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Andrea Biscarini, Samuele Contemori and Giuditta Grolla

-stability exercises executed in supine, prone, quadruped, bridge, or plank positions on an extended whole-body wobble board (WWB) specifically designed to accommodate the exerciser’s entire body, so that it comes into contact with only the wobble platform, without contact with any stable surface or support. We have

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Kathryn A. Webster and Phillip A. Gribble

Context:

Functional rehabilitation is often employed for ankle instability, but there is little evidence to support its efficacy, especially in those with chronic ankle instability (CAI).

Objective:

To review studies using both functional rehabilitation interventions and functional measurements to establish the effectiveness of functional rehabilitation for both postural control and self-reported outcomes in those with CAI.

Evidence Acquisition:

The databases of Medline, SPORTDiscus, and PubMed were searched between the years 1988 and 2008. Inclusion criteria required articles to have used a clinical research trial involving at least 1 functional rehabilitation intervention, have at least 1 outcome measure of function and/or functional performance, and to have used at least 1 group of subjects who reported either repeated lateral ankle sprains or episodes of “giving way.” The term functional was operationally defined as dynamic, closed-kinetic-chain activity other than quiet standing.

Evidence Synthesis:

Six articles met the inclusion criteria. The articles reviewed used multiple functional means for assessment and training, with a wobble board or similar device being the most common. Despite effect sizes being inconsistent for measures of dynamic postural control, all interventions resulted in improvements. Significant improvements and strong effect sizes were demonstrated for self-reported outcomes.

Conclusions:

The reviewed studies using functional rehabilitation interventions and functional assessment tools were associated with improved ankle stability for both postural control and self-reported function, but more studies may be needed with more consistent effect sizes and confidence intervals to make a definitive conclusion.

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Mary Spencer Cain, Stacy Watt Garceau and Shelley W. Linens

Context:

Chronic ankle instability (CAI) describes the residual symptoms present after repetitive ankle sprains. Current rehabilitation programs in the high school population focus on a multistation approach or general lower-extremity injury-prevention program. Specific rehabilitation techniques for CAI have not been established.

Objective:

To determine the effectiveness of a 4-wk biomechanical ankle platform system (BAPS) board protocol on the balance of high school athletes with CAI.

Design:

Randomized control trial.

Setting:

Athletic training facility.

Patients:

Twenty-two high school athletes with “giving way” and a history of ankle sprains (ie, CAI) were randomized into a rehabilitation (REH) (166.23 ± 0.93 cm, 67.0 ± 9.47 kg, 16.45 ± 0.93 y) or control (CON) (173.86 ± 8.88 cm, 84.51 ± 21.28 kg, 16.55 ± 1.29 y) group.

Interventions:

After baseline measures, the REH group completed a progressive BAPS rehabilitation program (3 times/wk for 4 wk), whereas the CON group had no intervention. Each session consisted of 5 trials of clockwise/counterclockwise rotations changing direction every 10 s during each 40-s trial. After 4 wk, baseline measurements were repeated.

Main Outcome Measures:

Dependent measures included longest time (time-in-balance test), average number of errors (foot lift test), average reach distance (cm) normalized to leg length for each reach direction (Star Excursion Balance Test [SEBT]), and fastest time (side hop test [SHT]).

Results:

Significant group-by-time interactions were found for TIB (F 1,20 = 9.89, P = .005), FLT (F 1,20 = 41.18, P < .001), SEBT-anteromedial (F 1,20 = 5.34, P = .032), SEBT-medial (F 1,20 = 7.51, P = .013), SEBT-posteromedial (F 1,20 = 12.84, P = .002), and SHT (F 1,20 = 7.50, P = .013). Post hoc testing showed that the REH group improved performance on all measures at posttest, whereas the CON group did not.

Conclusion:

A 4-wk BAPS rehabilitation protocol improved balance in high school athletes suffering from CAI. These results can allow clinicians to rehabilitate in a focused manner by using 1 rehabilitation tool that allows benefits to be accomplished in a shorter time.

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Diane Madras and J. Bradley Barr

Objective:

The article presents a focused review of the literature surrounding training methods for addressing the proprioceptive loss and subsequent balance problems that result from inversion ankle sprains.

Data Sources:

The authors searched the MEDLINE and CINAHL databases for the period 1985 through December 2001 using the key words ankle, ankle sprain, and rehabilitation.

Study Selection:

Any study investigating a rehabilitation or prevention program for the proprioceptive or balance aspects of ankle instability was included.

Data Synthesis:

Key components of the training regimen used in each study are described, and major findings are summarized.

Conclusions:

Based on the literature reviewed, there is evidence to suggest that training programs for individuals with ankle instability that include ankle-disk or wobble-board activities help improve single-leg-stance balance and might decrease the likelihood of future sprains.

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Cynthia J. Wright and Shelley W. Linens

Objective:

To track the patient-reported efficacy of a 4-wk intervention (wobble board [WB] or resistance tubing [RT]) in decreasing symptoms of chronic ankle instability (CAI) at 6 mo postintervention (6PI) as compared with immediately postintervention (IPI).

