The Influence of Cognitive Loading on Landing Mechanics: A Systematic Review
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Tyler Havard, SPT, Jenny Hofer, SPT, Paul Johnson, SPT, Rachael Severson, SPT
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Tyler Havard, SPT, Jenny Hofer, SPT, Paul Johnson, SPT, Rachael Severson, SPT
USD PT Research 
Very interesting topic, and wonderful job on your presentation!
While shuffling through the databases, did you come across studies analyzing cognitive loading for other movements, such as cutting, take-off, etc.? Although there are sports that require jumping, such as basketball, there are other predominantly utilized movements in different sports, such as cutting with soccer. Do you think the results would be the same if these other movements were analyzed?
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Hi Erin, thank you for asking that wonderful question. Yes we did come across studies that analyzed other movements besides jumping. For example the Almondroder study references several studies within that study that looked at cognitive load and other decision making tasks such as cutting to the right or left upon landing from a jump. and their results were similar to the ones reported in this study where the cognitive load would negatively impact the performance.
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Great job guys! Since current return to sport protocols do not include dual tasks/cognitive loading, what are some ways we as future physical therapists could incorporate this into rehab?
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Part of our goal of this study was to come up with a few ways to incorporate dual task and cognitive loading into clinical practice. There are many ways of incorporating dual task cognition into rehabilitation but we believe that the best way to add in dual tasks to your treatment would be to make it specific to the person/ population that you are treating. For example, if you were working with a defensive back football player on a return to sport protocol it would be a good idea to incorporate some directional cutting that requires the athlete to carry out decision making tasks that are game relevant like a offensive player trying to cut back on them.
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Great job on your poster! This is a very interesting topic and very relevant for our future athletic patients! Since the majority of the participants included in this study participated in recreational sports and a few of them in competitive sports, do you think that your results would have changed if the majority of the participants were participating in competitive sports?
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Great question, Morgan! The effect of cognitive loading and dual task training on athletes’ performance has a range of applications for injury prevention and rehabilitation whether it is recreational or competitive sport. We believe that including participants in more recreational sports would have increased the likelihood on ACL injury. This is because participants involved in more competitive sports practice task-relevant drills in high-pressure situations to further allow them to make decisions about dual task strategies. Whereas recreational sports often times include athletes who don’t regularily practice the sport nor develop those motor skill learning and movement techniques. It would be worth warranting further research into the inclusion of competitive athletes in this study.
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Nice work on the poster! This is a really intriguing topic to me, and it left me thinking about how important sport specific training can be for athletes RTS or for their training in general given the cognitive load it provides. How might the implementation of dual task training be different for athletes returning from injury compared to using with athletes for preventative measures or could it possibly look the same?
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Great question Zachary! The overall interventions for returning from injury and preventative measures may look the same within a sport but the differences may be seen with the specific needs of each athlete for example, an athlete in a preventative program may tolerate a higher intensity treatment sooner than an athlete recovering from an injury. Adding dual-task training into return to sport or preventative protocols would provide a good foundation for treatment but would allow the physical therapist the flexibility to appropriately treat their patients.
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Very well presented poster! This topic is a very interesting one because as you guys state, cognitive loading tasks can tend to be forgotten about when it comes to rehabilitation and RTS protocols, but it definitely alters landing mechanics and puts athletes at risk for injury. My question is how might someone accurately assess an athletes ability to manage cognitive loading/dual tasks in a RTS testing scenario? Can RTS tests ever be accurate in recreating the cognitive stresses experienced in sport?
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Hi Drew! That is a great question. We didn’t complete a thorough dive into current RTS protocols. Although, based on what we found, there are no current RTS ACL protocols that include cognitive loading or dual tasks. But, a clinician may be able to add a cognitive task to already implemented RTS protocols. For example, a clinician could add heading a soccer ball following a vertical jump test or a hopping test for a soccer player. Other examples would be adding a shuffle drill, counting, or color tasks such as the studies above. One of the most challenging aspects of implementing dual tasks scenarios into RTS protocols is finding an objective way to measure success with resources in the clinic. Further research in this area is warranted in order to create useful, valid, and reliable measures for this population. I do not think that RTS testing can be 100% accurate in recreating the cognitive challenges in sport. Though with further research, I believe that an RTS protocol with a cognitive loading aspect could be a more accurate picture of an athlete’s readiness to return to sport. Lastly, clinicians can better prepare patients for return to sport by implementing dual task and sport specific scenarios throughout a patient’s plan of care.
