Neurocognitive Ankle Training for Instability to Optimize Neuromusculoskeletal Outcomes (NATION)
Womack Army Medical Center
180 participants
Oct 13, 2025
INTERVENTIONAL
Conditions
Summary
The purpose of this study is to examine the effectiveness of a novel ankle rehabilitation protocol on improving clinical and health outcomes in physically active individuals with chronic ankle instability (CAI). Our central hypothesis is NATION, a novel rehabilitation intervention that includes neurocognitive tasks, will improve overall health and function, and reduce lower extremity musculoskeletal injury in physically active individuals with CAI.
Eligibility
Inclusion Criteria8
- Physically active and engage in regular exercise/training
- -44 years old (accounts for 86% of the individuals deployed in recent military conflicts)
- Answer "yes" to Question 1 (i.e., have you ever sprained an ankle?) on the Ankle Instability Instrument
- Answer "yes" to any four of the remaining Ankle Instability Instrument questions
- Score <24 on the Cumberland Ankle Instability Tool
- Report at least two episodes of the ankle "giving way" in the last six months
- Access to a functional email address and internet for completion of health and Service member outcomes
- Ability to provide informed consent
Exclusion Criteria6
- Unable to read or comprehend the English language.
- An ankle sprain within the last six (≤6) weeks that resulted in altered or missed physical activity for one or more (≥1) consecutive days.
- History of ankle surgery.
- History of lower extremity fracture in the last year or history of fracture that required fixation.
- Any peripheral neuropathies or other health conditions/current musculoskeletal injuries that may influence balance.
- Pregnant females (will be eligible for participation in the study after delivery of the baby and medical clearance by a qualified and licensed healthcare provider).
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Interventions
The NATION rehabilitation protocol will serve as the true intervention group. NATION is a 6-week evidence-based chronic ankle instability (CAI) rehabilitation protocol that incorporates neurocognitive exercises. Participants will complete up to 18 unsupervised home sessions and up to 12 supervised sessions. Treatment volume and exercises may vary based on participant progress and study team member guidance.
The Evidence-Based rehabilitation protocol will serve as the active comparator group. The Evidence-Based protocol will be similar to the intervention (i.e., NATION protocol), but the exercises will exclude the neurocognitive tasks. Participants assigned to the Evidence-Based protocol will complete up to 18 unsupervised home sessions and up to 12 supervised sessions over the course of 6-weeks. Treatment volume and exercises may vary based on participant progress.
Locations(2)
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NCT06527287