Effect of Functional Core Stability Training or Cognitive Training on Balance and Postural Control in Chronic Ankle Instability

Official title

Effect of Adding Functional Core Stability Training or Cognitive Training on Balance and Postural Control in Rehabilitation of Chronic Ankle Instability

Overview

The purpose of the study is to investigate dynamic core stability training versus cognitive training on balance, functional performance, postural control, ankle instability scores, ankle dorsiflexion range of motion, and mental workload in chronic ankle instability

Detailed description

Lateral ankle sprains (LAS) are prevalent in sports, with 40% leading to chronic ankle instability (CAI), impacting muscle coordination and balance, primarily controlled by the central nervous system (CNS). Core muscles play a vital role in stabilization and postural control, particularly for individuals with chronic ankle instability, because they significantly contribute to the risk of injury. Even with intact strength and balance, individuals with chronic ankle instability may re-injure when attention shifts, highlighting the need for dual-task training to improve postural control. Core stability training, which includes cognitive elements, has been shown to enhance muscle function and reduce instability. Training programs incorporating dual-task exercises have proven superior for improving joint position sense and postural control while addressing associated mental health issues in chronic ankle instability patients. Therefore, this study aims to analyze the effects of combining dynamic core stability exercises with cognitive training on dual-task conditions, marking a novel approach in chronic ankle instability rehabilitation.

Interventions

• Other strengthening exercises
  Stretch the gastrocnemius and soleus muscles for 30 seconds with 3 repetitions. Strengthen all ankle muscles using TheraBand resistance for various movements (dorsiflexion, plantar flexion, inversion, and eversion) and combined movements for 3 sets of 10 repetitions, three sessions weekly for two months. The training program includes progression from seated to standing for stretching and single-limb for bipedal calf raises.
• Other Balance training
  Challenging disc training, utilized in balance studies, begins with participants standing with slightly bent knees. The dynamic balance training comprises 9 protocols focused on tracking a moving red circular target zone using a green point cursor that represents the center of pressure. Participants shift their body weight in various directions with visual feedback on a computer screen. Over 8 weeks, participants complete 16 sessions, each lasting 20 seconds with 7 seconds of rest in between. Th
• Other Functional core training
  Participants will receive functional core motor control (stabilization) exercise and the traditional program (consisting of stretching protocol, strengthening of all ankle muscles, and balance activities) 3 sessions per week for 2 months.
• Other Spinal motor control (stabilization) exercises
  The training program consists of three phases: 1. \*\*Cognitive Phase (Weeks 1-2):\*\* Focuses on isolating the transversus abdominis and multifidus muscles using a biofeedback pressure device. Exercises involve isometric contractions with 10-second holds, repeated four times daily. 2. \*\*Associative Phase (Weeks 3-4):\*\* Introduces less stable exercises (e.g., quadruped and standing positions) aimed at enhancing spine neutrality. 3. \*\*Automatic Phase (Weeks 5-8):\*\* Involves dynamic movem
• Other Cognitive training
  Balance training is combined with a cognitive task involving a backward digit span test, where participants must recall and repeat sequences of numbers in reverse order, testing working memory. This test includes three difficulty levels (3-, 4-, and 5-digit sequences) performed over 35 seconds. Participants will either recall digits while maintaining static stability or after squatting upon hearing a number, with a focus on accuracy within 5 seconds. Performance is measured by the percentage of

Primary outcome measures

• assessment of change of pain [Time frame: at baseline and after 2 months]
• assessment of ankle instability [Time frame: at baseline and after 2 months]

Secondary outcome measures (6)

• assessment of foot function [Time frame: at baseline and after 2 months]
• assessment of functional performance [Time frame: at baseline and after 2 months]
• assessment of postural control [Time frame: at baseline and after 2 months]
• assessment of balance [Time frame: at baseline and after 2 months]
• assessment of Dorsiflexion range of motion [Time frame: at baseline and after 2 months]
• assessment of mental workload [Time frame: at baseline and after 2 months]

Eligibility criteria

Inclusion criteria

Inclusion criteria will be based on the standard criteria outlined by the International Ankle Consortium

• History of chronic lateral ankle sprain and/or recurrent sprain and/or "feelings of instability or giving way" for 6 months or more before the study, with at least 2 episodes.
• Patients are between 18 and 30 years old. 3- Body mass index less than 30

4\. The patient has a history of at least one significant ankle sprain with associated inflammatory symptoms and at least one day of interrupted physical activity.

5\. Patients who have unilateral chronic ankle instability. 6. Self-reported ankle instability should be confirmed using a validated ankle instability questionnaire (greater than 24).

Exclusion criteria

Those with a history of spine, pelvis, and lower extremity injury, fracture, or surgery 2- Those with low back pain that require medical or surgical intervention. 3- Having a history of an acute lower extremity injury or lower extremity surgery or fracture in the 3 months before the Study 4. Participation in formal ankle rehabilitation in the 3 months before the study.

5\. Being diagnosed with neurologic dysfunction, such as multiple sclerosis, Parkinson's disease, or head injury

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Egypt · 1 center

• out-patient clinic, faculty of physical therapy, Cairo university — Cairo

Identifiers

NCT: NCT07283276 · Manar-PHD

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