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Zhang G, Zha C, Cao S, Xiong L, Huang P, Zhang G, Ji Y. Effect of a semirigid ankle brace on the in vivo kinematics and muscle activity of patients with functional ankle instability during simulated ankle sprain. Medicine (Baltimore) 2024; 103:e37832. [PMID: 39121304 PMCID: PMC11315482 DOI: 10.1097/md.0000000000037832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/15/2024] [Indexed: 08/11/2024] Open
Abstract
INTRODUCTION Ankle braces can effectively decrease the incidence of recurrent ankle sprain; however, whether the brace can decrease the severity of sprain and its related mechanism during sprain remain unknown. METHODS Twenty-two patients with functional ankle instability (FAI) (12 males and 10 females) and 16 healthy subjects (8 males and 8 females) were enrolled in this study. All of the subjects walked on a custom-built tilting platform that offered a 30° inversion (IV) to mimic the IV of ankle sprain. We collected the kinematic and surface electromyography data of patients with FAI with or without ankle brace and normal controls 6 times. RESULTS The FAI without brace group showed significantly higher maximum IV angles and average IV velocities than the control group (P < .001). The FAI with brace group revealed significantly lower maximum IV angles and average IV velocities than the FAI without brace group (P < .001); this group also showed significantly higher maximum external rotation (ER) angle and average ER velocities than the FAI with brace (P < .001) and control (P < .001) groups. The FAI with brace group indicated significantly lower average EMGPrep (P = .047), EMGTilt (P = .037), and EMGafterTilt (P = .004) of the peroneus longus than the FAI without brace group. CONCLUSIONS The ankle brace could effectively decrease IV angles and their velocities and increase ER angles and their corresponding velocities during ankle sprain in patients with FAI. It could also decrease the activity of the peroneus longus muscle during ankle sprain.
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Affiliation(s)
- Gonghao Zhang
- Department of Orthopedics, Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaochao Zha
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Xiong
- Department of Orthopedics, Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Huang
- Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai, China
| | - Guoning Zhang
- Department of Orthopedics, Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhan Ji
- Department of Orthopedics, Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Mei N, Jiang Z, Zhong Z, Fu L, Hao J, Li Z, Wang Q, Wang Y, Zhang H, Chang F. Modified Stabilization Test to Diagnose Chronic Syndesmotic Injuries Based on Posture Control. Foot Ankle Int 2023; 44:1034-1043. [PMID: 37772832 DOI: 10.1177/10711007231189713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND To propose and validate a modified noninvasive method for the diagnosis of chronic syndesmotic injuries. METHODS This study included 16 patients with chronic ankle instability. Herein, we propose the Modified Stabilization Test, a new measurement for use in the diagnosis of chronic syndesmotic injury, as determined by wearing a 60-kPa pneumatic brace. The test combines the center of pressure and sensory organization test to measure postural control. For comparison, we also measured the tibiofibular clear space, tibiofibular overlap, and medial clear space using anteroposterior radiograph; a line marked horizontally above the tibial plaque using computed tomography (CT) to measure the syndesmotic gap and fibular rotation angle; and magnetic resonance imaging (MRI) scans to determine the presence of the λ sign. The distance of syndesmosis was confirmed in 16 individuals through arthroscopy, and the results of the examination were used to determine the diagnostic efficacy of each index. RESULTS Receiver operating characteristic curve analysis revealed that the optimal cut-off value, sensitivity, and specificity of the Modified Stabilization Test for the diagnosis of chronic syndesmotic injuries were 0.80, 100%, and 87.5%, respectively. The area under the curve (AUC) of the Modified Stabilization Test was 0.906 (95% CI 0.656, 0.993; P < .001), which was superior to imaging indices such as radiography, CT, and MRI (AUC = 0.516-0.891). CONCLUSION We developed the Modified Stabilization Test-a noninvasive diagnostic tool for the screening of chronic syndesmotic injuries. The test showed high sensitivity and specificity for the identification of chronic syndesmotic injuries and is helpful in the identification of chronic syndesmotic injuries. LEVEL OF EVIDENCE Level II, diagnostic-investigating a diagnostic test.
