Effects of Neurocognitive Training on Chronic Ankle Instability

The IDFAI is a self-reported questionnaire consisting of 9 items designed to identify the presence and severity of functional ankle instability. Scores range from 0 to 37, with higher scores indicating greater instability. A score above 11 suggests the presence of instability. Scores are unitless numeric values representing the severity of symptoms and frequency of ankle sprains.

The CAIT is a self-assessment tool with 9 items measuring subjective ankle instability. Scores range from 0 (severe instability) to 30 (no instability). A score of 27 or below indicates functional ankle instability. The score is a unitless numeric value that reflects the level of perceived instability and risk of recurrent sprains.

The Visual Analog Scale (VAS) is a 10 cm line ranging from "No pain" to "Worst imaginable pain." Participants mark their pain intensity on the line, which is measured in centimeters to quantify pain severity. This unitless numeric score reflects pain intensity at rest, during training, and post-training in ankles with instability history.

Joint Position Sense test evaluates proprioception by measuring the accuracy of reproducing a passively positioned joint angle. The ankle dorsiflexion is set at 10°, and plantarflexion at 20°. The difference between target and reproduced angles is measured in degrees using a goniometer. Lower angular deviation indicates better proprioceptive accuracy.

The Sport Injury Anxiety Scale (SIAS) was developed to assess the level of anxiety athletes experience after injury. The Turkish adaptation, validity, and reliability study of the scale was conducted by Caz et al. (2019) with university students participating in amateur sports. An increase in the average score obtained from the scale indicates a higher level of injury-related anxiety (Caz et al., 2019).

Using the Multireha portable balance device, postural stability is assessed by measuring the average sway in millimeters in anterior, posterior, medial, and lateral directions during a single-leg stance on the unstable ankle side. Two trials of 30 seconds are conducted. Lower sway values indicate better postural stability.

YBT measures dynamic balance in three directions: anterior, posteromedial, and posterolateral. The composite score is calculated as (sum of three reach distances) / (3 x limb length) × 100, yielding a percentage. Higher percentages reflect better dynamic balance and postural control.

Participants perform 10 lateral hops over a 30 cm distance on the affected limb as fast as possible. The shortest completion time of two trials, measured in seconds, is recorded. Lower times indicate better functional performance and ankle stability.

RBT combines YBT setup with a smartphone-connected LED system. Participants respond to randomly illuminated lights by touching them quickly without losing balance. Performance metrics include visual-motor reaction time (milliseconds) and accuracy percentage. Two trials are conducted; the second trial is recorded for analysis. Lower reaction times and higher accuracy indicate better reactive balance.

Participants sit with dominant hand ready to press LED lights arranged on a table. Lights illuminate randomly every 0.5-2.5 seconds. Reaction time (milliseconds) and accuracy (number of correct responses) over one minute are recorded. This test evaluates selective attention and cognitive-motor processing speed.