Visual-Motor Coordination Assessments for Patients with Chronic Ankle Instability: Decision Support Tools to Optimize Return to Duty

Grants and Contracts Details


LAY ABSTRACT According to US Armed Forces Defense Medical Surveillance System, lateral ankle sprains accounted for 92,000 medical encounters per year from 2006-2015 placing a substantial burden on the military health system. Once active-duty service members sustain an ankle sprain, they have a much greater risk for sustaining a future ankle injury. Service members who experience multiple lateral ankle sprains are at greater risk for shorter time in service. Approximately 40% of lateral ankle sprain patients develop chronic ankle instability (CAI) indicating that up to 36,800 service members develop CAI on an annual basis. CAI is characterized by recurrent lateral ankle sprains, repetitive sensations of ankle “giving way”, residual ankle sprain symptoms, and self-reported disability. CAI contributes to the medically non-available number of service members, creates substantial economic burden, impacts the quality of duty-relevant task performance, and generates a large population of service members who require long-term care after retirement. Overall, the current rehabilitation strategies and return to duty readiness assessments are insufficient for preventing complications following lateral ankle sprain. The proposed study is in response to the FY21 PRORP Clinical Translation Research Award to address the Focus Area of Retention Strategies related to Return to Duty. The purpose of this proposal is to establish a novel outcomes assessment paradigm focused on visual-motor coordination (VMC) in patients with CAI. This study will establish a series of novel VMC assessments that can be used as decision support tools to optimize return to duty following lateral ankle sprain injuries. This study will provide short-term impact by providing a new testing battery which will provide clinically feasible assessments to gauge readiness for return to tactical environments for patients with LAS or CAI. The long-term impact will be related to the expansion of the rehabilitation paradigm as a result of the VMC deficits identified using these outcomes. The VMC assessments proposed by our research team were designed to provide clinically feasible outcome measures that integrate the detection of perceptual input, cognitive processing, and corresponding motor responses. Through our preliminary research, we have identified slower visuomotor reaction time on an upper extremity reaction test in collegiate athletes with a history of lateral ankle sprain which indicates these individuals have a diminished ability to visually identify, cognitively process, and respond to stimuli. Based on our preliminary work, we expect the VMC assessments will more effectively identify residual motor dysfunction (Aim 1), exhibit associations with brain connectivity, cognitive performance, and injury-related fear (Aim 2), and demonstrate strong test-retest reliability in CAI patients (Aim 3). The successful execution of these aims will facilitate the long-term goal of this research agenda which is to develop a novel evaluation and rehabilitation strategies that improve the immediate and long-term health of warfighters with CAI. This study will establish the VMC testing battery as effective decision support tools to optimize return to duty in individuals with CAI. We expect participants with CAI will exhibit motor and cognitive deficits on VMC assessments which will be related to alterations in brain function, cognition, and psychological variables. These findings will signal that the current rehabilitation strategy for CAI does not address the full continuum of impairments associated with this condition and more advanced treatment strategies are warranted. Furthermore, we expect the VMC assessments will demonstrate strong test-retest reliability with modest measurement error. These findings will provide additional support to implement VMC assessments as outcome assessments in clinical practice and future clinical trials. Cumulatively, the outcomes of this study will provide the impetus to advance the continuum of care for individuals with history of ankle sprain by developing more effective outcomes and rehabilitation strategies that will optimize the immediate and long-term performance capabilities of warfighters with this condition. This study supports the vision of the FY21 PRORP to improve the health and well-being of military service members, veterans, and beneficiaries by establishing the VMC assessment battery as novel health outcomes for patients with CAI. The primary deliverables following completion of this research are Knowledge Products specifically in the form of a technical report, evidence-based testing protocol, and clinician training materials to equip clinicians and researchers with the knowledge and skills to execute these measures. These knowledge products will be directed for distribution to clinicians throughout the military health system. We believe the development of these knowledge products are essential to the impact of the study by translating the study findings directly to the clinicians who interact with this patient population.
Effective start/end date9/1/228/31/26


  • Army Medical Research and Materiel Command: $1,494,315.00


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