***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 
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    Input: Background and Purpose — Previous studies have shown that repeated sensory inputs could enhance brain plasticity and cortical motor output . The purpose of this study was to investigate whether combining electrically induced sensory inputs through transcutaneous electrical nerve stimulation ( TENS ) with task-related training ( TRT ) in a home-based program would augment voluntary motor output in chronic stroke survivors better than either treatment alone or no treatment . Methods — Eighty-eight patients with stroke were assigned r and omly to receive a home-based program of ( 1 ) TENS , ( 2 ) TENS+TRT , ( 3 ) placebo TENS+TRT , or ( 4 ) no treatment ( control ) 5 days a week for 4 weeks . Outcome measurements included Composite Spasticity Scale , peak torques generated during maximum isometric voluntary contraction of ankle dorsiflexors and plantarflexors , and gait velocity recorded at baseline , after 2 and 4 weeks of treatment , and 4 weeks after treatment ended . Results — When compared with TENS , the combined TENS+TRT group showed significantly greater improvement in ankle dorsiflexion torque at follow-up and in ankle plantarflexion torque at week 2 and follow-up ( P<0.01 ) . When compared with placebo+TRT , the TENS+TRT group produced earlier and greater reduction of plantarflexor spasticity and improvement in ankle dorsiflexion torque at week 2 ( P<0.01 ) . When compared with all 3 groups , the TENS+TRT group showed significantly greater improvement in gait velocity ( P<0.01 ) . Conclusions — In patients with chronic stroke , 20 sessions of a combined TENS+TRT home-based program decreased plantarflexor spasticity , improved dorsiflexor and plantarflexor strength , and increased gait velocity significantly more than TENS alone , placebo+TRT , or no treatment . Such improvements can even be maintained 4 weeks after treatment ended Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Background Transcutaneous electrical nerve stimulation ( TENS ) is a useful modality for pain control .  TENS has recently been applied to decrease spasticity . The purpose of this study is to determine whether the addition of TENS to an exercise program reduces spasticity and improves balance and gait in chronic stroke patients . Material / Methods This was a single-blinded , multicenter , r and omized controlled trial . Thirty-four ambulatory individuals with chronic stroke participated and were r and omly allocated to the TENS or Placebo group . The TENS group performed therapeutic exercise with TENS while the placebo ( non-stimulation ) TENS group performed therapeutic exercise with placebo TENS . Participants in both groups followed the same 30-min exercise regimen 5 times per week for a period of 6 weeks . Spasticity ( modified Ashworth scale ) , static ( balance system ) , and dynamic balance ( timed up and go test ) , and gait ability ( gait analyzer ) were measured at 1 week before and 1 week after the intervention . Results Significant differences were observed between the 2 groups . Spasticity improved by 0.80 points in the TENS group . Anterior-posterior and medial-lateral sway velocity among static balance parameters and dynamic balance showed significant differences between the TENS and Placebo TENS groups ( p=.000 ) . Gait speed and cadence were enhanced significantly in the TENS group ( p=.000 ) . Step and stride length on the paretic side showed a significant difference in the TENS group ( p=.000 ) , while only velocity showed a significant difference in the Placebo TENS group ( p=.004 ) . Conclusions A combination of therapeutic exercise and TENS may reduce spasticity and improve balance , gait , and functional activity in chronic stroke patients OBJECTIVE To investigate whether transcutaneous electrical stimulation , when applied to acupuncture points in patients after acute stroke , decreases spasticity and /or increases muscle strength more effectively than placebo stimulation and st and ard rehabilitation . DESIGN R and omized control trial . SUBJECTS Sixty-two patients aged 70.0 ( st and ard deviation 7.4 ) years and 9.2 ( st and ard deviation 3.4 ) days post-stroke . METHODS The patients were r and omly assigned to 3 groups receiving transcutaneous electrical stimulation , placebo stimulation , or st and ard rehabilitation alone . Stimulation was applied to 4 acupuncture points in the affected lower leg for 60 min , 5 days a week for 3 weeks . Plantarflexor spasticity , ankle muscle strength , and functional mobility were measured before treatment , weekly during treatment , and at follow-up at week 8 post-stroke . RESULTS No significant difference was found in the outcome measures among groups before treatment . When compared with st and ard rehabilitation or placebo stimulation , transcutaneous electrical stimulation to acupuncture points significantly increased the percentage of patients with normal tone , increased ankle dorsiflexor strength , and decreased antagonist co-contraction ratio ( p < 0.05 ) . The patients in the transcutaneous electrical stimulation group also tended to walk 2 - 4 days earlier than the patients in the other 2 groups . CONCLUSIONS Three weeks of transcutaneous electrical stimulation to lower leg acupuncture points , given 5 times a week within 10 days post-stroke , significantly decreased ankle plantarflexor spasticity , and increased dorsiflexor strength concomitant with a decrease in antagonist co-contraction Sit-to-st and is a fundamental movement of human being for performing mobility and independent activity . However , Stroke people symptoms experience difficulty in conducting the sit-to-st and due to paralysis and especially ankle spasticity . Recently , transcutaneouselectrical- stimulation ( TENS ) is used to reduce pain but also to manage spasticity . The purpose of this study was to determine ( 1 ) whether TENS would lead to ankle spasticity reduction and ( 2 ) whether sit-to-st and training combined with TENS would improve spasticity , muscle strength and balance ability in stroke patients . Forty-stroke patients were recruited and were r and omly divided into two groups : TENS group ( n=20 ) and sham group ( n=20 ) . All participants underwent 30-sessions of sit-to-st and training ( for 15-min , five-times per week for 6-weeks ) . Prior