Sensory-Targeted Ankle Rehabilitation Strategies (STARS)

描述(申请人提供)：与运动和娱乐相关的伤害是停止身体活动的主要原因，这与重大的长期负面后遗症有关。脚踝扭伤是最常见的与体力活动相关的损伤，每3个扭伤脚踝的人中至少有1人会继续发展为慢性脚踝不稳定(CAI)，其定义为终生残留症状，包括体力活动减少。传统的康复策略侧重于运动障碍，但伤残、创伤后踝关节骨关节炎的高发生率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以证据为基础的干预措施来治疗计算机辅助教学方面进行范式转变。到目前为止，很少有人注意到通过感觉通路进行干预来改善功能的潜力。研究表明，感觉运动系统根据对系统的要求而改变对各种感觉输入的依赖。因踝关节外侧感受器受损，CAI患者更重视皮肤和肌腱受体。然而，通过使用以感觉为目标的踝关节康复策略，如踝关节松动、足底按摩和伸展小腿三头肌，我们假设我们可以增强感觉运动系统可用的信息，以便调整有效的运动解决方案。事实上，我们的证据表明，针对感觉的策略可能是最有效地治疗脑梗塞患者的关键。因此，这项建议的目的是确定感觉定向踝关节康复策略在导致临床残疾和感觉运动障碍的临床残疾和感觉运动障碍的主观和客观结果指标的即时和长期改善方面的有效性。这项初步调查将是一项随机对照试验，其中80名患有脑梗塞的患者将被随机分配到三种实验干预措施(松动、按摩、拉伸)之一或对照治疗。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)踝关节背屈活动范围，3)通过姿势控制和步态启动措施的感觉运动功能。然后，受试者将被随机分配到接受踝关节松动术(n=20)、足底按摩(n=20)、小腿三头肌伸展(n=20)或对照治疗(n=20)。在第一次和最后一次治疗后立即采取后续措施，为期两周，以及在接受治疗干预后1个月。在这项调查中，单独的MANOVA将评估治疗(松动、按摩、拉伸、控制)和时间(基线、第一次治疗后、最后一次治疗后、1个月随访)对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脑梗塞患者感觉运动功能和残疾方面的有效性。 公共卫生相关性：脚踝扭伤是体力活动者经历的最常见的损伤，与这些损伤相关的复发性残疾是非常常见的。在这项研究中，我们旨在确定以感觉为目标的踝关节康复策略对慢性踝关节不稳定患者临床残疾和感觉运动功能的主客观结果的益处。通过为这种普遍存在的疾病开发新的感官靶向策略，我们希望优化慢性踝关节不稳定患者的治疗效率和质量，从而减少他们相关的长期负面后遗症和残疾。

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. PUBLIC HEALTH RELEVANCE:: Ankle sprains are the most common injury experienced by those who are physically active and recurrent disability associated with these injuries is extremely common. In this study, we aim to determine the benefits of sensory-targeted ankle rehabilitation strategies on subjective and objective outcomes of clinical disablement and sensorimotor function in those with chronic ankle instability. By developing new sensory-targeted strategies for this pervasive condition, we hope to optimize treatment efficiency and quality for patients with chronic ankle instability and subsequently reduce their associated long-term negative sequelae and disability.