Balance Performance With and Without Visual Information: A Comparison of Elite Players With Chronic Ankle Instability

Introduction: This research was conducted to determine whether professional athletes with Chronic Ankle Instability (CAI) exhibit differences in maintaining balance under conditions of with and without visual information Materials and Methods: Forty-five elite players with CAI were classified into soccer, volleyball, and basketball groups (n=15 each). All participants performed a static single-leg balance test in conditions wherein visual information was provided and withheld. Also, their center of pressure (CoP) oscillation parameters was measured. The data were examined through an analysis of variance (ANOVA) and the Tukey test. Results: A significant difference was found between the soccer and volleyball players (P=0.034) in anteroposterior CoP displacement. Furthermore, there was a significant difference between soccer compared with volleyball (P=0.001) and basketball (P=0.02) groups regarding mediolateral sway and sway area (P=0.003 and P=0.03, respectively) when they performed the test with their eyes open. A significant difference occurred between the soccer and volleyball players concerning anteroposterior and mediolateral sway (P=0.002 and P=0.04, respectively) and sway area (P=0.004) when they performed the test with their eyes closed. Conclusion: Given the necessity of maintaining a good balance in sports, volleyball coaches should design practices that reduce players’ reliance on visual information. These practices should strengthen their proprioceptive abilities through an increased challenge to their proprioceptive senses.

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

Revista Fisioterapia Invasiva ◽

10.1055/s-0039-3401876 ◽

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.

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

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.94 ◽

2015 ◽

Vol 50 (4) ◽

pp. 343-349 ◽

Cited By ~ 17

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 < .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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Rehabilitation for Chronic Ankle Instability With or Without Destabilization Devices: A Randomized Controlled Trial

Journal of Athletic Training ◽

10.4085/1062-6050-51.3.09 ◽

2016 ◽

Vol 51 (3) ◽

pp. 233-251 ◽

Cited By ~ 35

Author(s):

Luke Donovan ◽

Joseph M. Hart ◽

Susan A. Saliba ◽

Joseph Park ◽

Mark Anthony Feger ◽

...

Keyword(s):

Center Of Pressure ◽

Ankle Instability ◽

Controlled Trial ◽

Neuromuscular Control ◽

Chronic Ankle Instability ◽

Rehabilitation Program ◽

Balance Test ◽

Randomized Controlled ◽

Eyes Closed ◽

Lower Extremity Muscle

Individuals with chronic ankle instability (CAI) have deficits in neuromuscular control and altered movement patterns. Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function.Context: To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function, range of motion (ROM), strength, and balance than rehabilitation without devices in patients with CAI.Objective: Randomized controlled clinical trial.Design: Laboratory.Setting: A total of 26 patients with CAI (7 men, 19 women; age = 21.34 ± 3.06 years, height = 168.96 ± 8.77 cm, mass = 70.73 ± 13.86 kg).Patients or Other Participants: Patients completed baseline measures and were randomized into no-device and device groups. Both groups completed 4 weeks of supervised, impairment-based progressive rehabilitation with or without devices and then repeated baseline measures.Intervention(s): We assessed self-reported function using the Foot and Ankle Ability Measure. Ankle ROM was measured with an inclinometer. Ankle strength was assessed using a handheld dynamometer during maximal voluntary isometric contractions. Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance. We compared each dependent variable using a 2 × 2 (group × time) analysis of variance and post hoc tests as appropriate and set an a priori α level at .05. The Hedges g effect sizes and associated 95% confidence intervals were calculated.Main Outcome Measure(s): We observed no differences between the no-device and device groups for any measure. However, both groups had large improvements in self-reported function and ankle strength.Results: Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions resulted in similar improvements. Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI.Conclusions:

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Influence of Foot Progression Angle on Center of Pressure During Stair Ascending in Subjects With Chronic Ankle Instability

International Journal of Biology and Biomedical Engineering ◽

10.46300/91011.2021.15.42 ◽

2021 ◽

Vol 15 ◽

pp. 350-354

Author(s):

Jung-Hyun Ban ◽

Tae-Ho Kim

Keyword(s):

Center Of Pressure ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Foot Progression Angle ◽

Significant Difference ◽

The Stability ◽

Neutral Posture ◽

Criteria For Selection ◽

Anterior Posterior ◽

Selection Of

The purpose of this study was to identify changes in the center of pressure during stair ascending in subjects with chronic ankle instability while different angles of foot are applied. The subjects of this study were 20 male and female adults with chronic ankle instability were selected from among the employees of D Hospital in Daegu Metropolitan City. The criteria for selection of subjects with chronic ankle instability were those who felt wobbling in the ankle joint and scored not higher than 24 points in a test using the Cumberland Ankle Instability Tool (CAIT). The subjects carried out stair ascending in neutral, toe-in and toe-out postures, respectively, and changes in the center of pressure (COP) were compared and analyzed. The results of this study, no statistically significant difference appeared in the comparison between the toe-in posture and neutral posture or between the neutral posture and the toe-out posture but medial/lateral movements of the center of pressure showed significant differences between the toe-in and toe-out postures. In addition, the total travel range and the moving range of the center of pressure, the average velocity, and the anterior/posterior movements of the center of pressure showed no statistically significant difference among all three postures. As a result, it could be seen that when adults with chronic ankle instability climb the stairs, the toe-in posture reduce the medial/lateral movements of the center of pressure thereby increasing the stability of the ankle and effectively preventing re-injuries.

