***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: Background Of all athletic knee injuries an anterior cruciate ligament ( ACL ) rupture results in the longest time loss from sport . Regardless of the therapy chosen , conservative or reconstructive , athletes are often forced to reduce their level of physical activity and their involvement in sport . Moreover , a recent review reported prevalences of osteoarthritis ranging from 0 % to 13 % for patients with isolated ACL-deficient ( ACL-D ) knees and respectively 21 % to 48 % in patients with combined injuries . The need for ACL injury prevention is clear . The identification of risk factors and the development of prevention strategies may therefore have widespread health and economic implication s. The focus of this investigation is to assess the role of implicit and explicit motor learning in optimising the performance of a side-step-cutting task . Methods / design A r and omized controlled laboratory study will be conducted . Healthy basketball players , females and males , 18 years and older , with no previous lower extremity injuries , playing at the highest recreational level will be included . Subjects will receive a dynamic feedback intervention . Kinematic and kinetic data of the hip , knee and ankle and EMG activity of the quadriceps , hamstrings and gastrocnemius will be recorded . Discussion Female athletes have a significantly higher risk of sustaining an ACL injury than male athletes . Poor biomechanical and neuromuscular control of the lower limb is suggested to be a primary risk factor of an ACL injury mechanism in females . This r and omized controlled trial has been design ed to investigate whether individual feedback on task performance appears to be an effective intervention method . Results and principles found in this study will be applied to future ACL injury prevention programs , which should maybe more focus on individual injury predisposition . Trial registration Trial registration number NTR2250 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The hippocampus shrinks in late adulthood , leading to impaired memory and increased risk for dementia . Hippocampal and medial temporal lobe volumes are larger in higher-fit adults , and physical activity training increases hippocampal perfusion , but the extent to which aerobic exercise training can modify hippocampal volume in late adulthood remains unknown . Here we show , in a r and omized controlled trial with 120 older adults , that aerobic exercise training increases the size of the anterior hippocampus , leading to improvements in spatial memory .  Exercise training increased hippocampal volume by 2 % , effectively reversing age-related loss in volume by 1 to 2 y. We also demonstrate that increased hippocampal volume is associated with greater serum levels of BDNF , a mediator of neurogenesis in the dentate gyrus . Hippocampal volume declined in the control group , but higher preintervention fitness partially attenuated the decline , suggesting that fitness protects against volume loss . Cau date nucleus and thalamus volumes were unaffected by the intervention . These theoretically important findings indicate that aerobic exercise training is effective at reversing hippocampal volume loss in late adulthood , which is accompanied by improved memory function Background . Rehabilitation of the severely affected paretic arm after stroke represents a major challenge , especially in the presence of sensory impairment . Objective . To evaluate the effect of a therapy that includes use of a mirror to simulate the affected upper extremity with the unaffected upper extremity early after stroke . Methods . Thirty-six patients with severe hemiparesis because of a first-ever ischemic stroke in the territory of the middle cerebral artery were enrolled , no more than 8 weeks after the stroke . They completed a protocol of 6 weeks of additional therapy ( 30 minutes a day , 5 days a week ) , with r and om assignment to either mirror therapy ( MT ) or an equivalent control therapy ( CT ) . The main outcome measures were the Fugl-Meyer subscores for the upper extremity , evaluated by independent raters through videotape . Patients also underwent functional and neuropsychological testing . Results . In the subgroup of 25 patients with distal plegia at the beginning of the therapy , MT patients regained more distal function than CT patients . Furthermore , across all patients , MT improved recovery of surface sensibility . Neither of these effects depended on the side of the lesioned hemisphere . MT stimulated recovery from hemineglect . Conclusions . MT early after stroke is a promising method to improve sensory and attentional deficits and to support motor recovery in a distal plegic limb This article investigates whether or not mirror therapy alters the neural mechanisms in human motor cortex . Six healthy volunteers participated . The study investigated the effects of three main factors of mirror therapy ( observation of h and movements in a mirror , motor imagery of an assumed affected h and , and assistance in exercising the assumed affected h and ) on excitability changes in the human motor cortex to clarify the contribution of each factor . The increase in motor-evoked potential ( MEP ) amplitudes during motor imagery tended to be larger with a mirror than without one . Moreover , MEP amplitudes increased greatly when movements were