Effects of Therapeutic Interventions on Neural Excitability in Individuals with CAI: A Systematic Review
Poster #: 174
Session/Time: A
Author:
Saeed Eshghi Sr, BS, MS
Mentor:
Ryan S. McCann, Sr, PhD, ATC
Research Type: Review Article
Abstract
INTRODUCTION:
Chronic ankle instability (CAI) is a frequent consequence of ankle sprains and is linked to sensorimotor deficits. Alterations in spinal and corticospinal excitability may impair motor control, contribute to instability, and increase the risk of re-injury. Understanding whether therapeutic interventions can modulate neural excitability is essential for improving rehabilitation outcomes in this population.
MAIN BODY:
A systematic search of PubMed, CINAHL, and SPORTDiscus through March 2025 identified studies examining therapeutic interventions targeting neural excitability in individuals with CAI. Eligible studies assessed changes in spinal reflex activity via the Hoffmann reflex (H-reflex) or corticospinal excitability via transcranial magnetic stimulation (TMS). Fourteen studies (12 randomized controlled trials, 2 quasi-experimental) met the inclusion criteria. Interventions included balance training, joint mobilization, sensory-level stimulation (e.g., TENS), cryotherapy, taping, neuromuscular electrical stimulation, and neuromodulatory approaches such as anodal transcranial direct current stimulation. Moderate-quality evidence supports balance training, joint mobilization, and sensory stimulation in enhancing spinal excitability. Limited but promising evidence suggests that neuromodulatory and movement-based interventions can improve corticospinal excitability, although findings varied across studies depending on posture, dosage, and task engagement.
CONCLUSION:
Therapeutic interventions can positively influence neural excitability in individuals with CAI, particularly when they emphasize active, proprioceptive, and task-specific engagement. Spinal adaptations were more consistent than corticospinal changes. While these findings highlight promising rehabilitation strategies, further high-quality and standardized studies are required to establish the long-term clinical effectiveness of neuromodulatory approaches in CAI management.
Chronic ankle instability (CAI) is a frequent consequence of ankle sprains and is linked to sensorimotor deficits. Alterations in spinal and corticospinal excitability may impair motor control, contribute to instability, and increase the risk of re-injury. Understanding whether therapeutic interventions can modulate neural excitability is essential for improving rehabilitation outcomes in this population.
MAIN BODY:
A systematic search of PubMed, CINAHL, and SPORTDiscus through March 2025 identified studies examining therapeutic interventions targeting neural excitability in individuals with CAI. Eligible studies assessed changes in spinal reflex activity via the Hoffmann reflex (H-reflex) or corticospinal excitability via transcranial magnetic stimulation (TMS). Fourteen studies (12 randomized controlled trials, 2 quasi-experimental) met the inclusion criteria. Interventions included balance training, joint mobilization, sensory-level stimulation (e.g., TENS), cryotherapy, taping, neuromuscular electrical stimulation, and neuromodulatory approaches such as anodal transcranial direct current stimulation. Moderate-quality evidence supports balance training, joint mobilization, and sensory stimulation in enhancing spinal excitability. Limited but promising evidence suggests that neuromodulatory and movement-based interventions can improve corticospinal excitability, although findings varied across studies depending on posture, dosage, and task engagement.
CONCLUSION:
Therapeutic interventions can positively influence neural excitability in individuals with CAI, particularly when they emphasize active, proprioceptive, and task-specific engagement. Spinal adaptations were more consistent than corticospinal changes. While these findings highlight promising rehabilitation strategies, further high-quality and standardized studies are required to establish the long-term clinical effectiveness of neuromodulatory approaches in CAI management.