Progressive Visual Occlusion and Postural Control Responses in Individuals With and Without Chronic Ankle Instability

2021 ◽  
pp. 1-6
Author(s):  
Lilly H. VanDeMark ◽  
Christina B. Vander Vegt ◽  
Cassie B. Ford ◽  
Jason P. Mihalik ◽  
Erik A. Wikstrom
Keyword(s):  
Postural Control ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Heterogeneous Sample ◽  
Eyes Closed ◽  
Visual Occlusion ◽  
Sensory Organization ◽  
Eyes Open ◽  
History Of ◽  
Partially Occluded

Context: Prophylactic and rehabilitative balance training is needed to maximize postural control and develop appropriate sensory organization strategies. Partially occluding vision during functional exercise may promote appropriate sensory organization strategies, but little is known about the influence of partially occluded vision on postural control in those with and without a history of musculoskeletal injury. Objective: To determine the effect of increasing levels of visual occlusion on postural control in a heterogeneous sample of those with and without chronic ankle instability (CAI). The secondary objective was to explore postural control responses to increasing levels of visual occlusion among those with unilateral and bilateral CAI relative to uninjured controls. Design: Cross-sectional. Setting: Sports medicine research laboratory. Patients or Other Participants: Twenty-five participants with unilateral CAI, 10 with bilateral CAI, and 16 participants with no history of lower extremity injury. Main Outcome Measures: All participants completed four 3-minute postural control assessments in double-limb stance under the following 4 visual conditions: (1) eyes open, (2) low occlusion, (3) high occlusion, and (4) eyes closed. Low- and high-occlusion conditions were produced using stroboscopic eyewear. Postural control outcomes included time-to-boundary minima means in the anteroposterior (TTB-AP) and mediolateral directions (TTB-ML). Repeated-measures analysis of variances tested the effects of visual condition on TTB-AP and TTB-ML. Results: Postural control under the eyes-open condition was significantly better (ie, higher) than the limited visual occlusion and eyes-closed conditions (P < .001) for TTB-AP and TTB-ML. For TTB-AP only, partially occluded vision resulted in better postural control than the eyes-closed condition (P ≤ .003). Conclusions: Partial and complete visual occlusion impaired postural control during dual-limb stance in a heterogeneous sample of those with and without CAI. Stroboscopic eyewear appears to induce postural control impairments to the same extent as complete visual occlusion in the mediolateral direction.

Altered Plantar-Receptor Stimulation Impairs Postural Control in Those With Chronic Ankle Instability

2012 ◽  
Vol 21 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Patrick O. McKeon ◽  
Alex J. Stein ◽  
Christopher D. Ingersoll ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Physically Active ◽  
Plantar Surface ◽  
Eyes Closed ◽  
Eyes Open ◽  
Sensorimotor Mechanisms ◽  
Control Sham

Context:Postural control as assessed via time-to-boundary (TTB) measures has been shown to be impaired in those with chronic ankle instability (CAI). Foot orthotics have been shown to improve postural control, although it is not clear if this is via mechanical or sensorimotor mechanisms.Objective:To assess the effect of textured shoe inserts that provide no mechanical support on postural control as assessed by TTB measures in subjects with CAI.Design:A crossover design to examine the effects of a textured insole on postural control in individuals with unilateral CAI. The independent variables were vision (eyes open, eyes closed) and texture (textured insole, sham insole, control).Setting:Laboratory.Participants:20 physically active individuals, 12 men, 8 women, age 18–45 y (21.5 ± 5.51) with self-reported CAI.Intervention:Each subject balanced in shod single-limb stance with eyes open and eyes closed under 3 conditions (control, sham, and textured insole). The order of testing under the 3 shoe conditions and 2 vision conditions was counterbalanced.Main Outcome Measures:The mean of TTB minima and the standard deviation of TTB minima in the mediolateral (ML) and anteroposterior directions.Results:There were significant reductions in TTB ML magnitude and variability found in the textured condition compared with the control and sham conditions. In the textured condition, subjects failed significantly more trials than any other condition.Conclusions:Stimulating the plantar surface of the foot, via a textured insole, has an effect in the broad spectrum of postural-control maintenance in individuals with CAI.

