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The primary aim of this study is to evaluate the immediate and short-term effects of the Graded Motor Imagery (GMI) method on individuals with chronic ankle instability (CAI). In this context, the effects of the Graded Motor Imagery intervention on pain level, muscle stiffness, muscle strength, functional performance, and subjective instability level will be investigated. Additionally, these effects will be comparatively analyzed with an age- and sex-matched control group consisting of healthy individuals.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| instability group | Experimental |
| |
| control group | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| graded motor imagery | Other | The Graded Motor Imagery (GMI) program will be applied six consecutive days nd will consist of three progressive stages: Laterality Training: Participants will perform right-left ankle discrimination tasks using validated foot and ankle images. Accuracy and response time will be recorded. Motor Imagery: Participants will mentally rehearse ankle movements such as dorsiflexion, plantarflexion, inversion, and eversion without performing the motion. Imagery tasks will progress from simple movements to functional patterns based on tolerance. Mirror Therapy: A mirror will be placed in the midsagittal plane, allowing participants to view the reflection of the non-affected ankle while performing movements. The visual illusion of normal movement is intended to improve motor control and proprioception. |
| Measure | Description | Time Frame |
|---|---|---|
| Subjective Instability (CAIT) | A valid-reliable questionnaire that questions the perceived instability in daily life and sports activities. Clinical Significance: ≥ 3 point increase is considered clinically significant | baseline |
| Subjective Instability (CAIT) | A valid-reliable questionnaire that questions the perceived instability in daily life and sports activities. Clinical Significance: ≥ 3 point increase is considered clinically significant | 1-week post-intervention |
| Ground Reaction Force & Static Balance (ForceDecks) | Device: ForceDecks dual force platform.
Clinical Importance:* Captures short-term changes in neuromuscular control and explosive strength in a detailed manner. | baseline |
| Ground Reaction Force & Static Balance (ForceDecks) | Device: ForceDecks dual force platform.
Clinical Importance:* Captures short-term changes in neuromuscular control and explosive strength in a detailed manner. | 1-week post-intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Muscle Stiffness (Myoton PRO) | Tonic stiffness (N·m-¹) reflects the passive mechanical properties of muscle tissue. The device applies a 0.4 N mechanical impulse to the skin and records the resulting tissue oscillation response. In this study, data will be recorded as the average of 3 impulses. Clinical Importance: Acute changes in stiffness are considered an indirect indicator of neuroplastic responses in proprioception and motor control. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| SEDA ATEŞ, Bachelor degree | Contact | 90+ 5388543087 | seda.ates@ogr.iuc.edu.tr |
| Name | Affiliation | Role |
|---|---|---|
| SEZEN KARABÖRKLÜ ARGUT, Assistant Professor, PhD | Istanbul University-Cerrahpaşa, Faculty of Health Sciences | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| İstanbul Üniversitesi-Cerrahpaşa | Recruiting | Istanbul | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35893186 | Background | Kim KM, Estepa-Gallego A, Estudillo-Martinez MD, Castellote-Caballero Y, Cruz-Diaz D. Comparative Effects of Neuromuscular- and Strength-Training Protocols on Pathomechanical, Sensory-Perceptual, and Motor-Behavioral Impairments in Patients with Chronic Ankle Instability: Randomized Controlled Trial. Healthcare (Basel). 2022 Jul 22;10(8):1364. doi: 10.3390/healthcare10081364. | |
| 39828772 |
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|
| baseline |
| Muscle Stiffness (Myoton PRO) | Tonic stiffness (N·m-¹) reflects the passive mechanical properties of muscle tissue. The device applies a 0.4 N mechanical impulse to the skin and records the resulting tissue oscillation response. In this study, data will be recorded as the average of 3 impulses. Clinical Importance: Acute changes in stiffness are considered an indirect indicator of neuroplastic responses in proprioception and motor control. | 1-week post-intervention |
| Muscle Strength Assessment - Isokinetic dynamometer (Isoforce) | Parameter: Concentric inversion-eversion peak torque (Nm) at 60°·s-¹ Objectively measures agonist-antagonist muscle performance around the ankle joint. Clinical Significance:* Improvements in strength contribute to functional stability and a reduced risk of re-injury. | baseline |
| Muscle Strength Assessment - Isokinetic dynamometer (Isoforce) | Parameter: Concentric inversion-eversion peak torque (Nm) at 60°·s-¹ Objectively measures agonist-antagonist muscle performance around the ankle joint. Clinical Significance:* Improvements in strength contribute to functional stability and a reduced risk of re-injury. | 1-week post-intervention |
| Pain Level | Visual Analog Scale (VAS, 0-10 cm): 0 = "no pain," 10 = "unbearable pain"; the participant marks the scale before and after the session. | baseline |
| Pain Level | Visual Analog Scale (VAS, 0-10 cm): 0 = "no pain," 10 = "unbearable pain"; the participant marks the scale before and after the session. | 1-week post-intervention |
| Functional Performance | Star Excursion Balance Test (SEBT) Parameter: Normalized reach distance in three primary directions (anteromedial, medial, posteromedial), expressed as a percentage of leg length. Clinical Significance: Assesses dynamic balance and lateral load-transfer capacity; asymmetries in individuals with chronic ankle instability (CAI) may serve as prognostic indicators. | baseline |
| Functional Performance | Star Excursion Balance Test (SEBT) Parameter: Normalized reach distance in three primary directions (anteromedial, medial, posteromedial), expressed as a percentage of leg length. Clinical Significance: Assesses dynamic balance and lateral load-transfer capacity; asymmetries in individuals with chronic ankle instability (CAI) may serve as prognostic indicators. | 1-week post-intervention |
| Background |
| Naderi A, Ahi K. Comparative analysis of land-based vs. water-based balance training on quality of life and physical and psychological deficits in athletes with chronic ankle instability: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2025 Jan 20;17(1):9. doi: 10.1186/s13102-024-01049-3. |
| 23343782 | Background | David P, Halimi M, Mora I, Doutrellot PL, Petitjean M. Isokinetic testing of evertor and invertor muscles in patients with chronic ankle instability. J Appl Biomech. 2013 Dec;29(6):696-704. doi: 10.1123/jab.29.6.696. Epub 2013 Jan 18. |
| 28137476 | Background | Wright CJ, Linens SW, Cain MS. Establishing the Minimal Clinical Important Difference and Minimal Detectable Change for the Cumberland Ankle Instability Tool. Arch Phys Med Rehabil. 2017 Sep;98(9):1806-1811. doi: 10.1016/j.apmr.2017.01.003. Epub 2017 Jan 27. |
| 17082465 | Background | Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology. 2006 Dec 26;67(12):2129-34. doi: 10.1212/01.wnl.0000249112.56935.32. Epub 2006 Nov 2. |