渐进式平衡训练对慢性踝关节不稳患者运动皮质兴奋性、本体感觉和平衡能力的影响

doi:10.3969/j.issn.1006-9771.2026.06.010

Abstract

Abstract:

Objective To investigate the effect of progressive balance training on motor cortical excitability, proprioception and balance in patients with chronic ankle instability(CAI).
Methods From September to December, 2024, 46 patients with CAI in Hebei Sport University were enrolled and randomly allocated into control group(n=24)and intervention group(n=22). Both groups received health education, while the intervention group completed a progressive balance training program additionally, for six weeks. Before and after intervention, the following indicators were measured: active motor threshold, latency, amplitude and cortical silent period of motor-evoked potentials of the soleus muscle; ankle joint inversion position sense; the anteroposterior and mediolateral velocities of the center of pressure(COP)on the affected side during single-leg standing with eyes open and closed; and reach distances in the Y-Balance Test.
Results After intervention, significant group, time and interaction effects were observed in the cortical silent period and mediolateral COP velocity under eyes-closed condition(F>7.877, P<0.05). Significant time and interaction effects were found in motor-evoked potential amplitude, anteroposterior COP velocity with eyes open and eyes closed, as well as anterior and posteromedial reach distances of the Y-Balance Test(F>4.333, P≤ 0.05). Significant main time effects existed in motor-evoked potential latency and ankle inversion position sense(F>4.711, P<0.05). Simple effect analysis revealed that after intervention, the observation group presented improvements in active motor threshold, motor-evoked potential amplitude, cortical silent period, ankle inversion position sense, anteroposterior COP velocity under eyes-open and eyes-closed conditions, mediolateral COP velocity with eyes closed, and anterior and posteromedial Y-Balance Test reach distances(P<0.05). Furthermore, the observation group achieved superior outcomes relative to the control group in motor-evoked potential amplitude, cortical silent period, ankle inversion position sense, eyes-closed mediolateral COP velocity, and anterior Y-Balance Test reach distance(P<0.05).
Conclusion Progressive balance training may enhance corticospinal excitability, and improve ankle proprioception and static and dynamic balance performance in patients with CAI.

Key words: chronic ankle instability, progressive balance training, motor cortical excitability, proprioception, balance

CLC Number:

R684.7

CAO Chuanbao, MA Gang, YAN Shifang. Effect of progressive balance training on motor cortical excitability, proprioception and balance in patients with chronic ankle instability[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(6): 721-730.

Figures/Tables 10

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Table 10

Simple affect test results of COP and Y-Balance Test"

变量		组别	组别	平均值差	P值	95%CI
变量		组别	组别	平均值差	P值	下限	上限
COP	睁眼前后方向速度	对照组干预前	对照组干预后	0.386	0.516	-0.824	1.596
		观察组干预前	观察组干预后	1.703	0.004	0.605	2.801
		对照组干预前	观察组干预前	-0.190	0.378	-0.627	0.248
		对照组干预后	观察组干预后	1.121	0.054	-0.021	2.262
	睁眼左右方向速度	对照组干预前	对照组干预后	0.366	0.420	-0.557	1.289
		观察组干预前	观察组干预后	0.672	0.274	-0.572	1.915
		对照组干预前	观察组干预前	-0.113	0.860	-1.432	1.206
		对照组干预后	观察组干预后	-0.063	0.925	-1.437	1.311
	闭眼前后方向速度	对照组干预前	对照组干预后	0.554	0.429	-0.868	1.975
		观察组干预前	观察组干预后	2.768	<0.001	2.211	3.325
		对照组干预前	观察组干预前	-0.835	0.510	-3.427	1.757
		对照组干预后	观察组干预后	1.513	0.194	-0.830	3.857
	闭眼左右方向速度	对照组干预前	对照组干预后	1.149	0.069	-0.095	2.394
		观察组干预前	观察组干预后	3.356	<0.001	2.160	4.552
		对照组干预前	观察组干预前	0.478	0.162	-0.208	1.163
		对照组干预后	观察组干预后	2.407	0.003	0.947	3.867
Y平衡测试	前侧	对照组干预前	对照组干预后	1.600	0.093	-0.289	3.489
		观察组干预前	观察组干预后	-7.208	0.005	-12.005	-2.410
		对照组干预前	观察组干预前	3.000	0.268	-2.480	8.480
		对照组干预后	观察组干预后	-5.425	0.010	-9.424	-1.425
	后内侧	对照组干预前	对照组干预后	-1.760	0.316	-5.316	1.796
		观察组干预前	观察组干预后	-6.995	<0.001	-8.416	-5.574
		对照组干预前	观察组干预前	-1.456	0.598	-7.114	4.202
		对照组干预后	观察组干预后	-5.865	0.060	-11.997	0.267
	后外侧	对照组干预前	对照组干预后	2.638	0.261	-2.100	7.376
		观察组干预前	观察组干预后	-3.031	0.162	-7.383	1.321
		对照组干预前	观察组干预前	2.486	0.232	-1.711	6.683
		对照组干预后	观察组干预后	-2.537	0.310	-7.609	2.535

