Lateral ankle sprains are one of the most common injuries among physically active individuals, especially those who participate in soccer, basketball, and volleyball.5 Furthermore, the recurrence rate has been estimated to be as high as 80%.11 The repeated ankle injury and giving-way feelings that occur in some individuals after the first sprain lead to a condition that has been defined as functional ankle instability (FAI).10 Neuromuscular deficits are believed to have a major contribution to the development of FAI. Poor postural control, which t StUdy deSiGN: Case-control study.t oBJeCtive: To compare the effect of dualtasking on postural and cognitive performance between subjects with functional ankle instability (FAI) and a matched control group without FAI.t BaCKGroUNd: Deficit and expertise in sensorimotor functions have been proposed as factors that can modify the interference between postural control and cognition. To the authors' knowledge, no study has investigated the posture-cognition interaction in individuals with recurrent ankle sprain, an orthopaedic condition with documented sensorimotor deficits.t MethodS: Single-limb postural stability was assessed in 15 recreational athletes with FAI and 15 matched healthy athletes without FAI. Each athlete stood on a Biodex Stability System at platform stabilities of 7 and 5, while they performed or did not perform a digits-backward cognitive task. Overall stability index (OSI), anteroposterior stability index (APSI), and mediolateral stability index (MLSI) were used as measures of postural performance. t reSUltS: At stability level 5, the individuals in the FAI group had poorer postural stability compared to those in the group without FAI (OSI, P.01; MLSI, P.01). A significant increase in OSI (P.01) and MLSI (P = .02) was also demonstrated by the individuals in the FAI group during dual-task performance compared to the single-task performance.t CoNClUSioN: Subjects with FAI demonstrated poorer postural stability when tested at level 5 on the Biodex Stability System, but not at level 7. Also, the results indicate that concurrent performance of a cognitive task decreased postural stability in the subjects with FAI, suggesting an increased dependency on attentional demands for maintenance of balance in that group. Such findings highlight the need for the assessment of postural control in patients with ankle sprain to include cognitive loading.
It is believed that unihemispheric concurrent dual-site transcranial direct current stimulation (tDCSUHCDS) of the primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) causes an increase in motor cortex excitability. However, the clinical effect of this type of stimulation on patients with neurological conditions is not yet known. The aim of the present study was to assess the effect of anodal-tDCSUHCDS (a-tDCSUHCDS) on upper limb motor function in subacute stroke patients. Fifteen patients participated in this sham-controlled crossover study. The main outcome measures were the reaction time (RT) to visual stimuli, completion time of a nine-pin pegboard (9-PPB), and the scores from the Fugl–Meyer assessment (FMA) for the upper limb of the involved side before and after three brain stimulation conditions. For a-tDCSUHCDS, the anodal electrodes were placed on the M1 and the DLPFC, while for a-tDCS, the anodal electrode was placed on the M1. For the sham stimulation, the tDCS was turned off after 30 s. For brain stimulation, the selected current was 1 mA for 20 min. After a-tDCSUHCDS, there was a significant reduction in the RT and completion time of the 9-PPB compared with the times after a-tDCS and the sham stimulation: p = 0.013 and p = 0.022, respectively). However, there was no significant difference in the FMA scores after the three types of stimulations (p = 0.085). Compared with a-tDCS, a-tDCSUHCDS temporarily improved the RT and dexterity of the involved hand in subacute stroke patients.Clinical Trial Registration: Iranian Registry of Clinical Trials (IRCT), identifier IRCT2015012520787N1.
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