***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: The purpose of this study was to determine whether use of an abdominal binder would affect oxygen uptake , trunk range of motion , and duration of the stroke phase during wheelchair propulsion . The subjects were six paraplegic wheelchair athletes with T1-T6 injuries and no abdominal muscle function . Each subject performed two trials , one while wearing the binder and one without the binder . Each trial consisted of submaximal and maximal exercise tests conducted on wheelchair rollers . Oxygen uptake was determined by open circuit spirometry while heart rate was determined by telemetry . Max VO2 values averaged 2.51 l.min-1 while average maximum heart rate values were 190 b.min-1 . A 3-D video-based motion analysis system was used to obtain kinematic parameters of wheelchair propulsion . In general , 30 % of the cycle time was comprised of the stroke phase , while 70 % was comprised of the recovery phase across speeds . There were no statistically significant effects of the abdominal binder on any of the cardiovascular or kinematic variables at submaximal or maximal levels of exercise . Under the conditions of this laboratory investigation , it appears that an abdominal binder does not alter physiological or selected biomechanical measures in highly trained athletes Abstract In most Paralympic wheelchair sports , active trunk range of movement is assessed by observing shoulder girdle excursion during active trunk movements and is a key determinant of an athlete 's class . However , to date research evaluating the impact of reduced trunk range of movement on wheelchair sports performance has not been conducted . In the present study , 15 non-disabled male participants performed two 20-s sprints on a wheelchair ergometer in each of three seating positions . Positions were typical of those used to enhance sitting stability in wheelchair sport and each impacted available trunk range of movement differently : condition-90 ( seated with thighs horizontal ; unrestricted range of movement ) condition-45 ( seated with thighs in 45 ° ) , and condition-0 ( seated with hips maximally flexed ; minimum range of movement ) . In condition-90 , the trunk only actively contributed to the first push ; for the remainder of the sprint , the trunk was held almost isometrically at 48.2 ° to the horizontal ( range 42.1–56.4 ° ) . Similar patterns were observed for both condition-45 and condition-0 . Compared with condition-90 , participants in condition-0 had reduced capacity to accelerate of statistical ( P < 0.05 ) and practical significance . These findings are an important initial step towards evidence -based decision making in classification . Future research should evaluate the individual and collective impact of other factors that affect the trunk 's contribution to wheelchair sports performance , including strapping , seating position , and impairments of trunk muscle power and coordination The quality of reporting of cohort studies published in the most prestigious scientific medical journals was investigated to indicate to what extent the items in the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) checklist are addressed . Six top scientific medical journals with high impact factor were selected including New Engl and Journal of Medicine , Journal of the American Medical Association , Lancet , British Medical Journal , Archive of Internal Medicine , and Canadian Medical Association Journal . Ten cohort studies published in 2010 were selected r and omly from each journal . The percentage of items in the STROBE checklist that were addressed in each study was investigated . The total percentage of items addressed by these studies was 69.3 ( 95 % confidence interval : 59.6 to 79.0 ) . We concluded that reporting of cohort studies published in the most prestigious scientific medical journals is not clear enough yet . The reporting of other types of observational studies such as case-control and cross-sectional studies particularly those being published in less prestigious journals expected to be much more imprecise OBJECTIVE To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury ( SCI ) during rehabilitation . DESIGN Observational prospect i ve cohort study . Measurements were taken 3 times during subjects ' rehabilitation . SETTING Eight rehabilitation centers in the Netherl and s. PARTICIPANTS Ninety-seven subjects with SCI . