Neuroplasticity and ACLR - Part II

Last week, we began our discussion on neuroplasticity following an ACL injury and/or ACL reconstruction.  What we found out, was there are changed in the higher centers of the brain and if these are not properly trained that this could be an additional factor that could lead to a reinjury or a decrease in performance once the athlete RTPlay. 

So this is great information, but what do we do with it?  I hope, as a follower of this blog, that you see that any product I ever talk about are ones that I believe in.  I don't do it often but the one's that I do are legit.  I don't push them because I have financial incentive to do so, I do it because I believe in the product.  That said and knowing the pethora of research out there on neuroplasticity following ACL injuries, I started to look for ways to incorporate training that would drive neuroplastic changes, help to reduce risk of reinjury with RTPlay and would improve athletic performance.  That is when I came across Quick Board. 

Background on Quick Board

There are some visual motor training systems out there that are very expensive and cumbersome to use in a PT facility or sports performance center.  I have found Quick Board to be a reasonably priced system that does not require a lot of space and effectively helps train the implicit strategies we spoke about in the last blog. 

Quick Board is lower extremity training and rehabilitation technology that targets the visual motor system. The first generation Quick Board was developed to objectively test and train athlete quickness, reaction and agility through sequencing and reaction exercises. Before the system was launched, the University of Memphis conducted a research study to investigate whether Quick Board’s methodology transferred to whole body change of direction. The study concluded that Quick Board’s training protocol significantly improved agility after completing 12 training sessions over a four-week time frame.

With the Quick Board, you can objectively quantify an athlete's reaction time, error rates, LSI in speed and agility tasks.  The system also has the ability to print this out in a report which can be logged into an athlete's training log or patient chart.  Due to the system’s objective nature, interest has been quickly growing in the rehabilitation and strength and conditioning markets.  By listening to the market and continually improving the technology, Quick Board has positioned itself as the only scientifically-proven technology that targets lower extremity visual motor training.

How does it work?
Quick Board’s software has a diverse library of exercises that target reaction, neurocognitive reaction, speed, stability, coordination, strength, balance and proprioception. The software also includes protocols based on injury, rehabilitation phase and patient population. It is critical for patients to engage the visual motor system by focusing on the software feedback without looking down at their feet. This enhances proprioception and addresses neuroplastic changes that occur with injuries. During exercises, patients are performing the required movements on the sensor board while focusing on the Quick Board software’s real-time feedback.

For reaction exercises, the Quick Board software lights up a dot area on the iPad screen and the patient reacts to the corresponding sensor on the sensor board. Sequence exercises consist of predetermined movements which the patient must complete as quickly as possible.

The Quick Board software provides exercise results consisting of:

1. Correct touches completed
2. Errors incurred by pressing an incorrect sensor location
3. Average ground contact time
4. Average reaction time for reaction exercises

Patients perform exercises on Quick Board’s sensor board while focusing on the iPad software’s real-time feedback. The technology’s methodology is based on providing patients with real-time movement feedback during exercises to enhance the neurological impact. Real-time feedback provided during the exercises includes displaying average contact time for each sensor location on the iPad, total number of touches, errors and a progress bar communicating whether the patient is ahead or behind their best result which keeps the patient goal-oriented. 

Automated protocols were developed to reduce the therapist's or strength coach's interaction with the iPad during a patient’s session. Prior to a patient beginning their protocol, the clinician can program the number of sets for each exercise and rest time between exercises. Once those parameters are programmed, the clinician taps the start button and Quick Board’s software takes the patient through the protocol and saves all results to their patient profile.

Before each exercise begins, a patient will see:

• The exercise name 
• Exercise settings
• Demo video
• Their best result for that exercise 
• Their most recent result for that exercise 
• The rest time countdown 
• How many exercises they have remaining for their session

Quick Board has also developed logical sequences designed to take the athlete from easy task to much more complex tasks (as depicted in the video below).

ACL Protocols

Quick Board has been working with industry experts to develop ACL protocols that can be implemented as a part of a comprehensive ACL rehabilitation program. Use of these specific protocols has been shown to have a direct impact and improve performance on the biomechanical factors that put athlete's at risk for injury. We are seeing that when these protocols are implemented as a part of a rehabilitation program, this results in:

• Improvement in Limb Symmetry Index
• Decrease in lateral shift during a squatting motion
• Decreased in magnitude of valgus at the knee during single limb testing
• Decrease in speed of valgus at the knee during single limb testing

These protocols have been laid out in a phased progressions and designed to emphasize symmetry in bilateral limb testing and symmetry in frontal plane control and speed of frontal plane motion in single limb tasks.  I have personally found the Quick Board to be an invaluable asset I can add to my athlete training that helps improve athletic performance and reduce risk of reinjury.

Next week, we will begin a new series on what we are learning from capturing such large amount of movement data.  Stay tuned as I am super excited to share with you.  If you enjoy this blog, please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie.