Promoting Neuroplasticity after Total Knee Replacement through Cognitive- Motor Dual- Task Training: A Meta analysis and Systematic review
DOI:
https://doi.org/10.67440/ahj.v21i5s.1521Keywords:
Total Knee Replacement (TKR), Total Knee Arthroplasty (TKA), Chronic Osteoarthritis, Cognitive-Motor Dual-Task Training (CMDT), Dual-Task Training, Neuro-plasticity, Cortical Plasticity, Neuro-imagining Technique, Systematic Review, Meta Analysis, Randomized Controlled Trials, PRISMA Protocol, Motor Recovery, Gait Performance, Functional Near-Infrared Spectroscopy (fNIRS), Transcranial Magnetic Stimulation (TMS), Electro-encephalography (EEG), Cortical Reorganization, Orthopedic Rehabilitation.Abstract
Background: Total Knee Replacement Surgeries are getting advanced day by day and getting popular among Chronic Osteoarthritis patients with more successful prognosis. Post surgical physiotherapy plays a vital role in rehabilitating the patients for better functional improvement. However, patients experience deficit in the gait mechanics and cognitive motor integration. Gradually the therapeutic approach “Cognitive-Motor Dual-Task Training” (CMDT) is surfacing as more promising approach that enhances Neuro-plasticity and enduring motor task improvement.
Objective: the study approach via Systematic Review and Meta Analysis is aimed to extract data from scientifically screened Randomized Controlled Trials available as published articles and to explore the effects of CMDT on the gait mechanics and cognitive motor integration, via brain –plasticity and functional – motor response as the outcome among post TKR patients.
Method: Applied PRISMA protocol for PICO format based RCTs to finalize 09 quality studies, which covered a total sample of 416 TKR cases. Pretest and Post test data from these 9 RCTs were focused on Cortical plasticity measures (fNIRS, TMS and EEG), as key functional and motor behavior outcomes.
Results: findings from all 9 RCTs established that Cognitive-Motor Dual-Task approach for the gait training stimulated strong brain rewiring adaptations in TKR cases. Neuro-imagining technique acquired by fNIRS discovered reduced activation with in the pre-frontal cortex and fronto- parietal control network. Results of TMS showed restoration of intra-cortical inhibitory mechanism, proved by the normalized SICI and extends Cortico-motor stillness periods, presenting setback of arthrogenic muscle inhibition and attenuation of central hyper-excitability. Furthermore, high-density EEG revealed reduced P300 latency, reflecting enhanced neural processing efficiency. These improvements in cortical function were accompanied by better gait performance, greater postural control, improved gait symmetry, enhanced dual-task ability, and a marked reduction in the incidence of falls.
Conclusion: CMDT promotes brain plasticity changes in post TKR cases, shifting recovery from mindful, high-workload cortical compensation to motor automatism. This intervention represents a crucial addition to standard orthopedic rehabilitation.
