Balance, Chronic Ankle Instability, Neurocognitive
Conditions
Keywords
Cognitive Load, Ankle Instability, RBT
Brief summary
Aim: This study aimed to investigate the effects of neurocognitive training on pain, proprioception, injury-related fear, functional, and neurocognitive performance in athletes with chronic ankle instability (CAI). Materials and Methods: A total of 30 athletes with CAI, with a mean age of 11.10±1.06 years and residing in Balıkesir, were included in the study. Participants were randomly assigned into two groups using simple randomization: the intervention group (n=15) and the control group (n=15). Two participants from the control group were excluded from the final analyses due to missing post-intervention assessments. The intervention group received a neurocognitive training program conducted twice a week for four weeks, following an initial familiarization week. The training was progressively administered on flat ground, balance mat, BOSU, and inverted BOSU. Both groups were evaluated before and after the 4-week intervention using the following measures: the Identification of Functional Ankle Instability (IdFAI), the Cumberland Ankle Instability Tool (CAIT), pain intensity, proprioception, fear of re-injury, Y Balance Test (YBT), Side Hop Test, Reactive Balance Test (RBT), and Upper Extremity Choice Reaction Time Test. Results: The results were analyzed.
Interventions
OTHERNeurocognitive training group
Neurocognitive training is a rehabilitation approach that, unlike traditional treatment methods which primarily focus on improving physical performance, emphasizes cognitive functions and psychometric skills. It is a program developed by integrating motor learning strategies and cognitive challenges into neuromuscular training. These cognitive challenges include tasks requiring quick reactions, motor-motor or cognitive-motor tasks (dual-task), congruent and incongruent tasks, exercises involving mathematical calculations (working memory), and response inhibition tasks.
Sponsors
Balikesir University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
10 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
Aged between 10 and 18 years At least 2 years of active athletic participation History of ankle sprain with at least 2 inflammatory symptoms (e.g., pain, swelling) The most recent sprain occurred at least 3 months prior to the study start date A score of 11 or above on the FABIT (Simon et al., 2012) A score of ≤27 on the CAIT (Yin et al., 2022) Willingness to participate in the study
Exclusion criteria
History of hip/pelvis, knee, or ankle surgery within the past year History of ankle fracture Diagnosis of a neurological disorder Presence of vestibular disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Functional Ankle Instability Assessment Using the Identification of Functional Ankle Instability Questionnaire (IDFAI) | from the beginning of the study until the end of the 4th week | The IDFAI is a self-reported questionnaire consisting of 9 items designed to identify the presence and severity of functional ankle instability. Scores range from 0 to 37, with higher scores indicating greater instability. A score above 11 suggests the presence of instability. Scores are unitless numeric values representing the severity of symptoms and frequency of ankle sprains. |
| Functional Ankle Instability Evaluation Using the Cumberland Ankle Instability Tool (CAIT) | from the beginning of the study until the end of the 4th week | The CAIT is a self-assessment tool with 9 items measuring subjective ankle instability. Scores range from 0 (severe instability) to 30 (no instability). A score of 27 or below indicates functional ankle instability. The score is a unitless numeric value that reflects the level of perceived instability and risk of recurrent sprains. |
| Pain Severity Assessment-Visual Analog Scale (VAS) | from the beginning of the study until the end of the 4th week | The Visual Analog Scale (VAS) is a 10 cm line ranging from No pain to Worst imaginable pain. Participants mark their pain intensity on the line, which is measured in centimeters to quantify pain severity. This unitless numeric score reflects pain intensity at rest, during training, and post-training in ankles with instability history. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Dynamic Balance Evaluation Using the Y Balance Test (YBT) | from the beginning of the study until the end of the 4th week | YBT measures dynamic balance in three directions: anterior, posteromedial, and posterolateral. The composite score is calculated as (sum of three reach distances) / (3 x limb length) × 100, yielding a percentage. Higher percentages reflect better dynamic balance and postural control. |
| Functional Performance Assessment with the Lateral Hop Test | from the beginning of the study until the end of the 4th week | Participants perform 10 lateral hops over a 30 cm distance on the affected limb as fast as possible. The shortest completion time of two trials, measured in seconds, is recorded. Lower times indicate better functional performance and ankle stability. |
| Proprioception Assessment with Reposition Test (Ankle Dorsiflexion and Plantarflexion Angles) | from the beginning of the study until the end of the 4th week | Joint Position Sense test evaluates proprioception by measuring the accuracy of reproducing a passively positioned joint angle. The ankle dorsiflexion is set at 10°, and plantarflexion at 20°. The difference between target and reproduced angles is measured in degrees using a goniometer. Lower angular deviation indicates better proprioceptive accuracy. |
| Upper Extremity Choice Reaction Time Test | from the beginning of the study until the end of the 4th week | Participants sit with dominant hand ready to press LED lights arranged on a table. Lights illuminate randomly every 0.5-2.5 seconds. Reaction time (milliseconds) and accuracy (number of correct responses) over one minute are recorded. This test evaluates selective attention and cognitive-motor processing speed. |
| Reactive Balance Performance Using the Reactive Balance Test (RBT) with LED Light System | from the beginning of the study until the end of the 4th week | RBT combines YBT setup with a smartphone-connected LED system. Participants respond to randomly illuminated lights by touching them quickly without losing balance. Performance metrics include visual-motor reaction time (milliseconds) and accuracy percentage. Two trials are conducted; the second trial is recorded for analysis. Lower reaction times and higher accuracy indicate better reactive balance. |
| The Sport Injury Anxiety Scale (SIAS) | from the beginning of the study until the end of the 4th week | The Sport Injury Anxiety Scale (SIAS) was developed to assess the level of anxiety athletes experience after injury. The Turkish adaptation, validity, and reliability study of the scale was conducted by Caz et al. (2019) with university students participating in amateur sports. An increase in the average score obtained from the scale indicates a higher level of injury-related anxiety (Caz et al., 2019). |
| Postural Stability Measurement Using Multireha Portable Balance Device (Sway in Millimeters During Single-Leg Stance) | from the beginning of the study until the end of the 4th week | Using the Multireha portable balance device, postural stability is assessed by measuring the average sway in millimeters in anterior, posterior, medial, and lateral directions during a single-leg stance on the unstable ankle side. Two trials of 30 seconds are conducted. Lower sway values indicate better postural stability. |
Countries
Turkey (Türkiye)
Outcome results
None listed