***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: OBJECTIVES Joint hypermobility ( JH ) or " ligamentous laxity " is felt to be an underlying risk factor for many types of musculoskeletal presentation in paediatrics , and joint hypermobility syndrome ( JHS ) describes such disorders where symptoms become chronic , often more generalized and associated with functional impairment . Clinical features are felt to have much in common with more severe disorders , including Ehlers-Danlos syndrome ( EDS ) , osteogenesis imperfecta and Marfan syndrome , although this has not been formally studied in children . We defined the clinical characteristics of all patients with joint hypermobility-related presentations seen from 1999 to 2002 in a tertiary referral paediatric rheumatology unit . METHODS Patients were identified and recruited from paediatric rheumatology clinic and ward , and a dedicated paediatric rheumatology hypermobility clinic at Great Ormond Street Hospital . Data were collected retrospectively on the patients from the paediatric rheumatology clinics ( 1999 - 2002 ) and prospect ively on patients seen in the hypermobility clinic ( 2000 - 2002 ) . Specifically , historical details of developmental milestones , musculoskeletal or soft tissue diagnoses and symptoms , and significant past medical history were recorded . Examination features sought included measurements of joint and soft tissue laxity , and associated conditions such as scoliosis , dysmorphic features , cardiac murmurs and eye problems . RESULTS One hundred and twenty-five children ( 64 females ) were included on whom sufficient clinical data could be identified and who had clinical problems ascribed to JH present for longer than 3 months . Sixty-four were from the paediatric rheumatology clinic and 61 from the hypermobility clinic . No differences were found in any of the measures between the two population s and results are presented in a combined fashion . Three-quarters of referrals came from paediatricians and general practitioners but in only 10 % was hypermobility recognized as a possible cause of joint complaint . The average age at onset of symptoms was 6.2 yr and age at diagnosis 9.0 yr , indicating a 2- to 3-yr delay in diagnosis . The major presenting complaint was arthralgia in 74 % , abnormal gait in 10 % , apparent joint deformity in 10 % and back pain in 6 % . Mean age at first walking was 15.0 months ; 48 % were considered " clumsy " and 36 % as having poor coordination in early childhood . Twelve per cent had " clicky " hips at birth and 4 % actual congenital dislocatable hip . Urinary tract infections were present in 13 and 6 % of the female and male cases , respectively . Thirteen and 14 % , respectively , had speech and learning difficulties diagnosed . A history of recurrent joint sprains was seen in 20 % and actual subluxation/dislocation of joints in 10 % . Forty per cent had experienced problems with  h and writing tasks  , 48 % had major limitations of school-based physical education activities , 67 % other physical activities and 41 % had missed significant periods of schooling because of symptoms . Forty-three per cent described a history of easy bruising . Examination revealed that 94 % scored > or = 4/9 on the Beighton scale for generalized hypermobility , with knees ( 92 % ) , elbows ( 87 % ) , wrists ( 82 % ) , h and metacarpophalangeal joints ( 79 % ) , and ankles ( 75 % ) being most frequently involved . CONCLUSIONS JHS is poorly recognized in children with a long delay in the time to diagnosis . Although there is a referral bias towards joint symptoms , a surprisingly large proportion is associated with significant neuromuscular and motor development problems . Our patients with JHS also show many overlap features with genetic disorders such as EDS and Marfan syndrome . The delay in diagnosis results in poor control of pain and disruption of normal home life , schooling and physical activities . Knowledge of the diagnosis and simple interventions are likely to be highly effective in reducing the morbidity and cost to the health and social services In 30 healthy volunteers with clinical ly inconspicuous knee joints and nine patients with posttraumatic recurrent patella dislocation , the proprioceptive abilities of the knee joint were evaluated by an angle reproduction test . The results of the control goup showed no gender-or dominant-specific difference . The patient group showed a significant deterioration of proprioceptive capability in the injured knee joint . Even in the contralateral , uninjured knee joint , the angle reproduction test result was significantly reduced compared with the control group . After applying an elastic knee b and age , the control group and the patients with patella dislocation showed a significant improvement of the proprioceptive capability The objective of the present study is to compare and quantify the postural differences and joint pain distribution between subjects with benign joint hypermobility syndrome ( BJHS ) and the normal population . This observational , non-r and omized , and controlled study was conducted at Rheumatology and Physical Medicine and Rehabilitation Medicine Departments of a tertiary care teaching hospital . Subjects comprise 35 persons with diagnosis of BJHS , and the control group was matched for age and sex .  