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ObjectiveTo compare the retest reliability and discriminant validity of dynamic postural stability indices for functional ankle instability (FAI) obtained by different algorithms based on acceleration signals at different positions of human body. MethodsFrom April to June, 2021, 21 subjects with unilateral FAI and 21 subjects with normal ankle were recruited. Three inertial sensors were attached to the waist points, knee and ankle positions. The ground reaction force (GRF) and kinematics data of the subjects in multi-direction single leg landing test were collected synchronously by 3D force plate and inertial sensors. The unbounded third order polynomial (UTOP) fitting method was used to calculate the stability time, and the root mean square was used to caculate the stability index. ResultsMost of the indicators calculated based on acceleration signal correlated with that based on GRF with low coefficient (|r| = 0.116 to 0.368, P < 0.05). The stability time and stability index based on the acceleration signals of different positions of human body showed low to high retest reliability (CMC 0.30 to 0.91). For the females, among the stability time based on acceleration signal, eleven indexes achieved average to very high discriminant validity (AUC = 0.702 to 0.942, P < 0.05); eight of the stability indexes reached general level of discriminant validity (AUC = 0.717 to 0.782, P < 0.05). No algorithms achieved good discriminant effect in male subjects. ConclusionBased on the acceleration signal of waist point in single-leg landing stability test, the stability time calculated by UTOP algorithm can evaluate the dynamic postural stability of female FAI patients with high discriminant validity and medium to high retest reliability.
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Objective:To investigate the immediate and short-term effects of virtual games on balance function in patients with functional ankle instability(FAI).Methods:Fifty-six FAI subjects from North China University of Science and Technology from September 2020 to December 2020 were selected by cruamberland ankle instability tool(CAIT). According to the computer random number method,the 56 subjects were randomly divided into the control group and the observation group with 28 subjects in each group,and the prospective cohort study method was used for this study. Control group accepted routine balance training,observation group based in the control group carries on the virtual game training. Before and immediately after intervention and 4 weeks after intervention,the static balance ability of subjects in the two groups was evaluated and compared by Tecnobody balance instrument,and the dynamic balance ability of subjects in the two groups was evaluated and compared by star excursion balance test(SEBT),and the CAIT score of subjects in the two groups was recorded and compared. The measurement data conforming to normal is expressed in xˉ ± s means independent sample t-test or paired t-test. χ2 test was used for counting data. Results:Immediately after intervention,the 8 directions of SEBT scores in the observation group are significantly improved compared with those before intervention: Anterior(69.06±7.57)% and (63.69±8.05)%, Anterolateral (61.14±6.68)% and (55.77±7.39)%, Lateral (67.71±7.99)% and (62.93±7.56)%, Posterolateral (76.43±6.98)% and (71.31±7.86)%, Posterior (75.45±6.78)% and (68.72±6.65)%, Posteromedial (79.13±8.09)% and (72.72±9.03)%, Medial(72.67±7.43)% and (65.67±8.16)%, Anteromedial (67.75±8.30)% and (63.18±8.95)% ( t values were 8.03, 11.88, 9.72, 6.43, 19.53, 9.36, 11.06 and 6.46, respectively; all P<0.001), and the observation group was significantly better than the control group (63.24±6.72)%, (55.41±7.74)%, (61.49±8.37)%, (70.02±6.81)%, (69.06±9.46)%, (72.41±7.20)%, (66.37±6.57)% and (62.15±6.89)%. There were significant differences between the two groups ( t values were 3.04, 2.97, 2.84, 3.47, 2.90, 3.28, 3.36 and 2.75, respectively; P values were 0.004, 0.004, 0.006, 0.001, 0.005, 0.002, 0.001 and 0.008,respectively). After 4 weeks of intervention,the static balance parameters in the observation group were significantly reduced compared with before intervention under the condition of opened eyes and closed eyes (open eyes: average AP speed of COP (24.68±6.85) mm/s and (27.57±7.15) mm/s,average ML speed of COP (26.25±6.20) mm/s and (30.61±6.99) mm/s, ellipse area of COP (915.75±356.08) mm and (1 286.54±530.05) mm, perimeter of COP (823.82±173.80) mm and (1 142.89±297.03) mm ( t values were 4.02, 3.09, 4.89 and 6.74, respectively; all P<0.001); closed eyes:average AP speed of COP (66.82±15.02) mm/s and (73.71±11.12) mm/s, average ML speed of COP (76.93±13.36) mm/s and (84.39±10.05) mm/s, ellipse area of COP (3 318.54±958.75) mm and (4 174.21±1 310.54) mm, perimeter of COP (2 156.96±665.80) mm and (2 817.75±528.22) mm ( t values were 3.23,3.29,4.95,5.02, respectively; P values were 0.003, 0.003,<0.001,<0.001,respectively). Average ML speed of COP (open eyes:(26.25±6.20) mm/s), ellipse area of COP (open eyes: (915.75±356.08) mm;closed eyes: (3 318.54±958.75) mm and perimeter of COP (open eyes: (823.82±173.80) mm; closed eyes: (2 156.96±665.80) mm) in the observation group were lower than those of the control group(30.68±9.81) mm/s, (1 137.25±423.27) mm, (3 973.36±1 306.61) mm, (1 038.79±242.90) mm, (2 603.43±703.81) mm, the differences were statistically significant ( t values were 2.02,2.12,2.14,3.81,2.44,respectively; P values were 0.049,0.039,0.037, <0.001,=0.018, respectively). After 4 weeks of intervention,the 8 directions of SEBT scores in both groups were significantly improved compared with those before intervention (Anterior:observation group (72.84±6.76)% and (63.69±8.05)%,control group (69.05±6.16)% and (62.96±6.56)%. Anterolateral:observation group (65.24±7.68)% and (55.77±7.39)%,control group (60.65±8.11)% and (54.65±8.98)%. Lateral: observation group(73.97±8.80)% and (62.93±7.56)%, control group (68.34±9.14)% and (61.24±9.42)%. Posterolateral: observation group (81.68±6.69)% and (71.31±7.86)%, control group (76.39±6.78)% and (69.74±8.11)%. Posterior: observation group (81.41±7.86)% and (68.72±6.65)%, control group (75.21±8.48)% and (68.45±9.96)%. Posteromedial: observation group (82.77±8.69)% and (72.72±9.03)%,control group (78.38±6.84)% and (72.36±7.34)%. Medial:observation group (77.47±7.85)% and(65.67±8.16)%, control group (72.66±6.93)% and (65.95±7.09)%. Anteromedial:observation group(73.33±8.91)% and (63.18±8.95)%, control group (68.35±6.53)% and (61.66±6.80)% ( t values were 14.19, 10.17, 12.71, 12.35, 12.32, 8.99, 11.38, 6.95, 12.66, 7.94, 9.54, 11.53, 11.89, 12.87, 11.69 and 12.53, respectively; all P<0.001)), and the observation group was significantly better than the control group,the differences were statistically significant ( t values were 2.19, 2.18, 2.35, 2.94, 2.84, 2.10, 2.43 and 2.38, respectively; P values were 0.033, 0.034, 0.023, 0.005, 0.006, 0.040, 0.018 and 0.021, respectively). After 4 weeks of intervention,the CAIT score of subjects in both groups was significantly improved compared with before intervention (observation group (18.89±3.62) points and (14.93±4.09) points,control group (16.96±3.18) points and (15.25±3.81) points ( t values were 10.54 and 5.65; all P<0.001), and The CAIT score in observation group was higher than that in control group,the differences were statistically significant ( t=2.12, P=0.039). Conclusion:Virtual games could immediately improve the dynamic balance ability of FAI patients,which combined with conventional balance training intervention for 4 weeks significantly also improved the balance ability and ankle joint stability of FAI patients.