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Affiliation(s)
- Nan Mei
- College of Human Movement Science, Jilin Sport University, Changchun, China
| | - Zhende Jiang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Zhuan Zhong
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Lijuan Fu
- College of Human Movement Science, Jilin Sport University, Changchun, China
| | - Jianyuan Hao
- Laboratory of Athletic Training, Jilin Sport University, Changchun, China
| | - Zhaoyan Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Qingyu Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yinan Wang
- Division of Clinical Research, First Hospital of Jilin University, Changchun, China
| | - Hanyang Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Fei Chang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
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Fuerst P, Gollhofer A, Wenning M, Gehring D. People with chronic ankle instability benefit from brace application in highly dynamic change of direction movements. J Foot Ankle Res 2021; 14:13. [PMID: 33596976 PMCID: PMC7890883 DOI: 10.1186/s13047-021-00452-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/26/2021] [Indexed: 12/26/2022] Open
Abstract
Background The application of ankle braces is an effective method for the prevention of recurrent ankle sprains. It has been proposed that the reduction of injury rates is based on the mechanical stiffness of the brace and on beneficial effects on proprioception and neuromuscular activation. Yet, how the neuromuscular system responds to the application of various types of ankle braces during highly dynamic injury-relevant movements is not well understood. Enhanced stability of the ankle joint seems especially important for people with chronic ankle instability. We therefore aimed to analyse the effects of a soft and a semi-rigid ankle brace on the execution of highly dynamic 180° turning movements in participants with and without chronic ankle instability. Methods Fifteen participants with functional ankle instability, 15 participants with functional and mechanical ankle instability and 15 healthy controls performed 180° turning movements in reaction to light signals in a cross-sectional descriptive laboratory study. Ankle joint kinematics and kinetics as well as neuromuscular activation of muscles surrounding the ankle joint were determined. Two-way repeated measures analyses of variance and post-hoc t-tests were calculated. Results Maximum ankle inversion angles and velocities were significantly reduced with the semi-rigid brace in comparison to the conditions without a brace and with the soft brace (p ≤ 0.006, d ≥ 0.303). Effect sizes of these reductions were larger in participants with chronic ankle instability than in healthy controls. Furthermore, peroneal activation levels decreased significantly with the semi-rigid brace in the 100 ms before and after ground contact. No statistically significant brace by group effects were found. Conclusions Based on these findings, we argue that people with ankle instability in particular seem to benefit from a semi-rigid ankle brace, which allows them to keep ankle inversion angles in a range that is comparable to values of healthy people. Lower ankle inversion angles and velocities with a semi-rigid brace may explain reduced injury incidences with brace application. The lack of effect of the soft brace indicates that the primary mechanism behind the reduction of inversion angles and velocities is the mechanical resistance of the brace in the frontal plane.
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Affiliation(s)
- Patrick Fuerst
- Department of Sport Science, University of Freiburg, Sandfangweg 4, 79102, Freiburg i. Br, Germany.
| | - Albert Gollhofer
- Department of Sport Science, University of Freiburg, Sandfangweg 4, 79102, Freiburg i. Br, Germany
| | - Markus Wenning
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Dominic Gehring
- Department of Sport Science, University of Freiburg, Sandfangweg 4, 79102, Freiburg i. Br, Germany
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Eftekhar A, Norton JJS, McDonough CM, Wolpaw JR. Retraining Reflexes: Clinical Translation of Spinal Reflex Operant Conditioning. Neurotherapeutics 2018; 15:669-683. [PMID: 29987761 PMCID: PMC6095771 DOI: 10.1007/s13311-018-0643-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Neurological disorders, such as spinal cord injury, stroke, traumatic brain injury, cerebral palsy, and multiple sclerosis cause motor impairments that are a huge burden at the individual, family, and societal levels. Spinal reflex abnormalities contribute to these impairments. Spinal reflex measurements play important roles in characterizing and monitoring neurological disorders and their associated motor impairments, such as spasticity, which affects nearly half of those with neurological disorders. Spinal reflexes can also serve as therapeutic targets themselves. Operant conditioning protocols can target beneficial plasticity to key reflex pathways; they can thereby trigger wider plasticity that improves impaired motor skills, such as locomotion. These protocols may complement standard therapies such as locomotor training and enhance functional recovery. This paper reviews the value of spinal reflexes and the therapeutic promise of spinal reflex operant conditioning protocols; it also considers the complex process of translating this promise into clinical reality.
