Effect of Adding Neurofeedback to Neuromuscular Training on Brain Waves in Athletes With Chronic Ankle Instability: A Randomized Clinical Trial

Background and Aims This study evaluated the effects of neuromuscular training compared with neurofeedback and neuromuscular training on brain waves, foot and ankle ability, and pain intensity of table tennis players with chronic ankle instability. Methods This clinical trial study was conducted on 29 table tennis players with chronic ankle instability, which were randomly divided into combined neurofeedback+neuromuscular (Mean±SD age: 21.73±2.60 years, hieght: 173.42±5.57 cm, wieght: 77.10±10.42 kg) and neuromuscular groups (Mean±SD age: 22.14±2.53 years, Mean±SD height: 169.26±6.77 cm, Mean±SD weight:77.95±15.70 kg). ProComp Infiniti System and BioGraph Infiniti version 5 software were used to measure brain waves and perform neurofeedback protocol. The foot and ankle disability questionnaire and the visual analog scale were employed to assess foot and ankle ability and pain intensity, respectively. The rehabilitation protocol was performed for eight weeks. The paired t test and 1-way analysis of covariance were used for the data analyses. Results The paired t test results revealed a significant decrease in the amplitude of theta, alpha, and sensorimotor rhythm (SMR) waves in both groups (P<0.05) and an increase in the amplitude of the beta wave only in the combined group (P<0.05). In addition, ankle ability was significantly increased during daily activities and exercise in both groups (P<0.05). On the other hand, the results of a 1-way analysis of covariance indicated a significant difference between the two groups regarding theta and beta amplitudes and degree of ankle disability during exercise, and the improvement was greater in the combined group (P<0.05). Conclusion According to the results, combined exercises (neuromuscular and neurofeedback) can be used as rehabilitation in table tennis players with chronic ankle instability to correct brain waves, improve leg and ankle ability, and reduce pain.