Changes in Corticomotor Excitability of the Peroneal Muscles in People with Functional Ankle Instability Received Dynamic Balance Exercise: A Randomized Clinical Trial

Determination of motor cortex excitability changes following dynamic balance exercises

A controlled, parallel-group, single-blind, randomized clinical trial of 38 patients. Permutation block randomization is used.

Study will be conducted at the Neuromuscular Rehabilitation Research Center of Semnan University of Medical Sciences, people with functional ankle instability randomly allocated in control and treatment groups. the evaluator will be blinded to allocation.

inclusion criteria: at least once unilateral ankle sprain with grade II in last 1-3 years at least twice giving way in injured ankle in last 6 months score ≤ 24 in CAIT questionnaire 20-60 years old exclusion criteria: Ankle joint laxity Moderate to severe pain and swelling in ankle severe limitation in ankle range of motion surgery or fracture in lower limbs neurovascular and musculoskeletal disorders in lower limbs taking any medicine in last 2 weeks before the study physical therapy in last 6 months before the study systemic diseases or rheumatological disorders Balance and vestibular disorder brain surgery and head trauma migraine and seizures metal or electric implant in body psychiatric disorders Pregnancy or breastfeeding

Balance exercises on the involved leg in each session will be include two statics (3 sets of 30 seconds) and four dynamics (3 sets of 6 repetitions for posterior-anterior and medial-lateral tilts, 1 set of 10 repetitions for clockwise and counterclockwise rotations). Instability of static will be decrease from 11 and 7 in first week to 6 and 2 in sixth week, and in dynamic from 7 to 2. the control group will not receive balance exercises.

Cumberland ankle instability tools questionnaire score; motor evoked potential in rest and active state; cortical silence period

Permuted block randomization method will be used for randomization. In this regard, blocks of four with numbers 1 to 6 will be used as follows: (in each block, a means the intervention group and b means the control group): 1-aabb 2-abba 3-abab 4-baba 5-baab 6-bbaa After choosing numbers one to six from the table of random numbers (numbers 0 and 7 to 9 are not taken into account), the block associated with each number is determined and the eligible people are enrolled in the study from left to right in each block and will be assigned in one of a or b group. The numbers will be selected nine times and the first 36 people will be grouped in this way, and the last two people will be entered into the group by assigning a coin. Participants, therapists, and evaluators will be unaware of the grouping. To implement the generated random sequence, the method of hiding the box or coded cans is used. In this method, the cans will be numbered based on a random sequence, and inside the boxes, the desired intervention will be given to the therapist with a sheet on which the random allocation is written, with the condition that the boxes are completely sealed and the therapist will assign patients to intervention and control groups based on the order of arrival.

A physiotherapist will be in charge of the treatment process of the intervention group, and another physiotherapist will evaluate the desired variables. Therefore, the future study will be a single-blind study.

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