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Wang X, Wang Z, Adams R, Ganderton C, Lyu J, Han J. Ankle inversion proprioception measured during stair descent can identify chronic ankle instability. Musculoskelet Sci Pract 2024; 72:102958. [PMID: 38643590 DOI: 10.1016/j.msksp.2024.102958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Individuals with chronic ankle instability (CAI) may experience recurrent ankle sprains and symptoms during daily activities such as stair descent, where the associated proprioceptive deficit is largely unevaluated. OBJECTIVES To evaluate the reliability and validity of an ankle inversion discrimination apparatus for stair descent, and examine whether proprioceptive scores from this apparatus are associated with patient-reported symptoms. DESIGN Cross-sectional study. METHOD Sixty-six participants volunteered in this study. The ankle inversion discrimination apparatus was purpose-built to assess ankle proprioception across four positions of ankle inversion (10°, 12°, 14°, and 16°) during stair descent. The Area Under the Receiver Operating Curve (AUC) was employed as the ankle proprioceptive discrimination score. RESULTS Test-retest reliability ICC (3,1) for the whole group was 0.825, with 0.747 for the non-CAI group (95%CI = 0.331-0.920) and 0.701 for CAI (95%CI = 0.242-0.904). The CAI group performed at a significantly lower level than non-CAI on the ankle inversion discrimination apparatus for stair descent assessment (0.769 ± 0.034 vs. 0.830 ± 0.035, F = 33.786, p < 0.001). CAIT scores were strongly and significantly correlated with scores from this apparatus (Spearman's rho = 0.730, p < 0.001). CONCLUSIONS The ankle inversion discrimination apparatus for stair descent is reliable and valid for assessing task-specific ankle proprioceptive impairments in CAI. The strong and significant relationship found between ankle proprioception during stair descent and the severity of CAI suggests that rehabilitation programs focusing on deficits in ankle inversion proprioception during stair descent may improve self-reported instability in CAI.
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Affiliation(s)
- Xueying Wang
- Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Zheng Wang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Australia; College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China
| | - Charlotte Ganderton
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China; School of Health Science, Swinburne University of Technology, Australia; School of Biomedical Science and Health, Royal Melbourne Institute of Technology University, Australia
| | - Jie Lyu
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China.
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China.
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Huang Q, Zhong B, Elangovan N, Zhang M, Konczak J. A Robotic Device for Measuring Human Ankle Motion Sense. IEEE Trans Neural Syst Rehabil Eng 2023; 31:2822-2830. [PMID: 37347627 DOI: 10.1109/tnsre.2023.3288550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Proprioceptive signals about ankle motion are essential for the control of balance and gait. However, objective, accurate methods for testing ankle motion sense in clinical settings are not established. This study presents a fast and accurate method to assess human ankle motion sense acuity. A one degree-of-freedom (DOF) robotic device was used to passively rotate the ankle under controlled conditions and applied a psychophysical forced-choice paradigm. Twenty healthy participants were recruited for study participation. Within a trial, participants experienced one of three reference velocities (10°/s, 15°/s, and 20°/s), and a smaller comparison velocity. Subsequently, they verbally indicated which of the two movements was faster. As outcome measures, a just-noticeable-difference (JND) threshold and interval of uncertainty (IU) were derived from the psychometric stimulus-response difference function for each participant. Our data show that mean JND threshold increased almost linearly from 0.53°/s at the 10°/s reference to 1.6°/s at 20°/s ( ). Perceptual uncertainty increased similarly (median IU = 0.33°/s at 10°/s and 0.97°/s at 20°/s; ). Both measures were strongly correlated ( r s = 0.70). This implies that the bias of the human ankle motion sense is approximately 5 - 8% of the experienced movement velocity. We demonstrate that this robot-aided test produces quantitative data on human ankle motion sense acuity. It provides a useful addition to the current measures of ankle proprioceptive function.
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Shao X, Kang M, Luan L, Deng F, Adams R, Wu T, Han J. Reliability and validity of the ankle inversion discrimination apparatus during walking in individuals with chronic ankle instability. Front Physiol 2023; 14:1036194. [PMID: 36744024 PMCID: PMC9893012 DOI: 10.3389/fphys.2023.1036194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Purpose: 1) to explore the test-retest reliability of a new device for measuring ankle inversion proprioception during walking, i.e., the Ankle Inversion Discrimination Apparatus-Walking (AIDAW) in individuals with or without Chronic Ankle instability (CAI); 2) to assess its discriminant validity in differentiating individuals with or without CAI; 3) to investigate its convergent validity by examining its association with Cumberland Ankle Instability Tool (CAIT) and the Y Balance Test (YBT). Methods: For test-retest reliability, 15 participants with CAI and 15 non-CAI healthy controls were recruited. Participants completed the AIDAW test twice with a 7-day interval. The area under the receiver operating curve (AUC) was obtained as the AIDAW score. The intraclass correlation coefficient (ICC) and MDC90 were calculated. For the validity study, another 20 individuals with CAI and 20 non-CAI healthy controls were involved. The AIDAW scores were analyzed by an independent samples t-test, and the optimal cutoff value of AIDAW scores to best distinguish individuals with CAI was calculated by Youden's index. Spearman or Pearson correlation analysis was used to analyze the correlation between AIDAW proprioceptive scores and the CAIT and final YBT scores. Results: For test-retest reliability, the ICC values for the CAI, non-CAI, and the whole group were 0.755, 0.757, and 0.761 respectively. The MDC90 of the CAI and non-CAI group was 0.04 and 0.05. Regarding discriminant validity, the AIDAW proprioceptive discrimination scores in the CAI group were significantly lower than those in the non-CAI group (p = 0.003); and the cutoff score for distinguishing CAI from the non-CAI participants was 0.759. For convergent validity, the AIDAW scores were significantly correlated with the functional balance YBT final scores (p = 0.001) and the CAIT scores (p = 0.009). Conclusion: The AIDAW is a reliable and valid device for evaluating ankle inversion proprioception during walking in individuals with and without CAI. AIDAW can be used as a clinical assessment tool to discriminate CAI from non-CAI individuals and to monitor effects of rehabilitation. The AIDAW proprioceptive discrimination scores were significantly and positively correlated with YBT and CAIT scores.