scholarly journals Comparative Effectiveness of Plantar-Massage Techniques on Postural Control in Those With Chronic Ankle Instability

2017 ◽  
Vol 52 (7) ◽  
pp. 629-635 ◽  
Author(s):  
Erik A. Wikstrom ◽  
Kyeongtak Song ◽  
Ashley Lea ◽  
Nastassia Brown
Keyword(s):  
Postural Control ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Balance Test ◽  
Physically Active ◽  
Lateral Ankle ◽  
Massage Treatment ◽  
Eyes Open ◽  
University Setting ◽  
Stimulation Of

Context:  One of the major concerns after an acute lateral ankle sprain is the potential for development of chronic ankle instability (CAI). The existing research has determined that clinician-delivered plantar massage improves postural control in those with CAI. However, the effectiveness of self-administered treatments and the underlying cause of any improvements remain unclear. Objectives:  To determine (1) the effectiveness of a self-administered plantar-massage treatment in those with CAI and (2) whether the postural-control improvements were due to the stimulation of the plantar cutaneous receptors. Design:  Crossover study. Setting:  University setting. Patients or Other Participants:  A total of 20 physically active individuals (6 men and 14 women) with self-reported CAI. Intervention(s):  All participants completed 3 test sessions involving 3 treatments: a clinician-delivered manual plantar massage, a patient-delivered self-massage with a ball, and a clinician-delivered sensory brush massage. Main Outcome Measure(s):  Postural control was assessed using single-legged balance with eyes open and the Star Excursion Balance Test. Results:  Static postural control improved (P ≤ .014) after each of the interventions. However, no changes in dynamic postural control after any of the interventions were observed (P &gt; .05). No differences were observed between a clinician-delivered manual plantar massage and either a patient-delivered self-massage with a ball or a clinician-delivered sensory brush massage in any postural-control outcome. Conclusions:  In those with CAI, single 5-minute sessions of traditional plantar massage, self-administered massage, and sensory brush massage each resulted in comparable static postural-control improvements. The results also provide empirical evidence suggesting that the mechanism for the postural-control improvements is the stimulation of the plantar cutaneous receptors.

Static Postural Stability in Chronic Ankle Instability, an Ankle Sprain and Healthy Ankles

2018 ◽  
Vol 39 (08) ◽  
pp. 625-629 ◽  
Author(s):  
Yong Kwon
Keyword(s):  
Postural Stability ◽  
Ankle Instability ◽  
Mean Amplitude ◽  
Chronic Ankle Instability ◽  
Medial Gastrocnemius ◽  
Muscle Type ◽  
Eyes Closed ◽  
Ankle Muscles ◽  
Eyes Open ◽  
Balance Error

AbstractTo identify the single leg balance (SLB) test that discriminates among healthy, coper, and chronic ankle instability (CAI) groups and to determine effects of ankle muscles on the balance error scoring system (BESS) among the three populations. 60 subjects (20 per group) performed the SLB test with eyes open (EO) and eyes closed (EC). Normalized mean amplitude (NMA) of the tibia anterior (TA), fibularis longus (FL), and medial gastrocnemius (MG) muscles and BESS were measured while performing the SLB test. The coper group had a lower error score than the CAI group in the EC. NMA was greater in the CAI group compared to in the healthy and coper groups regardless of muscle type. NMA of the TA was less than the PL and MG regardless of the group in the EO. The CAI group demonstrated greater NMAs of the PL and MG than the healthy and coper groups in the EC. The CAI group demonstrated greater NMA of the PL and MG by compensating their ankle muscles in the EO and EC. BESS suggests that the coper group may have coping mechanisms to stabilize static postural control compared to the CAI group. The EC may be better to detect static postural instability in the CAI or coper group.

