- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00847769
Ankle Sprains and Corticospinal Excitability (ACE)
March 30, 2017 updated by: Beth Fisher, University of Southern California
Effect of Manual Therapy Intervention on Corticospinal Excitability in Individuals With Post-acute Ankle Sprains
The purpose of this study is to determine changes in the brain associated with improvement in ankle range of motion following ankle manual therapy procedures in individuals with post-acute ankle sprains
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Physical therapists use many ways to treat joints that do not move well.
One way takes 1-2 seconds.
Another way may take up to 1 minute.
Both stretches seem to work, but we do not know how.
Certain changes in the brain and spinal cord may cause joints to become more flexible after these kinds of stretches.
Right now, we do not have very much information about how these might work in people who have injured their ankle.
This study will find out if changes in the brain cause better flexibility in the ankle joint after different kinds of stretches.
In this study, subjects with a certain kind of ankle sprains and limited ankle joint flexibility will be assigned to 1 out of 3 groups.
Subjects will not get to choose their groups.
The first group will have an ankle stretch that lasts 1-2 seconds.
The second group will have a stretch that last 1 minute.
The third group will have their foot held without any stretching.
We will use a machine to stimulate the brain and spinal cord to find out how these stretches affect the brain and spinal cord.
The machine sends a magnetic signal to the brain, and we will measure how much signal gets through to the leg muscles using electrodes on the skin.
We also will use 3 flexibility tests to find out how well each stretch worked.
One test is with the subject lying on their stomach, and the others are with the subject standing up.
To start the study, subjects will get their brain stimulated.
They will then get their brain stimulated again one hour later.
After the second stimulation, subjects will have their flexibility tested and then get 1 of the 3 treatments.
After the treatment, subjects will get a last brain stimulation test and flexibility tests.
We think subjects that get a fast stretch will have better brain function and flexibility than subjects that get the slow stretch or no stretch.
To test our idea, we will compare how each group did with the brain stimulation and flexibility tests.
We will also look at the relationship between brain function and flexibility.
Study Type
Interventional
Enrollment (Actual)
27
Phase
- Phase 2
- Phase 1
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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California
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Los Angeles, California, United States, 90089
- University of Southern California
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 60 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Age 18-60 years
- Onset of ankle sprain at least 2 weeks prior to enrollment
- Foot and Ankle Ability Measure Activity of Daily Living subscale score less than or equal to 80%
- Ankle dorsiflexion range of motion less than or equal to 5 degrees
Exclusion Criteria:
- Current status of assisted ambulation (eg, use of cane or crutches)
- Inability to bear weight through the affected extremity immediately after injury combined with tenderness to palpation of the medial and lateral malleolar zones, styloid process of the 5th metatarsal, and navicular
- Positive anterior drawer or talar tilt dimple test
- Volume of the affected limb greater than 10% of the unaffected limb
- Previous history of ligament or bony reconstructive surgery to the ankle and foot
- Concomitant injury to other lower extremity joints
- Medical conditions that serve as contraindications to mobilization/manipulation and transcranial magnetic stimulation, such as presence of pacemaker, metal in head, pregnancy, neurological disorders, recent use of stimulants or medications known to lower seizure threshold, and personal or family history of seizures
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: High velocity, low amplitude stretch
With the subject in a seated position on a treatment table and the lower extremity of interest stabilized to the table with a belt, a single standardized treating investigator will grasp the foot of interested with the thenar eminences on the foot's plantar surface.
A thrust will be delivered parallel to the long axis of the subject's lower leg after the treating therapist induces passive ankle dorsiflexion to end range.
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This group (n=9) will receive talocrural traction manipulation.
With the subject in a seated position on a treatment table and the lower extremity of interest stabilized to the table with a belt, a single standardized treating investigator will grasp the foot of interested with the thenar eminences on the foot's plantar surface.
A thrust will be delivered parallel to the long axis of the subject's lower leg after the treating therapist induces passive ankle dorsiflexion to end range.