to each training session , 30-min of TENS over the peroneal nerve was given in TENS group , whereas sham group received non-electrically stimulated TENS for the same amount of time . Composite-Spasticity-Score was used to assess spasticity level of ankle plantar-flexors . Isometric strength in the extensor of hip , knee and ankle were measured by h and held dynamometer . Postural-sway distance was measured using a force platform . The spasticity score in the TENS group ( 2.6±0.8 ) improved significantly greater than the sham group ( 0.7±0.8 , p<0.05 ) . The muscle strength of hip extensor in the TENS group ( 2.7±1.1 kg ) was significantly higher than the sham group ( 1.0±0.8 kg , p<0.05 ) . Significant improvement in postural-sway was observed in the TENS group compared to the sham group ( p<0.05 ) . Thus , sit-to-st and training combined with TENS may be used to improve the spasticity , balance function and muscle strength in stroke patients Objective : To investigate the feasibility and potential efficacy of ‘ activeTENS ’ ( that is transcutaneous electrical nerve stimulation ( TENS ) during everyday activities ) by assessing the immediate effects on strength , proprioception , balance/falls risk and mobility after stroke . Design : A paired- sample r and omized cross-over trial . Subjects : Twenty-nine mobile chronic stroke survivors with no pre-existing conditions limiting balance or mobility or contra-indications to TENS . Setting : University clinical research facility . Intervention : A single session of ‘ activeTENS ’ delivered via a ‘ sock electrode ’ ( 70–130 Hz , five second cycle ) plus a session of control treatment ( wearing the sock electrode with no stimulation ) , lasting approximately two hours in total . Main Outcomes : Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dyanometer , balance and falls risk ( St and ing Forward Reach Test ) and gait speed ( 10-m walk test ) . Results : All participants tolerated ‘ active TENS ’  . Most parameters improved during stimulation with activeTENS ; balance ( p = 0.009 ) , gait speed ( p = 0.002 ) , plantarflexor strength ( p = 0.008 ) and proprioception of plantarflexion ( p = 0.029 ) , except dorsiflexor strength ( p = 0.194 ) and dorsiflexion proprioception ( p = 0.078 ) . Conclusions : The results provide initial evidence of the potential of ‘ active TENS ’ to benefit physical function after stroke which warrants further phase II trials to develop the intervention . Concerns that stimulation could have a detrimental impact on balance and increase risk of falls were not supported BACKGROUND The disorder of reflex and motor function in patients affected by stroke causes negative impact on the performance of movement patterns and affects the functional activities . OBJECTIVES To investigate the immediate effects of transcutaneous electrical nerve stimulation ( TENS ) and cryotherapy interventions on the spinal reflex excitability and in the voluntary electromyography ( EMG ) activity in people with chronic stroke . METHOD R and omized crossover trial . The maximum H-reflex ( Hmax ) , the H-reflex latency and the maximum motor response ( Mmax ) of the soleus muscle and also the EMG of the tibialis muscle where evaluated before and after the application of TENS , cryotherapy and control conditions . RESULTS The Hmax/Mmax ratio was statistically significant higher ( p=0.0245 ) and the H-reflex latency was statistically significant lower ( p=0.0375 ) in the soleus muscle of the affected limb . The EMG amplitude of the tibialis anterior was reduced in the compromised limb ( p<0.0001 ) . After the use of the TENS , a reduction in the Hmax/Mmax ratio ( p=0.0006 ) was observed leading to lower reflex excitability . However , after the cryotherapy intervention an increase of the Hmax/Mmax ratio was observed , which was accompanied by an increase in the H-reflex latency ( p=0.0001 ) . The EMG amplitude has not changed by any of the interventions . CONCLUSIONS Our findings suggest that TENS may be a choice for immediate reduction of reflex excitability , whereas cryotherapy intervention may increase reflex excitability in hemiparetic subjects . However , none of the changes mediated by either intervention were able to modify the electrical activity in the antagonist muscle of the spastic muscle Our previous studies showed that a single 45 min application of transcutaneous electrical nerve stimulation ( TENS ) prolonged soleus H and stretch reflex latencies in hemiparetic subjects . In addition , 9 daily 30 min TENS applications enhanced vibratory inhibition of the H reflex and tended to decrease hyperactive stretch reflexes . These findings suggested that longer-term TENS may be effective in reducing hemiparetic spasticity . Our present objectives were 2-fold : to determine whether longer-term repetitive TENS stimulation would lead to a reduction in clinical spasticity in hemiparetic subjects , and whether such a reduction could be associated with a decrease in stretch reflex excitability and an improvement in voluntary motor function . We compared the effects of 15 daily 60 min TENS treatments over a 3 week period , with those of placebo stimulation applied to the common peroneal nerve of the affected leg in similar groups of spastic hemiparetic subjects . Our test battery consisted of 5 measurements which assessed ( 1 ) clinical spasticity scores , ( 2 ) maximal H reflex to M response ratios , ( 3 ) vibratory inhibition of H reflex , ( 4 ) stretch reflexes , and ( 5 ) maximal voluntary isometric plantarflexion and dorsiflexion , in st and ing . In contrast to placebo stimulation which produced no significant effects , repeated applications of TENS over time decreased clinical spasticity ( P less than 0.05 ) , and increased vibratory inhibition of the soleus H reflex ( P = 0.02 ) after 2 weeks . These changes occurred with a substantial improvement in voluntary dorsiflexing force up to 820 % , but not plantarflexing force . They were followed by a reduction in the magnitude of stretch reflexes ( P = 0.05 ) in the spastic ankle plantarflexor , concomitant with a decrease in the EMG co-contraction ratios after a further week of stimulation . Our results thus indicated 
    Output:
    
Conclusion : The results support the use of repeated applications of TENS as an adjunct therapy for improving walking capacity and reducing spasticity in stroke survivors