Neurophysiology of Ankle Instability

February 11, 2026 updated by: University of Nebraska

Understanding the Neurophysiology of Ankle Instability to Improve Rehabilitation Outcomes

Chronic ankle instability (CAI) is a common debilitating orthopedic condition that disrupts physical function and decreases quality of life. Not all CAI is the same. It can be mechanical ligamentous laxity, perceived disability often referred to as functional instability, or a combination of the two. However, clinicians and researchers most often combine all chronic ankle instability patients without considering these sub-groups, which may account for poor recovery and recurrence. The objective of this research is to determine functional and neurophysiological differences between sub-groups of CAI to allow for development of evidence-based rehabilitation which may improve patient outcomes.

To accomplish this, the study will determine the differences among CAI sub-groups on performance of a traditional side-hop test and neurocognitive hop test, determine differences in neurophysiological response and motor control between CAI sub-groups during a lower limb and an ankle specific task, and determine the underlying neurophysiological effects of a 4-week neurocognitively enhanced balance training protocol among CAI subgroups. Time to complete each of the hop tests, cortical activation during the balance and force control tasks, and neurocognitive performance will be assessed to determine differences in performance and neurological function among subgroups of CAI

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Detailed Description

Chronic ankle instability (CAI) is a common debilitating orthopedic condition that disrupts physical function and decreases quality of life. CAI is heterogenous and can manifest as mechanical ligamentous laxity, perceived disability often referred to as functional instability, or a combination of the two. However, clinicians and researchers most often combine all chronic ankle instability patients without considering these sub-groups, which may account for the poor recovery and recurrent nature of this pathology. Neurocognitive and neurophysiologic discrepancies may explain the different sub-groups; however, technological limitations have previously limited this assessment. The objective of this research is to determine functional and neurophysiological differences between sub-groups of CAI to allow for development of evidence-based rehabilitation which may improve patient outcomes.

To accomplish this, the study will determine the differences among CAI sub-groups on performance of a traditional side-hop test and neurocognitive hop test, determine differences in neurophysiological response and motor control between CAI sub-groups during a lower limb and an ankle specific task, and determine the underlying neurophysiological effects of a 4-week neurocognitively enhanced balance training protocol among CAI subgroups. This study hypothesizes functional performance will be similar between sub-groups during a traditional side-hop test, but those with functional instability without mechanical laxity will perform worse during a choice-reaction hop test compared to those with mechanical ankle instability. It also hypothesizes individuals with functional ankle instability will demonstrate greater cortical activation during the research tasks and after a 4-week balance training protocol compared to individuals with mechanical ankle instability. Time to complete each of the hop tests, cortical activation during the balance and force control tasks, and neurocognitive performance will be assessed to determine differences in performance and neurological function among subgroups of CAI.

Study Type

Interventional

Enrollment (Estimated)

42

Phase

  • Not Applicable

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

  • United States
    • Nebraska
      • Omaha, Nebraska, United States, 68182
        • University of Nebraska-Omaha, Biomechanics Research Building

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

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • All participants must be physically active (participation in at least 90 total minutes of activity/week including running, walking, lifting weights, or playing a sport, etc.)

  • Healthy controls:

    • no history of lateral ankle sprain
    • no complaints of their ankle giving way
    • a Cumberland Ankle Instability Tool (CAIT) score greater than 28

  • Coper participants (participants coping with ankle problems:

    • a history of lateral ankle sprain, but no episodes of giving way in previous 12 months
    • CAIT score greater than 28

  • Chronic ankle instability (CAI):

    • history of ankle sprain
    • two or more episodes of ankle giving way in previous 12 months
    • CAIT score less than 25

Exclusion Criteria:

  • History of lower extremity surgery or fracture
  • Current signs or symptoms of a joint sprain in the lower extremity
  • Pregnancy
  • Diagnosis of a vestibular disorder
  • Diagnosis of a nerve or connective tissue disorder
  • Significant history of condition that impaired cognitive function such as concussion or learning disability
  • Currently taking medications that may affect cognitive function such as narcotics, anti-depressants, anti-anxiety agents, or stimulants

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: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Balance Training
Exercises include (1) single-limb hops to stabilization, (2) hop to stabilization and reach, (3) unanticipated hop to stabilization, (4) single-limb stance activities, and (5) continuous choice-reaction hopping.
Other: Physical Rehabilitation
Exercises include (1) single-limb hops to stabilization, (2) hop to stabilization and reach, (3) unanticipated hop to stabilization, (4) single-limb stance activities, and (5) continuous choice-reaction hopping.
Other Names:
  • Balance and hop-training

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Side-hop Test
Time Frame: Baseline and post-rehabilitation (six weeks total)
Amount of time it takes participants to hop medially and laterally across a 30-cm gap ten times will be measured. Greater times equals worse performance.
Baseline and post-rehabilitation (six weeks total)
Choice-reaction Hop Test
Time Frame: Baseline and post-rehabilitation (six weeks total)
Amount of time it takes participants hop on a mat medially and laterally across a 30-cm gap ten times, using visual cues to direct movement to one of two squares on each side. Greater times equals worse performance.
Baseline and post-rehabilitation (six weeks total)
Inversion-eversion Force Control
Time Frame: Baseline and post-rehabilitation (six weeks total)
The force control accuracy at 50% maximal contraction for eversion and inversion will be determined. This is analyzed by a non-linear analysis Lyapunov exponent (LyE) which measures the quality or the natural, inherent fluctuations in movement. Greater values indicate reduced neuromuscular control.
Baseline and post-rehabilitation (six weeks total)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Cumberland Ankle Instability Tool
Time Frame: Baseline and post-rehabilitation (six weeks total)
Cumberland Ankle Instability Tool (CAIT), a 9-item scale, will be used to measure the severity of functional ankle instability. It is scored from 0 to 30. Higher scores indicate a better outcome.
Baseline and post-rehabilitation (six weeks total)
Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL) Scale
Time Frame: Baseline and post-rehabilitation (six weeks total)
The Foot and Ankle Ability Measure Activities of Daily Living Scale will be used to assess physical function in activities of daily living (ADL) for individuals with foot and ankle impairments. It is a patient-reported outcome instrument that is scored as a percentage from 0% to 100%. Higher scores indicate a better outcome.
Baseline and post-rehabilitation (six weeks total)
Foot and Ankle Ability Measure Sport (FAAM-Sport) Scale
Time Frame: Baseline and post-rehabilitation (six weeks total)
The Foot and Ankle Ability Measure Activities of Daily Living Scale will be used to assess physical function in sports activities for individuals with foot and ankle impairments. It is a patient-reported outcome instrument that is scored as a percentage from 0% to 100%. Higher scores indicate a better outcome.
Baseline and post-rehabilitation (six weeks total)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Nebraska

Investigators

  • Principal Investigator: Adam B Rosen, PhD, University of Nebraska

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 (Actual)

October 30, 2025

Primary Completion (Estimated)

September 1, 2027

Study Completion (Estimated)

September 1, 2027

Study Registration Dates

First Submitted

August 26, 2024

First Submitted That Met QC Criteria

August 26, 2024

First Posted (Actual)

August 29, 2024

Study Record Updates

Last Update Posted (Actual)

February 17, 2026

Last Update Submitted That Met QC Criteria

February 11, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 0549-24-EP

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

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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