Effects of lifetime ethanol consumption on postural control: A computerized dynamic posturography study

2002 ◽  
Vol 12 (1) ◽  
pp. 53-64
Author(s):  
Saad Ahmad ◽  
John W. Rohrbaugh ◽  
Andrey P. Anokhin ◽  
Erik J. Sirevaag ◽  
Joel A. Goebel
Keyword(s):  
Alcohol Consumption ◽  
Postural Control ◽  
Spectral Power ◽  
Support Surface ◽  
Dependent Manner ◽  
Dynamic Posturography ◽  
Eyes Closed ◽  
Sensory Organization ◽  
Computerized Dynamic Posturography ◽  
Eyes Open

The relationship between lifetime alcohol consumption and postural control was investigated in 35 subjects with no clinically-detectable neurologic abnormalities, using computerized dynamic posturography (CDP) procedures. The estimated total number of lifetime alcoholic drinks was positively correlated with anteroposterior sway spectral power within the 2–4 Hz and 4–6 Hz frequency bands, in three Sensory Organization Test (SOT) conditions: eyes closed with stable support surface (SOT 2), eyes open with sway-referenced support (SOT 4), and eyes closed with sway-referenced support (SOT 5). All correlations remained significant after controlling for subject age, and were increased after excluding nine drug-abusing subjects. In contrast to the strong findings for frequency-based measures, no correlation was observed using conventional amplitude-based sway measures. These results suggest that 1) alcohol consumption compromises postural control in an exposure-dependent manner, and 2) sway frequency analysis reveals pathological processes not manifested in conventional CDP measures of sway amplitude.

Effect of a 2-Week Joint-Mobilization Intervention on Single-Limb Balance and Ankle Arthrokinematics in Those With Chronic Ankle Instability

2014 ◽  
Vol 23 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Matthew C. Hoch ◽  
David R. Mullineaux ◽  
Richard D. Andreatta ◽  
Robert A. English ◽  
Jennifer M. Medina-McKeon ◽  
...  
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Repeated Measures ◽  
Center Of Pressure ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Talocrural Joint ◽  
Joint Mobilization ◽  
Multiple Treatment ◽  
Eyes Open

Context:A single talocrural joint-mobilization treatment has improved spatiotemporal measures of postural control but not ankle arthrokinematics in individuals with chronic ankle instability (CAI). However, the effects of multiple treatment sessions on these aspects of function have not been investigated.Objective:To examine the effect of a 2-wk anterior-to-posterior joint-mobilization intervention on instrumented measures of single-limb-stance static postural control and ankle arthrokinematics in adults with CAI.Design:Repeated measures.Setting:Research laboratory.Participants:12 individuals with CAI (6 male, 6 female; age 27.4 ± 4.3 y, height 175.4 ± 9.78 cm, mass 78.4 ± 11.0 kg).Intervention:Subjects received 6 treatments sessions of talocrural grade II joint traction and grade III anterior-to-posterior joint mobilization over 2 wk.Main Outcome Measures:Instrumented measures of single-limb-stance static postural control (eyes open and closed) and anterior and posterior talar displacement and stiffness were assessed 1 wk before the intervention (baseline), before the first treatment (preintervention), 24–48 h after the final treatment (postintervention), and 1 wk later (1-wk follow-up). Postural control was analyzed as center-of-pressure velocity, center-of-pressure range, the mean of time-to-boundary minima, and standard deviation of time-to-boundary minima in the anteroposterior and mediolateral directions for each visual condition.Results:No significant differences were identified in any measures of postural control (P > .08) or ankle arthrokinematics (P > .21).Conclusions:The 2-wk talocrural joint-mobilization intervention did not alter instrumented measures of single-limb-stance postural control or ankle arthrokinematics. Despite the absence of change in these measures, this study continues to clarify the role of talocrural joint mobilization as a rehabilitation strategy for patients with CAI.

scholarly journals Effect of ultrasound-guided percutaneous neuromodulation in ankle instability: a case study

2019 ◽  
Vol 02 (02) ◽  
pp. 100-101
Author(s):  
Rodríguez Rosal M. ◽  
Sánchez Sixto A. ◽  
Álvarez Barbosa F. ◽  
Yáñez Álvarez A.
Keyword(s):  
Effect Size ◽  
Center Of Pressure ◽  
Tibial Nerve ◽  
Ankle Instability ◽  
Center Of Mass ◽  
Force Plate ◽  
Chronic Ankle Instability ◽  
Balance Test ◽  
Eyes Closed ◽  
Eyes Open

