***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To identify the effect of vibratory stimuli applied to the plantar region on the balance of women 60 years or older . DESIGN A r and omized controlled trial ( blinded assessor ) . SETTING University research laboratory . PARTICIPANTS All women ( N=30 ; age , ≥60y ) selected had a balance deficit , assessed by using the One-Leg Stance test with eyes open ( EO ) . INTERVENTIONS Participants were r and omly divided into an experimental group , which received vibratory stimuli , and a control group , which received no intervention . MAIN OUTCOME MEASURES Functional reach ( FR ) test and center-of-pressure ( CoP ) sway area ( force platform ) . RESULTS There was a significant difference in the time factor of the experimental group for the FR test and CoP sway area with eyes closed ( EC ) . For the group × time interaction , there was improvement in balance in anterior-posterior ( AP ) CoP sway velocity with EO and EC . There also was improvement in CoP sway area with EC . CONCLUSION Vibratory stimuli applied to the plantar region have beneficial effects on balance in women 60 years or older , with greater effectiveness in anterior displacement , postural control of the AP axis , and the EC condition This study investigated the effects on st and ing balance of r and om vibrations applied to the plantar side of the feet by vibrating insoles in subjects with neuropathy and nondisabled subjects . In four different conditions ( eyes open or closed and with or without an attention-dem and ing task [ ATD ] ) , subjects with neuropathy secondary to diabetes mellitus ( n = 17 ) and nondisabled subjects ( n = 15 ) stood for 60 s on vibrating insoles placed on a force plate . During each condition , the insoles were turned on for 30 s and off for 30 s ( r and om order ) . The calculated balance measures were mean velocity of the center of pressure displacements and root-mean-square of the velocity of these displacements in the anteroposterior and mediolateral directions . In subjects with neuropathy , an interaction effect between vibration and an ADT was found for balance . No effects of vibration on balance were found in nondisabled subjects .  Vibrating insoles improved st and ing balance in subjects with neuropathy only when attention was distracted . Improvement of the insoles and their activation is needed to make their implementation in daily living possible and effective Noise can enhance the detection and transmission of weak signals in certain nonlinear systems , via a mechanism known as stochastic resonance . Here we show that input noise can be used to improve motor control in humans . Specifically , we show that the postural sway of both young and elderly individuals during quiet st and ing can be significantly reduced by applying subsensory mechanical noise to the feet . We further demonstrate with input noise a trend towards the reduction of postural sway in elderly subjects to the level of young subjects . These results suggest that noise-based devices , such as r and omly vibrating shoe inserts , may enable people to overcome functional difficulties due to age-related sensory loss BACKGROUND One of the more pervasive effects of aging is loss of cutaneous sensation , which appears to correlate with impaired postural control and increased risk of falling . This study examined the potential for compensating for the destabilizing effects of reduced cutaneous sensitivity by placing a raised edge underneath the perimeter of the plantar foot surface , so as to facilitate sensation from the stability boundaries of the base of support . METHODS The main experiment involved 14 healthy older adults ( aged 65 - 73 ) selected because they were known , from a previous study , to have moderate plantar cutaneous insensitivity . We also report results of an initial experiment involving 7 healthy young adults ( aged 23 - 31 ) . In both experiments , we studied effects of the plantar facilitation on control of rapid stepping reactions evoked by unpredictable postural perturbation , applied via sudden platform movement in forward , backward , and lateral directions . We also studied effects on " feet-in-place " responses evoked by continuous pseudor and om platform motion in mediolateral and anteroposterior directions . Subjects were blindfolded in all tests . RESULTS Plantar facilitation reduced the incidence of " extra " limb movements , beyond the initial step , during forward-step reactions in the older adults . There also appeared to be an improved ability to control feet-in-place reactions : young subjects were better able to recover balance without stepping when falling backward ( given instructions to " try not to step " ) , and both young and older subjects reduced the extent to which the center of foot pressure approached the posterior foot boundary during continuous anteroposterior platform motion . CONCLUSIONS This study provides evidence that mechanical facilitation of sensation from the boundaries of the plantar surface of the foot can improve the efficacy of certain types of stabilizing reactions evoked by unpredictable postural perturbation . The results may be directly transferable to the design of special footwear insoles to reduce instability and risk of falling in older adults Stochastic resonance ( SR ) occurs when the detection of a subthreshold signal is aided by the presence of r and om energy fluctuations in the signal modality , commonly called noise . SR is counterintuitive because such noise usually worsens performance . Nonetheless , SR has been demonstrated both theoretically and experimentally in human sensory systems . Using a psychophysically sophisticated paradigm , we show that SR aids the detection of vibrating touch stimuli presented to the foot soles of both healthy elderly people with elevated vibrotactile thresholds and healthy young people with normal vibrotactile thresholds . The results also suggest that it is possible to know a priori the amount of noise needed for optimal SR effects given the degree to which the signal is subthreshold . Thus , SR may be practical as a rehabilitative aid for individuals with elevated sensory thresholds BACKGROUND AND PURPOSE Visual feedback related to weight distribution and center-of-pressure positioning has been shown to be effective in increasing stance symmetry following stroke , although it is not clear whether functional balance ability also improves . This study compared the relative effectiveness of visual feedback training of center-of-gravity ( CoG ) positioning with conventional physical therapy following acute stroke . SUBJECTS Forty-six people who had strokes within 80 days before the study , result ing in unilateral hemiparesis , and who were in need of balance retraining participated . METHODS AND MATERIAL S Initially , subjects were r and omly