Addressing Neuromuscular Deficits for Improved Outcomes in Ankle Rehabilitation
Abstract
Lateral ankle sprains (LAS) are the most commonly reported injury in military and civilian populations. LAS are associated with long-term pain, disability, time loss, and impose a substantial financial burden. Up to one million LAS are treated annually in US emergency departments, equating to over $7.5 billion in estimated costs. In the military, LAS represent 13% of the nearly 750,000 musculoskeletal injuries incurred annually, resulting in a $5.5 billion annual financial burden attributable to treating LAS and returning its Warfighters to active duty. Up to 70% of those who sustain a LAS will develop chronic ankle instability (CAI), a condition characterized by ongoing pain, ankle joint instability, re-injury, and persistent functional disability. CAI typically develops 6-12 months after the initial LAS while contributing to early onset ankle joint osteoarthritis. In the military, those who suffer from CAI typically have less service time prior to discharge as a function of the physical limitations imposed by the ankle injury. This joint degeneration of the ankle is marked by changes in its cartilage and has been shown in young adults with a history of LAS suggesting the need to determine why some individuals follow the cascade of events from sustaining a LAS, to developing CAI, to developing osteoarthritis. Fortunately, a small percentage of individuals who sustain a LAS are able to return to pre-injury activity levels without any remaining pain, disability, or functional limitations (LASCopers). The separation of the CAI and LASCoper populations appears to be related to lingering changes in the structure of the brain, which impact efficient control by the brain and spinal cord of overall body control. Standard of care (SOC) for CAI patients typically consists of symptom management or activity modification and a recovery protocol to improve motion and strength of the ankle, but does not typically address these central nervous system (CNS) deficiencies. The assumption is that LAS patients will recover without long-term consequence following the rehabilitative SOC. Contradicting this theory is the high rate of CAI observed in the military and general populations, indicating the SOC approach is insufficient and may need to focus on rehabilitation strategies beyond the musculoskeletal injury. Consistent with the Neuromusculoskeletal Injuries Rehabilitation Research Award Focus Areas, this study will address the limited understanding of the management of patient rehabilitation strategies following neuromusculoskeletal injury. Using the Identified Areas of Emphasis, to develop and evaluate innovative rehabilitation techniques for Service members with neuromusculoskeletal injuries, we will quantify the effectiveness of an innovative sensorimotor ankle rehabilitation training (SMART) protocol to address the CNS deficiencies that likely lead to CAI. Specifically, the primary purpose of this study is to demonstrate the effectiveness of a SMART protocol compared to a SOC protocol at improving clinical and novel outcomes, which will associate with lower rates of LAS re-injury and development of CAI during a 12-month follow-up period. Our hypothesis is that compared to the SOC, LAS patients participating in the SMART program will have improved clinical outcomes, lower LAS re-injury rates, improved CNS function, and less ankle joint cartilage turnover at the 12-month follow-up. The secondary purpose of this study will be to transition the results to methods that can be applied in multiple rehabilitation settings across civilian and military treatment facilities. We will determine which clinical measures are most related to the advanced brain and spinal cord measures which can indicate deficiencies in the CNS. This relationship will allow for greater distribution of the results and immediate implementation of the rehabilitation at clinical levels while minimizing the financial burden toward additional resources.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810083
Entities
People
- Phillip Gribble
Organizations
- United States Army
- University of Kentucky