Neurocognitive Enrichment During Functional Performance Testing in Chronic Ankle Instability

Overview

Chronic ankle instability (CAI) is associated with recurrent ankle sprains, impaired postural control, and reduced functional performance. Traditional functional performance tests are commonly used to assess athletes with CAI; however, these assessments are typically conducted under isolated motor conditions and may not adequately reflect the neurocognitive demands encountered during sports participation. The aim of this randomized crossover study is to investigate the acute effects of neurocognitively enriched testing conditions on balance and functional performance in athletes with CAI. Participants will perform functional performance tests under four different conditions: standard testing, internal focus of attention, external focus of attention, and cognitive dual-task conditions. Dynamic balance, vertical jump performance, single-leg hop performance, figure-of-8 hop performance, and dual-task cost will be assessed and compared across conditions. The findings of this study may contribute to the development of more ecologically valid assessment approaches for athletes with CAI and provide insights into the influence of attentional focus and cognitive load on functional performance.

Chronic ankle instability (CAI) is a common consequence of lateral ankle sprains and is characterized by recurrent episodes of giving way, repeated sprains, impaired sensorimotor control, and persistent functional limitations. Although functional performance tests are widely used to assess readiness for sports participation and return-to-sport status, these assessments are typically performed under isolated motor conditions and may not adequately represent the complex neurocognitive demands encountered during athletic activities. Recent evidence from motor learning and sports medicine literature suggests that attentional focus strategies and cognitive loading can substantially influence movement performance, postural control, and motor execution. Internal focus of attention directs individuals toward body movements and joint positions, whereas external focus of attention emphasizes movement outcomes and environmental effects. In addition, dual-task paradigms introduce cognitive demands that may alter motor performance by increasing attentional load and competing for cognitive resources. Understanding how these neurocognitive factors influence functional performance may provide valuable information for the assessment and management of athletes with CAI. The present study aims to examine the acute effects of neurocognitively enriched testing conditions on balance and functional performance in athletes with CAI. By comparing performance under standard testing, internal focus, external focus, and cognitive dual-task conditions, the study seeks to determine whether commonly used functional performance tests are sensitive to variations in attentional focus and cognitive load. This investigation is expected to contribute to a better understanding of the interaction between cognitive processes and motor performance in athletes with CAI. The findings may support the development of more ecologically valid assessment strategies and provide clinically relevant information for rehabilitation planning, functional evaluation, and return-to-sport decision-making in athletic populations with chronic ankle instability.