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Parameters of physical capacity were upper-extremity muscle strength ( manual muscle test [ MMT ] sum score ) , peak oxygen uptake , and peak power output ( POpeak ) . The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores : ability , performance time , and physical strain . RESULTS POpeak was related to all 3 scores of the Wheelchair Circuit , and the MMT sum score was related to the ability score and the performance time score . The results indicate that ( 1 ) subjects with higher values of POpeak and /or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and ( 2 ) when a subject increased his/her POpeak and /or MMT sum score , this was associated with better wheelchair skill scores . CONCLUSIONS There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI . To optimize wheelchair skill performance , attention should be directed toward manual wheelchair exercise training and strength training of the upper body Spinal cord injured ( SCI ) people try to compensate for the loss of postural muscle function by increased use of non-postural muscles . Such alternative muscle use , however , may necessitate important modifications in motor control . In this study motor programming processes were investigated in three groups , i.e. in high thoracic SCI , low thoracic SCI and non-SCI subjects . A bimanual forward-reaching task , in which grade d sitting balance perturbation was systematic ally invoked , was presented to the subjects as a visual precue choice reaction time ( RT ) task . Effects of movement preparation were examined by precuing reaching distance information . RT and movement times were recorded . Centre of pressure ( CP ) displacement was used as an indicator for sitting balance perturbation . Results indicated that high thoracic SCI subjects programmed balance-perturbing reaching movements as fast as did non-SCI subjects . Low thoracic SCI subjects , on the other h and , showed substantially longer programming times . This latter outcome is consistent with the hypothesis that the low thoracic SCI subjects adopted a more complex postural control strategy involving residual motor functions in an attempt to actively compensate for loss of postural muscle function . High thoracic SCI subjects , on the other h and , appeared to adopt a less complex and thus easier to programme postural control strategy One of the basic aims in the rehabilitation of thoracic spinal cord injured ( SCI ) patients concerns the regaining of sitting posture control . This implies the development of new postural strategies requiring the adjustment of motor programming processes . The aim of this study was to investigate the time course of postural reorganization during active , clinical rehabilitation of thoracic SCI patients with different SCI levels . Thus changes in motor programming in sitting balance control were investigated in two groups of complete low or high thoracic SCI patients . At several stages during the rehabilitation process an experiment was held in which sitting posture was perturbed systematic ally using submaximal reaching movements over four reaching distances . This bimanual reaching task was presented as a visual precue choice reaction time ( RT ) task in which reaching distance ( i.e. grade of postural perturbation ) was precued . Results indicated that in both high and low thoracic SCI patients RTs in movements involving postural perturbation became shorter during the course of the rehabilitation period . However , low thoracic SCI patients were generally slower in the programming of balance perturbing movements than high thoracic SCI patients , a phenomenon that did not change over time . Furthermore , initial differences in RTs as a function of grade of postural perturbation disappeared in both groups in the course of the rehabilitation phase . Precue benefit , equally large for both groups , did not change as a function of rehabilitation time . It is concluded that the observed phenomena signify the gradual development of new central postural control processes in both SCI groups during rehabilitation . Low thoracic SCI patients , having more residual sensorimotor functions , seem to adopt more complex strategies in maintaining and restoring sitting balance that take longer to specify and to programme . High thoracic SCI patients seem to rely on simpler strategies using more passive postural support OBJECTIVE To determine the stimulated strength of the paralyzed gluteal and paraspinal muscles and their effects on the seated function of individuals with paralysis . DESIGN Case series with subjects acting as their own concurrent controls . SETTING Hospital-based clinical biomechanics laboratory . PARTICIPANTS Users ( N=8 ) of implanted neuroprostheses for lower extremity function with low-cervical or thoracic level injuries . INTERVENTIONS Dynamometry and digital motion capture both with and without stimulation to the hip and trunk muscles . MAIN OUTCOME MEASURES Isometric trunk extension moment at 0 ° , 15 ° , and 30 ° of flexion ; seated stability in terms of simulated isokinetic rowing ; pelvic tilt , shoulder height , loaded and unloaded bimanual reaching to different heights , and subjective ratings of difficulty during unsupported sitting . RESULTS Stimulation produced significant increases in mean trunk extension moment ( 9.2±9.5Nm , P<.001 ) and rowing force ( 27.4±23.1N , P<.012 ) over baseline volitional values . Similarly , stimulation induced positive changes in average pelvic tilt ( 16.7±15.7 ° ) and shoulder height ( 2.2±2.5 cm ) during quiet sitting and bimanual reaching , and increased mean reach distance ( 5.5±6.6 cm ) over all subjects , target heights , and loading conditions . Subjects consistently rated tasks with stimulation easier than voluntary effort alone . CONCLUSIONS In spite of considerable intersubject variability , stabilizing the