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Affiliation(s)
- Xuerong Shao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China,Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming Kang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Lijiang Luan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Fawei Deng
- Department of Rehabilitation, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Roger Adams
- Research Institute for Sports and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Tao Wu
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China,*Correspondence: Tao Wu, ; Jia Han,
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China,Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia,*Correspondence: Tao Wu, ; Jia Han,
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Yu R, Yang Z, Witchalls J, Adams R, Waddington G, Han J. Can ankle proprioception be improved by repeated exposure to an ankle movement discrimination task requiring step-landing in individuals with and without CAI? Phys Ther Sport 2022; 58:68-73. [DOI: 10.1016/j.ptsp.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 10/31/2022]
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Ebrahimabadi Z, Naimi S, Rahimi A, Yousefi M, Wikstrom E. Postural phase duration during self-generated and triggered gait initiation in patients with chronic ankle instability. Sci Sports 2022. [DOI: 10.1016/j.scispo.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Yu R, Yang Z, Witchalls J, Adams R, Waddington G, Han J. Kinesiology tape length and ankle inversion proprioception at step-down landing in individuals with chronic ankle instability. J Sci Med Sport 2021; 24:894-899. [PMID: 34016535 DOI: 10.1016/j.jsams.2021.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the effect of different lengths of kinesiology tape (KT) on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI). DESIGN A repeated measures study. METHODS Fifteen participants with unilateral CAI and fifteen participants with no CAI volunteered. The Ankle Inversion Discrimination Apparatus for Landing (AIDAL) was used to measure ankle proprioceptive acuity. All participants were tested under four KT conditions: no tape (baseline), short tape length (only foot and ankle complex involved), mid length (below the knee) and long length (above the knee) taping. After the baseline test, participants underwent the 3 different taping tests in a random order. RESULTS Repeated measures ANOVA indicated that, compared to those without CAI, individuals with CAI performed significantly worse across the 4 different conditions (F = 8.196, p = 0.008). There was a significant KT main effect (F = 7.489, p < 0.001) and a significant linear effect (F = 17.083, p < 0.001), suggesting that KT significantly improved ankle proprioceptive performance in landing, and with longer tape length there was greater proprioceptive enhancement. Post-hoc analysis showed that for the CAI group, both mid length (p = 0.013, 95%CI = -0.063, -0.009) and long length (p = 0.010, 95%CI = -0.067, -0.011) taping can significantly improve ankle proprioceptive performance compared to no tape, whereas for the non-CAI group, ankle proprioceptive acuity was significantly improved only with long length taping (p = 0.007, 95%CI = -0.080, -0.015). CONCLUSIONS KT can be used to improve ankle inversion proprioceptive performance during landing in both individuals with and without CAI and increasing tape length may achieve greater proprioceptive improvement.
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Affiliation(s)
- Ruoni Yu
- School of Kinesiology, Shanghai University of Sport, China
| | - Zonghan Yang
- School of Kinesiology, Shanghai University of Sport, China; Faculty of Medicine, The university of Melbourne, Australia
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, Australia
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Australia
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, Australia
| | - Jia Han
- School of Kinesiology, Shanghai University of Sport, China; Research Institute for Sport and Exercise, University of Canberra, Australia.
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Han J, Yang Z, Adams R, Ganderton C, Witchalls J, Waddington G. Ankle inversion proprioception measured during landing in individuals with and without chronic ankle instability. J Sci Med Sport 2021; 24:665-669. [PMID: 33632662 DOI: 10.1016/j.jsams.2021.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/16/2021] [Accepted: 02/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research evidence has suggested that a more sensitive ankle proprioceptive testing method with higher ecological validity is needed for assessing proprioceptive deficits in individuals with chronic ankle instability (CAI). OBJECTIVES (1) To determine the test-retest reliability of a novel ankle proprioception assessment tool, the Ankle Inversion Discrimination Apparatus for Landing (AIDAL); (2) To assess whether AIDAL scores were sufficiently sensitive to detect proprioceptive deficits in chronic ankle instability (CAI); and (3) To examine whether AIDAL scores correlated with Cumberland Ankle Instability Tool (CAIT) scores. DESIGN Cross-sectional study. METHODS The AIDAL was purpose-built to assess ankle discrimination in four positions of ankle inversion (10°, 12°, 14° and 16°) upon landing from a 10cm drop. Area Under the Receiver Operating Curve (AUC) was employed as the ankle proprioceptive discrimination score. Seven-day test-retest reliability was evaluated with 23 university students (12 CAI and 11 non-CAI), and another 36 university students (18 CAI and 18 non-CAI) were in the comparison study. RESULTS The test-retest reliability ICC score for the whole group was 0.763 (95% CI=0.519-0.892), which showed an excellent reliability level. ICC (3,1) was 0.701 for the non-CAI group (95%CI=0.210-0.910) and 0.804 for the CAI group (95%CI=0.451-0.939). The CAI group performed at a significantly lower level on the AIDAL assessment than the non-CAI group (0.777±0.05 vs. 0.815±0.05, F=5.107, p=0.03). The discriminative AUC value for the AIDAL test was 0.756 with a cut point of 0.819 (sensitivity=0.733, specificity=0.800). The MDC90 scores for CAI and non-CAI groups were both 0.04. Spearman's correlation showed that the CAIT scores were significantly correlated with the ankle proprioceptive discrimination scores (rho=0.401, p=0.015). CONCLUSION The AIDAL showed good test-retest reliability for both non-CAI and CAI groups. Measuring ankle inversion proprioception during landing may be important for assessing the outcomes of CAI rehabilitation, as proprioceptive performance obtained from the AIDAL was significantly correlated with severity of functional ankle instability CAIT scores.
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Affiliation(s)
- Jia Han
- Department of Physiotherapy and Sport Rehabilitation Shanghai University of Sport, China; Faculty of Health, Arts and Design, Swinburne University of Technology, Australia; Research Institute for Sport and Exercise, University of Canberra, Australia.
| | - Zonghan Yang
- Department of Physiotherapy and Sport Rehabilitation Shanghai University of Sport, China; Department of Physiotherapy, University of Melbourne, Australia
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Australia
| | - Charlotte Ganderton
- Faculty of Health, Arts and Design, Swinburne University of Technology, Australia
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, Australia
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, Australia
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Spatiotemporal gait characteristics and ankle kinematics of backward walking in people with chronic ankle instability. Sci Rep 2020; 10:11515. [PMID: 32661274 PMCID: PMC7359031 DOI: 10.1038/s41598-020-68385-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022] Open
Abstract
Backward walking offers a unique challenge to balance and ambulation. This study investigated the characteristics of spatiotemporal gait factors and ankle kinematics during backward walking in people with chronic ankle instability. Sixteen subjects with chronic ankle instability and 16 able-bodied controls walked on a treadmill at their self-selected speed under backward and forward walking conditions. Gait speed, cadence, double limb support percentage, stride time variability, and three-dimensional ankle kinematics were compared between groups and conditions. During backward walking, both groups had significantly slower gait speed, lower cadence, and greater stride time variability. In addition, under backward walking condition, subjects in both groups demonstrated significant sagittal and frontal kinematic alternations, such as greater dorsiflexion and inversion following initial contact (0–27.7%, 0–25.0% of gait cycle respectively, p < 0.001). However, there were no significant differences between groups in any of the measured outcomes. This indicates that subjects with chronic ankle instability adapt to self-selected speed backward walking similarly to healthy controls. Assessments with more challenging tasks, such as backward walking with dual task and backward walking at fast speed, may be more appropriate for testing gait impairments related to chronic ankle instability.
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Mohamadi S, Ebrahimi I, Salavati M, Dadgoo M, Jafarpisheh AS, Rezaeian ZS. Attentional Demands of Postural Control in Chronic Ankle Instability, Copers and Healthy Controls: A Controlled Cross-sectional Study. Gait Posture 2020; 79:183-188. [PMID: 32422558 DOI: 10.1016/j.gaitpost.2020.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND It has been shown that cognitive loading affects postural control in different populations. However, there is limited and conflicting information about dual task challenges on postural control in chronic ankle instability (CAI). RESEARCH QUESTION Does cognitive task performance change standing postural control in individuals with CAI, copers and healthy subjects? METHODS A descriptive, analytic, and controlled cross-sectional study was conducted on 75 individuals. They were assigned into three matched groups, including CAI, copers, and healthy controls. Postural control variables were collected during single leg standing on a force plate with and without vision and cognition. Parameters of center of pressure (COP), including mean COP area, range, sway index and velocity, were measured. Additionally, cognitive task performance by auditory stroop was assessed by calculating the reaction time and error ratio. Mixed model ANOVAs were used to determine the effects of group and testing conditions. RESULTS The CAI group demonstrated greater COP sway parameters compared to other groups under all testing conditions. The main significant effect of vision was observed for all COP parameters with greater COP sway during eyes closed compared to eyes open (P < 0.05). The main effect of a cognitive task was significant with reduced COP sway while performing the secondary cognitive compared to a single task in all three groups (P < 0.05). The cognitive task results revealed significantly longer reaction times in the CAI group compared to copers and healthy individuals (p < 0.05). SIGNIFICANCE Considering postural control deficits in CAI, especially in eye-closed condition and effects of cognitive loading, may guide us to improve postural control in those with CAI with neurocognitive training. Furthermore, no difference between coper and healthy groups may imply a successful compensatory postural control mechanism in copers.
