Sensory-Targeted Ankle Rehabilitation Strategies (STARS)

描述（由申请人提供）：与运动和娱乐相关的伤害是停止体育活动的主要原因，这与显著的长期负面后遗症有关。踝关节扭伤是最常见的与身体活动相关的损伤，每3个扭伤踝关节的人中至少有1人会发展为慢性踝关节不稳定（CAI），其定义为终生残留症状，包括体力活动减少。传统的CAI康复策略侧重于运动障碍，但残疾的高发生率、创伤后踝关节骨关节炎以及随之而来的医疗负担清楚地表明，这种治疗模式是无效的。因此，迫切需要在开发有效的循证干预措施来治疗CAI方面进行范式转变。迄今为止，很少有人注意到通过干预感觉通路来改善功能的潜力。研究表明，感觉运动系统根据对系统的要求改变对各种感觉输入的依赖。由于踝关节外侧受体受损，CAI患者更强调皮肤和肌肉肌腱受体。然而，通过使用以感觉为目标的踝关节康复策略，如踝关节活动、足底按摩和三头肌表面拉伸，我们假设我们可以增强感觉运动系统的可用信息，以调整有效的运动解决方案。事实上，我们的证据表明，以感官为目标的策略可能是最有效地治疗CAI患者所必需的。因此，本研究的目的是确定以感觉为目标的踝关节康复策略对CAI患者临床残疾和感觉运动功能障碍的主观和客观结果指标的即时和长期改善的有效性。这项初步调查将是一项随机对照试验，其中80名CAI受试者将被随机分配接受三种实验干预（动员、按摩、拉伸）或对照治疗中的一种。为了评估实验治疗的效果，将采取以下基线措施：1)自我评估残疾，2)踝关节背屈运动范围，以及3)通过姿势控制和步态启动测量的感觉运动功能。然后将受试者随机分配接受踝关节活动（n=20）、足底按摩（n=20）、三头肌表面拉伸（n=20）或对照治疗（n=20）。在两周干预的第一次治疗和最后一次治疗后以及接受治疗干预后1个月立即采取随访措施。在这项研究中，单独的manova将评估治疗（活动、按摩、拉伸、控制）和时间（基线、第一次治疗后、最终治疗后、1个月随访）对CAI患者临床残疾和感觉运动功能的主观和客观测量的影响。这项随机对照研究的结果将阐明以感觉为目标的踝关节康复策略在改善CAI患者的感觉运动功能和残疾方面的有效性。

DESCRIPTION (provided by applicant): Injury associated with sport and recreation is a leading reason for physical activity cessation, which is linked with significant long-term negative sequelae. Ankle sprains are the most common injuries associated with physical activity and at least 1 out of every 3 individuals who sprain their ankle will go on to develop chronic ankle instability (CAI), defined by life-long residual symptoms including decreased physical activity. Traditional rehabilitation strategies for CAI have focus on motor impairments, but the high incidence of disability, post- traumatic ankle osteoarthritis, and consequent healthcare burdens clearly indicate that this treatment model is ineffective. Thus, a pressing need exists for a paradigm shift in the development of effective evidenced-based interventions to treat CAI. To date, little attention has been paid to the potential to improve function by intervening through sensory pathways. Research, has shown that the sensorimotor system shifts reliance on various sensory inputs depending on the demands placed on the system. Those with CAI place a greater emphasis on cutaneous and musculotendinous receptors due to damage of the lateral ankle joint receptors. However, by using sensory-targeted ankle rehabilitation strategies such as ankle joint mobilizations, plantar massage, and triceps surae stretching, we hypothesize that we can enhance the information available to the sensorimotor system in order to tune effective movement solutions. Indeed, our evidence suggests that sensory-targeted strategies may be essential to most effectively treating those with CAI. Therefore, the purpose of this proposal is to determine the effectiveness of sensory-targeted ankle rehabilitation strategies at causing immediate and prolonged improvements in subjective and objective outcome measures of clinical disablement and sensorimotor dysfunction in those with CAI. This preliminary investigation will be a randomized controlled trial in which 80 subjects with CAI will be randomly assigned to receive one of three experimental interventions (mobilization, massage, stretch) or a control treatment. To evaluate the effects of the experimental treatments, the following baseline measures will be taken: 1) self-assessed disability, 2) ankle dorsiflexion range of motion, and 3) sensorimotor function via measures of postural control and gait initiation. Subjects will then be randomly assigned to receive ankle mobilization (n=20), plantar massage (n=20), triceps surae stretching (n=20), or a control treatment (n=20). Follow up measures will be taken immediately after the first and final treatment of a two-week intervention as well as 1-month after receiving the treatment intervention. For this investigation, separate MANOVAs will assess the effects of treatment (mobilization, massage, stretch, control) and time (baseline, post 1st treatment, post final treatment, 1-month follow-up) on subjective and objective measures of clinical disablement and sensorimotor function in those with CAI. The results of this randomized controlled study will elucidate the effectiveness of sensory-targeted ankle rehabilitation strategies at improving sensorimotor function and disability in those with CAI.