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

Cairo University45 enrolled

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

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Cognitive Training

Interventions

strengthening exercisesOTHER

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.

Balance trainingOTHER

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. The time spent correctly tracking the target is measured and analyzed across all protocols.

Functional core trainingOTHER

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.

Spinal motor control (stabilization) exercisesOTHER

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 movements that integrate spine control with extremity movements. Key exercises include lunges with a medicine ball, squats, and various plank variations, emphasizing co-contraction of core muscles for stability during movements.

Cognitive trainingOTHER

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 correctly recalled digits, and error scoring will be documented via video recording for each posture task.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 30 Years

Medical Language ↔ Plain English

Inclusion Criteria: Inclusion criteria will be based on the standard criteria outlined by the International Ankle Consortium 1. 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. 2. 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

Outcomes

Primary Outcomes

assessment of change of pain

Ankle pain will be evaluated using the Arabic version of the Cumberland Ankle Instability Tool, which consists of questions that the patient must answer to reflect their condition. The scoring ranges from 0 to 30, with 0 indicating severe instability and 30 indicating normal stability. A score below 24 suggests Chronic Ankle Instability as defined by the International Ankle Consortium