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Affiliation(s)
- Somayeh Mohamadi
- Department of Physiotherapy, Iran University of Medical Sciences, 13487-15459, Tehran, Iran.
| | - Ismail Ebrahimi
- Department of Physiotherapy, Iran University of Medical Sciences, Tehran, Iran.
| | - Mahyar Salavati
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Mehdi Dadgoo
- Department of Physiotherapy, Iran University of Medical Sciences, 13487-15459, Tehran, Iran.
| | - Amir Salar Jafarpisheh
- Department of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Zahra Sadat Rezaeian
- Department of Physiotherapy, Isfahan University of Medical Sciences, Isfahan, Iran.
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Effects of Textured Balance Board Training in Adolescent Ballet Dancers With Ankle Pathology. J Sport Rehabil 2019; 28:584-592. [PMID: 30040016 DOI: 10.1123/jsr.2018-0052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/22/2018] [Accepted: 05/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Ankle sprains are common among adolescent ballet dancers and may be attributed to inadequate ankle proprioception. Thus, a short period of training utilizing proprioceptive activities requires evaluation. OBJECTIVE To assess training conducted for 3 or 6 weeks on a textured-surface balance board using ankle proprioception scores for ballet dancers with and without chronic ankle instability, and with and without previous ankle sprain (PAS). DESIGN Intervention study. SETTING The Australian Ballet School. PARTICIPANTS Forty-two ballet dancers, aged 14-18 years. INTERVENTIONS Dancers randomized into 2 groups: group 1 undertook 1 minute of balance board training daily for 3 weeks; group 2 undertook the same training for 6 weeks. MAIN OUTCOME MEASURES Preintervention, Cumberland Ankle Instability Tool questionnaire data were collected, and PAS during the last 2 years was reported. Active ankle inversion movement discrimination ability was tested immediately pre and post intervention and at 3 and 4 weeks. RESULTS Ankle discrimination acuity scores improved over time for both groups, with a performance decline associated with the early cessation of training for group 1 (P = .04). While dancers with PAS had significantly worse scores at the first test, before balance board training began (P < .01), no significant differences in scores at any test occasion were found between dancers with and without chronic ankle instability. A significantly faster rate of improvement in ankle discrimination ability score over the 4 test occasions was found for dancers with PAS (P = .002). CONCLUSIONS Three weeks of textured balance board training improved the ankle discrimination ability of ballet dancers regardless of their reported level of chronic ankle instability and at a faster rate for dancers with PAS. Previous ankle sprain was associated with a lower level of ankle discrimination ability; however, following 3 weeks of balance board training, previously injured dancers had significantly improved their ankle discrimination acuity scores.
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Huynh B, Tacker R, Hung YJ. Active ankle position sense and single-leg balance in runners versus non-runners. Physiother Theory Pract 2019; 37:1429-1437. [PMID: 31793354 DOI: 10.1080/09593985.2019.1698084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Ankle sprain is one of the most common injuries in collegiate athletes, including runners. The purpose of the study was to examine whether runners exhibited compromised ankle stability, ankle position sense, and single-leg balance.Methods: Thirty-seven individuals (21 non-runners and 16 runners) participated in the study. To be included in the runner group, subjects were required to run greater than 150 minutes per week for the past three months. We used the Cumberland Ankle Instability Tool (CAIT) to categorize ankle stability, and we used a dual-axis electronic goniometer to examine active ankle position sense. We examined single-leg balance with the Athletic Single Leg Stability Test of the Biodex Balance System using three different protocols: 1) default setting, 2) no extrinsic visual feedback, and 3) no extrinsic feedback with a cognitive demand.Results: Runners and non-runners had similar ankle stability (CAIT = 26.88 and 26.45 respectively; p = .666). Although runners had significantly larger ankle position errors than non-runners overall (2.56° vs. 1.68°; p = .004), they had better single-leg balance than non-runners without extrinsic visual feedback (Stability Index 1.67 vs. 4.39; p < .001), even with an added cognitive loading (Stability Index 2.18 vs. 4.32; p < .001).Conclusions: For runners, having worse ankle position sense did not compromise ankle stability, nor contribute to single-leg balance deficits. Runners may have established better motor control to maintain their single-leg balance and ankle stability.
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Affiliation(s)
- Brian Huynh
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
| | - Ryan Tacker
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
| | - You-Jou Hung
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
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Rosen AB, Needle AR, Ko J. Ability of Functional Performance Tests to Identify Individuals With Chronic Ankle Instability: A Systematic Review With Meta-Analysis. Clin J Sport Med 2019; 29:509-522. [PMID: 31688183 DOI: 10.1097/jsm.0000000000000535] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this systematic review with meta-analysis was to determine the effectiveness of functional performance tests (FPTs) in differentiating between individuals with chronic ankle instability (CAI) and healthy controls. DATA SOURCES The National Library of Medicine Catalog (PubMed), the Cumulative Index for Nursing and Allied Health Literature (CINAHL), and the SPORTDiscus, from inception to June 2017 were searched. Search terms consisted of: "Functional Performance Test*" OR "Dynamic Balance Test*" OR "Postural Stability Test*" OR "Star Excursion Balance Test*" OR "Hop Test*" AND "Ankle Instability" OR "Ankle Sprain." Included articles assessed differences in FPTs in patients with CAI compared with a control group. MAIN RESULTS Included studies were assessed for methodological quality and level of evidence. Individual and mean effect sizes were also calculated for FPTs from the included articles. Twenty-nine studies met the criteria and were analyzed. The most common FPTs were timed-hop tests, side-hop, multiple-hop test, single-hop for distance, foot-lift test, and the Star Excursion Balance Tests (SEBTs). The side-hop (g = -1.056, P = 0.009, n = 7), timed-hop tests (g = -0.958, P = 0.002, n = 9), multiple-hop test (g = 1.399, P < 0.001, n = 3), and foot-lift tests (g = -0.761, P = 0.020, n = 3) demonstrated the best utility with large mean effect sizes, whereas the SEBT anteromedial (g = 0.326, P = 0.022, n = 7), medial (g = 0.369, P = 0.006, n = 7), and posteromedial (g = 0.374, P < 0.001, n = 13) directions had moderate effects. CONCLUSIONS The side-hop, timed-hopping, multiple-hop, and foot-lift seem the best FPTs to evaluate individuals with CAI. There was a large degree of heterogeneity and inconsistent reporting, potentially limiting the clinical implementation of these FPTs. These tests are cheap, effective, alternatives compared with instrumented measures.
