On the basis of our systematic review with meta-analysis, it appears that CAI patients do not use somatosensory information to the same extent as uninjured controls and instead upregulate the use of visual information during single limb stance.
While statistically no more effective, exceeding minimal detectable change scores and favorable effect sizes suggest that a 4-week progressive BTS program may be more effective at improving self-assessed disability and postural control in CAI patients than balance training in isolation.
People with CAI have deficits in plantar sensation relative to controls and copers. Cognitive loading increases plantar cutaneous sensation thresholds irrespective of CAI status.
Context
Motor planning, a prerequisite for goal-driven movement, is a complex process that occurs in the cortex. Evidence has suggested that motor planning is altered in patients with chronic ankle instability (CAI). We know balance training can improve balance, but we do not know if it also improves motor planning. Such changes in cortical activity can be assessed using electroencephalography.
Objective
To evaluate changes in cortical measures of motor planning after balance training in patients with CAI.
Design
Controlled laboratory study.
Setting
Research laboratory.
Patients or Other Participants
Fifteen patients with CAI (age = 20.80 ± 2.37 years, height = 169.47 ± 7.95 cm, mass = 70.45 ± 19.25 kg).
Intervention(s)
A 4-week progression-based balance-training program.
Main Outcome Measure(s)
Motor planning was assessed via electroencephalography before a lateral-stepping task. We calculated event-related spectral perturbations in the θ (4–8 Hz), α (8–12 Hz), β (14–25 Hz), and γ (30–50 Hz) bands. The change in power (in decibels) was calculated in each band for the 500 milliseconds before the onset of the lateral-stepping movement. Additional outcomes were the Foot and Ankle Ability Measure (FAAM)–Activities of Daily Living and Sport subscales; the anterior-, posteromedial-, and posterolateral-reach directions of the Star Excursion Balance Test; and static balance. Patients completed 3 test sessions: baseline, 24- to 48-hour posttest, and 1-week posttest. Repeated-measures analyses of variance were used to assess changes over time. The α level was set at .05.
Results
The FAAM–Activities of Daily Living subscale score was improved at both posttests (P < .05), and the FAAM-Sport subscale score was improved at the 1-week posttest (P = .008). Balance was better in all 3 directions of the Star Excursion Balance Test at both posttest sessions (P < .001). After balance training, no differences were identified in cortical activity at either posttest session (P > .05).
Conclusions
No improvements were identified in electroencephalography measures of motor planning during lateral stepping in patients with CAI. Improved balance suggested that sensorimotor adaptations occurred, but they may not have transferred to the lateral-stepping task or they may have been mediated via other processes in patients with CAI.
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