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Evaluation of Standing Balance Performance in Indian Classical Dancers

Journal of Dance Medicine & Science ◽

10.12678/1089-313x.24.1.19 ◽

2020 ◽

Vol 24 (1) ◽

pp. 19-23

Author(s):

Juhi K. Bharnuke ◽

Rajani P. Mullerpatan ◽

Claire Hiller

Keyword(s):

Dual Task ◽

Center Of Pressure ◽

Standing Balance ◽

Balance Performance ◽

Classical Dance ◽

Eyes Closed ◽

Eyes Open ◽

Second Dual ◽

Indian Classical Dance ◽

Base Of Support

Indian classical dance involves a constant change of the base of support from stance to low jumps and spins along with intricate footwork. Graceful movement of the torso, shifting from side to side and turning around the axis of the spine, challenges balance. Yet, balance performance remains unexplored in Indian classical dancers. Therefore, the present study aimed to compare the standing balance of 36 active female dancers (18 to 25 years of age) who had performed Indian classical dance for a minimum of 10 years with 36 healthy age-matched women not involved in regular physical activity. Balance was evaluated in static and dynamic conditions of single and dual-limb stance on a force plate using center-of-pressure trajectory and the Star Excursion Balance Test (SEBT). Dancers demonstrated better balance on both instrumented and non-instrumented outcome variables: wide base of support with eyes open and with eyes closed; for 30-second single limb stance with eyes open and with eyes closed; for 13-second dual task in single limb stance; and for 22-second dual task in wide base of support. The SEBT revealed significantly better balance performance of dancers in the three directions tested: anterior, posteromedial, and posterolateral. There was also a strength component of the study on which the dancers achieved significantly higher scores than controls for the three muscle groups tested (gastrocsoleus, gluteus medius, and quadriceps), which can be attributed to their training. These findings can be used to recommend classical dance training to achieve the dual purpose of deriving better balance and stronger bodies and maintaining the Indian dance heritage.

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

Journal of Athletic Training ◽

10.4085/1062-6050-52.4.02 ◽

2017 ◽

Vol 52 (7) ◽

pp. 629-635 ◽

Cited By ~ 8

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 > .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.

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Static Balance in Patients with Vestibular Impairments: A Preliminary Study

Scientifica ◽

10.1155/2016/6539858 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Hossein Talebi ◽

Mohammad Taghi Karimi ◽

Seyed Hamid Reza Abtahi ◽

Niloofar Fereshtenejad

Keyword(s):

Path Length ◽

Center Of Pressure ◽

Balance Control ◽

Force Plate ◽

Static Balance ◽

Eyes Closed ◽

Significant Difference ◽

Eyes Open ◽

Age Limits ◽

The Difference

Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments.Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50±7). We evaluated excursion and velocity of center of pressure (COP) and path length in anteroposterior (AP) and mediolateral (ML) planes with eyes open and with eyes closed.Results. There was no significant difference between COP excursions in ML and AP planes between both groups with eyes open and eyes closed (pvalue > 0.05). In contrast, the difference between velocity and path length of COP in the mentioned planes was significant between both groups with eyes open and eyes closed (pvalue < 0.05).Conclusions. The present study showed the static instability and balance of patients with vestibular impairments indicated by the abnormal characteristics of body balance.

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The Cut-Off Score of Four Clinical Tests to Quantify Balance Impairment in Individuals with Chronic Ankle Instability

Malaysian Journal of Medical Sciences ◽

10.21315/mjms2021.28.4.9 ◽

2021 ◽

Vol 28 (4) ◽

pp. 87-96

Author(s):

Nontawit Udompanich ◽

Kanok-on Thanasootr ◽

Raoyrin Chanavirut ◽

Uraiwan Chatchawan ◽

Torkamol Hunsawong

Keyword(s):

Roc Curve ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Youden Index ◽

Clinical Tests ◽

Balance Performance ◽

Operating Characteristics ◽

Balance Test ◽

Balance Impairment ◽

Hop Test

Background: Balance impairment is a common consequence of chronic ankle instability (CAI). This study aimed to assess the discriminative validity of four clinical tests for quantifying balance impairment in individuals with CAI. Methods: Participants were screened for their balance using the single-leg balance test (SLBT) and were assigned to either the positive or the negative SLBT groups. Fifty-four individuals with CAI (N = 27 per group) were recruited and completed four clinical tests including the foot-lift test (FLT), the time-in-balance test (TIBT), the modified star excursion balance test in the posteromedial (mSEBT-PM) direction and the side-hop test (SHT). The receiver operating characteristics (ROC) curve coupled with Youden index were calculated to determine the optimal cut-off scores of each test. Results: We found significant differences in balance between groups for all tests, with good to excellent values for the area under the ROC curve (AUC). All four tests reached good to excellent sensitivity and specificity values and had significant cut-off scores to discriminate balance performance among CAI participants. Conclusion: All four clinical tests can be conducted with their respective cut-off scores to quantify balance impairment in individuals with CAI.

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

International Journal of Sports Medicine ◽

10.1055/a-0608-4552 ◽

2018 ◽

Vol 39 (08) ◽

pp. 625-629 ◽

Cited By ~ 1

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.

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

Journal of Sport Rehabilitation ◽

10.1123/jsr.2012-0125 ◽

2014 ◽

Vol 23 (1) ◽

pp. 18-26 ◽

Cited By ~ 17

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.

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