Integrating Contemporary Models of Motor Control and Health in Chronic Ankle Instability: A Review of the Literature

Numerous structural and functional alterations have been identified as contributing factors associated with chronic ankle instability (CAI). However, little evidence has connected local instability with self-reported disability or functional loss. The dynamical-systems theory of motor control offers a constraints-led approach for interpreting movement dysfunction based on organismic, task-specific, and environmental factors. These factors interact to organize sensorimotor coordination, creating functional variability to complete movement goals. The International Classification of Functioning, Disability, and Health (ICF) is a model of health, examining function at the level of the body or body parts, the whole person, and the whole person in his or her environment. Combining the fundamental components of both theories offers a model that may recognize the link between instability and function. The purpose of this literature review is to discuss the dynamic systems theory, the ICF model, and how integrating both concepts can be used to address, track, and interpret deficits associated with CAI. Ankles sprains are the most frequently reported injury among physically active individuals.1 Approximately 1 of 3 people who sustain a single ankle sprain experience reoccurring sprains and residual bouts of joint instability known as chronic ankle instability (CAI). 2 In addition, ankle sprains are one of the major contributing factors in the development of posttraumatic ankle osteoarthritis.3 High reoccurrence rates and the prevalence of long-term functional loss related to ankle sprains begs the question if current rehabilitation strategies are effective.4 Examining CAI through the integration of the most contemporary theory of motor control and the most contemporary model of health may provide a comprehensive assessment of a person’s overall functional ability and elucidate the link between disability and health in this population. Recent advancement in motor control theory may help interpret how sources of functional loss and disability are manifestations of impaired sensorimotor coordination.5,6 This theory, known as dynamic systems, views movement from a context-specific perspective. The dynamic systems theory aims to explain how we use the freedom of the sensorimotor system to develop strategies to cope with changes in health, task complexity, and the environment.5 Similarly, the International Classification of Functioning, Disability, and Health (ICF) examines the effects of injury and illness on the dynamic nature of function based on quality of life, overall health status, and impairment associated with societal and environmental factors.7 The authors are from the Division of Athletic Training, University of Kentucky, College of Health Sciences, Lexington, Ky. Originally submitted April 6, 2009. Accepted for publication June 4, 2009. The authors have no financial or proprietary interest in the materials presented herein. Address correspondence to Matt Hoch, MS, ATC, Division of Athletic Training & Rehabilitation Sciences Doctoral Program, University of Kentucky, College of Health Sciences, Wethington Building, Room 206B, 900 South Limestone, Lexington, KY 40536-0200; e-mail: mcho222@uky.edu. doi:10.3928/19425864-2010xxxx-xx