Impact of Balance Training When Incorporating Cognitive Tasks/External Focus of Attention, On Postural Control in Subjects Following Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Abstract

Introduction: The current investigation assessed effects of balance exercises both incorporating and excluding cognitive tasks (CTs) and external focus of attention (EFA) on postural control in athletes who have undergone anterior cruciate ligament reconstruction (ACLR).

Methods: A total of 48 athletes post-ACLR were randomly assigned to one of the three groups: traditional balance training (BT), balance training with external focus of attention (BTF), and balance training with cognitive demands (BTC). Postural control was evaluated by a force platform before and after an 8-week intervention, during which participants engaged in balance exercises four times a week. The interventions included standard balance exercises, balance exercises with EFA, and balance exercises incorporating CTs. Assessments included sway amplitude, average sway velocity, and standard deviation of sway velocity in both anteroposterior (AP) and mediolateral (ML) directions during single-leg quiet standing. Additionally, the time taken to regain stability following mechanical perturbation was measured.

Results: The results indicated a remarkable reduction in the sway amplitude especially in ML direction for intervention groups. Also, standard deviation of sway velocity was significantly reduced in intervention groups when comparing to the control group. In general, time to return to stability after mechanical perturbation did not changed in any group. It just increased in BT group post intervention.

Conclusion: incorporating cognitive load and external focus of attention in the conventional balance training of athletes post ACLR surgery reduced sway amplitude and postural control cost, but had no significant effect on  time to return to stability after applying mechanical perturbation.