Balance Assessments for Identifying Ankle Instability: Introduction (02:27)

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Scott Ross objectives include defining balance deficits, discuss the sensorimotor system and balance, describe clinical balance assessments and force plate assessments.

Balance Deficits With Ankle Instability (02:41)

Chronic ankle instability normally includes balance deficits. CAI and Functional Ankle Instability both have recurrent ankle sprains, but people diagnosed with CAI tend to experience more pain and mechanical difficulty. Sensory motor deficits lead to functional instability.

Balance Deficits with Ankle Instability (02:52)

The latest studies reveal inconsistent results because the sample sizes were too small and differing outcome variables; recently Ross published a meta-analysis, combining several studies that revealed that balance deficits existed with FAI. Clinical tests reveal instability more frequently than other methods. The athletic trainer reviews how the sensorimotor system works.

Balance Strategies (03:40)

The human body employs a strategy in the ankle and the hip, engaging a stepping strategy if one loses balance. On the sagittal plane, anterior/posterior muscles provide stability. When balancing on a narrow base, individuals use more of a hip strategy than an ankle.

Clinical Implications (04:36)

Balance strategies will show determine how stable an ankle is and how well the sensorimotor system works. Ross wants after the mini-course for athletic trainers to know what test to give, how to administer it, and interpret the results. Learn about the different types of available tests.

Single Leg Balance Test (04:14)

Ross describes how to administer the single leg balance test for chronic ankle instability. A positive outcome includes one of the following reactions: reports of imbalance, touching legs, foot movement, foot contact with the floor, and hands moving from the start position.

Studies on SLB (02:11)

This test is highly reliable and does not count errors. When used in studies, a positive SLB predicted participants who might be at an increased risk for an ankle sprain.

The Foot Lift Test (04:15)

Ross describes how to administer the FLT. The clinician must count the number of times the foot wobbles; errors committed simultaneously are counted as one. Patients with ankle instability tend to perform 10 more foot lifts during the test.

The Time-in-Balance Test (03:29)

Ross describes how to administer the TBT test. It can be performed with eyes closed or open. Clinicians tend to ask athletes to perform the test three times and compute the average.

The Balance Error Scoring System (03:56)

Ross describes how to administer the BESS. The outcome measure is a cumulative error score of the combined six tests. Errors include lifting hands off the hips, hip abduction of greater than 30 degrees, hopping on the foot, opening eyes, or touching the ground.

Testing the Audience (05:17)

Ross shows a video of a patient performing the BESS test and quizzes the audience about how many errors occurred. Studies conclude that it is a good test to give, but time-consuming.

Star Excursion Balance Test (03:58)

Ross describes how to administer the SEBT test and explains that it is time-consuming because each direction must be performed three times. The greater the distance a person reaches the better the stability.

The Best Clinical Test (01:59)

The SEBT predicts lower extremity injury. After meta-analysis, Ross concluded the FLT is the best at determining ankle instability.

Force Plate Balance Test (03:30)

AccuSway, Balance Master, and the Wii Balance Board measure for ankle stability using the center of balance or center of pressure. The Wii performs rehabilitation games to help make the patient more aware of their posture.

Protocols for Force Plate Testing (04:47)

Force plates use different methods to test the center of pressure. Clinicians can calculate different outcome variables including excursion and velocity. The center of gravity confidence ellipse, area, and time to boundary measurements can determine which patients are experiencing ankle instability.

Force Plate Vs. Clinical (02:14)

Clinical tests outperform force plate testing in ankle instability. Ross summarizes his talk and concludes his remarks.

Q/A: Screening using SLB Test (01:05)

Ross suggests performing the FLT or TTB test in addition to confirm results of a patient.

Q/A: Feet Flat? (01:05)

Ross confirms he wants patients to keep their feet flat during the SEBT and explains when patients stop keeping their hips level, it leads to other errors.

Credits: Balance Assessments for Identifying Ankle Instability (00:26)

Credits: Balance Assessments for Identifying Ankle Instability