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Effect of a Balance Adjustment System on Postural Control in Patients with Chronic Ankle Instability

Authors:
Kazushi Yoshida at Chukyo University
Kazushi Yoshida
Rieko Kuramochi
Rieko Kuramochi
Rieko Kuramochi
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Junji Shinohara at Chukyo University
Junji Shinohara
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Abstract and Figures

Background/Purpose This study aimed to evaluate how a two-week program using the in-phase mode of a balance adjustment system (the BASYS) affected postural control in participants with chronic ankle instability (CAI). It was hypothesized that the in-phase mode on the BASYS would lead to improved postural control compared with training on a balance disc. Study Design Randomized control trial. Methods Twenty participants with CAI were recruited. The participants were divided into two intervention groups: the BASYS (n = 10) and Balance Disc (BD; cushion type, n = 10). All participants underwent six supervised training sessions over a two-week period. Static postural control during single leg standing with closed eyes was assessed for the CAI limb. We collected COP data while participants balanced on the BASYS. The test was performed for 30 sec, and the total trajectory length and 95% ellipse area were calculated. In the assessment of dynamic postural stability, Y-Balance tests-anterior, posteromedial, and posterolateral directions were measured on the CAI limb for all participants and normalized to the individual’s leg length. Participants were recorded at three instances: pretraining (Pre), post-training 1 (Post1: after the first training), and post-training 2 (Post2: after the last training). Results There was an effect on time in the COP total trajectory length of the BASYS group, which was significantly decreased for Post 1 and Post 2 than for the Pre (p = 0.001, 0.0001). Group differences and time-by-group interactions were not observed for either of the Y-balance test reach distances. Conclusions The study’s primary finding was that two weeks of intervention in the in-phase mode on the BASYS improved static postural control in participants with CAI. Level of Evidence Level Ⅰ, randomized control trial
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Kazushi Yoshida1a, Rieko Kuramochi1,2, Junji Shinohara1,2
1 Graduate School of Health and Sports Sciences, Chukyo University, 2 School of Health and Sports Sciences, Chukyo University
Keywords: Balance adjustment system, Chronic ankle instability, Postural control, Randomized control trial
https://doi.org/10.26603/001c.74722
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Corresponding author:
Kazushi Yoshida,
Graduate School of Health and Sports Sciences, Chukyo University
Tokodachi 101, Kaizucho, Toyota, Aichi, 470-0393, Japan
TEL: +81 90-2011-4636, E-mail: k-yoshida@sass.chukyo-u.ac.jp
a
Yoshida K, Kuramochi R, Shinohara J. E>ect of a Balance Adjustment System on
Postural Control in Patients with Chronic Ankle Instability. IJSPT. 2023;V18(3):636-644.
doi:10.26603/001c.74722
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Variable BASYS Balance Disc p-value
n 10 10 -
Gender 4M 6F 5M 5F -
Age (year) 21.0±0.9 20.7±1.2 0.55
Height (cm) 164.9±8.2 165.6±5.9 0.85
Body Mass (kg) 61.1±5.5 63.5±5.4 0.36
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International
Journal
of
Sports
Physical
Therapy
&  --# *),-.+& )(-+)& /+#&, )+ -"  ( &( #, !+).*,
COP
BASYS (n=10)
mean±SD
Balance Disc (n=10)
mean±SD p-value
Pre Post1 Post2 Pre Post1 Post2 Time Group×Time
95% ellipse area (cm2) 42.0±23.6 30.1±9.8 25.4±8.2 35.1±16.2 33.2±20.1 32.9±15.8 0.031 0.126
Total trajectory (cm) 277.1±76.9 216.3±60.8 213.9±42.7 259.8±45.4 233.5±56.1 241.4±61.5 0.001 0.035
&' 46?E6C @C AC6DDFC6 ).) 32=2?46 25;FDE>6?E DJDE6> '@DE 27E6C E96 VCDE EC2:?:?8 '@DE 27E6C E96 =2DE EC2:?:?8 ) DE2?52C5 56G:2E:@?