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Affiliation(s)
- Adam B Rosen
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
| | - Alan R Needle
- Department of Health & Exercise Science, Appalachian State University, Boone, North Carolina
| | - Jupil Ko
- Department of Physical Therapy & Athletic Training, Northern Arizona University, Flagstaff, Arizona
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Reliability and Recalibration of the Persian Version of Cumberland Ankle Instability Tool Cut-off Score in Athletes with Functional Ankle Instability. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 3:e26. [PMID: 31410403 PMCID: PMC6683592 DOI: 10.22114/ajem.v0i0.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction The Cumberland Ankle Instability Tool (CAIT) is a valid instrument for determining the presence and severity of functional ankle instability. This questionnaire was recently cross-culturally adapted into Persian; however, the reliability of the Persian version has not been examined in athletes. CAIT has also been used with various independently-selected cut-off scores to determine instability. Objective The present study was conducted to evaluate the psychometric properties of the Persian version of CAIT and to determine its optimal cut-off score in athletic populations. Method One-hundred and sixteen athletes (volleyball, basketball and track and field players) over 18 years old both with and without ankle instability completed the Persian version of the CAIT. The internal consistency, test-retest reliability and discriminative ability of the tool were assessed. A receiver operating characteristic (ROC) curve was drawn to confirm the cut-off point of the Persian version of CAIT using the Youden index. Results The average CAIT score was 25.14±4.98 for the right and 25.76±4.94 for the left ankle. The Persian version of CAIT had a good internal consistency (Cronbach's α of 0.78 for the right ankle and 0.79 for the left ankle) and substantial reliability (ICC2, 1 = 0.88; 95% CI: 0.86 - 0.90) in athletes. No ceiling or floor effects were observed. The optimal cut-off score for discriminating between athletes with and without FAI was 24. Conclusion The Persian version of CAIT was shown to be a reliable tool for assessing functional ankle instability among Iranian athletes.
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A. El Gaya H, R. Zahran M, I. Ali O, A. Abdel R N. Chronic ankle instability, cumberland ankle instability tool, cervical proprioception, cervical reposition error, ankle ligaments, cervical active repositioning
accuracy. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.3923/jms.2019.38.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Influence of Passive Joint Stiffness on Proprioceptive Acuity in Individuals With Functional Instability of the Ankle. J Orthop Sports Phys Ther 2017; 47:899-905. [PMID: 28990440 DOI: 10.2519/jospt.2017.7030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study, cross-sectional. Background Deficits in ankle proprioceptive acuity have been reported in persons with functional instability of the ankle. Passive stiffness has been proposed as a possible mechanism underlying proprioceptive acuity. Objective To compare proprioceptive acuity and passive ankle stiffness in persons with and without functional ankle instability, and to assess the influence of passive joint stiffness on proprioceptive acuity in persons with functional ankle instability. Methods A sample of 18 subjects with and 18 without complaints of functional ankle instability following lateral ankle sprain participated. An isokinetic dynamometer was used to compare motion perception threshold, passive position sense, and passive ankle stiffness between groups. To evaluate the influence of passive stiffness on proprioceptive acuity, individuals in the lateral functional ankle instability group were divided into 2 subgroups: "high" and "low" passive ankle stiffness. Results The functional ankle instability group exhibited increased motion perception threshold when compared with the corresponding limb of the control group. Between-group differences were not found for passive position sense and passive ankle stiffness. Those in the functional ankle instability group with higher passive ankle stiffness had smaller motion perception thresholds than those with lower passive ankle stiffness. Conclusion Unlike motion perception threshold, passive position sense is not affected by the presence of functional ankle instability. Passive ankle stiffness appears to influence proprioceptive acuity in persons with functional ankle instability. J Orthop Sports Phys Ther 2017;47(12):899-905. Epub 7 Oct 2017. doi:10.2519/jospt.2017.7030.
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Sousa ASP, Leite J, Costa B, Santos R. Bilateral Proprioceptive Evaluation in Individuals With Unilateral Chronic Ankle Instability. J Athl Train 2017; 52:360-367. [PMID: 28318316 DOI: 10.4085/1062-6050-52.2.08] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Despite extensive research on chronic ankle instability, the findings regarding proprioception have been conflicting and focused only on the injured limb. Also, the different components of proprioception have been evaluated in isolation. OBJECTIVE To evaluate bilateral ankle proprioception in individuals with unilateral ankle instability. DESIGN Cohort study. SETTING Research laboratory center in a university. PATIENTS OR OTHER PARTICIPANTS Twenty-four individuals with a history of unilateral ankle sprain and chronic ankle instability (mechanical ankle instability group, n = 10; functional ankle instability [FAI] group, n = 14) and 20 controls. MAIN OUTCOME MEASURE(S) Ankle active and passive joint position sense, kinesthesia, and force sense. RESULTS We observed a significant interaction between the effects of limb and group for kinesthesia (F = 3.27, P = .049). Increased error values were observed in the injured limb of the FAI group compared with the control group (P = .031, Cohen d = 0.47). Differences were also evident for force sense (F = 9.31, P < .001): the FAI group demonstrated increased error versus the control group (injured limb: P < .001, Cohen d = 1.28; uninjured limb: P = .009, Cohen d = 0.89) and the mechanical ankle instability group (uninjured limb: P = .023, Cohen d = 0.76). CONCLUSIONS Individuals with unilateral FAI had increased error ipsilaterally (injured limb) for inversion movement detection (kinesthesia) and evertor force sense and increased error contralaterally (uninjured limb) for evertor force sense.
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Affiliation(s)
- Andreia S P Sousa
- Escola Superior de Saúde do Porto, Centro de Estudos de Movimento e Actividade Humana, Instituto Politécnico do Porto, Portugal
| | - João Leite
- Escola Superior de Saúde do Porto, Centro de Estudos de Movimento e Actividade Humana, Instituto Politécnico do Porto, Portugal
| | - Bianca Costa
- Escola Superior de Saúde do Porto, Centro de Estudos de Movimento e Actividade Humana, Instituto Politécnico do Porto, Portugal
| | - Rubim Santos
- Escola Superior de Saúde do Porto, Centro de Estudos de Movimento e Actividade Humana, Instituto Politécnico do Porto, Portugal
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Halim-Kertanegara S, Raymond J, Hiller CE, Kilbreath SL, Refshauge KM. The effect of ankle taping on functional performance in participants with functional ankle instability. Phys Ther Sport 2017; 23:162-167. [DOI: 10.1016/j.ptsp.2016.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 02/24/2016] [Accepted: 03/24/2016] [Indexed: 12/26/2022]
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Hung YJ, Miller J. Extrinsic visual feedback and additional cognitive/physical demands affect single-limb balance control in individuals with ankle instability. World J Orthop 2016; 7:801-807. [PMID: 28032032 PMCID: PMC5155255 DOI: 10.5312/wjo.v7.i12.801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/06/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the impact of extrinsic visual feedback and additional cognitive/physical demands on single-limb balance in individuals with ankle instability.
METHODS Sixteen subjects with ankle instability participated in the study. Ankle instability was identified using the Cumberland Ankle Instability Tool (CAIT). The subject’s unstable ankle was examined using the Athletic Single Leg Stability Test of the Biodex Balance System with 4 different protocols: (1) default setting with extrinsic visual feedback from the monitor; (2) no extrinsic visual feedback; (3) no extrinsic visual feedback with cognitive demands; and (4) no extrinsic visual feedback with physical demands. For the protocol with added cognitive demands, subjects were asked to continue subtracting 7 from a given number while performing the same test without extrinsic visual feedback. For the protocol with added physical demands, subjects were asked to pass and catch a basketball to and from the examiner while performing the same modified test.
