Corticomotor Excitability in the Lower Extremity Musculature in Individuals with Chronic Ankle Instability: A Systematic Review and Meta-Analysis

Title

Corticomotor Excitability in the Lower Extremity Musculature in Individuals with Chronic Ankle Instability: A Systematic Review and Meta-Analysis

College

College of Health Sciences

Program

Ph.D. Kinesiology & Rehabilitation

Publication Date

3-28-2019

Abstract

Individuals with CAI display neuromuscular control deficits attributed to central nervous system changes. Transcranial magnetic stimulation is a non-invasive method for measuring corticomotor excitability and could enhance our understanding of these alterations. Objective: To conduct a systematic review and meta-analysis of current literature investigating corticomotor excitability in lower extremity (LE) musculature in individuals with and without CAI. Methods: A search of PubMed, CINHAL, SPORTDiscus, and ERIC was conducted. Inclusion required examination of corticomotor excitability measures in the LE of individuals with and without CAI. Methodological quality was evaluated independently by two investigators and discrepancies were discussed until consensus was reached. Sample sizes, means, and standard deviations of excitability measures were extracted. Random effects meta-analysis modeling calculated pooled effect sizes (ES) and 95% confidence intervals for limb-to-limb and group comparisons. Results: 5 articles were included which examined multiple excitability measures and four muscles of the LE: vastus medialis, fibularis longus, soleus, and tibialis anterior. The meta-analysis was limited, but found no group differences in the motor threshold of the soleus (ES = 0.17[-0.33, 0.68]) and fibularis longus (ES = -0.12[-0.64, 040]). Similarly, no limb-to-limb differences were found in the motor threshold of the fibularis longus (ES = 0.30[-0.20, 080]). Other muscles and excitability variables were measured, but were only examined in individual studies, thus were omitted from the meta-analysis. In particular, corticomotor mapping of the fibularis longus and cortical silent period of the soleus differed between groups. Conclusions: There’s level C evidence that motor thresholds of the studied LE musculature are not different between individuals with andwithout CAI. The lack of available literature limited the meta-analysis, preventing inclusion of other corticomotor alterations found to be significant between groups. Continued exploration of these variables in other LE musculature may provide deeper understanding of the central changes contributing to CAI.

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Corticomotor Excitability in the Lower Extremity Musculature in Individuals with Chronic Ankle Instability: A Systematic Review and Meta-Analysis


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