assisted . Watching the movement of one h and in a mirror makes it easier to move the other h and in the same way . Moreover , the increase in MEP amplitudes is related to the synergic effects of afferent information and motor imagery Cross-education strength training has being shown to retain strength and muscle thickness in the immobilized contralateral limb . Corticospinal mechanisms have been proposed to underpin this phenomenon ; however , no transcranial magnetic stimulation ( TMS ) data has yet been presented . This study used TMS to measure corticospinal responses following 3 weeks of unilateral arm training on the contralateral , immobilize arm . Participants ( n = 28 ) were r and omly divided into either immobilized strength training ( Immob + train ) immobilized no training ( Immob ) or control . Participants in the immobilized groups had their nondominant arm rested in a sling , 15 h/day for 3 weeks . The Immob + train group completed unilateral arm curl strength training , while the Immob and control groups did not undertake training . All participants were tested for corticospinal excitability , strength , and muscle thickness of both arms . Immobilization result ed in a group x time significant reduction in strength , muscle thickness and corticospinal excitability for the untrained limb of the Immob group . Conversely , no significant change in strength , muscle thickness , or corticospinal excitability occurred in the untrained limb of the Immob + train group . These results provide the first evidence of corticospinal mechanisms , assessed by TMS , underpinning the use of unilateral strength training to retain strength and muscle thickness following immobilization of the contralateral limb PURPOSE Unilateral strength training strengthens not only the muscles on the trained side but also the homologous muscles on the untrained side ; however , the magnitude of this interlimb cross-education is modest . We tested the hypothesis that heightened sensory feedback by mirror viewing the exercising h and would augment cross education by modulating neuronal excitability . METHODS Healthy adults were r and omized into a mirror training group ( MG , N = 11 ) and a no-mirror training group ( NMG , N = 12 ) and performed 640 shortening muscle contractions of the right wrist flexors at 80 % maximum voluntary contraction ( MVC ) during 15 sessions for 3 wk . Maximal strength and specific transcranial magnetic stimulation metrics of neuronal excitability , measured in the mirror and no-mirror setup at rest and during unilateral contractions at 60 % MVC , were assessed before and after the strength intervention . RESULTS Trained wrist flexor MVC increased 72 % across groups , whereas cross-education was higher for the MG ( 61 % ) than NMG ( 34 % , P = 0.047 ) . The MG showed a reduction ( 15%-16 % ) in the contralateral silent period duration measured from the contracting left-untrained flexor carpi radialis , whereas the NMG showed an increase ( 12 % , P ≤ 0.030 ) . Interhemispheric inhibition , measured from the trained to the untrained primary motor cortex , increased in the MG ( 11 % ) but decreased in the NMG ( 15 % ) when measured in the mirror setup at rest ( P = 0.048 ) . Other transcranial magnetic stimulation measures did not change . CONCLUSION Viewing the exercising h and in a mirror can augment the cross-education effect . The use of a mirror in future studies can potentially accelerate functional recovery from unilateral impairment due to stroke or upper limb fracture Objective : To evaluate the effects of individual or group mirror therapy on sensorimotor function , activities of daily living , quality of life and visuospatial neglect in patients with a severe arm paresis after stroke . Design : R and omized controlled trial . Setting : Inpatient rehabilitation centre . Subject : Sixty patients with a severe paresis of the arm within three months after stroke . Interventions : Three groups : ( 1 ) individual mirror therapy , ( 2 ) group mirror therapy and ( 3 ) control intervention with restricted view on the affected arm . Main measures : Motor function on impairment ( Fugl-Meyer Test ) and activity level ( Action Research Arm Test ) , independence in activities of daily living ( Barthel Index ) , quality of life ( Stroke Impact Scale ) and visuospatial neglect ( Star Cancellation Test ) . Results : After five weeks , no significant group differences for motor function were found ( P > 0.05 ) . Pre – post differences for the Action Research Arm Test and Fugl-Meyer Test : individual mirror therapy : 3.4 ( 7.1 ) and 3.2 ( 3.8 ) , group mirror therapy : 1.1 ( 3.1 ) and 5.1 ( 10.0 ) and control therapy : 2.8 ( 6.7 ) and 5.2 ( 8.7 ) . However , a significant effect on visuospatial neglect for patients in the individual mirror therapy compared to control group could be shown ( P < 0.01 ) . Furthermore , it was possible to integrate a mirror therapy group intervention for severely affected patients after stroke . Conclusion : This study showed no effect on sensorimotor function of the arm , activities of daily living and quality of life of mirror therapy compared to a control intervention after stroke . However , a positive effect on visuospatial neglect was indicated 
    Output:
    
It is unclear whether the effects of  MTr on motor performance are more pronounced than the direct vision pattern , passive vision pattern or action observation .