paralyzed trunk with electrical stimulation can positively impact seated posture , extend forward reach , and allow exertion of larger forces on objects in the environment Our purpose was to compare the effects of using wheelchair trunk and lower extremity stabilization on sitting trunk mobility and functional reach of wheelchair users . Seven subjects with paraplegia who averaged 35.6 years of age and nine able-bodied control subjects with an average age of 26.0 years participated in this study . Each subject 's functional reach in the transverse and sagittal planes was video-recorded in each of three conditions , r and omized in order : ( 1 ) without a belt ; ( 2 ) with a neoprene chest belt ; and ( 3 ) with a webbing thigh belt . The area circumscribed by each subject 's functional reach under each condition was processed using the Motion Analysis Expert Vision Flextrak program . Functional reach in each belting condition was compared within each subject and between able-bodied controls and subjects with high and low thoracic levels of paraplegia . This study showed that in the sagittal plane , subjects with both high and low thoracic levels of paraplegia were able to substantially increase the area of their functional reach when using a chest belt when compared with the thigh belt or no-belt condition . The mean area of their sagittal plane functional reach increased by over 50 % by stabilizing the chest to the wheelchair using a neoprene belt . However , in the transverse plane , only those individuals with lower thoracic paraplegia ( T8 to L1 ) gained substantial benefit from chest strapping , increasing the area of their functional reach by a mean of 24 % . In contrast , able-bodied control subjects gained no benefit in functional reach from either belting condition . ( ABSTRACT TRUNCATED AT 250 WORDS Study Design : A study of the impact of spinal cord injury ( SCI ) on seated balance was conducted by comparing the results obtained from experiments with able-bodied and SCI subjects . Objectives : The purpose of this preliminary study was to examine the lateral postural stability of seated individuals with SCI in a dynamic environment . Setting : Experiments were conducted at the Clevel and Clinic Foundation in Clevel and , Ohio . Methods : Controlled perturbations were applied to each subject , seated in a wheelchair , through the use of a servo-controlled tilt platform . The platform was rotated so as to create disturbances similar in nature to those experienced in the frontal plane during left turns in a vehicle . Four quadriplegic , four paraplegic , and five able-bodied subjects participated in this study . Kinematic information and center of pressure ( COP ) movement were recorded . Results : None of the spinal cord-injured subjects was able to maintain his stability when exposed to the stronger perturbations , while all of the able-bodied subjects stayed upright for all of the trials . On an individual basis , injury level was not always indicative of balance . However , regression results suggest a correlation between ability to perform static leaning and dynamic balance ( P<0.001 ) . Conclusions : SCI subjects lost stability under dynamic conditions even though they were stable in the static situation . Initial results also raise some questions about where and when external support may be needed . Information of this nature could help to guide the design of new lateral supports with improved client acceptance To compensate for postural muscle function loss spinal cord injured ( SCI ) people have to use parts of the sensorimotor system which are still intact . In this study ,  postural control  was investigated in high and low thoracic SCI people and in able-bodied controls , using a bimanual forward-reaching task . Muscle activity was recorded bilaterally from the erector spinae ( ES ) at level L3 , T9 and T3 , latissimus dorsi ( LD ) , ascending part of the trapezius muscle ( TPA ) , serratus anterior ( SA ) , sternocostal head of the pectoralis major ( PM ) and the oblique abdominal muscles ( OA ) by means of surface electromyography .  Sitting balance was monitored by measuring the changes in the location of the centre of pressure ( CP ) using a force platform . Muscle activity analyzed in different phases of the movement showed that SCI people adopt different postural adjustments to face the balance changes due to the reaching movement . SCI people make alternative use of non-postural muscles like the LD and TPA to maintain their sitting balance The development of new patterns of postural control in patients with a complete thoracic spinal cord injury ( SCI ) 
    Output:
    
Conclusions Limited evidence was found about the impact of trunk impairment on wheelchair activities .
Reach to the front and multidirectional reach was further in able bodied persons than in persons with SCI .
In a perturbation that equals deceleration in wheelchair court sports , able bodied persons maintain balance , whereas persons with SCI lose balance .
No evidence was found to support a difference in acceleration between persons with partial trunk muscle strength and persons with full trunk muscle strength .