&   - ,#2, &.&- +)' -" *+*),- *+*),- ( *),-*),- )+ " ,--# *),-.+& )(-+)& /+#& ( -"#+ ％ )(4( #(-+/&,
COP
Effect size
[95%CI]
BASYS (n=10) Balance Disc (n=10)
Pre-Post1 Pre-Post2 Post1-Post2 Pre-Post1 Pre-Post2 Post1-Post2
95% ellipse area 0.66
[-0.27,1.53]
0.94
[-0.02,1.82]
0.52
[-0.39,1.39]
0.11
[-0.78,0.98]
0.66
[-0.27,1.55]
0.66
[-0.27,1.56]
Total trajectory 0.88
[-0.08,1.75]
1.02
[0.05,1.90]
0.05
[-0.83,0.92]
0.52
[-0.40,1.38]
0.34
[-0.56,1.21]
-0.13
[-1.01,0.75]
&' 46?E6C @7 AC6DDFC6 ).) 32=2?46 25;FDE>6?E DJDE6> '@DE 27E6C E96 VCDE EC2:?:?8 '@DE 27E6C E96 =2DE EC2:?:?8
&  1('# *),-.+& )(-+)& /+#&, )+ -"  ( &( #, !+).*,
Y-Balance Test
BASYS (n=10)
mean±SD
Balance Disc (n=10)
mean±SD p-value
Pre Post1 Post2 Pre Post1 Post2 Time Group×Time
Anterior reach (cm) 65.9±6.1 64.6±5.9 64.6±5.2 61.4±7.7 61.3±8.3 62.2±8.6 0.667 0.446
PM reach (cm) 277.1±76.9 216.3±60.8 213.9±42.7 259.8±45.4 233.5±56.1 241.4±61.5 0.021 0.131
PL reach (cm) 103.8±8.2 104.9±7.9 107.6±6.6 99.6±11.3 103.7±10.0 105.3±9.0 0.003 0.367
).) 32=2?46 25;FDE>6?E DJDE6> '@DE 27E6C E96 VCDE EC2:?:?8 '@DE 27E6C E96 =2DE EC2:?:?8 '$ A@DE6C@>65:2= '# A@DE6C@=2E6C2= ) DE2?52C5 56G:2E:@?
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International
Journal
of
Sports
Physical
Therapy
&   - ,#2, &.&- +)' -" *+*),- *+*),- ( *),-*),- )+ " 1('# *),-.+& )(-+)&
/+#& ( -"#+ ％ )(4( #(-+/&,
Y-Balance Test
Effect size
[95%CI]
BASYS (n=10) Balance Disc (n=10)
Pre-Post1 Pre-Post2 Post1-Post2 Pre-Post1 Pre-Post2 Post1-Post2
Anterior reach 0.21
[-1.01,0.74]
0.22
[-0.67,1.09]
-0.01
[-0.88,0.87]
0.01
[-0.87,0.88]
-0.11
[-0.98,0.77]
-0.11
[-0.98,0.77]
PM reach 0.03
[-0.85,0.91
-0.25
[-1.12,0.64]
-0.24
[-1.11,0.65]
-0.47
[-1.33,0.44]
-0.55
[-1.42,0.36]
-0.06
[-0.93,0.82]
PL reach -0.14
[-1.01,0.74]
-0.52
[-1.38,0.40]
0.37
[-1.24,0.53]
-0.39
[-1.25,0.52]
-0.57
[-1.44,0.35]
-0.18
[-1.05,0.71]
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This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License
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... Dynamic and unstable balance training have been reported to be an effective modality for improve the symptoms of ankle instability and promote proprioceptive recovery in clinical practice (Yoshida, Kuramochi et al. 2023). A review concluded that balance training effectively reduces the risk of ankle sprain in sports participants (Schiftan, Ross et al. 2015). ...
