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Neurocognitive training with visual perturbation improves dual-task hop performance in male athletes after anterior
Ebrahim Heidarnia1, Mostafa Zarei2, Dustin R Grooms3
1Faculty of Sport Science and Health, Shahid Beheshti University, Tehran, Iran.
Background:
Returning to sport after anterior cruciate ligament reconstruction (ACLR) carries high re-injury risk and persistent functional impairments. Sensorimotor control changes not addressed by standard rehabilitation may lead to neurological compensations affecting functional performance and psychological readiness. Specifically, neural activity associated with sensory, visual, and cognitive processing is elevated for knee motor control in ACLR patients compared to healthy controls. Therefore, developing complementary therapies that target injury-related neuroplasticity may improve rehabilitation effectiveness in resolving both functional and psychological deficits.
Methods:
Twenty-four athletes post-ACLR randomized into Visual-Cognitive Neuromuscular Training (VCNT, n = 12) or Visual-Cognitive Neuromuscular Training with stroboscopic glasses (VCNT-S, n = 12). Both groups trained 3x/week for 8 weeks with neuromuscular exercises combined with cognitive dual-tasks. X-hop performance and Tampa Scale of Kinesiophobia (TSK) assessed pre- and post-intervention.
Results:
Both groups improved functional performance from pretest to post test. For the ACLR limb, the VCNT group improved from 349.78 ± 8.62 to 367.57 ± 5.35 (5.08% change), while the VCNT-S group improved from 347.44 ± 8.14 to 375.48 ± 5.1 (8.07% change). For the uninvolved limb, the VCNT group improved from 355 ± 6.79 to 370.09 ± 5.57 (4.25% change), while the VCNT-S group improved from 352.35 ± 6.86 to 378.59 ± 4.65 (7.45% change). The group * time interaction was significant for both limbs, favoring VCNT-S over VCNT (ACLR limb: interaction effect size = 1.00, p-interaction = 0.01; uninvolved limb: interaction effect size = 1.19; p-interaction = 0.01) Regarding fear of movement, both group showed improvement (VCNT: 4.25 ± 2.73, % change = -18.09%; VCNT-S group: 4.66 ± 3.67, % change = -19.66%) relative to their pre-test scores, but no significant differences were found between the groups (P-Interaction = 0.4, interaction effect size = 0.29). In addition, hop improvements for both limbs showed weak, non-significant correlations with kinesiophobia reduction (ACLR: r = 0.08, p = 0.71; uninvolved: r = 0.17, p = 0.43).
Conclusions:
VCNT-S improved hop performance under dual-task conditions beyond VCNT alone. Adding visual perturbation to VCNT may be able to further improve functional performance and readiness for return to sport. However, psychological readiness may not uniquely benefit from stroboscopic training but does benefit from VCNT generally.
Trial Registration:
Iranian Registry of Clinical Trials (IRCT), IRCT20250314065070N1. Date of Registration: 3 June 2025, retrospective registration.