The Effects of Vestibulo-Ocular Reflex Exercises Added to Postural Stabilization Training in Chronic Ankle Instability

Y Balance Test

The Y-Balance Test will be used to assess dynamic postural control. Participants will perform the test barefoot, standing on the test limb with hands on the hips, and will reach in the anterior, posteromedial, and posterolateral directions with the free limb. Invalid trials, including loss of balance, movement of the stance foot, or removal of the hands from the hips, will be repeated. Reach distances will be recorded in centimeters, normalized to limb length, and a composite score will be calculated.

Cumberland Ankle Instability Tool

The Cumberland Ankle Instability Tool is a 9-item questionnaire used to evaluate perceived ankle instability and functional limitations. The total score ranges from 0 to 30, with lower scores indicating greater ankle instability. A score of 24 or lower is considered consistent with functional ankle instability

Single-Leg Stance + Number / Word Sequence Task

This task will assess static balance under cognitive load. Participants will stand on the affected limb on a foam pad and perform a backward number or word sequence task. In the first 10 seconds, the researcher will read six random items; participants must repeat them in reverse order within the next 10 seconds while maintaining balance. Each trial will last 20 seconds. Postural errors include removing hands from the hips, touching the ground with the non-stance foot, moving or hopping on the stance foot, hip flexion or abduction \>30°, limb contact, loss of balance, or failure to maintain the position for \>5 seconds. Each error scores 1 point, up to 10 per trial. One cognitive error is recorded for incorrect order, incomplete recall, or no response within 10 seconds. The total score is the sum of postural and cognitive errors; higher scores indicate poorer performance. After one practice trial, three trials will be recorded, and the mean total error score will be used for analysis.

Side Hop Test + Pinhole Glasses

This test will assess hopping performance under visual constraint. Participants will stand on the affected limb and hop laterally and medially over two parallel lines placed 30 cm apart. Before testing, they will complete 3-4 submaximal practice repetitions without visual constraint. During testing, participants will wear pinhole glasses and complete the task as quickly as possible. One repetition is defined as hopping from the outside of one line to the outside of the opposite line and back to the starting side. The time required to complete 10 round-trip hops will be recorded in seconds. Two trials will be performed with a 60-second rest interval, and the shortest time will be used for analysis. A trial will be repeated if the contralateral limb touches the ground, the participant steps on a line, double-limb contact occurs, or the hopping sequence is interrupted.

Figure-of-Eight Hop Test + Backward Counting Task

The Figure-of-Eight Hop Test with backward counting will assess hopping performance under cognitive load. Participants will hop on the affected limb around two cones placed 5 m apart, completing the figure-of-eight pattern twice as quickly as possible. Before testing, they will walk through the course and complete one submaximal hopping trial without the cognitive task. During testing, participants will count backward by sevens from a number between 200 and 250; numbers ending in 7 or 0 will be excluded. They will perform both tasks simultaneously without prioritizing either. After a cognitive error, the researcher will provide the correct response and the participant will continue. A trial will be repeated after contralateral foot contact, double-limb contact, cone contact or displacement, course deviation, pattern disruption, or balance loss. Two trials will be performed with 60-s rest. The shortest completion time and number of correct cognitive responses will be recorded.