# Understanding the Neurophysiology of Ankle Instability to Improve Rehabilitation Outcomes

> **NIH NIH R15** · UNIVERSITY OF NEBRASKA OMAHA · 2024 · $446,072

## Abstract

Understanding the Neurophysiology of Ankle Instability to Improve Rehabilitation Outcomes
Abstract
Chronic ankle instability is a common debilitating orthopedic condition that disrupts physical
function and decreases quality of life. Chronic ankle instability 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 subgroups, which may account for the poor
recovery and recurrent nature of this pathology. Neurocognitive and neurophysiologic
discrepancies may explain the different subgroups observed in this population, however,
technological limitations have previously limited this assessment. The objective of our research
is to determine functional and neurophysiological differences between subgroups of chronic
ankle instability to allow for development of evidence-based rehabilitation which may improve
patient outcomes. To accomplish this, the aims of this study are to determine 1) the differences
among CAI subgroups on performance of a traditional side-hop test and neurocognitive hop
test, 2) differences in neurophysiological response and motor control between chronic ankle
instability subgroups during a lower limb and an ankle specific task, and 3) the underlying
neurophysiological effects of a 4-week neurocognitively enhanced balance training protocol
among CAI subgroups. We hypothesize functional performance will be similar between
subgroups 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. We also hypothesize 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. To assess our aims,
individuals with chronic ankle instability who present with functional ankle instability as well as
with mechanical ankle instability will perform a series of hop tests, single limb balance test, a
force control test, a neurocognitive assessment, and 4-weeks of neurocognitive balance
training. 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 chronic ankle instability. Therefore,
the long-term objective of this research is to determine the underlying neurologic,
neurophysiologic, and motor control mechanisms underpinning chronic ankle instability to
improve evidence-based decision making across patients with chronic ankle instability.

## Key facts

- **NIH application ID:** 10796185
- **Project number:** 1R15AG085105-01
- **Recipient organization:** UNIVERSITY OF NEBRASKA OMAHA
- **Principal Investigator:** Adam B Rosen
- **Activity code:** R15 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $446,072
- **Award type:** 1
- **Project period:** 2024-09-15 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10796185

## Citation

> US National Institutes of Health, RePORTER application 10796185, Understanding the Neurophysiology of Ankle Instability to Improve Rehabilitation Outcomes (1R15AG085105-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10796185. Licensed CC0.

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