Abstract Background and Aims Ankle proprioception can be tested in many ways. Some studies have found improvements in individuals with chronic ankle instability after receiving treatment and training proprioceptive acuity and speed. Currently, there is a scarcity of evidence concerning percutaneous neuromodulation. The first findings were reported in the post-surgical stage after total knee arthroplasty and in neural improvements and symptoms in patients with hyperactive bladder. Aim To evaluate the effectiveness of percutaneous neuromodulation on the tibial nerve for the improvement of various proprioception parameters in patients with chronic ankle instability. Material and Methods Five men (age: 24.8 ± 4.9 years; height: 1.78 ± 0.08 m; weight: 86 ± 9.8 kg) with chronic ankle instability, who regularly practiced sports activities participated in the present study. People who had undergone an injury in the previous three months were excluded from the speed. Currently, there is a scarcity of evidence concerning test before and immediately after percutaneous neuromodulation. A single leg balance test was performed with eyes open and closed, maintaining the single-legged position on a force plate during 30 seconds (Accupower; AMTI, Watertown, MA) registering 1000 Hz. The displacement of the center of pressure (DOT) was determined based on the distances of its antero-posterior axes (DOT_AP) and medio-lateral (DOT_ML). Furthermore, the amplitudes of anteroposterior and mediolateral displacement were evaluated (ACPap and ACPml). The posterior tibial nerve was stimulated under ultrasound guidance using a 100 Vpp current, with a pulse width of 250 μs and a repetition frequency of 2 to 10 Hz. The process was performed on three occasions during 30 seconds, with an intensity that was acknowledged by the patient but which did not go beyond a score of 3 in the visual analog scale (VAS). The means and standard deviations were calculated for all variables. The effect size was calculated establishing the confidence interval at 90% and the probability of the change being significant was qualitatively calculated. Results A decrease was found in the ACPap (Pre-test eyes open: 5.42 ± 0.62 and eyes closed: 15.99 ± 0.60; Post-test eyes open 4.05 ± 0.36 and eyes closed 10.33 ± 0.49) after the neuromodulation intervention on the tibial nerve. This was a significant change and a “possible” effect size was found in the closed eyes condition (-0.54; ± 0.72), according to Hopkins. For the remaining variables, no significant differences were observed. Conclusions A decreased displacement of the center of mass was found in the antero-posterior axis after performing the neuromodulation technique on the tibial nerve in patients with chronic ankle instability.

scholarly journals Modulation of the Fibularis Longus Hoffmann Reflex and Postural Instability Associated With Chronic Ankle Instability

2016 ◽  
Vol 51 (8) ◽  
pp. 637-643 ◽  
Author(s):  
Kyung-Min Kim ◽  
Joseph M. Hart ◽  
Susan A. Saliba ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Center Of Pressure ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Postural Instability ◽  
H Reflex ◽  
Reflex Modulation ◽  
Hoffmann Reflex ◽  
Eyes Closed ◽  
The Relationship