Other Names:
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Active Comparator: Slow, mobilization stretch
With the subject in a seated position on a treatment table and the lower extremity of interest stabilized to the table with a belt, a single standardized treating investigator will grasp the foot of interested with the thenar eminences on the foot's plantar surface.
Traction will be delivered to the talocrural joint at the treating therapist's second perception of tissue resistance in 3 bouts of 30-second holds, separated by 10 seconds of rest.
|
This group (n=9) will receive talocrural traction mobilization.
With the subject in a seated position on a treatment table and the lower extremity of interest stabilized to the table with a belt, a single standardized treating investigator will grasp the foot of interested with the thenar eminences on the foot's plantar surface.
Traction will be delivered to the talocrural joint at the treating investigator's second perception of tissue resistance in 3 bouts of 30-second holds, separated by 10 seconds of rest.
Other Names:
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Sham Comparator: Passive positioning
With the subject in a seated position on a treatment table and the lower extremity of interest stabilized to the table with a belt, a single standardized treating investigator will grasp the foot of interested with the thenar eminences on the foot's plantar surface, which is similar to the positioning used for the active comparator groups.
The treating investigator will maintain passive positioning of the ankle for the duration of 1 deep inhalation and exhalation by the subject rather than induce an iatrogenic force.
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This group (n=9) will receive the manual therapy control intervention.
This will consist of the same patient and clinician preparation for the mobilization/manipulation techniques.
However, a single standardized treating investigator will simply maintain passive ankle positioning for the duration of 1 deep inhalation and exhalation by the subject rather than induce an iatrogenic force characteristic of the intervention received by the other 2 comparison groups.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Corticospinal motor excitability (transcranial magnetic stimulation variables)
Time Frame: Pre-intervention measurement, 1 additional repeated pre-intervention measurement, post-intervention measurement
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Pre-intervention measurement, 1 additional repeated pre-intervention measurement, post-intervention measurement
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Single leg squat reach test
Time Frame: Pre-intervention measurement, 1 additional repeated pre-intervention measurement, post-intervention measurement
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Pre-intervention measurement, 1 additional repeated pre-intervention measurement, post-intervention measurement
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Ankle flexibility test (laying on stomach)
Time Frame: Pre-intervention measurement, 1 additional repeated pre-intervention measurement, post-intervention measurement
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Pre-intervention measurement, 1 additional repeated pre-intervention measurement, post-intervention measurement
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Ankle flexibility test (standing against wall)
Time Frame: Pre-intervention measurement, 1 additional repeated pre-intervention measurement, post-intervention measurement
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Pre-intervention measurement, 1 additional repeated pre-intervention measurement, post-intervention measurement
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Beth E Fisher, PhD, PT, University of Southern California
- Study Director: Todd E Davenport, DPT, OCS, University of the Pacific
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Fisher BE, Piraino A, Lee YY, Smith JA, Johnson S, Davenport TE, Kulig K. The Effect of Velocity of Joint Mobilization on Corticospinal Excitability in Individuals With a History of Ankle Sprain. J Orthop Sports Phys Ther. 2016 Jul;46(7):562-70. doi: 10.2519/jospt.2016.6602. Epub 2016 Jun 6.
- Fisher BE, Davenport TE, Kulig K, Wu AD. Identification of potential neuromotor mechanisms of manual therapy in patients with musculoskeletal disablement: rationale and description of a clinical trial. BMC Neurol. 2009 May 21;9:20. doi: 10.1186/1471-2377-9-20.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
December 1, 2008
Primary Completion (Actual)
August 1, 2011
Study Completion (Actual)
August 1, 2011
Study Registration Dates
First Submitted
January 22, 2009
First Submitted That Met QC Criteria
February 17, 2009
First Posted (Estimate)
February 19, 2009
Study Record Updates
Last Update Posted (Actual)
April 4, 2017
Last Update Submitted That Met QC Criteria
March 30, 2017
Last Verified
March 1, 2017
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- HS-08-00192
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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