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Affiliation(s)
- Amir Eftekhar
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
| | - James J S Norton
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Christine M McDonough
- School of Health and Rehabilitation Services, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan R Wolpaw
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA
- Department of Neurology, Stratton VA Medical Center, Albany, NY, USA
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Expecting ankle tilts and wearing an ankle brace influence joint control in an imitated ankle sprain mechanism during walking. Gait Posture 2014; 39:894-8. [PMID: 24365326 DOI: 10.1016/j.gaitpost.2013.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 11/19/2013] [Accepted: 11/27/2013] [Indexed: 02/02/2023]
Abstract
A thorough understanding of the functional aspects of ankle joint control is essential to developing effective injury prevention. It is of special interest to understand how neuromuscular control mechanisms and mechanical constraints stabilize the ankle joint. Therefore, the aim of the present study was to determine how expecting ankle tilts and the application of an ankle brace influence ankle joint control when imitating the ankle sprain mechanism during walking. Ankle kinematics and muscle activity were assessed in 17 healthy men. During gait rapid perturbations were applied using a trapdoor (tilting with 24° inversion and 15° plantarflexion). The subjects either knew that a perturbation would definitely occur (expected tilts) or there was only the possibility that a perturbation would occur (potential tilts). Both conditions were conducted with and without a semi-rigid ankle brace. Expecting perturbations led to an increased ankle eversion at foot contact, which was mediated by an altered muscle preactivation pattern. Moreover, the maximal inversion angle (-7%) and velocity (-4%), as well as the reactive muscle response were significantly reduced when the perturbation was expected. While wearing an ankle brace did not influence muscle preactivation nor the ankle kinematics before ground contact, it significantly reduced the maximal ankle inversion angle (-14%) and velocity (-11%) as well as reactive neuromuscular responses. The present findings reveal that expecting ankle inversion modifies neuromuscular joint control prior to landing. Although such motor control strategies are weaker in their magnitude compared with braces, they seem to assist ankle joint stabilization in a close-to-injury situation.
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Barlow G, Donovan L, Hart JM, Hertel J. Effect of lace-up ankle braces on electromyography measures during walking in adults with chronic ankle instability. Phys Ther Sport 2014; 16:16-21. [PMID: 24810252 DOI: 10.1016/j.ptsp.2014.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 01/29/2014] [Accepted: 02/11/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lace-up ankle braces reduce the incidence of ankle sprains and have been hypothesized to do so through both mechanical and neuromuscular mechanisms. OBJECTIVE To determine the effect of lace-up ankle braces on surface electromyography (sEMG) measures during walking in adults with chronic ankle instability (CAI). DESIGN Randomized crossover. SETTING Laboratory. PARTICIPANTS Fifteen adults with CAI. MAIN OUTCOME MEASURES Surface EMG activity was recorded from the anterior tibialis, peroneus longus, lateral gastrocnemius, rectus femoris, biceps femoris and gluteus medius during treadmill walking with and without lace-up ankle braces. The dependent variables were sEMG amplitude 100 ms pre- and 200 ms post-initial contact, time of activation relative to initial contact, and percent of activation across the stride cycle. RESULTS When compared to no brace, ankle bracing resulted in lower pre-contact amplitude of the peroneus longus (p = 0.02). The anterior tibialis, peroneus longus, rectus femoris, and gluteus medius were activated later relative to initial contact (p < 0.03). The peroneus longus and rectus femoris were activated for a shorter percentage of the stride cycle (p < 0.05). CONCLUSION Braces cause a change in neuromuscular activity during walking. Clinicians should be aware of these changes when prescribing braces, as it may relate to the mechanism in which braces decrease sprains.
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Affiliation(s)
- Greg Barlow
- University of Virginia, 210 Emmet St. South, Charlottesville, VA 22904, USA.
| | - Luke Donovan
- University of Virginia, 210 Emmet St. South, Charlottesville, VA 22904, USA.
| | - Joseph M Hart
- University of Virginia, 210 Emmet St. South, Charlottesville, VA 22904, USA.
| | - Jay Hertel
- University of Virginia, 210 Emmet St. South, Charlottesville, VA 22904, USA.
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