Context: Individuals with chronic ankle instability (CAI) present with decreased modulation of the Hoffmann reflex (H-reflex) from a simple to a more challenging task. The neural alteration is associated with impaired postural control, but the relationship has not been investigated in individuals with CAI. Objective: To determine differences in H-reflex modulation and postural control between individuals with or without CAI and to identify if they are correlated in individuals with CAI. Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 15 volunteers with CAI (9 males, 6 females; age = 22.6 ± 5.8 years, height = 174.7 ± 8.1 cm, mass = 74.9 ± 12.8 kg) and 15 healthy sex-matched volunteers serving as controls (9 males, 6 females; age = 23.8 ± 5.8 years, height = 171.9 ± 9.9 cm, mass = 68.9 ± 15.5 kg) participated. Intervention(s): Maximum H-reflex (Hmax) and motor wave (Mmax) from the soleus and fibularis longus were recorded while participants lay prone and then stood in unipedal stance. We assessed postural tasks of unipedal stance with participants' eyes closed for 10 seconds using a forceplate. Main Outcome Measure(s): We normalized Hmax to Mmax to obtain Hmax : Mmax ratios for the 2 positions. For each muscle, H-reflex modulation was quantified using the percentage change scores in Hmax : Mmax ratios calculated from prone position to unipedal stance. Center-of-pressure data were used to compute 4 time-to-boundary variables. Separate independent-samples t tests were performed to determine group differences. Pearson product moment correlation coefficients were calculated between the modulation and balance measures in the CAI group. Results: The CAI group presented less H-reflex modulation in the soleus (t26 = −3.77, P = .001) and fibularis longus (t25 = −2.59, P = .02). The mean of the time-to-boundary minima in the anteroposterior direction was lower in the CAI group (t28 = −2.06, P = .048). We observed a correlation (r = 0.578, P = .049) between the fibular longus modulation and mean of time-to-boundary minima in the anteroposterior direction. Conclusions: The strong relationship indicated that, as H-reflex amplitude in unipedal stance was less down modulated, unipedal postural control was more impaired. Given the deficits in H-reflex modulation and postural control in the CAI group, the relationship may provide insights into the neurophysiologic mechanism of postural instability.

scholarly journals Baseline Postural Control and Lower Extremity Injury Incidence Among Those With a History of Concussion

2020 ◽  
Vol 55 (2) ◽  
pp. 109-115
Author(s):  
Nicholas Murray ◽  
Emily Belson ◽  
Brian Szekely ◽  
Arthur Islas ◽  
Daniel Cipriani ◽  
...  
Keyword(s):  
Postural Control ◽  
Root Mean Square ◽  
National Collegiate Athletic Association ◽  
Injury Incidence ◽  
Mean Square ◽  
Logistic Regression Models ◽  
Eyes Closed ◽  
Complexity Index ◽  
Eyes Open ◽  
History Of

Context Lower extremity musculoskeletal (LEMSK) injury may be more prevalent among those with a history of sport-related concussion (SRC). Objective To investigate the relationship between baseline postural control metrics and the LEMSK injury incidence in National Collegiate Athletic Association Division I student-athletes with a history of SRC. Setting National Collegiate Athletic Association Division I athletes. Design Cohort study. Patients or Other Participants Of 84 total athletes (62 males), 42 had been previously diagnosed with an SRC, and 42 were matched controls based on age, sex, height, weight, and sport. Main Outcome Measure(s) During the preseason baseline evaluation, all participants performed 3 trials of eyes-open and eyes-closed upright quiet stance on a force platform. Medical charts were assessed for all the LEMSK injuries that occurred from preseason baseline to 1 year later. Center-of-pressure data in the anteroposterior and mediolateral directions were filtered before we calculated root mean square and mean excursion velocity; the complexity index was calculated from the unfiltered data. Factorial analysis-of-variance models were used to examine differences between groups and across conditions for root mean square; mean excursion velocity, complexity index, and tests of association to examine between-groups LEMSK differences; and logistic regression models to predict LEMSK. Results Concussion history and injury incidence were related in the SRC group (P = .043). The complexity index of the SRC group was lower with eyes closed (14.08 ± 0.63 versus 15.93 ± 0.52) and eyes open (10.25 ± 0.52 vs 11.80 ± 0.57) in the mediolateral direction than for the control participants (P &lt; .05). Eyes-open root mean square in the mediolateral direction was greater for the SRC group (5.00 ± 0.28 mm) than the control group (4.10 ± 0.22 mm). Logistic regression models significantly predicted LEMSK only in control participants. Conclusions These findings may suggest that LEMSK after SRC cannot be predicted from postural-control metrics at baseline.

scholarly journals Eyes-Open Versus Eyes-Closed Somatosensory Motor Balance in Professional Soccer Players With Chronic Ankle Instability: A Case-Control Study

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098360
Author(s):  
David Rodríguez-Sanz ◽  
Antonio García-Sánchez ◽  
Ricardo Becerro-de-Bengoa-Vallejo ◽  
Eva María Martínez-Jiménez ◽  
César Calvo-Lobo ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Balance Training ◽  
Chronic Ankle Instability ◽  
Soccer Players ◽  
Exercise Protocol ◽  
Eyes Closed ◽  
Professional Soccer ◽  
Before And After ◽  
Eyes Open ◽  
Open Versus

