EFFECTS OF A 4-WEEK BALANCE TRAINING AND COGNITIVE LOADING PROGRAM IN SUBJECTS WITH CHRONIC ANKLE INSTABILITY
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Abstract
Introduction: Previous research has suggested that dynamic balance training can improve both static and dynamic postural control in subjects with chronic ankle instability (CAI). Additionally, several studies have observed that performing various cognitive tasks may improve static balance. However, combining a traditional balance-training program with cognitive loading has not yet been investigated. Objective: The purpose of this study was to assess the effectiveness of a 4-week rehabilitation program combining balance training and cognitive tasks in subjects with CAI compared to balance training alone. Methods: Twenty-three subjects, (5 males and 18 females, height = 166.25±8.41 cm, weight = 74.56±14.6 kg, age = 20.4±1.12yrs), with CAI completed this study. Prior to the start of the study, all subjects performed baseline measurements consisting of static balance measures on a force plate, and the Star Excursion Balance Test (SEBT). Subjects were then randomly assigned to either the dual task group or the traditional balance-training group. The traditional balance training protocol was one established by McKeon. The dual task group completed the same balance training; however, they also performed various cognitive tasks. The cognitive tasks included backwards counting by 3s and 7s from a random three-digit number; as well as random number generation. For each group, training consisted of 3 times per week for a total of 4 weeks. After the 4-week training period, follow up testing was the same as baseline testing. A repeated measures ANOVA (group x time) was performed with an alpha level of p < 0.05 set prior to testing. Results: There were no significant group by time interactions for any of the time to boundary (TTB) dependent variables. There were significant main effects for time. Both group had a significant increase in medial lateral (ML) TTB mean (p = .002), in anterior posterior (AP) TTB mean (p = .003), in ML TTB standard deviation (StDev) (p = .048), and in AP TTB StDev (p = .041) at posttest compared to pretest. There was no significant interaction (p = .331) for the anterior direction of the SEBT. There was a significant main effect for time (p = .012). Both groups reached significantly further in the anterior direction at posttest compared to the baseline testing. There was no significant interaction (p = .396) for the posterior lateral direction of the SEBT. There was a significant main effect for time (p = .0001). Both groups reached significantly further in the posterior lateral direction at posttest compared to the baseline testing. There was also no significant interaction (p = .099) for the posterior medial direction of the SEBT. There was a significant main effect for time (p = .003). Both groups reached significantly further in the posterior medial direction at posttest compared to the baseline testing.Conclusions: A 4-week balance training program under both a traditional balance training program and dual task paradigm significantly improves static and dynamic postural control. As this study was one of the first of its kind in looking at dual task interference over a 4-week balance training program, it is unclear if dual task interference truly impacts training. What is clear is the dual task has the potential to influence training as demonstrated by the moderate to strong effects it had on TTB and SEBT outcomes. However, more research must be conducted in order to better understand this.