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ObjectiveTo compare the effects of proprioceptive neuromuscular facilitation (PNF) and whole body vibration training (WBVT) on functional ankle instability (FAI). MethodsFrom May to July, 2021, 17 male FAI undergraduates from Beijing Sport University received PNF (n = 8) and WBVT (n = 9), for six weeks. They were assessed with Y-balance test, Pro-Kin, Kistler and Motion Analysis Raptor before and after invention, to observe Y-balance score, average trajectory error, kinematics and dynamics after jump-landing of affected limb. ResultsThe main effect of training was not significant for all the Y-balance score, average trajectory error, kinematics and dynamics (F < 4.090, P > 0.05). However, the interactive effect of training and time was significant for the range of motion of ankle flexion (F = 6.232, P = 0.030), and the effect size was more for PNF; it was also significant for the time arriving peak ground reaction force (left-right) after landing (F = 10.674, P = 0.008), and the time was latter for WBVT (P < 0.05). ConclusionPNF and WBVT are similarly effective on FAI.
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Objective To explore the effect of intensive hip adductor isometric strength training on the balance ability of functional ankle joint instability. Methods From November, 2019 to January, 2020, 18 college students with functional ankle instability were recruited from a university in Shenzhen and randomly divided into control group (n = 9) and experimental group (n = 9). Both groups received ankle stability training, and the experimental group received isometric muscle strength training of hip adductor in addition, one hour a time, three times a week, for four weeks. The Cumberland Ankle Instability Assessment Questionnaire (CAIT), Y Balance Test (YBT), Balance-check balance equipment and Back-check hip adductor maximum isometric strength test were performed before and after training. Results After training, the scores of CAIT, YBT and balance-check increased in both groups (t > 2.540, P < 0.05); the strength of adductor hip muscle significantly increased in the experimental group (t = 8.485, P < 0.001). The d-value of CAIT score, YBT distance, the score of Balance-check, and the strength of adductor hip muscle were more in the experimental group than in the control group (t > 2.168, P < 0.05); the d-value of the average rotation speed, the maximum rotation speed and the balance level were less in the experimental group than in the control group (t > 2.804, P < 0.05). Conclusion Hip adductor isometric muscle strength training may promote the recovery of the balance after functional ankle instability.
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Objective:To investigate the effect of strength training of hip muscles on functional ankle instability (FAI), and be evaluated with surface electromyography (sEMG). Methods:From January, 2019 to June, 2020, 60 FAI patients were recruited in Qingdao Municipal Hospital. They were divided into control group (n = 30) and observation group (n = 30) randomly. The control group received conventional therapy, including ankle joint mobilization training, strength training and balance training for six weeks, while the observation group received strength training of hip muscles in addition. Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT) and sEMG were used to assess the function before and after intervention, and integrated electromyography (iEMG) was measured with sEMG. The correlation of CAIT and SEBT to iEMG was analyzed with Pearson coefficient. Results:No one dropped out. Before intervention, there was no significant difference between CAIT, SEBT and iEMG between two groups (P > 0.05). CAIT and SEBT improved significantly in both groups (t > 3.657, P < 0.001) after six-week intervention; the iEMG increased significantly in the observation group (t > 22.038, P < 0.001), while no significance was found in the control group (t < 1.916, P > 0.05); all the indexes were better in the observation group than in the control group (t > 2.125, P < 0.05). iEMG of gluteus medius and gluteus maximum correlated to CAIT and SEBT in the observation group (r = 0.712 to 0.866, P < 0.05). Conclusion:The strength training of the hip muscles could improve the ankle function of FAI patients. iEMG of gluteus medius and gluteus maximum could be a valid measure to assess the effect of strength training on FAI.
