The primary aim of this study is to evaluate the immediate and short-term effects of the Graded Motor Imagery (GMI) method on individuals with chronic ankle instability (CAI). In this context, the effects of the Graded Motor Imagery intervention on pain level, muscle stiffness, muscle strength, functional performance, and subjective instability level will be investigated. Additionally, these effects will be comparatively analyzed with an age- and sex-matched control group consisting of healthy individuals.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
48
The Graded Motor Imagery (GMI) program will be applied six consecutive days nd will consist of three progressive stages: Laterality Training: Participants will perform right-left ankle discrimination tasks using validated foot and ankle images. Accuracy and response time will be recorded. Motor Imagery: Participants will mentally rehearse ankle movements such as dorsiflexion, plantarflexion, inversion, and eversion without performing the motion. Imagery tasks will progress from simple movements to functional patterns based on tolerance. Mirror Therapy: A mirror will be placed in the midsagittal plane, allowing participants to view the reflection of the non-affected ankle while performing movements. The visual illusion of normal movement is intended to improve motor control and proprioception.
İstanbul Üniversitesi-Cerrahpaşa
Istanbul, Turkey (Türkiye)
RECRUITINGSubjective Instability (CAIT)
A valid-reliable questionnaire that questions the perceived instability in daily life and sports activities. Clinical Significance: ≥ 3 point increase is considered clinically significant
Time frame: baseline
Subjective Instability (CAIT)
A valid-reliable questionnaire that questions the perceived instability in daily life and sports activities. Clinical Significance: ≥ 3 point increase is considered clinically significant
Time frame: 1-week post-intervention
Ground Reaction Force & Static Balance (ForceDecks)
Device: ForceDecks dual force platform. 1. Single-Leg Jump Test\* Values: Net vertical ground reaction force (N·kg-¹), flight time (ms), asymmetry (%). 2. Single-Leg Static Balance\* Values: Total sway path (mm), ellipse area (mm²). Clinical Importance:\* Captures short-term changes in neuromuscular control and explosive strength in a detailed manner.
Time frame: baseline
Ground Reaction Force & Static Balance (ForceDecks)
Device: ForceDecks dual force platform. 1. Single-Leg Jump Test\* Values: Net vertical ground reaction force (N·kg-¹), flight time (ms), asymmetry (%). 2. Single-Leg Static Balance\* Values: Total sway path (mm), ellipse area (mm²). Clinical Importance:\* Captures short-term changes in neuromuscular control and explosive strength in a detailed manner.
Time frame: 1-week post-intervention
Muscle Stiffness (Myoton PRO)
Tonic stiffness (N·m-¹) reflects the passive mechanical properties of muscle tissue. The device applies a 0.4 N mechanical impulse to the skin and records the resulting tissue oscillation response. In this study, data will be recorded as the average of 3 impulses. Clinical Importance: Acute changes in stiffness are considered an indirect indicator of neuroplastic responses in proprioception and motor control.
Time frame: baseline
Muscle Stiffness (Myoton PRO)
Tonic stiffness (N·m-¹) reflects the passive mechanical properties of muscle tissue. The device applies a 0.4 N mechanical impulse to the skin and records the resulting tissue oscillation response. In this study, data will be recorded as the average of 3 impulses. Clinical Importance: Acute changes in stiffness are considered an indirect indicator of neuroplastic responses in proprioception and motor control.
Time frame: 1-week post-intervention
Muscle Strength Assessment - Isokinetic dynamometer (Isoforce)
Parameter: Concentric inversion-eversion peak torque (Nm) at 60°·s-¹ Objectively measures agonist-antagonist muscle performance around the ankle joint. Clinical Significance:\* Improvements in strength contribute to functional stability and a reduced risk of re-injury.
Time frame: baseline
Muscle Strength Assessment - Isokinetic dynamometer (Isoforce)
Parameter: Concentric inversion-eversion peak torque (Nm) at 60°·s-¹ Objectively measures agonist-antagonist muscle performance around the ankle joint. Clinical Significance:\* Improvements in strength contribute to functional stability and a reduced risk of re-injury.
Time frame: 1-week post-intervention
Pain Level
Visual Analog Scale (VAS, 0-10 cm): 0 = "no pain," 10 = "unbearable pain"; the participant marks the scale before and after the session.
Time frame: baseline
Pain Level
Visual Analog Scale (VAS, 0-10 cm): 0 = "no pain," 10 = "unbearable pain"; the participant marks the scale before and after the session.
Time frame: 1-week post-intervention
Functional Performance
Star Excursion Balance Test (SEBT) Parameter: Normalized reach distance in three primary directions (anteromedial, medial, posteromedial), expressed as a percentage of leg length. Clinical Significance: Assesses dynamic balance and lateral load-transfer capacity; asymmetries in individuals with chronic ankle instability (CAI) may serve as prognostic indicators.
Time frame: baseline
Functional Performance
Star Excursion Balance Test (SEBT) Parameter: Normalized reach distance in three primary directions (anteromedial, medial, posteromedial), expressed as a percentage of leg length. Clinical Significance: Assesses dynamic balance and lateral load-transfer capacity; asymmetries in individuals with chronic ankle instability (CAI) may serve as prognostic indicators.
Time frame: 1-week post-intervention
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