Analysis of Sensory Motor Training in Chronic Ankle Instability
Condition: Recruitment
Study type: Interventional

Summary: 
      Introduction: Sensory motor training (STS) is part of rehabilitation and injury prevention in
      individuals with chronic ankle instability (ICS). The use of footwear during SST may
      interfere with neuromuscular responses, but little is known about the difference in motor
      control response when training is applied with the use of shoes or bare feet. Objectives: To
      establish the effect of sensory motor training with and without sports shoes on the dynamic
      postural control of athletes with chronic ankle instability. Materials and Methods: The study
      will be performed with athletes linked to the Athletics of the State University of Londrina,
      aged between 18 and 30 years, both sexes, with chronic ankle instability assessed using the
      Cumberland Ankle Instability Tool (CAIT) questionnaire. Dynamic postural control will be
      evaluated in Force Platform and muscle recruitment through the electromyography of the
      muscles: anterior tibial, lateral and medial gastrocnemius, long fibular, gluteus maximus and
      gluteus medius. After the evaluation the volunteers will be randomized into two groups: 1)
      barefoot sensory-motor training and 2) sensory motor training with sneakers. The two groups
      will develop the same protocol of sensory motor training consisting of exercises, for five
      weeks, twice a week. At the end of the training they will be re-evaluated and the data
      analyzed. Expected Results: It is expected to find better postural control in the group that
      will perform in barefoot sensory-motor training.
    

Detailed description: 
      The total sample was determined in 54 volunteers, distributed equally in two groups: Chronic
      Ankle Instability and Control. Each group will be randomized for sensory-motor training with
      sneakers and without sneakers.

      Inclusion criteria: athletes of both sexes, aged between 18 and 30 years, with history of
      ankle sprain in the last 12 months, sensation of instability or "yielding" of the ankle and
      score determined by the CAIT <24 questionnaire, did not perform sensory-motor training or
      conventional physiotherapy in the last six months.

      Exclusion criteria: presence of pain complaints at the time of evaluation, recurrence of
      sprain with acute inflammatory signs, painful complaints in the lower limbs, lower limb
      surgery with neurological, cardiovascular, rheumatologic, diabetes, altered plantar
      sensitivity.

      Participants with chronic ankle instability and controls will be randomly assigned to the two
      treatment groups, through the program www.ramdom.com, in blocks in the two groups: Sensory
      Motor Training Group with Tennis (TSMT) and Group Training Sensory Motor Barefoot ( TSMD).

      Scratchs:

      Since this is a study with intervention in participants with chronic ankle instability, there
      is a risk of new sprain during sensorimotor training. In case it occurs, the participant will
      receive all the support of the team coordinated by the professor Christiane Guerino de Souza
      Macedo in the extension project: Physiotherapy from theory to practice.

      Procedures:

      Initially the participants will complete the demographic data sheet (age, weight, height,
      BMI, level of physical activity and dominance in the lower limbs) and history of lower limb
      injury. Will respond to the chronic ankle instability questionnaire CAIT-p. They will sign
      the informed consent form (TCLE).

      Following, the Lunge test will be performed to analyze ankle mobility. The same will be
      developed with the participant in orthostatism in front of a wall, with a tape measure, the
      participant will begin the test with a distance of 2cm from the wall and will be incremented
      by 1cm each time until the greater distance is reached. You will perform maximum knee flexion
      without the heel lifting from the floor or assuming a valgus position, with the goal of
      bringing the knee up to the wall. The result will be established by means of the halux-wall
      distance.

      Postural control and muscle recruitment of a lower limb with the same direction should not be
      assessed by force platform and electromyography, respectively. The evaluations are made for
      the blind and according to the order of the instruments and the use or not of the shoe.

      The anchoring of electromyographic analysis electrodes is performed on the anterior tibialis
      muscle (TA), lateral gastrocnemius (GL), medial gastrocnemius (GM), long fibularis (FL),
      gluteus maximus (GMe) and gluteus maximus (GMa). There will be a screening of electrotherapy
      supplements and cleaning of the area with alcohol rubbing (Moraes et al., 2012). The
      electrodes will be attached to the previous muscular points, according to the guide.

      After placement of the electrodes the participant will be positioned with the lower limb to
      be tested on one step (based on height of applied force platform) and perform a series of
      assactions per second for thirty seconds controlled by metronome. This evaluation will be
      done 3 times. With a rest period of one full day in each test.

      For an evaluation of dynamic postural control (BIOMEC400, Sistema EMG do Brasil, SP Ltda.).
      On the platform will be placed the member with chronic instability of the ankle and perform
      squatting to 30 seconds. With a rest period of one morning between each sitting test. They
      will be carried out 3 times with sneakers and 3 times with bare feet.

      At this moment, the main parameters of COP-based postural control are: The area of COP
      ellipse (A-COP in cm²) and the mean COP oscillation distance (VEL in cm / s) are the most
      indicated in the directions: anteroposterior (A / P) and medium-lateral (M / L). Results were
      calculated for an average of three trials.
    

Intervention name(s): Group TSM ICT sneakers; Group TSM ICT barefoot; Group TSM health sneaker; Group TSM health barefoot
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Sensory motor training with sneakers for volunteers with Chronic ankle instability, for five weeks, twice a week.; Sensory motor training without sneakers for volunteers with Chronic ankle instability, for five weeks, twice a week.; Sensory motor training with sneakers for volunteers with Chronic ankle instability, for five weeks, twice a week.; Sensory motor training without sneaker for volunteers with Chronic ankle instability, for five weeks, twice a week.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Postural Balace; Physioteraphy; Ankle Injuries; Electromyography