Effect of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability：A systematic review and meta- analysis
Preprint
Full-text available
  • Mar 2024
Conclusion: Balance training benefits ankle function with CAI patients and improve the dynamic balance ability. It is recommended to obtain the best rehabilitation effect by intervening 3 times a week, each intervention time of 20min to 30min, and consecutively intervening for 4 weeks or 6 weeks. Objective: To investigate and contrast the effects of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability (CAI). Methods: The PubMed, Embase, Web of Science, Medline, Cochrane were searched up to December 2023. Quality assessment was performed using the Cochrane Collaboration’s risk-of-bias guidelines, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were calculated. Results: Among 20 eligible studies, including 682 participants were analyzed in this meta-analysis. The results of the meta-analysis showed that balance training was effective in improving ankle function with self-functional scores (SMD =1.02 ; 95% CI,0.61 to 1.43;P < 0.00001; I² = 72%) and variables associated with the ability of dynamic balance such as SEBT-A (MD=5.88; 95% CI, 3.37 to 8.40; P<0.00001; I2 = 84%), SEBT-PM (MD=5.47; 95% CI, 3.40 to 7.54; P<0.00001; I² = 61%), and SEBT-PL (MD=6.04; 95% CI, 3.30 to 8.79; P<0.0001; I² = 79%) of CAI patients. Meta-regression showed that the intervention time may be the main reason for heterogeneity (P=0.046) in self-functional scores. In subgroup analyses of self-functional score across intervention types, among the intervention time, more than 20 minutes and less than 30 minutes had the best effect(MD=1.21, 95% CI: 0.96 to 1.46, P<0.00001，I²=55%);among the intervention period, 4 weeks (MD=0.84, 95% CI:0.50 to 1.19, P<0.00001，I²=78%)and 6 weeks (MD=1.21, 95% CI: 0.91 to1.51, P<0.00001，I²=71%) had significant effects; among the intervention frequency, 3 times (MD=1.14, 95% CI:0.89 to 1.38), P<0.00001，I²=57%)had significant effects. Secondly, in subgroup analyses of SEBT across intervention types, a 4-week and 6-week intervention with balance training 3 times a week for 20-30 min is the best combination of interventions to improve SEBT (dynamic balance) in patients with chronic ankle instability. Conclusion: Balance training benefits ankle function with CAI patients and improve the dynamic balance ability. It is recommended to obtain the best rehabilitation effect by intervening 3 times a week, each intervention time of 20min to 30min, and consecutively intervening for 4 weeks or 6 weeks. Systematic review registration: http://www.crd.york.ac.uk/PROSPERO/,identifier CRD4202450 2230.
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... The potential benefits are manifold -enhanced athletic performance, reduced risk of recurrent ankle injuries, and improved overall quality of life for the athletes. Such insights are invaluable not only for the athletes themselves but also for sports medicine professionals, physiotherapists, and basketball coaches who are instrumental in the rehabilitation and training processes (23,24). Ultimately, this research could lead to more targeted, effective treatment and training strategies, catering specifically to the needs of basketball players with chronic ankle instability, thereby ensuring their continued engagement in the sport and enhancing their overall well-being. ...
Effects of Hop Stabilization versus Balance Training on Disability and Balance in Chronic Ankle Instability among Basketball Players
Article
Full-text available
  • Dec 2023
Background: Ankle sprains, which often lead to chronic ankle instability (CAI), are common within the young, athletic population, particularly among basketball players. Rehabilitation programs frequently employ hop stabilization and balance training to mitigate the complications associated with CAI. This research was undertaken to compare the effectiveness of these two training approaches in improving disability and balance in affected individuals. Objective: The study aimed to evaluate and contrast the impact of hop stabilization versus balance training on disability and balance in basketball players with CAI. Methods: The randomized clinical trial was conducted at Ranger’s Teaching Hospital in Lahore, targeting young basketball players aged between 25 to 35 years with a history of recurrent ankle sprains and at least 8 months of playing experience. Through a non-probability convenient sampling technique, the participants were randomized into two groups: Group A underwent 6 weeks of hop stabilization training in addition to general training, while Group B participated in 6 weeks of balance training coupled with their general training regimen. The efficacy of these interventions was quantified using the Star Excursion Balance Test, Functional Ankle Disability Index, Functional Ankle Ability Measure questionnaire, and Multiple Single Leg Hop Stabilization Test (MSLHST). Results: Post-training assessments within groups indicated significant enhancements in disability and balance scores, with p-values below 0.05, suggesting notable improvements. However, when comparing the two groups, the Functional Ankle Ability Measure, Ankle Disability Index, and Star Excursion Balance Test showed no significant differences, with p-values exceeding 0.05. Notably, the MSLHST exhibited a significant contrast, with Group B showing a mean score decrease from 10.7857 to 5.7857, reflecting a 46% improvement, whereas Group A displayed a reduction in mean score from 13.625 to 11.7, a 14% enhancement, resulting in a significant p-value of 0.0289. Conclusion: The study concluded that balance training surpasses hop stabilization training in terms of efficacy, significantly improving balance and reducing disability in basketball players with chronic ankle instability.