Design:

Randomized controlled trial.

Participants:

Fourteen of 21 participants (66.7%) responded to an electronic 6-m follow-up questionnaire (age 19.6 ± 0.9 y, height 1.63 ± 0.18 m, weight 70.5 ± 16.3 kg; 2 male, 12 female; 5 WB, 9 RT). All participants met CAI criteria at enrollment, including a history of ankle sprain and recurrent episodes of giving way.

Interventions:

Participants completed either RT or WB protocols, both 12 sessions over 4 wk of progressive exercise. WB sessions consisted of five 40-s sets of clockwise and counterclockwise rotations. RT sessions consisted of 30 contractions against resistance tubing in each of 4 ankle directions.

Main Outcome Measurements:

Patient-reported symptoms of “giving way” preintervention and at 6PI, global rating of change (GRC) frequencies at IPI and 6PI, and resprains at 6PI were reported descriptively. Changes in global rating of function (GRF) and giving way were compared using Wilcoxon tests, while GRC was compared with Fisher exact test.

Results:

All participants reported giving way preintervention, only 57.1% reported giving way at 6PI. Resprains occurred in 21.4% of participants. Giving-way frequency (P = .017), but not GRF or GRC (P > .05), was significantly different at IPI vs 6PI.

Conclusions:

Simple 4-wk interventions maintained some but not all improvements at 6PI. At least 42.9% of participants would no longer meet the current study’s CAI inclusion criteria due to a reduction in giving way.

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Cynthia J. Wright, Shelley W. Linens and Mary S. Cain

Context:

There is minimal patient-oriented evidence regarding the effectiveness of interventions targeted to reduce symptoms associated with chronic ankle instability (CAI). In addition, clinicians aiming to prioritize care by implementing only the most effective components of a rehabilitative program have very little evidence on comparative efficacy.

Objective:

To assess the comparative efficacy of 2 common ankle rehabilitation techniques (wobble-board [WB] balance training and ankle strengthening using resistance tubing [RT]) using patient-oriented outcomes.

Design:

Randomized controlled trial.

Setting:

Laboratory.

Patients:

40 patients with CAI randomized into 2 treatment groups: RT and WB. CAI inclusion criteria included a history of an ankle sprain, recurrent “giving way,” and a Cumberland Ankle Instability Tool (CAIT) score ≤25.

Interventions:

Participants completed 5 clinician-oriented tests (foot-lift test, time-in-balance, Star Excursion Balance Test, figure-of-8 hop, and side-hop) and 5 patient-oriented questionnaires (CAIT, Foot and Ankle Ability Measure [FAAM], Activities of Daily Living [ADL] and FAAM Sport scale, Short-Form 36 [SF-36], and Global Rating of Function [GRF]). After baseline testing, participants completed 12 sessions over 4 wk of graduated WB or RT exercise, then repeated baseline tests.

Main Outcome Measures:

For each patient- and clinician-oriented test, separate 2 × 2 RMANOVAs analyzed differences between groups over time (alpha set at P = .05).

Results:

There was a significant interaction between group and time for the FAAM-ADL (P = .04). Specifically, the WB group improved postintervention (P < .001) whereas the RT group remained the same (P = .29). There were no other significant interactions or significant differences between groups (all P > .05). There were significant improvements postintervention for the CAIT, FAAM-Sport, GRF, SF-36, and all 5 clinician-oriented tests (all P < .001).

Conclusions:

A single-exercise 4-wk intervention can improve patient- and clinician-oriented outcomes in individuals with CAI. Limited evidence indicates that WB training was more effective than RT.

Level of Evidence:

Therapy, level 1b.

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Damla Karabay, Yusuf Emük and Derya Özer Kaya

exercise ball, knees elevated UT and SA %MVIC de Araújo et al 25 n = 18 M from control group Mean (SD): age, 21.50 (2.60) y Dominant side Push-up, feet elevated Push-up on a wobble board, feet elevated UT and SA %MVIC de Araújo et al 22 n = 20 M Mean (SD): age, 22 (3) y Dominant side One-hand bench press

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Nili Steinberg, Roger Adams, Oren Tirosh, Janet Karin and Gordon Waddington

, without applying physical constraints to nonactive limbs. 15 Previous findings with the AMEDA showed that both subjects with previous unilateral and those with bilateral ankle injuries have poorer movement discrimination scores than never-injured subjects. 16 In another study, 5 weeks of wobble board

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Deborah A.M. Jehu, Nicole Paquet and Yves Lajoie

support perturbations on the both sides up ball, walking in tandem along half foam rollers, weaving around foam rollers when walking across balance pods, balancing on a square or circular wobble board arranged in the medial–lateral, anterior–posterior, or diagonal direction, trunk stability exercises on a

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Aaron Derouin and Jim R. Potvin

squat tasks for 3 different leg conditions, at 3 knee flexion angles. The leg conditions were control (contralateral intact ACL leg), unbraced (ACL affected leg), and braced (ACL affected leg). The 2 stability conditions were unstable single-leg squats on a wobble board and stable single-leg squats on