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The Effects of Ankle Braces on Rehabilitation PowerPoint Presentation

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  • Slide 1 - The Effects of Ankle Braces on Rehabilitation Molly Plueger, ATC Brooke Jackson, ATC
  • Slide 2 - Overview 1) Previous Research -Chronic Ankle Instability (CAI) -Ankle Rehabilitation -Ankle Braces -Effects of Ankle Braces 2) Purpose 3) Hypothesis 4) Methods 5) Results 6) Discussion
  • Slide 3 - Chronic Ankle Instability (CAI) Subjective feeling of the ankle “giving way” after an ankle injury, weakness, and episodes of instability resulting in repeated ankle sprains 40% of those experiencing a lateral ankle sprain have symptoms of CAI. (Osborne, 2003)
  • Slide 4 - Proposed Causes of CAI Functional Ankle Instability (FAI) Neurmuscular and proprioceptive deficits Impaired balance, diminished joint position sense, delayed peroneal muscle response to inversion perturbation, and strength deficits (Hertel, 2000) Mechanical Ankle Instability (MAI) Abnormal ankle mechanics Laxity of ankle due to structural damage (Hubbard & Hertel, 2006)
  • Slide 5 - Ankle Rehabilitation Goal: return to same or higher level as before injury CAI: proprioception, reflexes, muscular strength, reaction time, power, endurance, agility Research on many rehabilitation techniques for CAI has been conducted. balance boards, coordination-training, strength training, ankle joint proprioception
  • Slide 6 - Ankle Braces The purpose of an ankle brace is to improve physical function, prevent injury, slow disease progression, and diminish pain 2 Types: Rigid Functional Semi-rigid Soft, lace-up
  • Slide 7 - Effects of Ankle Braces Agility/Performance Static Balance (Postural Control) Dynamic Balance Proprioception
  • Slide 8 - Agility/Performance Current information suggests external ankle support produces minimal to small decrements on lower extremity function (Cordova & Ingersoll 2002, Bot & Mechelen 1999,Hume & Gerrard 1998 ) Gross et. al. 1997 tested CAI participants, no significant difference in 40-meter sprint, figure-eight run, or standing vertical jump
  • Slide 9 - Agility/Performance Cordova et. al. 2002 meta-analysis indicates mixed results for running speed, agility performance, and vertical jump height Other studies show little to no effect on performance. (Hals, Sitler, Mattacola 2000, Verbrugge 1997; Burks et. al. 1991; Paris 1992; Beriau, Cox, Manning, 1994) Research inconclusive
  • Slide 10 - Static Balance-Postural Control Decreased postural control, more susceptible to ankle injury (Mattacola & Dwyer, 2002; Cordova et. al, 2002; Kinzey et. al, 1997) Brace decreased sway patterns (Kinzey et. al, 1997; Feuerbach & Grabiner, 1993; Baier & Hopf, 1998; Palmieri et. al, 2002; Papadopoulos et. al. 2007) Results remain unclear and more work needs to be done on the influence of external support on postural control
  • Slide 11 - Dynamic Balance Brace did not effect SEBT for healthy subjects. (Hardy et. al, 2008) Taping and bracing do not have detrimental effect on balance in frontal plane. (Barkoukis et. al, 2002) Dynamic postural stability was not improved during a jump protocol while wearing a brace. (Wilkstrom et. al. 2006) Research on ankle braces and dynamic balance is lacking
  • Slide 12 - Proprioception Improvements through rehabilitation Thought to stimulate cutaneous mechanoreceptors (Cordova et. al, 2002) CAI decreases joint position sense compared to healthy ankles (Hartsell, 2000)
  • Slide 13 - Proprioception Error in joint angle reproduction reduced while wearing brace, tape, and circumferential ankle pressure (Feuerbach et. al, 1994; Konradsen & Magnusson, 2000; Hartsell, 2000; You et. al, 2004; Robbins et. al, 1995)
  • Slide 14 - Mattacola & Dwyer (2002) “... initial exercises and ROM should be performed with some prophylactic support in an attempt to improve sensory and proprioceptive feedback...” Clinical interpretation and inconclusive research on effects of ankle braces has led to question will the application of a brace improve ankle rehabilitation outcomes?
  • Slide 15 - Purpose To determine if the use of an ankle brace during a six week rehabilitation protocol improves dynamic balance, static balance, and agility course performance for individuals suffering from chronic ankle instability.
