The Effects of Vestibulo-Ocular Reflex Exercises Added to Postural Stabilization Training in Chronic Ankle Instability

Официальное название

The Effects of Vestibulo-Ocular Reflex Exercises Added to Postural Stabilization Training in Amateur Athletes With Chronic Ankle Instability

Обзор

Chronic ankle instability (CAI) is a common condition after lateral ankle sprain. CAI is characterized by mechanical and/or functional instability, or recurrent episodes of "giving way," persisting for at least 12 months after the initial injury, and is associated with limitations in activity and participation. In amateur athletes, CAI may be overlooked or undertreated, although sport-specific activities require rapid integration of visual, vestibular, somatosensory, and cognitive information. Postural stabilization training is commonly used to improve balance and neuromuscular control in individuals with CAI. However, individuals with CAI may show increased reliance on visual information and altered visual-vestibular sensory reweighting during postural control tasks. The vestibulo-ocular reflex (VOR) contributes to gaze stability and visual clarity during head movements and may also be related to neurocognitive processes such as attention and processing speed. This study is designed as a randomized controlled, prospective, parallel-group, pretest-posttest design trial to investigate whether VOR exercises added to postural stabilization training improve dynamic balance, functional instability, and neurocognitive performance in amateur athletes with CAI.

Подробное описание

Chronic ankle instability (CAI) is a common condition after lateral ankle sprain. CAI is characterized by mechanical and/or functional instability, or recurrent episodes of "giving way," persisting for at least 12 months after the initial injury, and is associated with limitations in activity and participation. In amateur athletes, CAI may be overlooked or undertreated, although sport-specific activities require rapid integration of visual, vestibular, somatosensory, and cognitive information.

CAI has been explained through various theories, including poor neuromuscular control, reduced muscle strength, decreased kinesthetic awareness, deficits in postural stability, and functional and mechanical instability \[10\]. However, contemporary models emphasize that CAI cannot be explained solely by peripheral or mechanical changes; rather, it represents a multidimensional condition in which the interaction between the perception of sensory input, central processing of this information, and generation of an appropriate motor response is impaired \[10,12\]. Accordingly, in addition to peripheral adaptations, these alterations may also affect neurocognitive functions, and it has been reported that neurocognitive abilities such as attention, inhibitory control, and visual memory may be impaired in individuals with CAI. Current evidence suggests that lower neurocognitive performance may be associated with impaired neuromuscular control and coordination in musculoskeletal injuries. Although this relationship has been more clearly described in anterior cruciate ligament injuries, it has been examined to a more limited extent in ankle injuries.

Postural stabilization training is commonly used to improve balance and neuromuscular control in individuals with CAI. However, individuals with CAI may show increased reliance on visual information and altered visual-vestibular sensory reweighting during postural control tasks. The vestibulo-ocular reflex (VOR) contributes to gaze stability and visual clarity during head movements and may also be related to neurocognitive processes such as attention and processing speed.

This study is designed as a randomized controlled, prospective, parallel-group, pretest-posttest trial to investigate the effects of vestibulo-ocular reflex (VOR) exercises added to postural stabilization training on dynamic balance, functional ankle instability, and neurocognitive performance in amateur athletes with chronic ankle instability (CAI). Dynamic balance will be assessed using the Y-Balance Test, while functional ankle instability will be evaluated using the Turkish version of the Cumberland Ankle Instability Tool. Neurocognitive performance will be assessed through single-leg balance and figure-of-eight performance under cognitive load, hopping performance under visual constraint, selective attention, and inhibitory control measures. Approximately 56 participants with CAI will be randomly allocated to either a Postural Stabilization Training Group or a Postural Stabilization Training plus Vestibulo-Ocular Reflex Exercises Group. Both groups will participate in a six-week intervention program conducted three days per week. Each session will last approximately 45 minutes, including 40 minutes of exercise and 5 minutes of ankle mobilization. Outcome measures will be assessed at baseline, immediately after the six-week intervention, and at a four-week follow-up.

