The Effect of Intrinsic Foot Muscle on Type of Feedback According to Ability of Ankle Instability and Balance

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1 Vol.132 (Healthcare and Nursing 2016), pp The Effect of Intrinsic Foot Muscle on Type of Feedback According to Ability of Ankle Instability and Balance Eunsang Lee 1, Juchul Cho 1, Seungwon Lee 2 1 Dept. of Physical Therapy, The Graduate School of Sahmyook University 815 Hwarang-ro, Nowon-gu, Seoul 01795, KOREA 2 Dept. of Physical Therapy, Sahmyook University 815 Hwarang-ro, Nowon-gu, Seoul 01795, KOREA Corresponding Author: swlee@syu.ac.kr Abstract. This study was carried out so as to search for a more effective feedback method of intrinsic foot muscle training into practice on the basis of study results showing that intrinsic foot muscle training was effective in proprioception of chronic ankle sprain patient. In order to select suitable participants, Comberland Ankle Instability Tool was applied to 53 patients having experienced ankle sprain. And 30 patients with ankle sprain and ankle instability getting a score of less than 24 were selected. And 15 persons were randomly allotted to visual feedback group and auditory feedback group in consideration of male and female respectively. And in order to examine an effect of intrinsic foot muscle training according to each feedback, an ankle instability and static balance. With regard to ankle stability, a significant effect was produced in both groups. And visual feedback training showed a more significant increase (p<.05). And with regard to static balance ability, both groups showed a significant decrease in anterior-posterior, medial-lateral and overall balance ability (p<.05). However, no significant decrease was shown in anterior-posterior balance ability between groups. And visual feedback training showed a significant decrease in medial-lateral and overall balance ability (p<.05). The visual feedback method is more effective than auditory feedback training as sensory training for intrinsic foot muscle training in ankle sprain patients. And it is recommended that visual feedback method be performed at the same time in intrinsic food muscle training in the future. Keywords: Ankle sprain, Feedback, Intrinsic foot muscle, Balance 1 Introduction Ankle injury being one of the common during exercise, with sprains occupying the most presenting 75% of ankle injuries [1]. Excessive ankle inversion leads to injury of ankle lateral soft tissues and is referred to as lateral ankle sprain. Lateral ankle sprain This research was supported by Sahmyook University. ISSN: ASTL Copyright 2016 SERSC

2 of Grade 1, 2 presents high re-impairment risk and 80% patients who experienced ankle sprains repeatedly experienced ankle sprains and it was reported that 50-59% of athletes with a history of ankle sprains experienced more than second ankle sprains [2]. The 70-80% patients of ankle sprain suffer from chronic ankle instability. Chronic ankle instability may cause a defect in mechanical and neurological control of ankle joint complex and most studies explained the cause of ankle instability to be proprioceptive sense deficiency associated with lowered coordination [3] and that there has been injury of such proprioceptive sense due to ankle injury [4]. Therefore, many studies have been conducted for effective training of this proprioceptive sense. However, the study by Lee [5] proposed that improvement of proprioceptive sense by training of intrinsic foot muscle is more effective compared to general proprioceptive sense training through general balance training. However, in regards to short foot exercises (SFE) used as intrinsic foot muscle training, it is difficult for patients without prior knowledge on this training to conduct it in the correct way [6]. Therefore, the purpose of this study is to propose a more effective method for intrinsic foot muscle activation by comparing the cognition method through visual feedback of intrinsic foot muscles mostly used subconsciously and training method through auditory feedback. 2 Methods 2.1 Subjects The subjects of this study were adult males and females from G university located in Gwangju with an eyesight of both 1.0 or higher including corrected visuals, with cognition of change in subject 1m in front of them, and without abnormal medical findings in visual and auditory sense. All subjects were given a detailed explanation on the requirement and purpose of this study. In order to select patients appropriate for the experiment among 53 chronic ankle sprain patients with voluntary consent for study participation, Comberland Ankle Instability Tool (CAIT) was used to select 15 males and 30 females among patients with a score of 24 or lower which indicates ankle instability and traits of the subjects are as illustrated below (Table 1). 2.2 Outcome measure In order to examine the ankle instability of chronic ankle sprain patients, the measurement was conducted using CAIT. CAIT is composed of a total of 9 questions. Among them, 5 questions are with responses from 3 to 0, 2 questions from 4 to 0, 1 question from 5 to 0, and 1 question from 2 to 0. With 30 being the perfect score as a standard, 28 or higher and 24 or lower were considered as stable and instable ankles. Thus it was revealed that there was a decrease in stability followed by a decrease in score. For the measurement of static balance, evaluation on objective static balance 156 Copyright 2016 SERSC

