Sponsored Content NBC News Learn is a former division of NBC News ‐ distributing the journalism and storytelling of NBC News to students in the classroom, at home, and in the community. Injury & Recovery – Integration Guide (Grades 4-12) June 1, 2020 | 16 minutes, 27 seconds read This document is a companion piece to video titled Injury and Recovery and is intended as a resource for educators. Background and Planning Information About the Video Injury & Recovery discusses the occurrence of knee injuries in downhill skiing and an innovative new technology to repair one type of knee injury: anterior cruciate ligament (ACL) damage. The video describes the ACL injury sustained by downhill skier, Lindsey Vonn, and the related work of Dr. Cato Laurencin at the University of Connecticut. Dr. Laurencin specializes in a type of biotechnology that would use a special mesh to help the body generate new ACL tissue to replace tissue that has been damaged by injury. While ACL repair has not yet been accomplished using this method, the technology has great promise, when fully developed and tested, for athletes like Vonn to make full recoveries. 0:00 0:14 Series opening 0:15 0:44 Introducing Vonn 0:45 1:37 Describing Vonn’s 2013 injury 1:38 1:55 Explaining an ACL injury and why it is so common 1:56 2:07 Introducing Laurencin 2:08 2:44 Explaining what the ACL does 2:45 3:34 Explaining how development of a new solution could reduce injury recovery time 3:35 4:14 Describing regenerative engineering 4:15 4:34 Explaining that other body parts are being regenerated 4:35 4:58 Describing goals of regenerative engineering 4:59 5:14 Closing credits Language Support To aid those with limited English proficiency or others who need help focusing on the video, click the Transcript tab on the side of the video window, then copy and paste the text into a document for student reference. Promote STEM with Video Connect to Science Science concepts described in this video fall under two content areas: biology and human physiology. Biology concepts include cell growth and tissue development, in discussing the technology associated with the development of new ACL tissue in the mesh that is implanted in the knee. Also, human physiology is covered in discussing the structure of the knee: bone structure and the characteristics and function of ligaments in the knee. Extensions can be made to physics concepts related to the construction of the knee and how the ligaments and bones come together to support a person’s weight and withstand an outside force without failing. Related Science Concepts force and motion weight cell growth tissue formation and function human physiology ligament structure measurement (page 1) Take Action with Students • Use the video as a springboard for a discussion of structure related to function. Have students describe the forces that are acting upon the knee for various activities. Begin by playing the video, and particularly the sections that show the motion of a downhill skier. Students can draw stick figure diagrams of some of the body positions they see while the skier is skiing. Have students draw arrows, like rudimentary free body diagrams, representing the forces acting on the knee. Examples might be gravity, torque, or the weight of the skier. Prompt students to think about the direction that the skier is moving and the role that the knee might play in that motion. Finally, end the discussion by talking about the structure of the bones and ligaments in the knee as seen in the video and how the structure of the knee functions in weight support and forward motion. Connect to Technology The video highlights the technology used to generate new ACL tissue using a structure of fine mesh that can be implanted into a person’s body. The video provides a springboard for discussing the evolution of technology related to injury and recovery in the human body, because it also provides a brief description of how ACL injury is currently repaired, using cadaver tissue. Take Action with Students After watching Injury & Recovery for an overview of ACL injury and function, use the Kidshealth website link below to help explain the process of injury and recovery for an ACL tear, including surgery options and specific options for injuries sustained by children and teens. To support Common Core ELA standards, have students read through the article and identify places where they see technology at work to help recovery or repair the knee. Discuss with students the relative nature of technology; that while some treatments are not as advanced as the tissue engineering developed by Dr. Laurencin, many were not available decades ago, and therefore technology has advanced treatment considerably. Kids Health-Anterior Cruciate Ligament Injuries: http://kidshealth.org/parent/nutrition_center/exercise_safety/acl_injuries.html Use the link below to read the Wall Street Journal article, “First Patient Receives L-C Ligament(R) in EU Clinical Trial.” Have students read the article, which describes the success of the first implantation of an L-C Ligament to treat an ACL injury. The article also describes the process by which the treatment is being considered for wider use through the clinical