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Towards the Development of an Objective Movement Analysis Method within a Sport-Specific Context for the Improvement of RTS Decision-Making during ACL Rehabilitation

Snijders, M.A.H.C. (2023) Towards the Development of an Objective Movement Analysis Method within a Sport-Specific Context for the Improvement of RTS Decision-Making during ACL Rehabilitation.

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Abstract:Within the current post-operative rehabilitation practice of anterior cruciate ligament (ACL) ruptures, the functional movement evaluation for the return to sports (RTS) is performed through the use of standardised tests and interpreted based on the expertise of the physiotherapist. Central to this key evaluation is the frequently-used horizontal single-leg jump, in which jumping performance is considered based on ill-defined qualitative aspects as well as the limb symmetry index (LSI) that quantifies leg performance based on a jumping distance comparison. This method of evaluation does not adequately identify risk factors in the movement functionality nor does it provide an objective insight into the performance of a patient, leading to high re-injury and discrepancies between physiotherapist clinics. To improve the current decision-making during the RTS evaluation of ACL patients, this work proposes a combination of sensor technology for objective movement evaluation within a rich perceptual-cognitive virtual environment. Within the design, IMU sensors (Xsens MVN) were integrated into a Virtual Reality (VR) setup that triggered study participants to make single-leg jumps at pre-determined intervals of 20, 40, 60, and 80% of their maximum single-leg jumping distance (as measured within the VR condition). In addition, perceptual-cognitive pressure was increased by including an unpredictable dual-task for the jump, sensory stimulation and motivating external focus in the jump task. The system was evaluated with a user study of n = 18 healthy participants who were externally perturbed on their non-dominant leg to simulate the ACL-affected jumping movement behaviours. Based on this proof-of-concept evaluation, we were able to show the effectiveness of using VR as a more ecologically valid and high-potential method for increasing sport-specificity in ACL-affected functional movement tests. The use of such a gamified system was found to be engaging and challenging while participants were still able to safely and comfortably perform all movements required of them. With the current methodology, the kinematic data allowed for identifying discriminatory features between the perturbed and non-perturbed leg, which gives hope for exploring similar features that can evaluate the functional movement performance of the ACL-affected leg at the RTS decision. In addition, as differences in jumping performance were also identified for the smaller-distance jumps, this study motivates the use of more single-leg jumps at targeted shorter distances using sensor measurement rather than relying on maximum single-leg jumps for LSI evaluation, to provide a deeper and more reliable consideration of knee functionality.
Item Type:Essay (Master)
Faculty:EEMCS: Electrical Engineering, Mathematics and Computer Science
Programme:Interaction Technology MSc (60030)
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