RESULTS The subject’s single-limb postural control varied significantly among different testing protocols (F = 103; P = 0.000). Subjects’ postural control was the worst with added physical demands and the best with the default condition with extrinsic visual feedback. Pairwise comparison shows subjects performed significantly worse in all modified protocols (P < 0.01 in all comparisons) compared to the default protocol. Results from all 4 protocols are significantly different from each other (P < 0.01) except for the comparison between the “no extrinsic visual feedback” and “no extrinsic visual feedback with cognitive demands” protocols. Comparing conditions without extrinsic visual feedback, adding a cognitive demand did not significantly compromise single-limb balance control but adding a physical demand did. Scores from the default protocol are significantly correlated with the results from all 3 modified protocols: No extrinsic visual feedback (r = 0.782; P = 0.000); no extrinsic visual feedback with cognitive demands (r = 0.569; P = 0.022); no extrinsic visual feedback with physical demands (r = 0.683; P = 0.004). However, the CAIT score is not significantly correlated with the single-limb balance control from any of the 4 protocols: Default with extrinsic visual feedback (r = -0.210; P = 0.434); no extrinsic visual feedback (r = -0.450; P = 0.081); no extrinsic visual feedback with cognitive demands (r = -0.406; P = 0.118); no extrinsic visual feedback with physical demands (r = -0.351; P = 0.182).
CONCLUSION Single-limb balance control is worse without extrinsic visual feedback and/or with cognitive/physical demands. The balance test may not be a valid tool to examine ankle instability.
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Ali OI, Alasar SA. Assessment of lumbar proprioception in participants with functional ankle instability: a cross-sectional study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2016. [DOI: 10.4103/1110-6611.196780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Kunugi S, Masunari A, Noh B, Mori T, Yoshida N, Miyakawa S. Cross-cultural adaptation, reliability, and validity of the Japanese version of the Cumberland ankle instability tool. Disabil Rehabil 2016; 39:50-58. [DOI: 10.3109/09638288.2016.1138555] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Shun Kunugi
- Department of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Akihiko Masunari
- Department of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Byungjoo Noh
- Department of Kinesiology and Integrative Physiology, Michigan Technology University, Michigan, USA
| | - Toshio Mori
- Department of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Naruto Yoshida
- Faculty of Health Care, Teikyo Heisei University, Tokyo, Japan
| | - Shumpei Miyakawa
- Department of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
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Hung YJ. Neuromuscular control and rehabilitation of the unstable ankle. World J Orthop 2015; 6:434-438. [PMID: 26085985 PMCID: PMC4458494 DOI: 10.5312/wjo.v6.i5.434] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/21/2015] [Accepted: 05/11/2015] [Indexed: 02/06/2023] Open
Abstract
Lateral ankle sprain is a common orthopedic injury with a very high recurrence rate in athletes. After decades of research, it is still unclear what contributes to the high recurrence rate of ankle sprain, and what is the most effective intervention to reduce the incident of initial and recurrent injuries. In addition, clinicians often implement balance training as part of the rehabilitation protocol in hopes of enhancing the neuromuscular control and proprioception of the ankle joint. However, there is no consensus on whether the neuromuscular control and proprioception are compromised in unstable ankles. To reduce the prevalence of ankle sprains, the effectiveness of engaging balance training to enhance the neuromuscular control and proprioception of the ankle joint is also questionable.
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Marrón-Gómez D, Rodríguez-Fernández ÁL, Martín-Urrialde JA. The effect of two mobilization techniques on dorsiflexion in people with chronic ankle instability. Phys Ther Sport 2015; 16:10-5. [DOI: 10.1016/j.ptsp.2014.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 01/27/2014] [Accepted: 02/04/2014] [Indexed: 12/26/2022]
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Rodríguez-Fernández ÁL, Rebollo-Roldán J, Jiménez-Rejano JJ, Güeita-Rodríguez J. Psychometric properties of the Spanish version of the Cumberland Ankle Instability Tool. Disabil Rehabil 2014; 37:1888-94. [DOI: 10.3109/09638288.2014.984879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
UNLABELLED Many studies investigated the contributing factors of chronic ankle instability, but a consensus has not yet been obtained. The objective of this critical review is to provide recent scientific evidence on chronic ankle instability, including the epidemiology and pathology of lateral ankle sprain as well as the causative factors of chronic ankle instability. We searched MEDLINE from 1964 to December 2013 using the terms ankle, sprain, ligament, injury, chronic, functional, mechanical, and instability. Lateral ankle sprain shows a very high recurrence rate and causes considerable economic loss due to medical care, prevention, and secondary disability. During the acute phase, patients with ankle sprain demonstrate symptoms such as pain, range of motion deficit, postural control deficit, and muscle weakness, and these symptoms may persist, leading to chronic ankle instability. Although some agreement regarding the effects of chronic ankle instability with deficits in postural control and/or concentric eversion strength exists, the cause of chronic ankle instability remains controversial. LEVELS OF EVIDENCE Therapeutic Level IV: Review of Level IV studies.
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Affiliation(s)
- Takumi Kobayashi
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
| | - Kazuyoshi Gamada
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
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Wright CJ, Arnold BL, Ross SE, Linens SW. Recalibration and validation of the Cumberland Ankle Instability Tool cutoff score for individuals with chronic ankle instability. Arch Phys Med Rehabil 2014; 95:1853-9. [PMID: 24814563 DOI: 10.1016/j.apmr.2014.04.017] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To independently recalibrate and revalidate the Cumberland Ankle Instability Tool (CAIT) cutoff score for discriminating individuals with and without chronic ankle instability (CAI). There are concerns the original cutoff score (≤27) may be suboptimal for use in the CAI population. DESIGN Case control. SETTING Research laboratory. PARTICIPANTS Two independent datasets were used (total N=200). Dataset 1 included 61 individuals with a history of ≥1 ankle sprain and ≥2 episodes of giving way in the last year (CAI group) and 57 participants with no history of ankle sprain or instability in their lifetime (uninjured group). Dataset 2 included 27 uninjured participants, 29 participants with CAI, and 26 individuals with a history of a single ankle sprain and no subsequent instability (copers). INTERVENTIONS All participants completed the CAIT during a single session. In dataset 1, a receiver operating characteristic (ROC) curve was calculated using the CAIT score and group membership as test variables. The ideal cutoff score was identified using the Youden index. The recalibrated cutoff score was validated in dataset 2 using the ROC analysis and clinimetric characteristics. MAIN OUTCOME MEASURES CAIT cutoff score and clinimetrics. RESULTS In dataset 1, the optimal cutoff score was ≤25, which is lower than previously reported. In dataset 2, the recalibrated cutoff score demonstrated a sensitivity of 96.6%, specificity of 86.8%, positive likelihood ratio of 7.318, and negative likelihood ratio of .039. There were 7 false positives and 1 false negative. CONCLUSIONS The recalibrated CAIT score demonstrated very good clinimetric properties; all properties improved compared with the original cutoff score. Clinicians using the CAIT should use the recalibrated cutoff score to maximize test characteristics. Caution should be taken with copers, who had a high rate of false positives.