trial and testing process. Lead a whole-class discussion about how this process is related to new technologies. Why do we test new technologies? How is it done? How is the process different if the technology in question is used in the human body? How is human testing more complicated than testing in animal models or with digital models? (For example, discuss the clinical trial process.) Wall Street Journal-First Patient Receives L-C Ligament(R) in EU Clinical Trial: http://online.wsj.com/article/PR-CO- 20130709-906763.html Students might also explore the technology associated with artificial knees and how they are similar to and different from humanones. (page 2) Connect to Engineering Design The engineering design process uses human ingenuity to draw from science, math, and technology to solve a problem. In this case, the problem was the recovery of the human knee after an injury of the ACL. Dr. Laurencin worked within the constraints of tissue compatibility in the human body and the need to not injure other tissues in the body, among other requirements when developing the L-C Ligament(R), which has the benefit of generating new ACL tissue without having to use cadaver tissue or harvest tissue from another part of the injured person’s body. Take Action with Students Address the first two NGSS engineering design standards for middle school: MS-ETS1-1. Define the criteria and constraints of a design problem with sufficient precision to ensure a successful solution, taking into account relevant scientific principles and potential impacts on people and the natural environment that may limit possible solutions. MS-ETS1-2. Evaluate competing design solutions using a systematic process to determine how well they meet the criteria and constraints of the problem. After watching Injury & Recovery, instruct small groups of students to analyze the information from an engineering perspective by doing the following: Defining the design problem faced by the L-C Ligament(R) development team. Define the constraints and criteria for the developed solution. What requirements did the solution have to meet? Evaluate the multiple solutions that are already in place for ACL recovery (rehabilitation only, cadaver replacement and rehabilitation, tissue from another tendon in injured person’s body and rehabilitation, L-C Ligament(R) replacement and rehabilitation). Using the constraints and criteria just developed by the class, ask “What are the merits and drawbacks of each?” Design a randomized test that would provide data to demonstrate whether your solution was effective. Injury & Recovery describes treatment for ACL injury that meets the requirements of knee function. Use the link below to watch a video about a procedure called rotationplasty, which is used to preserve leg function for children who need to undergo an amputation due to a type of bone cancer. In this case, the function of a knee is preserved by using the patient’s ankle as their knee joint. Have students watch both videos and think about the knee and the ankle from an engineering perspective. What are the requirements of the knee in the human body? How does the ankle satisfy and not satisfy those requirements? Why was this procedure developed as a solution to the problem of a lost knee? Caitlin’s rotationplasty: www.youtube.com/watch?v=PHdoXr-Zyt4 Connect to Math The math lessons embedded in the video are not explicitly discussed, however measurement is key to much of what is described, from the speed at which downhill skiers ski to the weight that a repaired ACL is able to support, to the range of motion that a damaged or repaired knee might have. (page 3) Take Action with Students Use the fact that Injury & Recovery is not explicit about the math used in the ACL injury and recovery process as a jumping off point for students to begin to brainstorm where math is used. As students watch the video, have them take notes on where they think math is necessary in order to understand downhill skiing performance, injury, L-C Ligament(R) design and function, or knee repair and rehabilitation. Students might extend their thinking to the rate of increase in strength or decrease in time through training and/or rehabilitation. Have them consider whether the rates are linear or exponential. Use the SCIENCE Inquiry section of Injury & Recovery Inquiry Guide to test the amount of weight necessary to collapse the model knees students construct. Depending on the materials the models are made of, each group could perform several trials on each side of the knee to determine an average for each side or multiple models for repeated trials. Students can work together as a class to decide on a number of trials each group should perform in order to calculate an average for each test. Work with students to calculate their averages and discuss the meaning and significance of averages in scientific analysis. Students may share their data as a class to compare and contrast values and discuss surprising, as well as expected findings. Encourage students to explore how the lattice structure increases surface area by creating models and measuring the available surface on which cells can grow. Incorporate Video into Your Lesson