Ethan N. Saliba

Balance Training Improves Function and Postural Control in Those with Chronic Ankle Instability

PURPOSE The purpose of this randomized controlled trial was to determine the effect of a 4-wk balance training program on static and dynamic postural control and self-reported functional outcomes in those with chronic ankle instability (CAI). METHODS Thirty-one young adults with self-reported CAI were randomly assigned to an intervention group (six males and 10 females) or a control group (six males and nine females). The intervention consisted of a 4-wk supervised balance training program that emphasized dynamic stabilization in single-limb stance. Main outcome measures included the following: self-reported disability on the Foot and Ankle Disability Index (FADI) and the FADI Sport scales; summary center of pressure (COP) excursion measures including area of a 95% confidence ellipse, velocity, range, and SD; time-to-boundary (TTB) measures of postural control in single-limb stance including the absolute minimum TTB, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions with eyes open and closed; and reach distance in the anterior, posteromedial, and posterolateral directions of the Star Excursion Balance Test (SEBT). RESULTS The balance training group had significant improvements in the FADI and the FADI Sport scores, in the magnitude and the variability of TTB measures with eyes closed, and in reach distances with the posteromedial and the posterolateral directions of the SEBT. Only one of the summary COP-based measures significantly changed after balance training. CONCLUSIONS Four weeks of balance training significantly improved self-reported function, static postural control as detected by TTB measures, and dynamic postural control as assessed with the SEBT. TTB measures were more sensitive at detecting improvements in static postural control compared with summary COP-based measures.

Effects of balance training on gait parameters in patients with chronic ankle instability: a randomized controlled trial

Objective: To examine the effects of a four-week balance training programme on ankle kinematics during walking and jogging in those with chronic ankle instability. A secondary objective was to evaluate the effect of balance training on the mechanical properties of the lateral ligaments in those with chronic ankle instability. Design: Randomized controlled trial. Setting: Laboratory. Subjects/patients: Twenty-nine participants (12 males, 17 females) with self-reported chronic ankle instability were randomly assigned to a balance training group or a control group. Intervention: Four weeks of supervised rehabilitation that emphasized dynamic balance stabilization in single-limb stance. The control group received no intervention. Main outcome measures: Kinematic measures of rearfoot inversion/eversion, shank rotation, and the coupling relationship between these two segments throughout the gait cycle during walking and jogging on a treadmill. Instrumented ankle arthrometer measures were taken to assess anterior drawer and inversion talar tilt laxity and stiffness. Results: No significant alterations in the inversion/eversion or shank rotation kinematics were found during walking and jogging after balance training. There was, however, a significant decrease in the shank/rearfoot coupling variability during walking as measured by deviation phase after balance training (balance training posttest: 13.1°± 6.2°, balance training pretest: 16.2° ± 3.3°, P = 0.03), indicating improved shank/rearfoot coupling stability. The control group did not significantly change. (posttest: 16.30° ± 4.4°, pretest: 18.6° ± 7.1°, P40.05) There were no significant changes in laxity measures for either group. Conclusions: Balance training significantly altered the relationship between shank rotation and rearfoot inversion/eversion in those with chronic ankle instability.

Differences in Lateral Ankle Laxity Measured via Stress Ultrasonography in Individuals With Chronic Ankle Instability, Ankle Sprain Copers, and Healthy Individuals

STUDY DESIGN Cross-sectional. OBJECTIVE To use stress ultrasonography to measure the change in anterior talofibular ligament length during the simulated anterior drawer and ankle inversion stress tests. BACKGROUND In approximately 30% of individuals, ankle sprains may eventually develop into chronic ankle instability (CAI) with recurrent symptoms. Individuals with CAI and those who have a history of ankle sprain (greater than 1 year prior) without chronic instability (copers) may or may not have mechanical laxity. METHODS Sixty subjects (n=60 ankles) were divided into 3 groups: 1) Control subjects without ankle injury history (n=20; mean ± SD age; 24.8 ± 4.8 years; height, 173.7 ± 9.4 cm; weight, 77.2 ± 19.5 kg), ankle sprain copers (n=20; 22.3 ± 2.9 years; 172.8 ± 11.3 cm; 72.4 ± 14.3 kg), and subjects with CAI (n=20; 23.5 ± 4.2 years; 174.6 ± 9.6 cm; 74.8 ± 17.3 kg). Ligament length change with the anterior drawer and end range ankle inversion was calculated from ultrasound images. The Foot and Ankle Ability Measure (FAAM) was used to quantify self-reported function on activities-of-daily living (ADL) and sports. RESULTS The anterior drawer test resulted in length changes that were greater (F₂,₅₇=6.2, P=.004) in the CAI (mean ± SD length change, 15.6 ± 15.1%, P=.006) and the coper groups (14.0 ± 15.9%, P=.016) compared to the control group (1.3 ± 10.7%); however the length change for the CAI and coper groups were not different (P=.93). Ankle inversion similarly resulted in greater ligament length change (F₂,₅₇=6.5, P=.003) in the CAI (25.3 ± 15.5%, P=.003) and coper groups (20.2 ± 19.6%, P=.039) compared to the control group (7.4 ± 12.9%); with no difference in length change between the copers and CAI groups (P=.59). The CAI group had a lower score on the FAAM-ADL (87.4 ± 13.4%) and FAAM-Sports (74.2 ± 17.8%) when compared to the control (98.8 ± 2.9% and 98.9 ± 3.1%, P<.0001) and coper groups (99.4 ± 1.8% and 94.6 ± 8.8%, P<.0001). CONCLUSION Stress ultrasonography identified greater length changes of the anterior talofibular ligament in both the coper and CAI groups compared to the control group. Only subjects with CAI had reductions in self-reported function.