assigned to visual feedback or conventional physical therapy groups for balance retraining until 16 subjects per group were recruited . The next 14 subjects were assigned to a control group . All subjects received physical therapy and occupational therapy ( regular therapy ) 2 hours a day , and subjects in the 2 experimental groups received additional balance training 30 minutes a day until discharge . The visual feedback group received information about their CoG position as they shifted their weight during various activities . The conventional therapy group received verbal and tactile cues to encourage symmetrical stance and weight shifting . Static ( postural sway ) and activity-based measures of balance ( Berg Balance Scale , gait speed , and the Timed " Up & Go " Test ) were contrasted across the 3 groups at baseline , at discharge , and at 1 month following discharge using an analysis of variance for repeated measures . RESULTS All groups demonstrated marked improvement over time for all measures of balance ability , with the greatest improvements occurring in the period from baseline to discharge . No between-group differences were detected in any of the outcome measures . CONCLUSION AND DISCUSSION Visual feedback or conventional balance training in addition to regular therapy affords no added benefit when offered in the early stages of rehabilitation following stroke OBJECTIVES To test whether subsensory vibratory noise applied to the sole of the foot using a novel piezoelectric vibratory insole can significantly improve sensation , enhance balance , and reduce gait variability in elderly people , as well as to determine the optimal level of vibratory noise and whether the therapeutic effect would endure and the user 's sensory threshold would remain constant during the course of a day . DESIGN A r and omized , single-blind , crossover study of 3 subsensory noise stimulation levels on 3 days . SETTING Balance and gait laboratory . PARTICIPANTS Healthy community-dwelling elderly volunteers ( N=12 ; age , 65 - 90y ) who could feel the maximum insole vibration . INTERVENTIONS A urethane foam insole with the piezoelectric actuators delivering subsensory vibratory noise stimulation to the soles of the feet . MAIN OUTCOME MEASURES Balance , gait , and timed Up and Go ( TUG ) test . RESULTS The vibratory insoles significantly improved performance on the TUG test , reduced the area of postural sway , and reduced the temporal variability of walking at both 70 % and 85 % of the sensory threshold and during the course of a day . Vibratory sensation thresholds remained relatively stable within and across study days . CONCLUSIONS This study provides proof of concept that the application of the principle of stochastic resonance to the foot sole sensory system using a new low-voltage piezoelectric technology can improve measures of balance and gait that are associated with falls . Effective vibratory noise amplitudes range from 70 % to 85 % of the sensory threshold and can be set once daily To study risk factors for falling , we conducted a one-year prospect i ve investigation , using a sample of 336 persons at least 75 years of age who were living in the community . All subjects underwent detailed clinical evaluation , including st and ardized measures of mental status , strength , reflexes , balance , and gait ; in addition , we inspected their homes for environmental hazards . Falls and their circumstances were identified during bimonthly telephone calls . During one year of follow-up , 108 subjects ( 32 percent ) fell at least once ; 24 percent of those who fell had serious injuries and 6 percent had fractures . Predisposing factors for falls were identified in linear-logistic models . The adjusted odds ratio for  sedative use was 28.3 ; for cognitive impairment , 5.0 ; for disability of the lower extremities , 3.8 ; for palmomental reflex , 3.0 ; for abnormalities of balance and gait , 1.9 ; and for foot problems , 1.8 ; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables . The risk of falling increased linearly with the number of risk factors , from 8 percent with none to 78 percent with four or more risk factors ( P less than 0.0001 ) . About 10 percent of the falls occurred during acute illness , 5 percent during hazardous activity , and 44 percent in the presence of environmental hazards . We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . The present r and omized controlled pilot study was conducted to determine the feasibility of the study protocol and the effects of four-week-long sessions involving stochastic resonance whole-body vibration ( SR-WBV ) training on chair rising in elderly individuals . Twenty elderly participants were divided into a SR-WBV group or a sham group .  Peak force , rate of force development , rising time , time to stabilization and total time during chair rising performance were investigated . Intraclass correlation coefficients , Mann-Whitney U-tests and Wilcoxon signed-ranked tests were used . Low volume SR-WBV over 12 training sessions might provide a safe treatment method Objective : To investigate the effect of a local vibration stimulus training programme on postural sway and gait in stroke patients . Design : A r and omized controlled trial with two groups : a local vibration stimulus training programme group and a sham group . Setting : Inpatient rehabilitation centre . Subjects : Thirty-one chronic stroke patients . Interventions : Both groups underwent a st and ard rehabilitation programme . The local vibration stimulus training programme group ( n = 16 ) participated in the local vibration stimulus training programme for 30 minutes a day , five times a week , for six weeks . The sham group ( n = 15 ) participated in a sham local vibration stimulus training programme for 30 minutes a day , five times a week , for six weeks . Main measures : A forceplate was used to measure postural sway under two conditions : st and ing with eyes open and eyes closed . Gait ability was measured using the GAITRite system . Results : In postural sway , greater improvements in the postural sway distance with eyes-open ( –11.91 vs. 0.80 ) and eyes-closed ( 
    Output:
    
Results There was reduction in center of pressure velocity and displacement especially with eyes closed using vibration in healthy elderly subjects and this effect was greater in elderly faller and patients with more balance deficiency .
Vibration programme training increased speed of walking , cadence , step time and length in stroke subjects .
The vibratory insoles significantly improved performance on the Timed Up and Go and Functional Reach tests in older people .
Conclusion Vibration was effective on balance improvement in elderly subject especially elderly with more balance deficiency and it can improve gait parameters in patients with greater baseline variability