Plan Integrate Video in Instruction As Part of the Day Compare and Contrast A few days ahead of when you want to discuss, allow students to grow crystals, such as alum (http://chemistry.about.com/cs/howtos/ht/alumcrystal.htm) or rock candy from a solution of sugar (http://www.exploratorium.edu/cooking/candy/recipe-rockcandy.html). Connect the growth of the crystal to Injury & Recovery, focusing on segment 2:45 to 3:50, where L-C Ligament(R) formation is discussed. Have students compare and contrast the growth of the crystals to the growth of the ligament tissue on the lattice of the L-C Ligament(R). You might weave a string as a lattice for the crystals to aid with the comparison. Students should understand that both materials use an existing structure as the foundation for the crystal or tissue. They should be able to conclude that both form in a regular pattern, while also understanding that the tissue forms from cell growth and division, in contrast to the sugar or alum crystal formation. Explain Watch the segment 2:08 to 2:28, which describes the structure of the knee and the ligaments. Extend student understanding by using the diagram provided in the video to demonstrate that the motion of their knee is dependent, in part, upon the length and position of the ligaments that are modeled. Students should note that the cruciate ligaments, including the ACL, are very short and hold the leg bones together. The ligament that goes over the knee cap is quite long in comparison, and allows for greater movement, so the knee will bend against this ligament. (page 4) As Part of a 5E Lesson Plan If you use a 5E approach to lesson plans, consider incorporating video in these Es: Explore Use the video to encourage students to learn more about the forces associated with downhill skiing. In what ways are the ligaments in skiers’ knees stressed, and why is an ACL injury likely? What is the job of the knee in the racer’s movement downhill? How does it transfer force to ensure the skier goes where he or she intends to go? Explain Use the information in the video and students’ results from the SCIENCE Inquiry section of Injury & Recovery Inquiry Guide to support your lessons on force, weight, and momentum. Elaborate Have students do research to explore the other ways that an ACL injury is treated. Methods include cadaver tissue replacement, tissue replacement from other ligaments in the knee, and no surgery. Students can compare the methods for the costs and benefits of each in terms of recovery and movement. Connect to ... Psychology The Psychology of Injury Use the video to spark a discussion of the psychology of the injured athlete. In the video Ms. Vonn shows tremendous tenacity and dedication to her sport, however the reality of an injury for a dedicated athlete can be very disorienting and disappointing. Students can use the video to generate questions about the psychology of sports injury, which they can then research online and discuss as a class. The following TODAY Show interview can provide students with insights: http://www.today.com/sochi/lindsey-vonn- injury-i-still-have-time-sochi-2D11663524. Given Vonn's decision not to compete at Sochi, additional debate about the psychological impact of an injury could be developed. Connect to ... Physical Education Use the video to spark a discussion and additional research about the risk factors associated with certain sports related to ACL injury. Sports deemed cutting sports are more prone to cause this type of injury. These are sports in which there are frequent direction changes or twisting. Also discuss the appropriate stretching and conditioning practices that can limit injury and that can aid rehabilitation from this type of injury. Use Video as a Writing Prompt Have students take notes during viewing of the Injury & Recovery segment that discusses the use of the lattice to generate new ACL tissue (2:45–3:50). Then, have students write a news release for a newspaper or Internet news site describing the ligament, the lattice, how it works to generate new tissue, and how they are beneficial to the recovery process. Use the Connect to ... Psychology section of this guide to consider with students the experience of the injured athlete. Have students write, from the first-person perspective, an account of their experience as an injured athlete. Even if students are not “athletic” in their own personal visions, injuries or debilitations from chemotherapy or other treatments can hamper everyday activities to the point of frustration. Students’ descriptions should include a narrative of their injury, as well as the emotional experience of being injured. (page 5) Connect Video to Common Core ELA Encourage inquiry via media research. Student work will vary in complexity and depth depending on grade level, prior knowledge, and creativity. Use prompts liberally to encourage thought and discussion. Common Core State Standards Connections: ELA/Literacy – RST.6-8.1 Cite specific textual evidence to support analysis of science and technical texts, attending to the precise details of explanations or descriptions WHST.6-8.1 Write arguments focused on discipline-specific content. WHST.6-8.7 Conduct short research projects