Background: Chronic ankle instability (CAI) is a condition defined by certain structural and functional deficits in the ankle joint complex after acute ankle injury. These deficits include pathological joint laxity, impaired postural control, and decreased strength and neuromuscular control. Purpose: To compare an eyes-open versus an eyes-closed balance training protocol in professional soccer players with CAI. Study Design: Cohort study; Level of evidence, 2. Methods: For this study, we evaluated 19 players from 2 professional soccer teams in Madrid, Spain, all of whom had CAI. Participants from both teams were randomly assigned to an eyes-open group (n = 9) or eyes-closed group (n = 10). All participants completed 4 weeks of a supervised exercise protocol consisting of 3 sessions per week. Members of both the eyes-open and eyes-closed groups performed the same exercise protocol in the same order of execution. At the end of the protocol, the participants were assessed for pain (visual analog scale), ankle dorsiflexion range of motion (weightbearing lunge test), dynamic stability (Star Excursion Balance Test), and fear of movement and reinjury (Tampa Scale for Kinesiophobia). We compared results both before and after balance training and between the eyes-open and eyes-closed balance training groups. Results: Statistically significant differences were found for all of the assessed variables before and after balance training. No statistically significant differences were found between the eyes-closed and eyes-open groups on any variable. Conclusion: In the current study, eyes-closed balance training was not more effective than eyes-open balance training for CAI in professional soccer players.

scholarly journals Balance Training and Center-of-Pressure Location in Participants With Chronic Ankle Instability

2015 ◽  
Vol 50 (4) ◽  
pp. 343-349 ◽  
Author(s):  
Abby Mettler ◽  
Lisa Chinn ◽  
Susan A. Saliba ◽  
Patrick O. McKeon ◽  
Jay Hertel
Keyword(s):  
Training Program ◽  
Center Of Pressure ◽  
Ankle Instability ◽  
Force Plate ◽  
Balance Training ◽  
Chronic Ankle Instability ◽  
Eyes Closed ◽  
Balance Task ◽  
Eyes Open ◽  
Data Points

Context Chronic ankle instability (CAI) occurs in some people after a lateral ankle sprain and often results in residual feelings of instability and episodes of the ankle's giving way. Compared with healthy people, patients with CAI demonstrated poor postural control and used a more anteriorly and laterally positioned center of pressure (COP) during a single-limb static-balance task on a force plate. Balance training is an effective means of altering traditional COP measures; however, whether the overall location of the COP distribution under the foot also changes is unknown. Objective To determine if the spatial locations of COP data points in participants with CAI change after a 4-week balance-training program. Design Randomized controlled trial. Setting Laboratory. Patients or Other Participants Thirty-one persons with self-reported CAI. Intervention(s) Participants were randomly assigned to a 4-week balance-training program or no balance training. Main Outcome Measure(s) We collected a total of 500 COP data points while participants balanced using a single limb on a force plate during a 10-second trial. The location of each COP data point relative to the geometric center of the foot was determined, and the frequency count in 4 sections (anteromedial, anterolateral, posteromedial, posterolateral) was analyzed for differences between groups. Results Overall, COP position in the balance-training group shifted from being more anterior to less anterior in both eyes-open trials (before trial = 319.1 ± 165.4, after trial = 160.5 ± 149.5; P = .006) and eyes-closed trials (before trial = 387.9 ± 123.8, after trial = 189.4 ± 102.9; P &lt; .001). The COP for the group that did not perform balance training remained the same in the eyes-open trials (before trial = 214.1 ± 193.3, after trial = 230.0 ± 176.3; P = .54) and eyes-closed trials (before trial = 326.9 ± 134.3, after trial = 338.2 ± 126.1; P = .69). Conclusions In participants with CAI, the balance-training program shifted the COP location from anterolateral to posterolateral. The program may have repaired some of the damaged sensorimotor system pathways, resulting in a more optimally functioning and less constrained system.

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