Reedco ’s Posture score ( RPS ) and visual analogue scale ( VAS ) were the outcome measures . The subjects were assessed for pain in ten major joints and rated on a VAS . A  st and ard posture assessment  was conducted using the Reedco ’s Posture score . The same procedure was executed for an age- and sex-matched control group . Mean RPS for the BJHS group was 55.29 ± 8.15 and for the normal group it was 67 ± 11.94 . The most common postural deviances in subjects with BJHS were identified in the following areas of head , hip ( Sagittal plane ) , upper back , trunk , and lower back ( Coronal plane ) . Intensity of pain was found to be more in BJHS persons than that of the normal persons , and the knee joints were the most affected . The present study compared and quantified the postural abnormalities and the pain in BJHS persons . The need for postural re-education and specific assessment and training for the most affected joints are discussed . There is a significant difference in posture between subjects with BJHS and the normal population . BJHS persons need special attention to their posture re-education during physiotherapy sessions to reduce long-term detrimental effects on the musculoskeletal system We carried out a prospect i ve study to determine the validity of different sets of criteria to define the hypermobility syndrome ( HMS ) , as well as the frequency , reliability and clinical features of HMS items . All consecutive cases of HMS attending the rheumatological outpatient clinic of Hospital del Mar ( Barcelona , Spain ) constituted the index group ( n = 114 ) . A control group of non-HMS rheumatological patients ( n = 59 ) was r and omly selected to assess suitable cutoff points and particular HMS item prevalences . Beighton 's , Carter 's and Rotés ' HMS scores correlated very highly among them . Both the correlation coefficients obtained between each pair of sets of HMS criteria and the predictive efficiencies were uniformly high , suggesting high concurrent and predictive validity . All but 2 of the major items were more frequent among women . A basic set of criteria to define HMS is proposed . In relation to previous criteria the new scale shows better internal reliability and homogeneity . Results suggest that it may be suitable for screening studies and in clinical rheumatological setting OBJECTIVE To determine differences between hypermobile subjects and controls in terms of maximum strength , rate of force development , and balance . METHODS We recruited 13 subjects with hypermobility and 18 controls .  Rate of force development and maximal voluntary contraction ( MVC ) during single leg knee extension of the right knee were measured isometrically for each subject . Balance was tested twice on a force plate with 15-second single-leg st and s on the right leg .  Rate of force development ( N/second ) and MVC ( N ) were extracted from the force-time curve as maximal rate of force development (= limit Deltaforce/Deltatime ) and the absolute maximal value , respectively . RESULTS The hypermobile subjects showed a significantly higher value for rate of force development ( 15.2 % higher ; P = 0.038 , P = 0.453 , epsilon = 0.693 ) and rate of force development related to body weight ( 16.4 % higher ; P = 0.018 , P = 0.601 , epsilon = 0.834 ) than the controls . The groups did not differ significantly in MVC ( P = 0.767 , P = 0.136 , epsilon = 0.065 ) , and MVC related to body weight varied r and omly between the groups ( P = 0.921 , P = 0.050 , epsilon = 0.000 ) . In balance testing , the mediolateral sway of the hypermobile subjects showed significantly higher values ( 11.6 % higher ; P = 0.034 , P = 0.050 , epsilon = 0.000 ) than that of controls , but there was no significant difference ( 4.9 % difference ; P = 0.953 , P = 0.050 , epsilon = 0.000 ) in anteroposterior sway between the 2 groups . CONCLUSION Hypermobile women without acute symptoms or limitations in activities of daily life have a higher rate of force development in the knee extensors and a higher mediolateral sway than controls with normal joint mobility Quantification of dynamic balance is often necessary to assess a patient 's level of injury or ability to function in order to initiate an appropriate plan of care . Some therapists use the star-excursion test in an attempt to quantify dynamic balance . This test requires the patient to balance on one leg while reaching with the other leg . For the purpose of this study , the reach was performed in four directions . No previous research ers have attempted to evaluate the reliability of this test . Twenty healthy subjects between the ages of 18 and 35 years participated in this study . During two testing sessions , each subject was required to perform five reaching trials in four directions . Reliability estimates , calculated using the intraclass correlation coefficient ( 2 , 1 ) , ranged from 0.67 to 0.87 . Six duplicate practice sessions were suggested to increase this range above 0.86 . Task complexity may account for the moderate reliability estimates . Subjects should engage in a learning period before being evaluated on the star-excursion test 
    Output:
    
To conclude , lower limb joint proprioception is reduced in those with BJHS compared to non-BJHS cohorts , whilst unclear in the upper limb