Table 10

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组别	n	性别(男/女)/n	年龄/岁	身高/cm	体质量/kg	BMI/(kg·m^-2)	CAIT评分
对照组	24	13/11	22.67±1.83	170.43±4.43	69.49±5.52	23.92±1.65	17.71±4.66
观察组	24	14/10	23.46±1.47	172.57±6.21	69.96±7.87	23.46±1.98	16.46±3.74
χ²/t值		0.285	-1.649	-1.370	-0.236	0.881	1.025
P值		0.777	0.106	0.177	0.814	0.383	0.311

变量	组别	n	干预前		干预后
变量	组别	n	均值	标准差	均值	标准差
主动运动阈值/%MSO	对照组	24	57.40	6.30	55.06	5.94
主动运动阈值/%MSO	观察组	22	56.49	4.34	51.87	5.08
运动诱发电位潜伏期/ms	对照组	24	24.47	3.98	23.18	4.30
运动诱发电位潜伏期/ms	观察组	22	25.06	5.50	22.72	4.26
运动诱发电位振幅/μV	对照组	24	0.34	0.07	0.35	0.07
运动诱发电位振幅/μV	观察组	22	0.33	0.07	0.41	0.04
皮质静息期/ms	对照组	24	89.00	10.50	88.90	8.97
皮质静息期/ms	观察组	22	90.25	10.42	74.45	8.52

变量	组别	平方和	自由度	均方	F值	P值
主动运动阈值	组别	104.431	1	104.431	4.761	0.041
	时间	271.232	1	271.232	12.144	0.002
	组别×时间	271.232	1	271.232	0.700	0.412
运动诱发电位潜伏期	组别	0.148	1	0.148	0.005	0.945
	时间	73.837	1	73.837	4.711	0.042
	组别×时间	5.585	1	5.585	0.301	0.589
运动诱发电位振幅	组别	0.013	1	0.013	1.981	0.174
	时间	0.034	1	0.034	15.079	0.001
	组别×时间	0.029	1	0.029	13.089	0.002
皮质静息期	组别	1035.538	1	1035.538	14.732	0.001
	时间	1390.415	1	1390.415	27.216	<0.001
	组别×时间	1357.053	1	1357.053	9.862	0.005

