Full length articleAttentional Demands of Postural Control in Chronic Ankle Instability, Copers and Healthy Controls: A Controlled Cross-sectional Study
Introduction
Lateral ankle sprain is one of the most common lower extremity injuries, particularly in physically active populations [1]. A large percent of individuals experiencing a lateral ankle sprain may have residual symptoms, such as pain, swelling and giving way for more than one year post injury, which is known as chronic ankle instability (CAI) [2]. Functional impairments associated with CAI decrease an individual's activity level over the lifespan and potentially may lead to early onset degenerative changes in ankle joints [3]. Nevertheless, some individuals fully recover from sprain and experience no residual symptoms, which is known as "copers" [4].
It has been assumed that altered postural control is one of the factors attributed to CAI [5]. Postural control involves an interaction between sensory, cognitive and motor systems [6]. Previously, postural control was assumed to be an automatic task; however, dual task studies revealed the cognitive involvement required for postural control [7]. It has been indicated that attention demanding cognitive tasks influence postural control in individuals with CAI [7,8]. Although a recent systematic review has indicated that by placing a cognitive load on individuals with musculoskeletal injuries, motor performance is impaired [9], there is limited and conflicting information regarding the impact of performing a concurrent cognitive task on the postural control of CAI individuals [[7], [8], [9], [10]]. This controversy could be due to several factors such as relatively small sample sizes, different assessment tools, and discrepancies in the definition of CAI [5,9].
From a clinical standpoint, individuals with CAI experience recurrent episodes of giving way, despite rehabilitation, which could indicate the limited gain transfer of postural control trainings to daily activities. This incongruence might be due to the greater cognitive demands of daily functions compared to the controlled clinical setting [11].
Therefore, a better understanding of postural control strategies and attention requirements of dual task conditions in individuals with ankle sprain could aid clinicians to design suitable prevention and rehabilitation programs. Thereby, further research in this field is a high priority that may allow clinicians to make better clinical decisions on CAI and its rehabilitation.
To the best of the author’s knowledge, little is known about the role of postural–cognitive interaction during manipulation of visual inputs in both groups of individuals with CAI and copers. The present study aimed to evaluate and compare the effect of performing a concurrent cognitive task on the postural control of subjects with CAI, copers and the healthy group during performing single leg stance.
Section snippets
Materials and methods
This controlled cross-sectional study was conducted from spring 2016 through winter 2017 in the rehabilitation research laboratory of Iran University of Medical Sciences.
Results
The data from all variables followed normal distribution as evidenced by Shapiro-Wilks tests. For all three groups, the ICC ranged between 0.70 and 0.93 for COP area, range, sway index, and velocity. Table 1 presents a summary of the demographic characteristics of the groups.
There were no significant differences in demographic characteristics (age, gender and BMI) between the groups (P > 0.05), confirming proper matching of the groups.
Postural task performance
This is the first study assessing the dual task paradigm in CAI subjects, copers and healthy controls based on standard classification criteria. The results demonstrated that individuals with CAI, compared to the other groups, had more postural sway across all testing positions. Our results confirmed no significant difference between copers and healthy groups in any test condition, implying an appropriate compensatory mechanism for postural control in copers.
Postural control deficit in
Conclusion
Our findings confirm decrement of postural control and attentional self-regulation during single leg static stance in CAI clients. It seems that postural control in CAI patients requires greater attention, and this should be considered for rehabilitation.
Funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors declare that they have no conflict of interest.
Acknowledgments
The authors would like to thank Pezhman Lali and Shiva Sherafat for their help into design of Persian version of the auditory Strop test. The authors are also grateful to the volunteers whom participated in the study.
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Development, validity, and test-retest reliability of a new neurocognitive functional performance test: The choice-reaction hop test
2023, Physical Therapy in SportCitation Excerpt :The CRHT adds to a influx of other recently developed neurocognitive hop tests, however, none of which are based on a CAI-focused FPT (Farraye et al., 2022; Millikan et al., 2019; Ness et al., 2020; Simon et al., 2020). Recent work has highlighted the need to develop FPTs that incorporate neurocognitive components to better understand the functional deficits in patients with CAI (Burcal et al., 2019; Mohamadi et al., 2020; Peri et al., 2021; Rosen et al., 2021; Song et al., 2021). Patients with CAI demonstrate a variety of neurocognitive impairments including attention, visual memory, and visuomotor reaction time (Ness et al., 2020; Peri et al., 2021; Rosen et al., 2021; Song et al., 2021).