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Accent Stabilizes 1:2 Sensorimotor Synchronization of Rhythmic Knee Flexion-Extension Movement in Upright Stance
Article
Full-text available
  • Apr 2019
Numerous studies have shown the importance of metrical structure on beat perception and sensorimotor synchronization (SMS), which indicates why metrical structure has evolved as a widespread musical element. In the current study, we aimed to investigate the effect of metrical structure with or without accented sounds and the alignment of accent with flexion or extension movements on the stability of 1:2 SMS in rhythmic knee flexion-extension movement in upright stance (flexing the knee once every two sounds). Fourteen participants completed 1:2 rhythmic knee flexion-extension movements with a metronome beat that accelerated from 2 to 8 Hz (the frequency of the movement was 1–4 Hz). Three sound-movement conditions were provided: (1) combining the flexion phase with loud (accented) sound and the extension phase with soft (non-accented) sound, (2) the reverse combination, and (3) combining both movements with loud sound. ANOVA results showed that metrical structure with accented sounds stabilizes 1:2 SMS in the range of 3.5–7.8 Hz in terms of timing accuracy, and flexing on the accented sound is more globally stable (resistant to phase transition) than flexing on the non-accented sound. Furthermore, our results showed that metrical structure with accented sounds induces larger movement amplitude in the range of 4.6–7.8 Hz than does that without accented sounds. The present study demonstrated that metrical structure with accented sounds stabilizes SMS and induces larger movement amplitude in rhythmic knee flexion-extension movement in upright stance than does SMS with sequences without accents. In addition, we demonstrated that coordinating flexion movement with accented sound is more globally stable than coordinating extension movement with accented sound. Thus, whereas previous studies have revealed that metrical structure enhances the timing accuracy of SMS, the current study revealed that metrical structure enhances the global stability of SMS.
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Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability: A Prospective Cohort Analysis
Article
Full-text available
  • Feb 2016
  • AM J SPORT MED
Background: Impairments in motor control may predicate the paradigm of chronic ankle instability (CAI) that can develop in the year after an acute lateral ankle sprain (LAS) injury. No prospective analysis is currently available identifying the mechanisms by which these impairments develop and contribute to long-term outcome after LAS. Purpose: To identify the motor control deficits predicating CAI outcome after a first-time LAS injury. Study design: Cohort study (diagnosis); Level of evidence, 2. Methods: Eighty-two individuals were recruited after sustaining a first-time LAS injury. Several biomechanical analyses were performed for these individuals, who completed 5 movement tasks at 3 time points: (1) 2 weeks, (2) 6 months, and (3) 12 months after LAS occurrence. A logistic regression analysis of several "salient" biomechanical parameters identified from the movement tasks, in addition to scores from the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure (FAAM) recorded at the 2-week and 6-month time points, were used as predictors of 12-month outcome. Results: At the 2-week time point, an inability to complete 2 of the movement tasks (a single-leg drop landing and a drop vertical jump) was predictive of CAI outcome and correctly classified 67.6% of cases (sensitivity, 83%; specificity, 55%; P = .004). At the 6-month time point, several deficits exhibited by the CAI group during 1 of the movement tasks (reach distances and sagittal plane joint positions at the hip, knee and ankle during the posterior reach directions of the Star Excursion Balance Test) and their scores on the activities of daily living subscale of the FAAM were predictive of outcome and correctly classified 84.8% of cases (sensitivity, 75%; specificity, 91%; P < .001). Conclusion: An inability to complete jumping and landing tasks within 2 weeks of a first-time LAS and poorer dynamic postural control and lower self-reported function 6 months after a first-time LAS were predictive of eventual CAI outcome.
