Efficacy of stability-based training with visualisation in people with chronic ankle instability

Chronic ankle instability (CAI) is associated with recurrent ankle sprains, mechanical laxity and/or perceived instability. Stability-based rehabilitative training has been found to prevent further injury, however poor programme compliance can hinder the programme's effectiveness. Virtual reality (VR) systems have been shown to provide a stimulating and motivational environment that may be more conducive to rehabilitation adherence [1]. An emerging technique, visualisation, is the connection of biomechanical analysis and VR. Visualisation produces real-time feedback, by accurately monitoring movement and progress, using VR to create a diverse, challenging, and controllable environment, representative of real-world situations. The aim of this study was to determine the feasibility of incorporating visualisation into stability training for people with chronic ankle instability. Specifically, the effect on performance of the Star Excursion Balance Test (SEBT), as well as participant's enjoyment of the experience. Individuals with CAI (n=15) were randomly allocated to the 4-week stability-based training programme with visualisation (VIS), or without (NO-VIS). Balance exercises were based on standard practice, with adaptations for visualisation. The SEBT was completed prior to, and after training. Participants recorded enjoyment of training using the Physical Activity Enjoyment Scale (PACES-8). The Strathclyde Cluster Model [2] and pointer calibration [3] were applied to all participants. Movement was tracked using Vicon Tracker (Vicon, Oxford, UK), with testing controlled and recorded using D-Flow (Motek Medical, Amsterdam, The Netherlands). Statistical analysis was performed using SPSS (Cohen's d,p<0.05) (IBM SPSS, 2017). Results showed no between-group differences in population demographics (p⩾0.2). The VIS group showed greater increase in average reach distance on the SEBT (d=1.7,p=0.02) and reported a higher enjoyment of training (d=1.3,p=0.03). Results of this study support the feasibility and safety of stability training with visualisation in those with CAI. Observations of a more enjoyable experience, alongside improved postural control suggest visualisation may enhance stability-based training.