  • Slide 16 - Hypothesis 1) Both the control and treatment groups will show improvements in dynamic balance, static balance, and agility course performance. 2) The treatment group will show greater improvements in dynamic balance, static balance, and agility course performance compared to the control group.
  • Slide 17 - Methods Participants: 26: 13 control, 13 treatment, 6 withdrawal 10 male, 16 female; ages 21.85 ± 2.27 yrs Auburn University students with CAI Neuromechanics Research Laboratory Ankle Injury History Questionnaire, Functional Ankle Instability Index (FADI), FADI Sport, Functional Ankle Instability Questionnaire Randomly selected group
  • Slide 18 - Measures 1) Static Balance-force platform -3x20 seconds single-leg eyes open -3x20 seconds single-leg eyes closed
  • Slide 19 - Measures - (cont.) 2) Dynamic Balance-Star Excursion Balance Test (SEBT) -anteromedial, medial, posteromedial -6 practice trials -6 recorded trials
  • Slide 20 - 3) Agility -KMS system: First Step Quickness -1x5 practice -2x5 recorded Measures - (cont.)
  • Slide 21 - Brace ASO EVO donated by Scott Gaylord and Medical Specialties
  • Slide 22 - Rehabilitation 3 sessions per week for 6 weeks (18 sessions) 5 exercises each session (20-30 min) Progressed throughout protocol Any missed session is made up within one week Not 3 consecutive days
  • Slide 23 - Rehabilitation Set-up
  • Slide 24 - Rehabilitation Protocol
  • Slide 25 - Results: Static Balance RM MANOVA revealed: Strong trend for measure x time interaction [F(1,24) = 2.44, p = 0.058] No interaction brace x time [F(1,24) = 2.55, p = 0.123]
  • Slide 26 - Within subjects effects: Expected interaction between measure x time indicating a pre-post improvement in all measures [F(1,24) = 7.04, p < 0.0001] No interaction between brace x time indicating no pre-post test effect of wearing the brace. [F(1,24) = 2.55, p < 0.1230] Results: Static Balance (cont)
  • Slide 27 - A RM MANOVA revealed: Measure x time interaction was found [F(1,24) = 7.88, p = 0.02] No interaction between brace x time [F(1,24) = 0.391, p = 0.537] Results: Dynamic Balance
  • Slide 28 - Within subjects effects: Expected measure x time interaction indicating a significant difference pre-post test in all measures [F(2,23) = 11.211, p < 0.0001] Follow-up t tests found no effect of brace (p = 0.167) Results: Dynamic Balance (cont)
  • Slide 29 - Results: Agility A RM MANOVA revealed: Measure x time interaction was found indicating changes in the measures pre-post test [F(1,24) = 5.05, p = 0.034] Strong trend toward an interaction between brace x time suggested the brace may have an effect on agility pre-post tests. [F(1,24) = 3.96, p = 0.058] Follow up assessement revealed no effect of brace (p = 0.60)
  • Slide 30 - Discussion Goal was to determine if application of ankle brace during 6 week ankle rehabilitation protocol for CAI would improve the outcome of static balance, dynamic balance, and agility performance Inconclusive results of ankle brace effects on balance and proprioception Hypothesis of cutaneous mechanoreceptor stimulation
  • Slide 31 - Discussion Rehabilitation protocol was effective Brace had no significant effect strong trend for agility: interaction between time x brace (p = 0.058)
  • Slide 32 - Discussion It has been hypothesized proprioception would be positively influenced by the brace’s stimulation of cutaneous mechanoreceptors Any increased afferent activity did not produce improved rehabilitation outcomes Other studies did not use brace in rehabilitation protocol just in balance testing
  • Slide 33 - Limitations The dynamic balance as tested with the SEBT is not the same type of dynamic balance involved in sporting activities such as basketball, football, or running Same rehabilitation progression was utilized for every participant Small sample size which could reduce the power of the results. Individual difference in ankle brace application
  • Slide 34 - Clinical Implications Rehabilitation is necessary for CAI Bracing during CAI rehabilitation does not significantly improve rehabilitation outcomes
  • Slide 35 - THANK YOU TO: Southeast Athletic Trainers’ Association – research grant Scott Gaylord and Medical Specialties – donation of ankle braces Dr. JoEllen Sefton Ceren Yarar RehabWorks Auburn AU Athletic Training Graduate Assistants Bonni Messner Shannon Polkowski Andrew Corley Sara Shanks Auburn University Students-Participants
  • Slide 36 - QUESTIONS????

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