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Influence of Balance Surface on Ankle Stabilizing Muscle Activity in Subjects with Chronic Ankle Instability
Article
Full-text available
  • Jun 2015
  • J REHABIL MED
To evaluate the effect of balance surface type on muscle activity of ankle stabilizing muscles in subjects with chronic ankle instability. Case-controlled, repeated-measures study design. Twenty-eight subjects with chronic ankle instability and 28 healthy controls. Subjects performed a barefooted single-legged stance on uniaxial and multidirectional unstable surfaces. Muscle activity of the mm. peroneus longus/brevis, tibialis anterior, gastrocnemius medialis were registered using surface electromyography. Mixed model analysis was used to explore differences in muscle activity between subjects with chronic ankle instability and controls, and the effect of surface type on muscle activity levels within subjects with chronic ankle instability. No differences were found between subjects with chronic ankle instability and healthy controls. Within subjects with chronic ankle instability, balancing along a frontal axis and on the Both Sides Up evoked overall highest muscle activity level, and the firm surface the least. Balancing on the firm surface showed the lowest tibialis anterior/peroneus longus muscle ratio, followed by balancing along a frontal axis and on the Airex pad. Clinicians can use these findings to improve the focus of balance training programmes by gradually progressing in difficulty level based on muscle activation levels taking co-contraction ratios into account.
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Ankle-Joint Self-Mobilization and CrossFit Training in Patients With Chronic Ankle Instability: A Randomized Controlled Trial
Article
  • Jan 2020
Context Ankle-joint mobilization and neuromuscular and strength training have been deemed beneficial in the management of patients with chronic ankle instability (CAI). CrossFit training is a sport modality that involves these techniques. Objective To determine and compare the influence of adding self-mobilization of the ankle joint to CrossFit training versus CrossFit alone or no intervention in patients with CAI. Design Randomized controlled clinical trial. Setting Research laboratory. Patients or Other Participants Seventy recreational athletes with CAI were randomly allocated to either self-mobilization plus CrossFit training, CrossFit training alone, or a control group. Intervention(s) Participants in the self-mobilization plus CrossFit group and the CrossFit training-alone group pursued a CrossFit training program twice a week for 12 weeks. The self-mobilization plus CrossFit group performed an ankle self-mobilization protocol before their CrossFit training, and the control group received no intervention. Main Outcome Measure(s) Ankle-dorsiflexion range of motion (DFROM), subjective feeling of instability, and dynamic postural control were assessed via the weight-bearing lunge test, Cumberland Ankle Instability Tool, and Star Excursion Balance Test (SEBT), respectively. Results After 12 weeks of the intervention, both the self-mobilization plus CrossFit and CrossFit training-alone groups improved compared with the control group ( P < .001). The self-mobilization plus CrossFit intervention was superior to the CrossFit training-alone intervention regarding ankle DFROM as well as the posterolateral- and posteromedial-reach distances of SEBT but not for the anterior-reach distance of SEBT or the Cumberland Ankle Instability Tool. Conclusions Ankle-joint self-mobilization and CrossFit training were effective in improving ankle DFROM, dynamic postural control, and self-reported instability in patients with CAI.
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Two 4-Week Balance-Training Programs for Chronic Ankle Instability
Article
  • Jul 2018
Context: Traditional single-limb balance (SLB) and progressive dynamic balance-training programs for those with chronic ankle instability (CAI) have been evaluated in the literature. However, which training program may be more beneficial is not known. Objective: To investigate the effects of a progressive hop-to-stabilization balance (PHSB) program compared with an SLB program on self-reported function, dynamic postural control, and joint position sense (JPS) where angle and direction were self-reported by participants with CAI. Design: Randomized controlled clinical trial. Setting: A single testing location in a mid-Atlantic state. Patients or other participants: A total of 18 participants (age = 18.38 ± 1.81 years; height = 175.26 ± 6.64 cm; mass = 75.79 ± 12.1 kg) with CAI. Intervention(s): Participants were randomly assigned to the PHSB or SLB program. The PHSB and SLB groups pursued their 4-week programs 3 times a week. The PHSB group performed a battery of single-limb hop-to-stabilization exercises, while the SLB group performed a series of SLB exercises. Exercises were advanced throughout the 4 weeks for both groups. Main outcomes measure(s): Pretest and posttest measurements were the Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living subscale; FAAM-Sports subscale; Star Excursion Balance Test in the anterior, posteromedial, and posterolateral directions; and weight-bearing JPS blocks (dorsiflexion, plantar flexion, inversion, eversion). Results: A significant main effect of time was present for the FAAM-Activities of Daily Living, FAAM-Sports, Star Excursion Balance Test (anterior, posteromedial, and posterolateral directions), and JPS (dorsiflexion, plantar flexion, inversion), as posttest results improved for the PHSB and SLB groups. The main effect of group was significant only for the FAAM-Sports, with the SLB group improving more than the PHSB group. Conclusions: Either a 4-week PHSB or SLB can be used in athletes with CAI, as both programs resulted in similar gains.