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@#Introduction: This study was designed to produce a validated and reliable Malay version of the Identification of Functional Ankle Instability (IdFAI-M) questionnaire. Materials and method: The cross-cultural adaptation was conducted based on standard guidelines to produce the Malay version of the Identification of Functional Ankle Instability (IdFAI-M) questionnaire. The reliability and validity testing were then performed among one hundred and twenty-three physically active University of Malaya students. Among them, twenty-two students also participated in the second return of the questionnaire over a two-week interval, which was then evaluated for test-retest reliability testing. Results: The content validity for item-level (I-CVI) and Kappa values for all items were more than 0.7, respectively and the all scales-level (S-CVI) values were 0.983 (consistency), 0.967 (representativeness), 1.00 (relevance) and 0.983 (clarity). The questionnaire also demonstrated excellent reliability with an intraclass correlation coefficient (ICC2.1) above 0.850 for all items. It was observed that outer loading of most items were more than the minimum acceptable value (0.7). Fornell-Larcker criterion demonstrate all values for each reflective construct was larger than the correlations with other constructs, indicating discriminant. The cross-loading values of each item has shown a weak correlation with all other constructs, except for the one to which it was theoretically associated. Conclusions: The Malay version of the IdFAI (IdFAI-M) is a reliable and valid instrument that can be readily utilised to subjectively assess ankle instability.
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Objective To study the effect of vibration training with adjusted frequency on changes in explosive force of lower limbs, balance and muscle function around ankle joints of patients with functional ankle instability (FAI), so as to provide an empirical basis for rehabilitation training of FAI patients in clinic. Methods Twenty-six FAI patients were randomly divided into the experimental group (n=14) and the control group (n=12). The experimental group received 8-week rehabilitation training with vibration intervention, while the control group only received 8-week rehabilitation training. Changes in maximum power, average power, maximum speed and average speed of the injured limb during vertical jump with single leg, changes in distances during long jump, changes in time during one-leg standing with eyes open and closed，changes in contract time (tc), relax time (tr) and displacement (Dm) of medial gastrocnemius (GM), lateral gastrocnemius (GL) and tibialis anterior (TA) muscles before and after training were measured and compared. Results In the experimental group, the maximum power and maximum speed of the injured limb during vertical jump with single leg, the distance during long jump with single leg and the time during one-leg standing with open and closed eyes were significantly improved, and the increase was higher than that of the control group. The increase of tc of all muscles in the experimental group was smaller than that of the control group, but tr and Dm did not show any regularity. Conclusions Vibration training with adjusted frequency can effectively improve the explosive force and balance ability of lower limbs of FAI patients, and promote the tc shortening of GL, GM and TA muscles, but whether vibration training with adjusted frequency can reduce muscle tension and promote muscle relaxation is still not clear.
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Objective To explore the static postural balance in individuals with or without functional ankle instability (FAI)by identifying and quantifying the spatial characteristics of center of pressure (COP),as well as rambling and trembling trajectory properties.Methods Twelve FAI patients was selected into the FAI group,while another 14 healthy students were chosen into the control group.The single-leg standing test with and without vision was conducted on the unstable side of the FAI group and the non-dominant side of the control group 3 trials with each trial lasting 30 s.The displacement of COP and the time and frequency domain of rambling and trembling were analyzed and compared between the two groups.Results There was no significant difference in the displacement of COP with opened eyes(P＞0.05).The area and the anterior-posterior length of COP of the FAI group were larger than those of the control group with eyes closed (P＜0.05).For the rambling and trembling trajectory,no significant differences were found in all the time domains between the two groups with eyes open or closed(P＞0.05),except the mean sway amplitude(MSA)(P＜0.05).Moreover,the mean square root and standard deviation of MSA of the FAI group were significantly bigger than the control group(P＜ 0.05).Significant differences were found in the MSA frequency between open and closed eyes(P＞0.05),but not between the FAI and control groups(P＜0.05).Conclusions The FAI patients are weaker than healthy people not only in the peripheral control,but also in the central control of the static postural balance.Therefore,injuries in the central neural system must also be considered when analyzing the reason for FAI.The imbalance of the FAI patients can be avoided by opening eyes.
