Sensorimotor and functional deficits following acute lateral ankle sprains

Chich-haung Yang (2010). Sensorimotor and functional deficits following acute lateral ankle sprains PhD Thesis, School of Health & Rehabilitation Sciences, The University of Queensland.

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Author Chich-haung Yang
Thesis Title Sensorimotor and functional deficits following acute lateral ankle sprains
School, Centre or Institute School of Health & Rehabilitation Sciences
Institution The University of Queensland
Publication date 2010-08
Thesis type PhD Thesis
Supervisor Bill Vicenzino
Paul W Hodges
Total pages 301
Total colour pages 11
Total black and white pages 290
Subjects 11 Medical and Health Sciences
Abstract/Summary Lateral ankle sprain is the most common injury in the lower extremity during sports activities. Following injury and despite initial recovery, recurrent and/or persistent symptoms often remain unresolved. Over the past four decades, numerous studies have demonstrated impairments and dysfunctions in people with recurrent ankle sprains. Although many hypotheses have been proposed with regards to the mechanisms that underpin recurrence of symptoms following injury, recurrence rates are still high due to a poor understanding of the mechanisms and sequelae following acute ankle sprains. Clinically, acute ankle sprains result in limited ankle dorsiflexion, persistent pain, swelling and functional limitations. However, little information is available as to on whether these factors may contribute or lead to re-injury over time or functional deficits. Recurrence following lateral ankle sprains is therefore an enigma that requires further exploration to improve understanding of underlying physiological mechanisms. This thesis aimed to understand the physiological mechanisms of persistent symptoms and dysfunction following lateral ankle sprains at the acute, sub-acute and recurrent phases. Measures included ankle dorsiflexion range of motion, proprioception, peripheral sensory function measures, balance and selected functional performance tests. In addition, the thesis aimed to assess kinematic and kinetic factors during stair walking in people with acute lateral ankle sprains that may contribute to recurrence of symptoms and functional deficits. The thesis involved a series of five experiments, including three single blind, cross-sectional and two case-control experiments. Experiment 1 investigated the validity and reliability of a new digital imaging-based measure for the assessment of weight-bearing ankle dorsiflexion range. Experiments 2 and 3 examined possible impairments in joint position sense (JPS), sensory function, ankle dorsiflexion, balance and functional performance at different phases of lateral ankle sprains (acute, sub-acute and recurrent). Experiments 4 and 5 explored new kinematic and kinetic measurements of the lower limbs to evaluate alterations in movement patterns and motor control during stair ascent and descent in people with an acute lateral ankle sprain. The data showed that a deficit in JPS was present in individuals with recurrent ankle sprains, but this was not present in the acute stage. Reduced ankle dorsiflexion, balance ability and functional performance were demonstrated in the acute phase following injury, but these findings were not observed in latter stages of lateral ankle sprain. In addition, significant mechanical hyperalgesia over the anterior talofibular ligament and inferior tibiofibualr joints were found in people with acute and sub-acute ankle sprains. All injured groups (acute, sub-acute and recurrent) reported mild to severe pain in the self-reported pain visual analogue scale (VAS). VAS was moderately associated with functional impairments (30 m run) in the injured groups. Following lateral ankle sprains, subjects presented with local sensory dysfunction, pain and functional deficits, and these were present regardless of the phase of injury. During stair descent and ascent, the results showed highly acceptable coefficients of multiple correlations (CMC) for the sagittal angular kinematics and ground reaction forces. In contrast, CMC's for angular kinematics in frontal and transverse planes were poor. The electromagnetic motion capture system can be used as a reliable measurement tool for lower limb kinematics in the sagittal plane, whereas ground reaction forces were reliable in all planes during stair descent and ascent. Furthermore, ankle angular kinematics (i.e., range of motion) and were reduced bilaterally during stair walking in 3 acute ankle sprained subjects were found when compared to healthy subjects. This suggests the presence of alterations in motor strategies. Interestingly, these changes were observed on the injured and non-injured sides. This novel finding demonstrates that alterations in motor strategies occur at an early phase following acute lateral ankle sprains, and may be a critical factor that contributes to recurrence. The findings of this thesis provide improved understanding of the characteristics of sensorimotor and functional impairments at various phases following lateral ankle sprains. Notably, the studies elucidate some of the underlying mechanisms that immediately follow an episode of acute lateral ankle sprain, which may contribute to recurrence and re-injury. Clinically, the data highlights the need for early rehabilitation that aims to improve ankle dorsiflexion, balance and functional activity performance following acute ankle sprain, which may aid in the prevention of further impairments and re-injury.
Keyword Lateral ankle sprain
Functional instability
Ankle dorisflexion
Joint position sense
Vibration sense
Ground reaction force
Additional Notes 4,8,11,55,73,75,135,173,195,198,212

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Created: Wed, 11 May 2011, 01:47:21 EST by Mr Chich-haung Yang on behalf of Library - Information Access Service