Вмешательства

• Другое Postural Stabilization Training
  Participants in this group will receive ankle joint mobilization followed by a structured postural stabilization training program. The program will include single-leg stance progression, hop stabilization tasks, and number-sequence hop tasks. Exercises will be progressed according to the participant's ability to complete each task without errors. Ankle joint mobilization will include talocrural anteroposterior mobilization and distal fibular mobilization with movement, applied before the exercis
• Другое Vestibulo-Ocular Reflex Exercise in addition to Postural Stabilization Training
  Participants in this group will receive the same ankle joint mobilization and postural stabilization training program as the Postural Stabilization Training Group. In addition, vestibulo-ocular reflex (VOR) exercises involving fixation on a visual target during head movements will be implemented. VOR exercises will be structured to progressively increase postural demands and will include sitting, standing, walking, and single-leg stance positions. The total session will last approximately 45 min

Первичные конечные точки

• Y Balance Test [Срок оценки: baseline, 6 weeks after baseline, and 10-week after baseline]

Вторичные конечные точки (8)

• Cumberland Ankle Instability Tool [Срок оценки: baseline, 6 weeks after baseline, and 10-week after baseline]
• Single-Leg Stance + Number / Word Sequence Task [Срок оценки: baseline, 6 weeks after baseline, and 10-week after baseline]
• Side Hop Test + Pinhole Glasses [Срок оценки: baseline, 6 weeks after baseline, and 10-week after baseline]
• Figure-of-Eight Hop Test + Backward Counting Task [Срок оценки: baseline, 6 weeks after baseline, and 10-week after baseline]
• Stroop Test [Срок оценки: baseline, 6 weeks after baseline, and 10-week after baseline]
• Foot and Ankle Ability Measure (FAAM) [Срок оценки: baseline, 6 weeks after baseline, and 10-week after baseline]
• Weight-Bearing Lunge Test [Срок оценки: baseline, 6 weeks after baseline, and 10-week after baseline]
• Dynamic Visual Acuity Test [Срок оценки: baseline, 6 weeks after baseline, and 10-week after baseline]

Критерии участия

Критерии включения

• Being between 18 and 35 years of age.
• Being classified as a Tier 2 athlete according to the McKay et al. Participant Classification Framework (trained/developmental level).
• Having a history of at least one lateral ankle sprain (LAS) occurring at least 12 months before enrollment, resulting in swelling, pain, and functional impairment, and followed by persistent instability.
• Having the most recent ankle sprain at least 3 months before study enrollment.
• Having a history of recurrent ankle sprains or episodes of "giving way."
• Having a diagnosis of unilateral chronic ankle instability (CAI).
• Having a Cumberland Ankle Instability Tool - Turkish Version (CAIT-T) score of ≤24.
• Having a Foot and Ankle Ability Measure (FAAM) score of <90%.
• Having a Foot and Ankle Ability Measure Sports subscale (FAAM-S) score of <80%.
• A side-to-side difference of ≥2.5 cm in Weight-Bearing Lunge Test distance, with the affected side demonstrating less dorsiflexion than the unaffected side.

Критерии исключения

• History of acute lateral ankle sprain within the last 3 months.
• History of lower extremity surgery.
• History of acute injury to other musculoskeletal structures of the lower extremity joints within the last 3 months that affected joint integrity and function and caused interruption of desired physical activity for at least one day.
• History of balance or vestibular disorders, including cerebellar, vestibular, cochlear, or inner ear dysfunction.
• Visual problems that may affect the administration or interpretation of the Dynamic Visual Acuity Test, including a history of amblyopia, diplopia, or significant visual loss.
• Persistent symptoms related to a previous concussion or traumatic brain injury.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Другое

Центры проведения

Turkey (Türkiye) · 1 центр

• Reset Fizyoterapi — Istanbul

Идентификаторы

NCT: NCT07728526 · MFP-CAI-2027

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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