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This article reviewed the mechanism of functional ankle instability and the progress in the diagnosis and screening of functional ankle instability using self-reported measures. The subjects with functional ankle instability demonstrated def-icits in ankle joint proprioception, muscle strength, peroneal reaction time and postural stability. The self-reported mea-sures had been widely used as diagnostic and screening methods. It is recommended to use Ankle Instability Instrument or Cumberland Ankle Instability Tool with investigation of ankle injury as selection criteria for patients with functional ankle instability.
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Objective To observe the effect of strengthening training of hip muscles on functional ankle instability (FAI). Methods From May, 2015 to June, 2016, 40 patients with FAI were randomly divided into control group (n=20) and observation group (n=20). Both groups were treated with routine exercise training including muscle strength and proprioceptive training of the ankle joint, while the treat-ment group received hip muscle strength training in addition, for six weeks. They were evaluated with hip force assessment, postural stabili-ty assessment, Star Excursion Balance Test (SEBT) and Cumberland Ankle Instability Tool (CAIT). Results There was no significant differ-ence in all the indexes between two groups before treatment (P>0.05). After treatment, the peak torques of hip muscles increased in the ob-servation group (t>3.528, P<0.01);the overall stability index, anteroposterior stability index, middle-lateral stability index decreased in both groups (t>2.360, P<0.05);the distance of eight direction in SEBT increased in both groups (t>2.254, P<0.05);the score of CAIT increased in both groups (t>3.268, P<0.01). All the above indexes were better in the observation group than in the control group (t>2.161, P<0.05). Conclusion Strengthening training of hip muscle, based on conventional ankle muscle strength and proprioceptive training, could facilitate to improve FAI.
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Objective: To investigate the assessment of patients with functional ankle instability prior to and post of regular rehabilitation therapies. Methods: One hundred and twenty-four patients with unilateral chronic ankle instability (51 females and 73 males, age 34-56) were received conventional rehabilitation for two month, including muscle strength, range of joint motion, balance, proprioception, etc. The visual analogue scale (V AS) scores (instant pain and pain after 500-meter walk) were recorded. Standing time of affected limb, the star excursion balance test, static and dynamic plantar pressure were performed. Results: There were significant differences in VAS pain score of instant pain (5. 32 ±0.27 vs 1. 07 ± 0. 08) and after 500 meter walk (8. 79 ± 1. 78 vs 4. 51 ± 1. 78) (P 0. 05). Conclusion: Rehabilitation therapy can significantly improve the pain-release, the balance, etc. However, the effect on the dynamic response is not accurate. Thus, the abnormal of walking posture, the biomechanics of the foot and ankle, and biomechanics of functional ankle instability should be considered during the rehabilitation treatment.
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Objective To study the effects of different types of ankle brace on human body static postural stability.Method Ten male subjects with unilateral functional ankle instability (FAI)were enrolled in the study.The FlexiForce pressure control system was used to control the pressure on the ankles when wearing the soft brace.The static postural stability without braces as well as with soft and semi-rigid braces was measured using WIN-POD system.Results (1)In eye-open testing,no significant difference was found in indexes of COP sway between wearing or not wearing braces (P＞0.05).Compared with wearing semi-rigid brace,significant increase was observed in the average X dev when wearing soft braces (P＜0.05).(2)In eye-close testing,no significant differences were found in COP sway either wearing braces or not,as well as wearing different braces.Conclusion Wearing soft and semi-rigid brace had no effects on the static postural stability of FAI patients.But the static balance ability of wearing semi-rigid braces is better than that of wearing soft braces.
