Neurocognitive Enrichment During Functional Performance Testing in Chronic Ankle Instability

Acute Effects of Neurocognitively Enriched Functional Performance Testing Conditions on Balance and Functional Performance in Athletes With Chronic Ankle Instability: A Randomized Crossover Study

Chronic ankle instability (CAI) is associated with recurrent ankle sprains, impaired postural control, and reduced functional performance. Traditional functional performance tests are commonly used to assess athletes with CAI; however, these assessments are typically conducted under isolated motor conditions and may not adequately reflect the neurocognitive demands encountered during sports participation.

The aim of this randomized crossover study is to investigate the acute effects of neurocognitively enriched testing conditions on balance and functional performance in athletes with CAI. Participants will perform functional performance tests under four different conditions: standard testing, internal focus of attention, external focus of attention, and cognitive dual-task conditions. Dynamic balance, vertical jump performance, single-leg hop performance, figure-of-8 hop performance, and dual-task cost will be assessed and compared across conditions.

The findings of this study may contribute to the development of more ecologically valid assessment approaches for athletes with CAI and provide insights into the influence of attentional focus and cognitive load on functional performance.

Study Overview

• Status: Recruiting
• Conditions: Chronic Ankle Instability, CAI
• Intervention / Treatment: Behavioral: Standard Testing Condition; Behavioral: Internal Focus of Attention; Behavioral: External Focus of Attention; Behavioral: Cognitive Dual-Task Condition

Detailed Description

Chronic ankle instability (CAI) is a common consequence of lateral ankle sprains and is characterized by recurrent episodes of giving way, repeated sprains, impaired sensorimotor control, and persistent functional limitations. Although functional performance tests are widely used to assess readiness for sports participation and return-to-sport status, these assessments are typically performed under isolated motor conditions and may not adequately represent the complex neurocognitive demands encountered during athletic activities.

Recent evidence from motor learning and sports medicine literature suggests that attentional focus strategies and cognitive loading can substantially influence movement performance, postural control, and motor execution. Internal focus of attention directs individuals toward body movements and joint positions, whereas external focus of attention emphasizes movement outcomes and environmental effects. In addition, dual-task paradigms introduce cognitive demands that may alter motor performance by increasing attentional load and competing for cognitive resources. Understanding how these neurocognitive factors influence functional performance may provide valuable information for the assessment and management of athletes with CAI.

The present study aims to examine the acute effects of neurocognitively enriched testing conditions on balance and functional performance in athletes with CAI. By comparing performance under standard testing, internal focus, external focus, and cognitive dual-task conditions, the study seeks to determine whether commonly used functional performance tests are sensitive to variations in attentional focus and cognitive load.

This investigation is expected to contribute to a better understanding of the interaction between cognitive processes and motor performance in athletes with CAI. The findings may support the development of more ecologically valid assessment strategies and provide clinically relevant information for rehabilitation planning, functional evaluation, and return-to-sport decision-making in athletic populations with chronic ankle instability.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Elif Aleyna Yazgan, Phd; Phone Number: 000000000 000000000; Email: elifaleyna.yazgan@nisantasi.edu.tr

Study Locations

• Turkey (Türkiye)
  • Sarıyer
    • Istanbul, Sarıyer, Turkey (Türkiye), 34453
      • Recruiting
      • Istanbul Nisantasi University
      • Contact: Elif Aleyna Yazgan, Phd; Phone Number: 0000000000; Email: elifaleyna.yazgan@nisantasi.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged between 16 and 25 years.
• Actively participating as a licensed football, basketball, or volleyball athlete.
• History of at least one lateral ankle sprain occurring ≥12 months before study participation, associated with pain and/or swelling and resulting in at least one day of restricted physical activity.
• History of recurrent ankle instability, defined as at least two episodes of giving way during the previous 6 months and/or recurrent ankle sprains.
• Cumberland Ankle Instability Tool (CAIT) score ≤25.
• Participating in regular sports training at least 3 times per week.
• No ankle surgery within the previous 6 months.
• Able to safely perform all functional performance tests.
• Willing to undergo assessment of the more symptomatic ankle; in participants with bilateral chronic ankle instability, the ankle with the lower CAIT score will be evaluated.

Exclusion Criteria:

• Acute ankle sprain within the previous 6 weeks accompanied by significant pain, swelling, or functional limitation.
• History of major lower-extremity surgery (e.g., knee, hip, or ankle surgery).
• History of neurological, vestibular, or systemic disorders that may affect balance or motor performance.
• Visual or cognitive impairments that could interfere with test performance.
• Lower-extremity injuries other than ankle instability within the previous 6 months that may negatively affect functional performance.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Standard Testing Condition; Participants perform all functional performance tests under standard testing conditions without attentional focus instructions or additional cognitive tasks. This condition serves as the reference condition for comparison with neurocognitively enriched testing conditions.	Behavioral: Standard Testing Condition; Participants perform functional performance tests under standard testing conditions without attentional focus instructions or additional cognitive tasks. This condition serves as the reference condition for comparison with neurocognitively enriched testing conditions
Experimental: Internal Focus of Attention Condition; Participants perform all functional performance tests while receiving internal focus of attention instructions directing attention toward body movements, joint positions, and movement control.	Behavioral: Internal Focus of Attention; Participants perform functional performance tests while receiving internal focus of attention instructions directing attention toward body movements, joint positions, and movement control during task execution.
Experimental: External Focus of Attention Condition; Participants perform all functional performance tests while receiving external focus of attention instructions directing attention toward movement outcomes and environmental targets.	Behavioral: External Focus of Attention; Participants perform functional performance tests while receiving external focus of attention instructions directing attention toward movement outcomes and environmental targets during task execution.
Experimental: Cognitive Dual-Task Condition; Participants perform all functional performance tests while simultaneously completing a cognitive task involving backward repetition of number sequences to increase cognitive load	Behavioral: Cognitive Dual-Task Condition; Participants perform functional performance tests while simultaneously completing a cognitive task involving backward repetition of number sequences, increasing cognitive load during motor performance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dynamic Balance Performance	Dynamic balance performance assessed using the Y Balance Test under standard, internal focus of attention, external focus of attention, and cognitive dual-task conditions.	Day 1 (during the study assessment session)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Vertical Jump Performance	Vertical jump height assessed using the My Jump 2 application under different neurocognitive testing conditions.	Day 1 (during the study assessment session)
Figure-of-8 Hop Performance	Figure-of-8 hop completion time assessed under different neurocognitive testing conditions.	Day 1 (during the study assessment session)
Dual-Task Cost	Dual-task cost calculated as the percentage change in motor performance between single-task and dual-task conditions.	Day 1 (during the study assessment session)

Collaborators and Investigators

• Sponsor: Bahçeşehir University
• Collaborators: The Scientific and Technological Research Council of Turkey

Study record dates

Study Major Dates

• Study Start (Actual): June 8, 2026
• Primary Completion (Estimated): October 8, 2026
• Study Completion (Estimated): November 8, 2026

Study Registration Dates

• First Submitted: June 13, 2026
• First Submitted That Met QC Criteria: July 5, 2026
• First Posted (Actual): July 8, 2026

Study Record Updates

• Last Update Posted (Actual): July 8, 2026
• Last Update Submitted That Met QC Criteria: July 5, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Attentional Focus; dual task; Dynamic Balance; Chronic Ankle Instability (CAI)
• Other Study ID Numbers: E-92045188-115.02-218837

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be made publicly available in order to maintain participant confidentiality and comply with institutional ethical requirements.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No