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Affiliation(s)
- Cynthia J Wright
- Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA.
| | - Brent L Arnold
- Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA
| | - Scott E Ross
- Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA
| | - Shelley W Linens
- Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA
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Tanen L, Docherty CL, Van Der Pol B, Simon J, Schrader J. Prevalence of chronic ankle instability in high school and division I athletes. Foot Ankle Spec 2014; 7:37-44. [PMID: 24287210 DOI: 10.1177/1938640013509670] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of chronic ankle instability among high school and collegiate athletes. DESIGN Descriptive epidemiological survey. METHODS Athletes from four high schools and a division I university were contacted to participate. For collegiate athletes, a questionnaire packet was distributed during preparticipation physicals. For high school athletes, parental consent was obtained and then questionnaires were distributed during preparticipation physicals, parent meetings, or individual team meetings. All athletes completed the Cumberland Ankle Instability Tool for both their left and right ankles. Subjects also provided general demographic data and completed the Ankle Instability Instrument regarding history of lateral ankle sprains and giving way. Athletes were identified as having chronic ankle instability if they scored less than 24 on the Cumberland Ankle Instability Tool. RESULTS Of the 512 athletes who completed and returned surveys, 23.4% were identified as having chronic ankle instability. High school athletes were more likely to have chronic ankle instability than their collegiate counterparts (P < .001). Chronic ankle instability was more prevalent among women than among men in both high school (P = .01) and collegiate settings (P = .01). CONCLUSIONS Findings of this study revealed differences in the distribution of chronic ankle instability that warrant further study.
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Affiliation(s)
- Leah Tanen
- Department of Kinesiology (LT, CLD, J Simon, J Schrader) and Department of Epidemiology and Biostatistics (BVDP), Indiana University, Bloomington, Indiana
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The role of arthroscopy in the treatment of functional instability of the ankle. Foot Ankle Surg 2013; 19:273-5. [PMID: 24095237 DOI: 10.1016/j.fas.2013.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/23/2013] [Accepted: 06/25/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle sprains are common, the majority resolving with functional rehabilitation. Some patients are left with symptoms of functional instability (FI). Ankle arthroscopy in those with symptoms of FI is not well covered in the literature. Our aim was to assess its role in FI of the ankle. METHODS Retrospective case note analysis of patients with FI following an ankle sprain from 2005 to 2007. All underwent arthroscopy, provided mechanical instability was excluded (EUA and stress X-rays), and there were no signs of soft tissue impingement. These patients had exhausted all options of conservative therapy. RESULTS Seventy-seven patients with a mean age of 38.1: five had true mechanical instability and were excluded. 72 underwent arthroscopy: 67 (93.1%) had significant amounts of scar tissue needing debridement, most commonly in the antero-lateral corner (58.3%). 52 patients improved (72.2%) at a minimum of 6 months follow-up. CONCLUSION Our study supports the role of ankle arthroscopy in the treatment of FI following trauma. It should be considered when conservative measures have failed.
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Witchalls JB, Waddington G, Adams R, Blanch P. Chronic ankle instability affects learning rate during repeated proprioception testing. Phys Ther Sport 2013; 15:106-11. [PMID: 23954386 DOI: 10.1016/j.ptsp.2013.04.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 03/12/2013] [Accepted: 04/30/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVES 1. To determine whether individuals with chronic ankle instability (CAI) have lower proprioception sensitivity scores from a test on the Active Movement Extent Discrimination Apparatus (AMEDA). 2. To determine whether individuals with CAI can improve proprioception sensitivity scores with repeated active movement testing using the AMEDA. 3. To assess the test-retest reliability of the AMEDA. DESIGN A cohort study comparing those with CAI or healthy ankles. SETTING University clinical laboratory. PARTICIPANTS 61 healthy university students, 36 with CAI, 25 with stable ankles. MAIN OUTCOME MEASURES A 2-way ANOVA was conducted to compare performance of CAI and stable ankle groups, over 3 test repetitions on the AMEDA. The reliability intra-class correlation coefficient (ICC) was obtained for test repetitions. RESULTS The scores improved in both groups when the AMEDA test was repeated (p = <0.001). The rates of improvement in proprioception test scores differed, with the CAI group showing a slower learning rate than the stable ankle group (p = 0.047). The ICC for the whole group across the three trials was 0.80 (95% CI = 0.69 to 0.87, p = <0.001). CONCLUSIONS CAI participants improve their proprioception scores more slowly upon repeated AMEDA testing, suggesting differences in learning strategies.
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Affiliation(s)
- Jeremy B Witchalls
- Faculty of Health, University of Canberra, University Drive, Bruce, ACT 2609, Australia; Dept of Physical Therapies, Australian Institute of Sport, Leverier Crescent, Bruce, ACT 2617, Australia.
| | - Gordon Waddington
- Faculty of Health, University of Canberra, University Drive, Bruce, ACT 2609, Australia
| | - Roger Adams
- Faculty of Health, Sydney University, Sydney, Australia
| | - Peter Blanch
- Dept of Physical Therapies, Australian Institute of Sport, Leverier Crescent, Bruce, ACT 2617, Australia
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Witchalls J, Waddington G, Blanch P, Adams R. Ankle instability effects on joint position sense when stepping across the active movement extent discrimination apparatus. J Athl Train 2013. [PMID: 23182010 DOI: 10.4085/1062-6050-47.6.12] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Individuals with and without functional ankle instability have been tested for deficits in lower limb proprioception with varied results. OBJECTIVE To determine whether a new protocol for testing participants' joint position sense during stepping is reliable and can detect differences between participants with unstable and stable ankles. DESIGN Descriptive laboratory study. SETTING University clinical laboratory. PATIENTS OR OTHER PARTICIPANTS Sample of convenience involving 21 young adult university students and staff. Ankle stability was categorized by score on the Cumberland Ankle Instability Tool; 13 had functional ankle instability, 8 had healthy ankles. INTERVENTION(S) Test-retest of ankle joint position sense when stepping onto and across the Active Movement Extent Discrimination Apparatus twice, separated by an interim test, standing still on the apparatus and moving only 1 ankle into inversion. MAIN OUTCOME MEASURE(S) Difference in scores between groups with stable and unstable ankles and between test repeats. RESULTS Participants with unstable ankles were worse at differentiating between inversion angles underfoot in both testing protocols. On repeated testing with the stepping protocol, performance of the group with unstable ankles was improved (Cohen d = 1.06, P = .006), whereas scores in the stable ankle group did not change in the second test (Cohen d = 0.04, P = .899). Despite this improvement, the unstable group remained worse at differentiating inversion angles on the stepping retest (Cohen d = 0.99, P = .020). CONCLUSIONS The deficits on proprioceptive tests shown by individuals with functional ankle instability improved with repeated exposure to the test situation. The learning effect may be the result of systematic exposure to ankle-angle variation that led to movement-specific learning or increased confidence when stepping across the apparatus.
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Affiliation(s)
- Jeremy Witchalls
- Australian Institute of Sport, Leverier Street, Bruce, Australia Capital Territory 2617, Australia.