to answer a question (including a self-generated question), drawing on several sources and generating additional related, focused questions that allow for multiple avenues of exploration. WHST.6-8.8 Gather relevant information from multiple print and digital sources, using search terms effectively; assess the credibility and accuracy of each source; and quote or paraphrase the data and conclusions of others while avoiding plagiarism and following a standard format for citation. Facilitate Inquiry through Media Research Show the video Injury & Recovery and encourage students to jot down notes while they watch. Elicit questions and problems from group members and help them determine which are better explored using print media or online resources. Then, students should brainstorm to form a list of key words and phrases they could use in Internet search engines that might result in resources that will help them answer a question or solve a problem. Review how to safely browse the Web, how to evaluate information on the Internet for accuracy, and how to correctly cite the information found. Suggest students make note of any interesting tangents they find in their research effort for future inquiry. Encourage students with prompts such as the following: Words and phrases associated with our question are.... The reliability of our sources was established by.... The science and math concepts that underpin a possible solution are.... Our research might feed into an engineering design solution such as.... To conduct the investigation safely, we will.... Related Internet Resources Description of knee ligament structure: http://www.youtube.com/watch?v=RTV5Yo3E7VQ Knee taping for stability: http://www.youtube.com/watch?v=sBgwY7cf_vI Wall Street Journal article: http://online.wsj.com/article/PR-CO-20130709-906763.html Make a Claim Backed by Evidence As students carry out their media research, ensure they record their sources and findings. Students should analyze their findings in order to state one or more claims. Encourage students with this prompt: As evidenced by... I claim... because.... Present and Compare Findings Encourage students to prepare presentations that outline their inquiry investigations so they can compare findings with others. Students might do a Gallery Walk through the presentations and write peer reviews as would be done on published science and engineering findings. Students might also make comparisons with material they find on the Internet, the information presented in the video, or an expert they chose to interview. Remind students to credit their original sources in their comparisons. Elicit comparisons from students with prompts such as: (page 6) My findings are similar to (or different from) those of the experts in the video in that.... My findings are similar to (or different from) those of my classmates in that.... My findings are similar to (or different from) those that I found on the Internet in that.... Reflect on Learning Students should reflect on their understanding, thinking about how their ideas have changed or what they know now that they didn’t before. Encourage reflection, using prompts such as the following: I claim that my ideas have changed from the beginning of this lesson because of.... My ideas changed in the following ways.... When thinking about the claims made by the experts, I am confused about.... One part of the investigation I am most proud of is.... Inquiry Assessment Assessment Rubric for Inquiry Investigations Criteria 1 point 2 points 3 points Initial question or problem Question or problem had had a yes/no answer or too simple of a solution, was off topic, or otherwise was not researchable or testable. Question or problem was researchable or testable but too broad or not answerable by the chosen investigation. Question or problem was clearly stated, was researchable or testable, and showed direct relationship to investigation. References cited Group incorrectly cited all of the references used in the study. Group correctly cited some of the references used in the study. Group correctly cited all of the references used in the study. Claim No claim was made or the claim had no evidence to support it. Claim was marginally supported by the group’s research evidence. Claim was well supported by the group’s research evidence. Presentations Groups neither effectively nor cooperatively presented findings to support their stance. Groups effectively or cooperatively presented findings to support their stance. Groups effectively and cooperatively presented findings to support their stance. Findings comparison Only a few members of the group constructively argued their stance. Most members of the group constructively argued their stance. All members of the group constructively argued their stance. Reflection None of the reflections were related to the initial questions. Some reflections were related to the initial questions. All reflections were related to the initial questions. Lesson plans produced by the National Science Teachers Association. Video produced by NBC News Learn in collaboration with the National Science Foundation. tags in this article Athlete Fan NBC News Learn Science of the Winter Olympics