Cost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: A 5-year experience

BACKGROUND Electrocardiographic screening of intercollegiate athletes is controversial because the costs and yield are not well defined. Both the American Heart Association (AHA) and the European Society of Cardiology (ESC) have different criteria for screening, partly because the populations being screened are different. OBJECTIVE The purpose of this study was to determine the cost and yield of a 5-year ECG screening program at a United States Division I college. METHODS At the University of Virginia, all 1,473 competitive athletes over the course of 5 years were screened with history and physical and with ECGs using ESC guidelines with follow-up testing as dictated by clinical symptoms and ECG findings. RESULTS History and physical alone uncovered five significant cardiac abnormalities. ECGs were abnormal in 275 (19%), resulting in 359 additional tests. Additional testing confirmed eight significant cardiac abnormalities that were not found by history and physical: 1 bicuspid aortic valve, 4 rapidly conducting accessory pathways, 1 long QT patient, 1 with frequent premature ventricular contractions and low ejection fraction, and 1 with frequent premature ventricular contractions but normal ejection fraction. No cases of hypertrophic cardiomyopathy were found. Total cost of the program was US

Differential Rates of Recovery After Acute Sport-related Concussion: Electrophysiologic, Symptomatic, and Neurocognitive Indices

894,870. Cost of history and physical screening alone was

A preliminary investigation of motor evoked potential abnormalities following sport-related concussion

343,725 or

Joint angle and contraction mode influence quadriceps motor neuron pool excitability.

68,745 per finding. The marginal cost of adding ECG screening, including resulting tests and procedures. was US

Exergaming and Static Postural Control in Individuals With a History of Lower Limb Injury

551,145 or US

Rehabilitation Considerations of a Brachial Plexus Injury With Complete Avulsion of C5 and C6 Nerve Roots in a College Football Player: A Case Study

68,893 per additional finding. CONCLUSION ECG screening of U.S. college athletes can uncover significant cardiac pathology not discovered by history and physical alone. Although ECG screening also results in many false positives resulting in additional tests, the overall cost per diagnosis of adding ECG screening is similar to that of history and physical screening alone.

Jogging gait kinetics following fatiguing lumbar paraspinal exercise

Purpose To determine if motor evoked potentials (MEPs), postconcussion signs and symptoms, and neurocognitive functions follow a similar recovery pattern after concussion. Methods Nine collegiate athletes with acute concussion (>24 hours after injury) participated in this retrospective time series design. Transcranial magnetic stimulation was applied over the motor cortex, and MEPs were recorded from the contralateral upper extremity. Self-reported symptoms were evaluated using the Head Injury Scale, and the Concussion Resolution Index was used to assess neurocognitive function. All measures were repeated on days 3, 5, and 10 after injury. Results Composite scores on the Head Injury Scale were significantly higher on day 1 after injury (F3,51 = 15.3; P = 0.0001). Processing speed on the Concussion Resolution Index was slower on days 1, 3, and 5 compared with that on day 10 (F3,24 = 6.75; P = 0.0002). Median MEP latencies were significantly longer on day 10 compared with day 1 after concussion (t8 = −2.69; P = 0.03). Ulnar MEP amplitudes were significantly smaller on day 3 after concussion compared with day 5 (t8 = −3.48; P = 0.008). Conclusions Acutely concussed collegiate athletes demonstrate changes in MEPs, which persist for up to 10 days after injury and do not follow the same recovery pattern as symptoms and neuropsychological test performance. The apparent differential rates of recovery most likely indicate different pathophysiological processes occurring in the immediate postconcussion period.