变量	组别	组别	平均值差	P值	95%CI
变量	组别	组别	平均值差	P值	下限	上限
主动运动阈值	对照组干预前	对照组干预后	2.347	0.195	-1.293	5.987
	观察组干预前	观察组干预后	4.623	0.003	1.716	7.531
	对照组干预前	观察组干预前	1.067	0.540	-2.496	4.629
	对照组干预后	观察组干预后	3.291	0.054	-0.057	6.639
运动诱发电位潜伏期	对照组干预前	对照组干预后	1.288	0.278	-1.109	3.684
	观察组干预前	观察组干预后	2.336	0.114	-0.609	5.281
	对照组干预前	观察组干预前	-0.422	0.810	-4.034	3.190
	对照组干预后	观察组干预后	0.586	0.626	-1.876	3.048
运动诱发电位振幅	对照组干预前	对照组干预后	-0.008	0.398	-0.028	0.011
	观察组干预前	观察组干预后	-0.076	<0.001	-0.114	-0.038
	对照组干预前	观察组干预前	0.012	0.605	-0.036	0.060
	对照组干预后	观察组干预后	-0.061	0.002	-0.096	-0.026
皮质静息期	对照组干预前	对照组干预后	0.103	0.973	-6.077	6.283
	观察组干预前	观察组干预后	15.804	<0.001	10.398	21.210
	对照组干预前	观察组干预前	-0.993	0.770	-7.975	5.988
	对照组干预后	观察组干预后	14.715	<0.001	8.970	20.459

组别	平方和	自由度	均方	F值	P值
组别	3.382	1	3.382	4.303	0.051
时间	11.590	1	11.590	8.569	0.008
组别×时间	1.543	1	1.543	1.965	0.176

Effect of progressive balance training on motor cortical excitability, proprioception and balance in patients with chronic ankle instability

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变量			平方和	自由度	均方	F值	P值
COP	睁眼前后方向速度	组别	4.770	1	4.770	2.628	0.120
		时间	24.160	1	24.160	4.333	0.050
		组别×时间	9.447	1	9.447	4.756	0.041
	睁眼左右方向速度	组别	0.171	1	0.171	0.027	0.872
		时间	9.198	1	9.198	2.827	0.108
		组别×时间	0.014	1	0.014	0.005	0.945
	闭眼前后方向速度	组别	2.532	1	2.532	0.091	0.766
		时间	55.892	1	55.892	15.332	0.001
		组别×时间	30.320	1	30.320	9.729	0.005
	闭眼左右方向速度	组别	45.763	1	45.763	11.398	0.003
		时间	125.829	1	125.829	23.935	<0.001
		组别×时间	20.472	1	20.472	7.877	0.011
Y平衡测试	前侧	组别	32.337	1	32.337	0.400	0.534
		时间	197.409	1	197.409	6.171	0.021
		组别×时间	390.372	1	390.372	10.801	0.004
	后内侧	组别	294.758	1	294.758	1.828	0.191
		时间	504.880	1	504.880	21.194	<0.001
		组别×时间	106.909	1	106.909	6.754	0.017
	后外侧	组别	0.014	1	0.014	0.000	0.982
		时间	5.940	1	5.940	0.228	0.638
		组别×时间	138.750	1	138.750	1.710	0.205

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变量		组别	n	干预前		干预后
变量		组别	n	均值	标准差	均值	标准差
COP	睁眼前后方向速度/cm·s^-1	对照组	24	6.91	2.20	6.53	1.91
	睁眼前后方向速度/cm·s^-1	观察组	22	7.18	2.06	5.48	1.21
	睁眼左右方向速度/cm·s^-1	对照组	24	6.47	2.21	6.11	2.40
	睁眼左右方向速度/cm·s^-1	观察组	22	6.68	2.15	6.01	2.06
	闭眼前后方向速度/cm·s^-1	对照组	24	11.13	3.87	10.58	4.09
	闭眼前后方向速度/cm·s^-1	观察组	22	11.67	3.63	8.90	2.91
	闭眼左右方向速度/cm·s^-1	对照组	24	13.69	3.02	12.54	3.14
	闭眼左右方向速度/cm·s^-1	观察组	22	13.29	3.19	9.94	2.03
Y平衡测试	前侧/cm	对照组	24	62.80	7.35	61.20	8.40
	前侧/cm	观察组	22	60.02	7.45	67.23	5.61
	后内侧/cm	对照组	24	79.39	6.61	81.15	7.69
	后内侧/cm	观察组	22	80.34	8.93	87.33	10.49
	后外侧/cm	对照组	24	75.80	7.35	73.16	8.36
	后外侧/cm	观察组	22	73.50	7.02	76.53	7.92