
Changes in voluntary activation	Approximately 8 weeks after the start of intervention	Voluntary activation will be measured using an electrical superimposition technique. Improvements in voluntary activation from baseline to the end of intervention will be assessed and compared between groups.

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