Friday, May 9, 2025
5/9/2025
Understanding the Neurophysiology of Ankle Instability to Improve Rehabilitation Outcomes - Understanding the Neurophysiology of Ankle Instability to Improve Rehabilitation Outcomes Abstract Chronic ankle instability is a common debilitating orthopedic condition that disrupts physical function and decreases quality of life. Chronic ankle instability is heterogenous and can manifest as mechanical ligamentous laxity, perceived disability often referred to as functional instability, or a combination of the two. However, clinicians and researchers most often combine all chronic ankle instability patients without considering these subgroups, which may account for the poor recovery and recurrent nature of this pathology. Neurocognitive and neurophysiologic discrepancies may explain the different subgroups observed in this population, however, technological limitations have previously limited this assessment. The objective of our research is to determine functional and neurophysiological differences between subgroups of chronic ankle instability to allow for development of evidence-based rehabilitation which may improve patient outcomes. To accomplish this, the aims of this study are to determine 1) the differences among CAI subgroups on performance of a traditional side-hop test and neurocognitive hop test, 2) differences in neurophysiological response and motor control between chronic ankle instability subgroups during a lower limb and an ankle specific task, and 3) the underlying neurophysiological effects of a 4-week neurocognitively enhanced balance training protocol among CAI subgroups. We hypothesize functional performance will be similar between subgroups during a traditional side-hop test, but those with functional instability without mechanical laxity will perform worse during a choice-reaction hop test compared to those with mechanical ankle instability. We also hypothesize individuals with functional ankle instability will demonstrate greater cortical activation during the research tasks, and after a 4-week balance training protocol compared to individuals with mechanical ankle instability. To assess our aims, individuals with chronic ankle instability who present with functional ankle instability as well as with mechanical ankle instability will perform a series of hop tests, single limb balance test, a force control test, a neurocognitive assessment, and 4-weeks of neurocognitive balance training. Time to complete each of the hop tests, cortical activation during the balance and force control tasks, and neurocognitive performance will be assessed to determine differences in performance and neurological function among subgroups of chronic ankle instability. Therefore, the long-term objective of this research is to determine the underlying neurologic, neurophysiologic, and motor control mechanisms underpinning chronic ankle instability to improve evidence-based decision making across patients with chronic ankle instability.
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