{
  "resourceType": "ActivityDefinition",
  "id": "single-leg-balance-star-excursion",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/single-leg-balance-star-excursion",
  "version": "1",
  "name": "SingleLegBalanceStarExcursion",
  "title": "Single-Leg Balance Exercises (Star Excursion Balance Test)",
  "status": "draft",
  "experimental": true,
  "description": "Balance exercises progressing from firm to unstable surfaces. Includes single-leg stance, star excursion balance test (reaching in 8 directions while standing on one leg), and eyes-closed balance. Enhances proprioception, ankle strength, and postural control. Long-term multifaceted exercise including proprioceptive training demonstrates superior rehabilitation efficacy for chronic ankle instability.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: intermediate"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "single-leg-balance-star-excursion",
          "display": "Single-Leg Balance Exercises (Star Excursion Balance Test)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "ankle",
          "display": "Ankle"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "70258002",
          "display": "Structure of ankle joint"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "127863007",
          "display": "Structure of subtalar joint"
        }
      ],
      "text": "Ankle"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×30 seconds per leg; progress from firm → foam → eyes closed"
    }
  ],
  "usage": "Evidence: strong. Multifaceted proprioceptive training shows superior efficacy for chronic ankle instability [Zhang 2025]",
  "note": [
    {
      "text": "Soft knee, quiet hip — small ankle reactions hold the line",
      "authorString": "focus:internal"
    },
    {
      "text": "Reach the free toe toward each line on the floor",
      "authorString": "focus:external"
    },
    {
      "text": "Stop where the standing knee can still track over the toe",
      "authorString": "focus:external"
    },
    {
      "text": "Free toe taps lightly — no weight transfer",
      "authorString": "focus:tactile"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    },
    {
      "type": "citation",
      "label": "wu-ankle-sprain-2025",
      "citation": "Wu V, Padilla CA, Smith NA. (2025). Management of Acute Ankle Sprains: Common Questions and Answers"
    },
    {
      "type": "citation",
      "label": "zhang-ankle-instability-2025",
      "citation": "Zhang C, Luo Z, Wu D, et al.. (2025). Effectiveness of Exercise Therapy on Chronic Ankle Instability: A Meta-Analysis",
      "document": {
        "url": "https://doi.org/10.1038/s41598-025-95896-w"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Peroneus Longus (Fibularis Longus)"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "59831009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Tibialis Anterior"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "73508007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Tibialis Posterior"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "74318005"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gastrocnemius"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35616000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Soleus"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "78376008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Medius"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "78333006"
          }
        }
      ]
    }
  ]
}