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Great job on the presentation! I never realized there were so many ACL injuries every year. They always seemed pretty common but over 200,000 is crazy and that is only in the US. Makes me wonder how we stack up world wide. I see some of your studies looked at SL landing while others looked at DL landing. My question is when looking through the research was there any difference between SL and DL landing? Considering different sports have different movement requirements, I’m curious to see if there is a difference between the 2.
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Hi Jason! That is a very good point! It would be interesting to know the statistics world wide for ACL injuries. That is a great question! We didn’t directly compare research between single leg landing and double leg landing. It is hard to directly compare these two variants considering that each study compared single/double leg landing tasks and adding cognitive loading to that same task. While completing single leg jumping tasks, it is likely that researchers would find decreased knee flexion angles, greater knee abduction, and increased tibial internal rotation due to the increased GRF during single leg vs double leg tasks. Additional research is warranted in comparing landing mechanics in single leg landing tasks vs double leg landing tasks.
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Nice job on your poster! The findings of your research are very interesting and are relevant for us as future physical therapists. In your research, did you guys find any differences in how loading mechanics changed with the addition of a cognitive task between the recreational athletes and the few competitive athletes? Additionally, did gender seem to play a role at all, or did loading mechanics seem to change for everyone equally?
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Great questions, Megan! In regard to your first question, most of our studies included recreational athletes and only few incorporated both recreational and competitive athletes. Overall, competitive athletes were more receptive to the cognitive tasks due to their repetitive experience with higher level dual-task demands during practice and game scenarios. Competitive athletes also participate in training programs that teach them proper jump-landing mechanics, therefore allowing most of them to have a predisposed advantage without even including a cognitive component. To answer your second question, the studies that we analyzed did not give great detail on the role of gender in loading mechanics, but from our research in the literature behind anatomical differences in male vs female, females are more prone to ACL injuries. This may be due to the fact that the female pelvis is wider, which changes the mechanics of the LE chain and may lead to higher stress on the soft tissues that support the tibiofemoral joint, such as the ACL.
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Nice job analyzing current research to create this systematic review on the influence of cognitive loading on landing mechanics.
Your poster stated that current prevention training and RTS protocols fail to represent the perceptual demands of game-like scenarios. Based on literature you analyzed or based on your clinical experience thus far, would you say there is a lack of adding in cognitive tasks in all clinical settings and for all sports? Or do you think clinical settings that don’t specialize in sports rehabilitation fail to add in cognitive tasks while focusing on movement quality and neuromuscular re-education?
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Great question, Jamie! The challenge with recreating game-like scenarios is the environment in sports is highly variable with dynamic movements in different directions and multiple sources for cognitive input leading to a lack of cognitive tasks in treatment and protocols. This makes it difficult to appropriately recreate and assess these movements in a controlled, clinical setting. There are other variables such as the clinician’s equipment, background, and overall familiarity with the sport as to the implementation of a cognitive task. Further research is needed in order to guide treatment with the inclusion of a cognitive task.
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Great job you guys, I really liked the organization of your poster! This is a very interesting topic and there’s been lots of great questions up to this point so I will try to avoid any overlap.
I’m interested if any of the studies you analyzed discussed ways to slowly increase the amount of cognitive load during an athlete’s rehab process in order to assess tolerance and to safely increase this load without increasing their risk for injury too quickly in a given PT session? I’d imagine that giving an athlete one cognitive task would be less load than giving that same athlete two or three tasks but was curious if any of the studies talked about that or not. This would be useful so that we don’t give the athlete too much too soon. Thank you in advance!
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Great question, Chris! Unfortunately, none of the studies we analyzed discussed progression or endurance of cognitive loading in the rehabilitation setting, but this is a concept that should be included in further research. Through our research on cognitive loading, we believe that just like any other exercise/intervention, you progress the patient based on clinical reasoning and patient response. Like you stated in your question, starting the athlete with one cognitive task has less of a demand on athlete’s performance and once the athlete performs safely and effectively at that level, progress them to two or three tasks to further challenge their cognitive ability and motor performance.