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Objective To observe the effect of strengthening training of hip muscles on functional ankle instability (FAI). Methods From May, 2015 to June, 2016, 40 patients with FAI were randomly divided into control group (n=20) and observation group (n=20). Both groups were treated with routine exercise training including muscle strength and proprioceptive training of the ankle joint, while the treat-ment group received hip muscle strength training in addition, for six weeks. They were evaluated with hip force assessment, postural stabili-ty assessment, Star Excursion Balance Test (SEBT) and Cumberland Ankle Instability Tool (CAIT). Results There was no significant differ-ence in all the indexes between two groups before treatment (P>0.05). After treatment, the peak torques of hip muscles increased in the ob-servation group (t>3.528, P<0.01);the overall stability index, anteroposterior stability index, middle-lateral stability index decreased in both groups (t>2.360, P<0.05);the distance of eight direction in SEBT increased in both groups (t>2.254, P<0.05);the score of CAIT increased in both groups (t>3.268, P<0.01). All the above indexes were better in the observation group than in the control group (t>2.161, P<0.05). Conclusion Strengthening training of hip muscle, based on conventional ankle muscle strength and proprioceptive training, could facilitate to improve FAI.
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@#Objective To investigate the effect of comprehensive rehabilitation direction on functional ankle instability (FAI). Methods 32 consecutive patients with FAI were divided into 2 groups. The rehabilitation group (n=16) finished their rehabilitation program under the instruction of physiotherapists in the hospital, and the control group (n=16) exercised at home by written instruction. All the patients were tested with One Leg Standing Test (OLST) and Foot and Ankle Disability Index (FADI) for the injured ankle before and 4 weeks after training.Results The scores of both OLST and FADI improved after training in the rehabilitation group (P<0.01), but did not in the control group (P>0.05); and improved more in the rehabilitation group than in the control group (P<0.05). Conclusion The comprehensive rehabilitation direction is effctive on FAI.
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BACKGROUND:At present, the study to balance ability of functional ankle instability patients is less. The balance ability deficiency may also be one of the important reasons for ankle repeated injury, so the research can effectively reduce the damage probability. OBJECTIVE:To explore the static balance ability characteristics of functional ankle instability patients. METHODS:Ten male subjects with unilateral functional ankle instability were enrol ed as the experimental group in the study, and other 10 healthy match-paired subjects were served as the control group. Their static balance ability was measured under double feet standing and single foot standing using win-pod system, the double feet testing lasted for 30 seconds and the single foot testing lasted for 10 seconds. Evaluation parameters of balance ability were obtained. RESULTS AND CONCLUSION:During double feet testing, there were no significant differences in balance ability parameters between the experimental group and the control group whether eyes be opened or closed (P>0.05), but the index values of double feet testing were obviously less than those of single foot testing. So we concluded that in the double feet standing, there was no significant difference in the static balance ability between functional ankle instability patients and normal persons. Moreover, the static balance ability of double feet was better than that of single feet. In the single foot standing of the affected foot, the static balance ability of functional ankle instability patients was slightly worse than that of the normal persons, especial y with eyes closed. Comparison of the average swing between the X-axis and Y-axis found that in the process of maintaining balance posture, the swing direction of the body center of gravity was mainly in the anteroposterior direction.
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Objective To investigate the functional ankle instability in nurses,and provide references for increase preventive and protective awareness and establishment of preventive measures.Methods 100 nurses recruited from 10 wards of Provincial Hospital Affiliated to Shandong University were included into this study.Chinese version of the Cumberland Ankle Instability Tool (CAIT) was used to investigate the condition of functional ankle instability of these nurses.A self-designed questionnaire was used to investigate cognitive degree of ankle sprain prevention and treatment knowledge.Results Only 16％ of these nurses had no unstable problems in both of their two ankles.There were functional ankle instable problems in either single or both of the two ankles of the other 84％ nurses.And most of the nurses had little knowledge of how to prevent or treat ankle sprain properly.Conclusions There is a high rote of functional ankle instability in nurses.It is necessary to pay great attention to the prevention of ankle sprain and instability in nurses,which is of great importance to health and occupational safety assurance of nurses.