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An experimental study to determine the effects of different rehabilitation programs after anterior cruciate ligament reconstruction


  • Peter Weingartner (Department of Biology, Eidgenössische Technische Hochschule (ETH) Zürich)
  • Kate Button
  • Dr Eling de Bruin (Department of Biology, Eidgenössische Technische Hochschule (ETH) Zürich)
  • Dr. Robert van Deursen

There is consistent evidence that motor skill performance and learning can be enhanced by giving learners instructions that direct their attention to the effects of their movements. This study was carried out to determine whether motor learning performance in a rehabilitation setting is affected by the type of attentional focus the patients are instructed to use.

Two groups were compared before and after intervention. Twenty three volunteers (average age: 36.7 ± 9.8 years, range: 24-53 years) who had been discharged from physiotherapy after an anterior cruciate ligament reconstruction participated in the study. Participants were randomly allocated to one of two groups differing in training instructions. Neuromuscular control training consisted of 18 exercise session over a 6 week period. Each session consisted of single-leg squatting, lunge (forward and sideways), single-leg hopping (vertical, forward, and sideways), each exercise to be repeated 10 times with both legs, and stretching (quadriceps, hamstring, and calf each 20seconds). Training instructions directed the participants either to an internal or an external focus of attention.

Assessments were conducted pre- and post-training using a force plate. Time to stability was determined by means of centre of pressure, vertical and anterior-posterior rate of change after single-leg hop for maximal distance. Peak force of landing was also measured.

The internal focus of attention condition led to significantly better improvement in time to stability in vertical and anterior-posterior direction compared to the external focus of attention condition. There was a significant improvement in hopping distance and reduction of peak landing force for both groups.

Our results suggest that an internal focus of attention is more appropriate for motor learning performance when treating patients who are in an early stage after anterior cruciate ligament reconstruction. Specific exercises independent of the type of instruction can lead to significant improvement in performance.