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Great job on your poster! This was a very interesting topic and very applicable to physical therapy! As I was following the content in your poster, I thought the various landing tasks were interesting and I liked that it covered many of the different types of landing often found in sports activities, whether anticipated or being used as a compensatory motion to avoid a loss of balance or quick change in direction. My question is, was the subjects wearing any sort of shoe or stocking? If so, were there significant differences in the type of footwear and injuries reported?
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Hey Madisyn! That’s a great question! Two studies specified standardizing shoes between all participants. The shoes they specifically used were Adidas Supernova while the other used Brooks Ghost. Other studies reported participants wearing their own athletic shoes or did not specify. No studies specifically stated that they had participants wear no shoes. There were no specific differences reported between shoe wear and no injuries occurred during any of our studies. It is likely that if participants were not wearing any shoe wear, the results would have significantly changed considering the biomechanics of the foot become less rigid and pronate upon landing. This would likely cause greater effects up the chain. I assume that researchers used shoes as this would closely resemble landing mechanics during sporting activities. This would be an area for future research while looking at specific footwear!
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Nice job with this, guys. I enjoy some of the earlier questions and your answers regarding how to progress cognitive loading and specificity, especially for the athletic population. There were a lot of good ideas there. My question is, since we’re talking about the athletic population, how to improve dynamic landing mechanics without the utilization of progressing of plyometric training and cognitive loading. Were there any applicable strength training interventions used to improve these individual’s landing mechanics, and if so what were they? The idea of eccentrically loading the hamstring and single-leg isometrics would make sense in a program to me, but I was curious as to what researchers would use.
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Hey Ryan, great question! While our study did not look specifically into strength interventions we can use the impairments found to come up with an idea of possible treatments. In terms of strength-specific interventions, your ideas are great. The exercises could vary depending on the patient and their deficits would point to what muscle groups to target such as the hamstrings, quadriceps, hip abductors, or even the calf musculature. We could also look at RTS protocols if it is an RTS situation for guidance of progression. The dual-task assessments found in this study could in turn become interventions along with various plyometrics with the end goal of recreating the sport-specific movement as close as possible.
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Great job with this poster everyone! I am intrigued by this topic as I am interested in working with athletes in the future, specifically more on the preventative side of things. I am wondering if any of the studies found a significant difference in the impact of the addition of the cognitive demand to landing mechanics in competitive athletes when compared to recreational athletes? It would make sense to me that the higher-level athletes would be able to adapt to the external demands more readily than the less experienced athletes due to a higher performance demand in the first place, but I am curious what the researchers found.
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Hey Madason, that’s a great question! Your are on the right track with your hypothesis! Most of our studies included recreational athletes and only few incorporated both recreational and competitive athletes. Overall, competitive athletes were more receptive to the cognitive tasks due to their repetitive experience with higher level dual-task demands during practice and game scenarios. Competitive athletes also participate in training programs that teach them proper jump-landing mechanics, therefore allowing most of them to have a predisposed advantage without even including a cognitive component.
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Great job with this poster! It was very interesting to read as I had never really thought about the cognitive impact on landing and how that can affect an individuals biomechanics. Now I know how important it is to work with dual task training in this population as well. I noticed you had a broad range of ages from 12-45 years, so I was just wondering if there were any differences found between teens and middle aged adults? I assume the teens would have been more involved in competitive sports while the middle aged adults were probably more recreational. Would training look different for these two different age groups or say if they were involved in recreational vs competitive sports?
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Correction: I meant to state that the study included age ranges from 16-27. I am still curious as to if age played a role in the findings and if treatment would look different for age or for recreational vs competitive sports.
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Hi Bailey, although our studies included a wide variety of age ranges they did not specifically look at the age matched results of the landing biomechanics and how they interacted with the addition of a cognitive load. So with that knowledge I cannot answer your question with certainty. However, the research did support that the addition of a cognitive load did increase the variability of the landing kinematic and kinetics in all populations studied. In other words adding in a cognitive load decreased the performance in all of our trials. I hope this helps
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