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The Epidemiology of Lateral Ligament Complex Ankle Sprains in National Collegiate Athletic Association Sports
Article
  • Aug 2016
  • AM J SPORT MED
Background: Ankle sprains are a common injury in collegiate sports. Few studies have examined the epidemiology of individual ligament injuries, specifically the lateral ligament complex (LLC) of the ankle. Purpose: To describe the epidemiology, including the estimated yearly national incidence, of LLC sprains among National Collegiate Athletic Association (NCAA) athletes. Study design: Descriptive epidemiology study. Methods: Injury surveillance data for 25 sports from the NCAA Injury Surveillance Program (NCAA-ISP) for the academic years 2009-2010 to 2014-2015 were used for analysis. All injuries included for analysis had a diagnosis of an LLC sprain. LLC sprain rates and rate ratios (RRs) with 95% CIs were calculated. From the sample, national estimates of the annual incidence of LLC sprains across the entire student-athlete body from these 25 sports were also calculated. Results: During the 2009-2010 to 2014-2015 academic years, 2429 LLC sprains were reported, for a rate of 4.95 per 10,000 athlete-exposures (AEs). LLC sprains comprised 7.3% of all reported collegiate sports injuries in the NCAA-ISP. Also, an estimated 16,022 LLC sprains occurred annually among the 25 sports. The sports with the highest LLC sprain rates were men's basketball (11.96/10,000 AEs) and women's basketball (9.50/10,000 AEs). Most LLC sprains occurred during practices (57.3%); however, the LLC sprain rate was higher in competitions than in practices (RR, 3.29; 95% CI, 3.03-3.56). Also, 11.9% of LLC sprains were identified as recurrent injuries, with the largest proportions of recurrent LLC sprains being found within women's basketball (21.1%), women's outdoor track (21.1%), women's field hockey (20.0%), and men's basketball (19.1%). In 44.4% of LLC sprains, the athlete returned to play in less than 24 hours; in 3.6%, the athlete required more than 21 days before returning to play (including those who did not return to play at all). Conclusion: LLC sprains were the most commonly reported injury diagnosis among United States collegiate student-athletes. Continued examination of interventions that aim to reduce the incidence, severity, and recurrence of LLC sprains, specifically in women, is warranted.
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Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains
Article
  • Jun 2016
Lateral ankle sprains (LASs) are the most prevalent musculoskeletal injury in physically active populations. They also have a high prevalence in the general population and pose a substantial healthcare burden. The recurrence rates of LASs are high, leading to a large percentage of patients with LAS developing chronic ankle instability. This chronicity is associated with decreased physical activity levels and quality of life and associates with increasing rates of post-traumatic ankle osteoarthritis, all of which generate financial costs that are larger than many have realised. The literature review that follows expands this paradigm and introduces emerging areas that should be prioritised for continued research, supporting a companion position statement paper that proposes recommendations for using this summary of information, and needs for specific future research.