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Pavão SL, Sousa NVDC, Oliveira CM, Castro PCG, Santos MCMD. O ambiente virtual como interface na reabilitação pós-AVE: relato de caso. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000200022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: O acidente vascular encefálico (AVE) é um quadro neurológico agudo de repercussões amplas, que exige de suas vítimas programas de reabilitação desafiadores na promoção da função. Nesse contexto, a Realidade Virtual (RV) é uma ferramenta de interface na reabilitação que pode gerar altos índices de motivação do paciente e permitir adaptação da terapia ao seu nível de função. OBJETIVO: Verificar o efeito da RV por meio de videogame sobre o controle postural de um indivíduo pós-AVE. MATERIAIS E MÉTODOS: Um indivíduo pós-AVE com um ano de lesão foi submetido a um protocolo de reabilitação física com videogame numa frequência de três vezes por semana por um período de 12 semanas. Anteriormente e após o programa foi realizada dinamometria por plataforma de força para análise de variáveis relacionadas ao centro de pressão (COP). RESULTADOS: Na reavaliação, observou-se que a amplitude de deslocamento médio-lateral (x) aumentou 67% na condição de olhos abertos (OA) e fechados (OF); amplitude anteroposterior (y) aumentou 25 e 44% em OA e OF, respectivamente; área aumentou 109 e 141% em OA e OF; velocidade diminuiu 26 e 0,27% em OA e OF. CONCLUSÃO: A RV como interface na reabilitação possivelmente ampliou a exploração da base de suporte para manutenção da estabilidade, constituindo recurso adicional no tratamento desses indivíduos.
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Aguilera Eguía R, Espinoza Salinas A, Zafra Santos E, Aguilera Eguía T. Proprioceptive exercises for ankle ligament injury: a CAT. Medwave 2013. [DOI: 10.5867/medwave.2013.05.5683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cruz-Díaz D, Hita-Contreras F, Lomas-Vega R, Osuna-Pérez MC, Martínez-Amat A. Cross-cultural adaptation and validation of the Spanish version of the Cumberland Ankle Instability Tool (CAIT): an instrument to assess unilateral chronic ankle instability. Clin Rheumatol 2012; 32:91-8. [PMID: 23053687 DOI: 10.1007/s10067-012-2095-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/07/2012] [Accepted: 09/15/2012] [Indexed: 12/26/2022]
Abstract
The Cumberland Ankle Instability Tool (CAIT) is a valid instrument to determine the presence of chronic ankle instability (CAI) and to assess its severity. Self-report test is very useful for researchers and clinical practice, and CAI is a widespread tool. Nevertheless, there is lack of measurement instruments validated into Spanish, which represents a major difficulty for research dealing with a Spanish-speaking population. The questionnaire was cross-culturally adapted into Spanish. The psychometric properties tested in the Spanish version of the CAIT were measured for internal consistency, test-retest reliability, construct validity, criterion validity, and responsiveness in 108 participants who were recruited from several fitness centers. The Spanish version of the CAIT had high internal consistency (Cronbach's α = 0.766) and reliability (intraclass correlation coefficient = 0.979, 95 % confidence interval (CI) = 0.958-0.990). Correlation with the 36-item Short-Form Health Survey (SF-36) physical component summary score (rho = 0.241, p = 0.012) was greater than the SF-36 mental component summary score (rho = -0.162, p = 0.094). The construct validity shows three different factors in the questionnaire and good responsiveness with a mean change of -2.43 (95 % CI = -3.12 to 1.73, p < 0.0001) and a size effect of Cohen's d = 1.07. The Spanish version of the CAIT has been shown to be a valid and reliable instrument for measuring chronic ankle instability and constitutes a useful instrument for the measurement of CAI in the clinical setting in Spain.
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Affiliation(s)
- David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071, Jaén, Spain
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Cronkey J, LaPorta G. Rating systems for evaluation of functional ankle instability: prospective evaluation in a cohort of patients treated with monopolar capacitive-coupled radiofrequency. Foot Ankle Spec 2012; 5:293-9. [PMID: 23008239 DOI: 10.1177/1938640012457941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Evaluation of patient outcomes should include the use of validated scoring systems to determine disease-specific outcomes. Many scoring systems are being used for disorders of the ankle joint. However, not all instruments are capable of detecting changes associated with functional ankle instability (FAI), since their focus is toward pathological entities with greater impact on individual's physical and mental well-being. METHODS In this prospective study, 6 instruments were used to evaluate outcomes associated with an intervention aimed at improving FAI. Twenty ankles that had been unsuccessfully treated for FAI were treated with a single session of noninvasive monopolar capacitive-coupled radiofrequency (mcRF) and followed prospectively. RESULTS Five out of 6 instruments failed to show changes that could be correlated with patients' outcomes. Only one instrument, the Cumberland Ankle Instability Tool (CAIT) demonstrated enough sensitivity and correlated well with meaningful clinical differences. Based on study's success criteria (proper function, no pain, no adverse events, and patient satisfaction), 78% of the ankles treated had successful outcomes whereas 87.5% evidenced significant improvement based on CAIT (P < .001). No adverse events were present during the study. CONCLUSIONS The study of FAI is hampered by the lack of disease-specific questionnaires, which oftentimes introduce ceiling or flooring effects. The CAIT was capable of detecting changes in patients' condition and response to the noninvasive mcRF procedure without evidencing ceiling or flooring effects. In this study, the CAIT was found to be reliable, valid, sensitive to changes of clinical importance, in addition to being short and practical to use.
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Postle K, Pak D, Smith TO. Effectiveness of proprioceptive exercises for ankle ligament injury in adults: a systematic literature and meta-analysis. ACTA ACUST UNITED AC 2012; 17:285-91. [PMID: 22459604 DOI: 10.1016/j.math.2012.02.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/04/2012] [Accepted: 02/22/2012] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to assess the effectiveness of such proprioceptive exercise following ankle ligament injury. A systematic review of the databases MEDLINE, EMBASE, CINHAL, AMED, the Cochrane library database and the PEDro database, in addition to unpublished literature databases was conducted to July 2011. When appropriate, meta-analysis was conducted to pool results from homogeneous studies. The methodological quality of the literature was reviewed using the Critical Appraisal Skills Programme tool. The results indicated that there is no statistically significant difference in recurrent injury between the addition of proprioceptive exercises during the rehabilitation of patients following ankle ligament injury (p = 0.68). The addition of proprioceptive training demonstrated a significant reduction in subjective instability and functional outcomes (p < 0.05). There was no consensus on the advantages of including proprioceptive training in the rehabilitation of this population for swelling, postural sway, joint position sense, ankle range of motion or return to sport outcomes. Further study is warranted to develop the rigour of the evidence-base and to determine the optimal proprioceptive training programme following ankle ligament injury with different populations.
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Affiliation(s)
- K Postle
- School of Allied Health Professions, Faculty of Medicine and Health Science, University of East Anglia, Queen's Building, Norwich NR4 7TJ, UK.