3 was conducted using a posture stability program equipped within a computer with the use of the Biodex balance system SD (BBS, Biodex Inc., USA) (Fig. 3.). In regards to reading, a tilt toward the central point was presented to be the balance index and a lower score signified a better balance. In regards to static balance, foothold moves better with a decrease in stage from stage 6 to stage 2. Measurement results are classified from 0 to 9. 0 is the highest score signifying a stable status and 9 is the lowest score signifying an unstable status and it is calculated to the hundredths. Table 1. Demographic characteristics of the subjects (N=30) VFG (n=15) AFG (n=15) t(p) Age (year) 21.80± ± (.930) Sex (male/female) 7 / 8 8 / (.726) Height (cm) ± ± (.419) Weight (kg) 61.62± ± (.552) Note. Values are presented as mean ± SD. VFG = visual feedback group, AFG = auditory feedback group. 2.3 Data analysis Mean and standard deviation of all works and statistics in this study were output with the use of SPSS ver (SPSS Inc., Chicago, USA). Shapiro-Wilk method was used for homogeneity test and normality test of all subjects. Descriptive statistical analysis was used for general traits of subject. Independent t-test and paired t-test were used in order to examine the differences between groups and compare the significance of before and after the experiment within groups respectively. The statistical significance was set as α= Results The ankle instability test CAIT score from to in VFG and from to in AFG and there was more significant increase in VFG (.05<p). In regards to static balance test, there was significant decrease in both groups from 3.21 to 2.04 in VFG and from 3.01 to 20.2 in AFG in anterior-posterior balance index (ABI) which indicates the anterior-posterior balance (.05<p) but there was no significant difference between two groups regarding the amount of decrease (.05>p) For mediolateral balance index (MBI) indicating medial-lateral balance, both groups presented significant decrease from 3.14 to 1.61 in VFG and from 2.61 to 1.47 in AFG and there was more significant decrease in VFG in regards to difference in change between two groups (.05<p). Also, in the overall balance index (OBI) exhibiting overall balance, there was significant change from 4.27 to 2.03 in VFG and from 3.82 to 2.76 in AFG (.05<p) and Copyright 2016 SERSC 157

4 there was more significant decrease in VFG in regards to difference in change between two groups (.05<p). Results for ankle instability and balance capacity were as illustrated below (Table 2), (Table 3). Table 2. Comparison of the ankle instability (N=30) VFG (n=15) AFG (n=15) t(p) CAIT(Score) Pre-test 21.60± ± (.751) Post-test 25.80± ±1.51 Change 4.20± ± (.000) t(p) (0.000) (0.000) Note. Values are presented as mean ± SD. VFG = visual feedback group, AFG = auditory feedback group, CAIT = Comberland ankle instability tool. Table 3. Comparison of the static balance (N=30) VFG (n=15) AFG (n=15) t(p) ABI(cm) Pre-test 3.39± ± (.550) Post-test 1.81± ±1.17 Change 1.58± ± (.040) t(p) (.000) 6.692(.000) MBI(cm) Pre-test 3.14± ± (.578) Post-test 1.73± ±0.42 Change 1.52± ± (.218) t(p) (.000) 5.219(.000) OBI(cm) Pre-test 4.28± ± (.340) Post-test 2.03± ±0.98 Change 2.25± ± (.010) t(p) 9.222(.000) 5.639(.000) Note. Values are presented as mean ± SD. VFG = visual feedback group, AFG = auditory feedback group, ABI = anteroposterior balance index, MBI = mediolateral balance index, OBI = overall balance index. 158 Copyright 2016 SERSC

5 4 Discussion Sensory feedback is the patient consciously sense and organizations can measure of motor system, one of the great training method to provide continuous and direct sensory information. In this study, ankle instability measured by CAIT had significant improved at VFG and AFG (p<.05). In the static balance, anteroposterior, mediolateral, and overall balance index had significant decreased at both groups. However, as results excluding anterior-posterior balance ability obtained of the VFG than AFG. These results can be considered that the training method with the visual feedback to guide and correct motion intrinsic foot muscle this provide better sensory information to the selective contract and to enhance exercise control ability represented a significant increase. According to Eimer [7] voluntary focus on sound is related to the upper level of the cerebral and Chen et al. [8] suggested that auditory feedback training accompanied by rhythmic cueing led to arm stretch capacity of stroke patients and more effective motivation could be provided as a result of training through auditory feedback. However, this study progress was to evaluate the sensory feedback more effective training of the two groups. As a result, visual feedback training method presented significant increase in ankle instability and static balance excluding anteriorposterior balance index ABI (.05>p). Also, the reason why MBI and OBI presented significant change lies in the fact that they are passive approaches that create the process of correct intrinsic foot muscle training through therapists while visual feedback training is active cognition training method as it entails voluntary grasping and revision of incorrect methods together with cognition to the cerebral by narrowing the error range when analyzing the traits of visual feedback and auditory feedback training. Bouet et al. [9] stated that active exercise is more effective than passive exercise as a lower limb muscle activation method. Therefore, it was revealed that the method in which patients voluntarily perform visual cognition to the cerebral and integrate afferent information within the central nerve system can bring about a more effective response toward intrinsic foot muscles in comparison with the auditory feedback method which uses stimulation by therapists. 5 Conclusions The purpose of this study is to conduct experiments to recognize which training method is more effective for intrinsic foot muscles upon provision of visual feedback and auditory feedback methods to chronic ankle sprain patients and provide ankle patients with stability of ankles through more effective intrinsic foot muscle training. As a result of the experiment, there was an enhancement in the left, right, and overall balance index of both visual feedback and auditory feedback training groups among ankle instability and static balance except anterior-posterior balance index. The visual feedback method was more effective when comparing the change in differences between two groups. Copyright 2016 SERSC 159

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