Attributions for recovery and adherence to rehabilitation following anterior cruciate ligament reconstruction: A prospective analysis

Abstract

The relationship between causal attributions for recovery and adherence was examined in a sample of 80 individuals (25 females and 55 males) undergoing rehabilitation following anterior cruciate ligament reconstruction. Participants estimated their speed of recovery and then rated their open-ended attributions for recovery on the Revised Causal Dimension Scale (McAuley, Duncan and Russell, 1992). Adherence was assessed in terms of attendance at rehabilitation sessions and practitioner ratings for the remainder of the rehabilitation period. Participants who perceived themselves as recovering rapidly attributed their recovery to more stable and personally controllable factors than participants who perceived themselves as recovering slowly. Causal dimension ratings predicted attendance at rehabilitation sessions, but not practitioner ratings of adherence. The results, which further demonstrate the relevance of causal attributions to health behavior, are compared with previous cross-sectional findings.     

Muscle strength and functional performance is markedly impaired at the recommended time point for sport return after anterior cruciate ligament reconstruction in recreational athletes

PurposeTo examine potential deficits in muscle strength or functional capacity when comparing (1) an ACL reconstructed group to matched healthy controls, (2) the ACL reconstructed leg to the non-injured leg and (3) the non-injured leg to matched healthy controls, at the time-point of recommended sport return 9–12 months post-surgery.MethodsSixteen patients (male-female ratio: 9:7) 9–12 months post ACL reconstruction and sixteen age and sex matched healthy controls were included. Outcome measures included maximal knee extensor (KE) and knee flexor (KF) dynamometry, including measurement of rate of force development, functional capacity (counter movement jump (CMJ) and single distance hop (SDH)) and the Lysholm score.ResultsCompared to the control group, maximal KE and KF muscle strength were impaired in the ACL reconstructed leg by 27–39% and 16–35%, respectively (p < .001). Also, impairments of both CMJ (38%) and SDH (33%) were observed (p < .001). Rate of force development for KE were reduced in the ACL group compared to the control group (p < .001). Similarly, the KE and KF muscle strength, CMJ and SDH of the ACL reconstructed leg were impaired, when compared to the non-injured leg by 15–23%, 8–20%, 23% and 20%, respectively (p < .05).ConclusionMuscle strength and functional capacity are markedly impaired in the ACL reconstructed leg of recreationally active people 9–12 months post-surgery when compared to healthy matched controls and to their non-injured leg. This suggests that objective criteria rather than “time-since-surgery” criteria should guide return to sport.     

Changes in lower limb co-contraction and stiffness by toddlers with Down syndrome and toddlers with typical development during the acquisition of independent gait

During gait acquisition, children learn to use their changing resources to meet the requirements of the task. Compared to typically developing toddlers (TD), toddlers with Down syndrome (DS) have functionally different musculoskeletal characteristics, such as hypotonia, and joint and ligament laxity, that could produce a reduced passive stiffness. The interplay between this inherently lower passive stiffness and the demands of walking may result in different strategies during gait acquisition. This study compared normalized global stiffness and lower limb's co-contraction indices (CCI) used by toddlers with TD (n=12) and with DS (n=12), during the early stages of gait acquisition. Stiffness and CCI were normalized by gravitational torque (mLg) in both phases of gait (stance, swing). Five longitudinal evaluations were conducted from the onset of locomotion until three months post-acquisition. All children were video taped and had electromyographic (EMG) recordings from muscle pairs of one leg, which were used to calculate CCI of hip, knee, ankle, and total leg CCI. Body and lower limb stiffness were calculated according to a hybrid pendulum resonance equation. Results from ANOVAs revealed no group differences on stiffness or on CCI's during stance but children with DS showed greater CCI during swing. Despite the structural musculoskeletal differences between toddlers with TD and with DS, the similarities observed in their processes of gait development suggest functional equivalences.