My article of the month (October 2024)
My article of the month (october 2024) is titled “From Control to Chaos: Visual-Cognitive Progression During Recovery From ACL Reconstruction”
The article presents a framework known as the Visual-Cognitive Control Chaos Continuum (VC-CCC). This framework is designed to enhance rehabilitation after anterior cruciate ligament reconstruction (ACLR) by integrating visual-cognitive challenges into traditional rehabilitation practices. The VC-CCC progresses through five phases, each increasing in complexity to simulate the demands of sport and improve both cognitive and motor performance. Throughout the VC-CCC, the visual-cognitive dual tasks progress from simple to complex.
VC-CCC Phases
Phase 1: High Control
Focusing on task stability and movement quality without any added visual-cognitive load. This phase serves as a foundation, allowing athletes to perform exercises with minimal cognitive interference.
Phase 2: Moderate Control
Introducing visually displayed working memory challenges to continuous exercises. The goal is to create mild cognitive-motor interference through divided attention mechanisms. For example, athletes might pace their repetitions to a visual metronome or solve simple math problems displayed on a screen while performing exercises.
Phase 3: Control to Chaos
Integrating problem-solving and decision-making tasks with continuous exercises. This could include both dual tasks and visual-cognitive tasks.
Phase 4: Moderate Chaos
The complexity of visual-cognitive tasks increases, incorporating decision-making tasks with response inhibition. This could be achieved using visual disturbance glasses or multicolor balls to add unpredictability and cognitive load.
Phase 5: High Chaos
Aims to create both physical and cognitive chaos, closely mimicking the demands of sport. For example, virtual reality with unanticipated physical perturbations, responding to visual and auditory stimuli.
My Clinical Take-away
The Visual-Cognitive Control Chaos Continuum (VC-CCC) framework is beneficial in progressing individual exercises throughout the continuum rather than categorizing exercises into specific phases of rehabilitation. For me, the VC-CCC is an extra layer to progress exercises. One example from the article is the lunge. In the high control environment, the patient performs the lunge at a self-paced tempo without any visual-cognitive task. In moderate control, the lunge is performed to tricolored targets, and a visual-cognitive task is given with a pretimed slide deck of randomized colors and transition times. In Control to Chaos, the lunge turns into a dynamic forward lunge, and the visual-cognitive task is added with simple math, where odd answers indicate a jump and even answers indicate a lunge. In moderate chaos, color can be added to the background with a given task. For the high chaos phase, the lunge turns into a four-corner reactive cone tap at submaximal speed with the same visual-cognitive task as before but with visual perturbation glasses.
