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Symposium #3

The CAI Rehabilitation Spectrum: A Multifaceted Approach to Improving Patient Outcomes

Symposium Chair: Alan Needle

Background & Relevance: Despite revelations into the complex etiology behind chronic ankle instability (CAI), deleterious outcomes persist in patients despite rehabilitation efforts. This is evident by high rates of recurrent injury, decreases in health-related quality of life, and increasing rates of post-traumatic osteoarthritis. Considering that CAI evolves from a musculoskeletal injury,rehabilitation has largely emphasized a peripheral impairment-based approach, targeting specific behavioral corrections (e.g. strength, motion, balance). While effective for improving function in the clinical setting, these patients appear to experience re-injury when returning to uncontrolled activity, thus failing to disrupt the continuum of disability.It has been well established that CAI is not solely a musculoskeletal injury, but rather a neuromechanical condition comprised of both central nervous and peripheral impairments with long-term effects impacting multiple body systems. These data suggest that clinicians and researchers must re-evaluate and expand their approach to rehabilitation for CAI & joint instability to encompass all contributing factors, and address multiplesystems.Thefocusoftheproposedsymposiawillbetopresentabroadapproachtothe rehabilitation of CAI that focuses on four key areas: neuromodulation, impairment, functional performance, and general health. Dr. Needle will present on what is known regarding the role of maladaptive neuroplasticity in affecting motion in patients following injury, and will discuss rehabilitation techniquesthat are neuromodulatory in nature. Dr. Donovan will present on the state of impairment-based rehabilitation, and discuss motor learning strategies that have the capability to improve the rate and durability of adaptations as it pertains to correcting behavioral impairments. Dr. Rosenwill present on functional performance deficits in patients with CAI, and what must be done in the clinic to facilitate the transfer of functional movements into real-world settings. Finally,Dr. Hubbard-Turner will present on the impact of CAI on general health, and the need to take a broad approach towards improving physical activity and decreasing fear-avoidance behaviors among this population. This presentation will be designed to engage bothcliniciansandresearchersattendingIAS2019,andwillgeneratethefollowinganticipatedoutcomes.As the focus of the symposia will be largely practical, attending clinicians will leave with knowledge of new techniquesthatcanbeimmediatelyadoptedintheircareofpatientswithankleinjury,aswellasanincreased awareness of the limitations of more traditional approaches. The attending research audience will similarly be engaged and will obtain an increased understanding of the multiple systems that are affected by CAI, hopefullystimulatingdiscussiontowardsthedevelopmentofnewrehabilitationparadigmsforCAI.

Speaker 1: Alan Needle

Presentation title: Can we rewire the sprained brain? Addressing neurophysiologic deficits in CAI rehabilitation

Speaker 2: Luke Donovan

Presentation title: Strategies to enhance the impairment-based rehabilitation model for patients with CAI

Speaker 3: Adam Rosen

Presentation title: Bringing the real-world to the clinic: the use of functional testing

Speaker 4: Tricia Hubbard-Turner

Presentation title:Increasing Physical Activity Across the Lifespan in CAI Patients