In patients with ankle instability, proprioceptive training has been proven to be a necessary component for successful rehabilitation (Schiftan, Ross & Hahne, 2015). This is especially true for patients who wish to return to athletic activities as studies suggest it can reduce reoccurrence of sprains. We have found clinically that including proprioceptive training with all of our patients has improved patients’ subjective reports of balance and confidence with daily activities.
Typically, we have relied on patients’ subjective reports as well as therapists’ clinical judgement and observations to measure changes in proprioceptive ability (such as with a timed single leg stance test). With BodiTrak, however, we are able to objectively capture and quantify a patient’s stability. Measuring center of pressure displacement (CoPD) over a finite timed trial provides a measurement of the distance the CoPD travelled. In a perfectly stable position, the CoPD would remain fixed. Increased CoPD indicates greater instability (what the patient would typically describe as feeling “unsteady” and the therapist might observe as increased weight shifting and trunk movements).
In our previous experiences with patients post-knee surgery, we found that using BodiTrak to provide visual biofeedback while coaching squat mechanics was far superior to verbal cues or having the patient self-monitor using a mirror. The Boditrak was able to provide more detailed, real-time feedback that patients found more credible and were thus more apt to integrate this feedback into their movement – the true definition of biofeedback!
Data-based comparative tests are widely used in rehab, such as evaluating force and pressure in single leg hops on BodiTrak as part of a return to sport protocol. When we can measure an athletes’ performance, we are able to quantify their improvement and enhance their engagement in the rehab process.
Given the value we place on proprioceptive training, we thought it logical to similarly enhance the proprioceptive training experience. Our traditional proprioceptive training approaches have typically progressed from minimally weight-bearing activities (ankle alphabets, BAPS board) to weight bearing on uneven surfaces (airex, BOSU ball) with minimal objective feedback as to the quality of the movement. To address this, we initiated a treatment regimen that utilized the BodiTrak center of pressure (CoP) map to visually represent weight shifts over the ankle. The treatments started with performing seated ankle circles with the verbal cue to make “large, slow circles”, and gradually progressed to more challenging, weight bearing versions of the exercise.
IN THIS VIDEO, WE SEE A PATIENT (A HIGH LEVEL GYMNAST RECOVERING FROM A SEVERE ANKLE SPRAIN) PERFORMING PROPRIOCEPTIVE ACTIVITIES USING THE CENTER OF PRESSURE VISUAL DISPLAY.
The visual biofeedback provides both patient and therapist with an enhanced view of the movement quality and allows for real-time adjustments by the patient. After an initial training period, it even allows the patient to receive valuable feedback without direct 1:1 supervision from the therapist. For example, when instructed to move the CoP dot in a circle while standing on BodiTrak, patients can clearly identify positions where they have less control. Focusing more on those areas can enhance the effectiveness of the exercise and accelerate improvement.
Subjectively, patients reported that they preferred performing the training sessions on the BodiTrak because it was more challenging and gave them greater awareness of their movements. One patient even remarked that subsequent balance activities felt easier after performing 5 mins of seated biofeedback proprioceptive training with BodiTrak.
As physical therapists, we are constantly looking for ways to elevate our level of practice, quantify the efficacy of our interventions, and engage our clients. BodiTrak has enabled us to accomplish all of these with our patients recovering from ankle injuries. The principles we’ve discussed here have obvious applications to just about any movement pattern as BodiTrak can help integrate visual biofeedback with movement analysis.
Schiftan, G.S., Ross, A.R., & Hahne, A.J. (2015). The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis. Journal of Science and Medicine in Sport, 18(2015) 283-244.
Dan Allcott, DPT and Edward Bolt, DPT are physical therapists at Advance Rehabilitation on St. Simons Island, GA. First introduced to BodiTrak through Edward’s TPI training, they work a variety of clients from professional athletes to active seniors in an outpatient orthopedic physical therapy setting