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Lee HH, Lin CW, Wu HW, Wu TC, Lin CF. Changes in biomechanics and muscle activation in injured ballet dancers during a jump-land task with turnout (Sissonne Fermée). J Sports Sci 2012; 30:689-97. [PMID: 22352458 DOI: 10.1080/02640414.2012.663097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Large impact loading with abnormal muscle activity and motion patterns may contribute to lower extremity injuries in ballet dancers. Yet, few studies investigated the influence of injury on the ballet movement. The purpose of this study was to find the neuromuscular and biomechanical characteristics in dancers with and without ankle injury during a jump-landing Sissonne Fermée task. Twenty-two ballet dancers were recruited and divided into the injured group (n = 11) and the uninjured group (n = 11). They performed a ballet movement called "Sissonne Fermée" with reflective markers and electrodes attached to their lower extremities. Ground reaction force, joint kinematics, and muscle activity were measured. The injured dancers had greater peak ankle eversion but smaller hindfoot-to-tibial eversion angles. Also, the injured dancers had greater activity of the hamstring of the dominant leg and tibialis anterior of the non-dominant leg during the pre-landing phase. The injured dancers had greater tibialis anterior activity of the dominant leg but less muscle activity in the medial gastrocnemius of the non-dominant leg during the post-landing phase. The injured dancers had a greater co-contraction index in the non-dominant ankle and a lower loading rate. The higher co-contraction indices showed that the injured dancers required more muscle effort to control ankle stability. Furthermore, the injured dancers used a "load avoidance strategy" to protect themselves from re-injury. Neuromuscular control training of the ankle joint for ballet dancers to prevent injury is necessary.
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Affiliation(s)
- Hsing-Hsan Lee
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
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Delahunt E, Coughlan GF, Caulfield B, Nightingale EJ, Lin CWC, Hiller CE. Inclusion criteria when investigating insufficiencies in chronic ankle instability. Med Sci Sports Exerc 2011; 42:2106-21. [PMID: 20351590 DOI: 10.1249/mss.0b013e3181de7a8a] [Citation(s) in RCA: 297] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The development of chronic ankle instability (CAI) is the primary residual deficit after ankle joint sprain. It has been proposed that CAI is characterized by two entities, namely, mechanical instability and functional instability. Each of these entities in turn is composed of various insufficiencies. Research of functional insufficiencies to date has shown large variances in results. One particular reason for this could be discrepancies in inclusion criteria and definitions between CAI, mechanical instability, and functional instability used in the literature. Thus, we endeavored to undertake a systematic investigation of those studies published in the area of CAI to identify if there is a large discrepancy in inclusion criteria across studies. METHODS A systematic search of the following databases was undertaken to identify relevant studies: Cochrane Central Register of Controlled Trials, PubMed, CINAHL, SportDiscus, PEDro, and AMED. RESULTS The results of this study indicate that there is a lack of consensus across studies regarding what actually constitutes ankle instability. Furthermore, it is evident that the majority of studies use very different inclusion criteria, which leads to a nonhomogenous population and to difficulties when comparing results across studies. CONCLUSIONS Future studies should endeavor to be specific with regard to the exact inclusion criteria being used. Particular emphasis should be given to issues such as the number of previous ankle sprains reported by each subject and how often and during which activities episodes of "giving way" occur as well as the presence of concomitant symptoms such as pain and weakness. We recommend that authors use one of the validated tools for discriminating the severity of CAI. Furthermore, we have provided a list of operational definitions and key criteria to be specified when reporting on studies with CAI subjects.
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Affiliation(s)
- Eamonn Delahunt
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
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WIKSTROM ERIKA, BISHOP MARKD, INAMDAR AMRUTAD, HASS CHRISJ. Gait Termination Control Strategies Are Altered in Chronic Ankle Instability Subjects. Med Sci Sports Exerc 2010; 42:197-205. [DOI: 10.1249/mss.0b013e3181ad1e2f] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Lim ECW, Tan MH. Side-to-side difference in joint position sense and kinesthesia in unilateral functional ankle instability. Foot Ankle Int 2009; 30:1011-7. [PMID: 19796597 DOI: 10.3113/fai.2009.1011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Impairment in proprioception has been suggested to be one of the causes of FAI. This study aimed to establish intra-session reliability of the Biodex System 2 in assessing joint position sense (JPS) and kinesthesia (K)~in addition to determining if there was any side to side difference in JPS and kinesthesia in people with unilateral functional ankle instability. MATERIALS AND METHODS Both JPS and K were determined by means of the Biodex Systems 2. During evaluation of JPS, participants' ability to actively reproduce ankle joint position was tested three times in each of the two predetermined positions. During evaluation of K, data collection began with the foot placed in a starting position of 0 degrees (neutral position). RESULTS A total of 25 participants (mean age 22.0 years, 95% confidence interval 19.9 to 24.1 years) were recruited into this study. No difference in JPS (p = 0.162 to 0.764) and K (p = 0.089 to 0.683) were found between the sprained and uninvolved ankle of subjects with unilateral functional ankle instability. There is moderate to good intra-session reliability in using the Biodex System 2 to assess JPS (ICC = 0.868 to 0.950, p < 0.01) and K (ICC = 0.825 to 0.893, p < 0.01). CONCLUSION This study suggests that there is perhaps no difference in JPS and K between both ankles in people with unilateral FAI. Proprioceptive deficits may not always be present in every case of FAI. CLINICAL RELEVANCE Proprioceptive training may not be beneficial in some patients with unilateral FAI.
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Affiliation(s)
- Edwin Choon Wyn Lim
- Singapore General Hospital, Physiotherapy, Blk 1 Level 1, Outram Road, Singapore 169608, Singapore.
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Munn J, Sullivan SJ, Schneiders AG. Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis. J Sci Med Sport 2009; 13:2-12. [PMID: 19442581 DOI: 10.1016/j.jsams.2009.03.004] [Citation(s) in RCA: 282] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 03/04/2009] [Accepted: 03/09/2009] [Indexed: 12/14/2022]
Abstract
Functional ankle instability (FAI) has been associated with impaired sensorimotor function; however individual studies have produced conflicting results. In an attempt to reduce this ambiguity, a systematic review with meta-analysis was undertaken to determine which sensorimotor deficits exist with FAI. Fifty-three studies assessing sensorimotor factors in subjects with FAI were included from 465 identified articles. Studies were rated for methodological quality and data were pooled for peroneal reaction time, joint position sense, and postural sway during single-leg stance and time to stabilisation from a single-leg jump. Data on joint movement sense were unable to be pooled. When subjects with unstable ankles were compared to healthy controls, sensorimotor impairments were demonstrated for passive joint position sense (mean difference (MD)=0.7 degrees , 95% confidence interval (CI): 0.2-1.2 degrees , p=0.004), active joint position sense (MD=0.6 degrees , 95% CI: 0.2-1.0 degrees , p=0.002), postural sway in single-leg stance (standardised MD (SMD)=0.6, 95% CI: 0.2-1.0, p=0.002), the star excursion balance test (SMD=0.4, 95% CI: 0.1-0.7, p=0.009), and time to stabilisation from a single-leg jump in a medio-lateral (MD=0.6 ms, 95% CI: 0.4-0.8, p<0.0001) and an antero-posterior direction (MD=0.7 ms, 95% CI: 0.4-1.0, p<0.0001). Peroneal reaction time was not affected. Sensorimotor deficits occur for joint position sense and postural control in subjects with FAI. Deficits in peroneal muscle reaction time following perturbation are not evident.
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Abstract
The presence of sensorimotor deficits in patients who have suffered ankle sprains or who have chronic ankle instability has been recognized for several decades; however, a body of research literature has developed that elucidates potential physiologic explanations for these deficits. Alterations in a spectrum of sensorimotor measures make it apparent that conscious perception of afferent somatosensory information, reflex responses, and efferent motor control deficits are present with ankle instability. The specific origin of these deficits local to the ankle ligaments or at the spinal or supraspinal levels of motor control have yet to be fully elucidated. It is clear, however, that both feedback and feedforward mechanisms of motor control are altered with ankle instability.
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