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Rehabilitation for Chronic Ankle Instability With or Without Destabilization Devices: A Randomized Controlled Trial
Article
  • Mar 2016
  • J ATHL TRAINING
Context: Individuals with chronic ankle instability (CAI) have deficits in neuromuscular control and altered movement patterns. Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function. Objective: To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function, range of motion (ROM), strength, and balance than rehabilitation without devices in patients with CAI. Design: Randomized controlled clinical trial. Setting: Laboratory. Patients or other participants: A total of 26 patients with CAI (7 men, 19 women; age = 21.34 ± 3.06 years, height = 168.96 ± 8.77 cm, mass = 70.73 ± 13.86 kg). Intervention(s): Patients completed baseline measures and were randomized into no-device and device groups. Both groups completed 4 weeks of supervised, impairment-based progressive rehabilitation with or without devices and then repeated baseline measures. Main outcome measure(s): We assessed self-reported function using the Foot and Ankle Ability Measure. Ankle ROM was measured with an inclinometer. Ankle strength was assessed using a handheld dynamometer during maximal voluntary isometric contractions. Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance. We compared each dependent variable using a 2 × 2 (group × time) analysis of variance and post hoc tests as appropriate and set an a priori α level at .05. The Hedges g effect sizes and associated 95% confidence intervals were calculated. Results: We observed no differences between the no-device and device groups for any measure. However, both groups had large improvements in self-reported function and ankle strength. Conclusions: Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions resulted in similar improvements. Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI.
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Comparative Effects of Different Balance-Training-Progression Styles on Postural Control and Ankle Force Production: A Randomized Controlled Trial
Article
  • Feb 2016
  • J ATHL TRAINING
Context: Despite the effectiveness of balance training, the exact parameters needed to maximize the benefits of such programs remain unknown. One such factor is how individuals should progress to higher levels of task difficulty within a balance-training program. Yet no investigators have directly compared different balance-training-progression styles. Objective: To compare an error-based progression (ie, advance when proficient at a task) with a repetition-based progression (ie, advance after a set amount of repetitions) style during a balance-training program in healthy individuals. Design: Randomized controlled trial. Setting: Research laboratory. Patients or other participants: A total of 28 (16 women, 12 men) physically healthy young adults (age = 21.57 ± 3.95 years, height = 171.60 ± 11.03 cm, weight = 72.96 ± 16.18 kg, body mass index = 24.53 ± 3.7). Intervention(s): All participants completed 12 supervised balance-training sessions over 4 weeks. Each session consisted of a combination of dynamic unstable-surface tasks that incorporated a BOSU ball and lasted about 30 minutes. Main outcome measure(s): Static balance from an instrumented force plate, dynamic balance as measured via the Star Excursion Balance Test, and ankle force production in all 4 cardinal planes of motion as measured with a handheld dynamometer before and after the intervention. Results: Selected static postural-control outcomes, dynamic postural control, and ankle force production in all planes of motion improved (P < .05). However, no differences between the progression styles were observed (P > .05) for any of the outcome measures. Conclusions: A 4-week balance-training program consisting of dynamic unstable-surface exercises on a BOSU ball improved dynamic postural control and ankle force production in healthy young adults. These results suggest that an error-based balance-training program is comparable with but not superior to a repetition-based balance-training program in improving postural control and ankle force production in healthy young adults.
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Cross-cultural adaptation, reliability, and validity of the Japanese version of the Cumberland ankle instability tool
Article
  • Feb 2016
Purpose To study validity and reliability of a Japanese version of the Cumberland Ankle Instability Tool and to determine the optimal cutoff score. Methods In this study, the questionnaire was cross-culturally adapted into Japanese. The psychometric properties tested in the Japanese version of the CAIT were measured for criteria validity, internal consistency and test–retest reliability in 111 collegiate soccer athletes. We also established the questionnaire cutoff score for discriminating between individuals with and without CAI. Results There was a significant correlation between the Japanese version of the CAIT and the Karlsson score (r = 0.604, p < 0.001). The questionnaire had a high internal consistency (Cronbach’s α = 0.833) and reliability [intraclass correlation coefficient (ICC) = 0.826, 95% confidence interval (CI): 0.732–0.888]. The optimal cutoff score was ≤25, which was consistent with previous reports. Conclusions The Japanese version of the CAIT has been shown to be a valid and reliable questionnaire for determining the presence of CAI. We expect that researchers and clinicians will use the Japanese version of the CAIT in Japan. • Implications for Rehabilitation • Chronic Ankle Instability (CAI), which not only increases recurrence rate of ankle sprain but also decreases athletic performance, is a residual symptom after ankle sprain. • Cumberland Ankle Instability Tool, which has the reliability and validity to assess CAI, will be critically useful in assessment procedure for CAI. • It is preferable for clinicians and researchers to use the native language version of the CAIT.
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