***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: STUDY DESIGN Prospect i ve cohort study . OBJECTIVE To assess the effect of 6 weeks of balance training on sensorimotor measures previously found to be deficient in participants with chronic ankle instability ( CAI ) . BACKGROUND CAI is the tendency toward repeated ankle sprains and recurring symptoms , occurring in 40 % to 70 % of individuals who have previously sustained a lateral ankle sprain . Recent studies have found deficits in sensorimotor measures in individuals with CAI . As balance training is a common component of ankle rehabilitation , underst and ing its effect on the sensorimotorsystem in individuals with CAI may enable us to optimize protocol s to better utilize this rehabilitation method . METHODS Twelve participants with CAI and 9 healthy volunteers participated . Independent variables were group ( CAI , control ) and time ( pretraining , posttraining ) . Participants with CAI who completed a 6-week balance training program and healthy controls who did not get any training were pretested and posttested at the beginning and at the end of 6 weeks . RESULTS The individuals in the CAI group who performed balance training demonstrated better performance than control participants on baseline adjusted posttraining measures of dynamic balance in the anterior medial ( P = .021 ) , medial ( P = .048 ) , and posterior medial directions ( P = .030 ) ; motoneuron pool excitability Hmax/Mmax ratio ( P = .044 ) and single-limb presynaptic inhibition ( P = .012 ) ; and joint position sense inversion variable error ( P = .017 ) . It may be of note that no systematic differences were detected for static balance or plantar flexion joint position sense tasks . CONCLUSIONS After 6 weeks of balance training , individuals with CAI demonstrated enhanced dynamic balance , inversion joint position sense , and changes in motoneuron pool excitability compared to healthy controls who did not train . LEVEL OF EVIDENCE Therapy , level 2b Objectives The purpose of the international multicenter prospect i ve single arm clinical trial was to evaluate restorative neurostimulation eliciting episodic contraction of the lumbar multifidus for treatment of chronic mechanical low back pain ( CMLBP ) in patients who have failed conventional therapy and are not c and i date s for surgery or spinal cord stimulation ( SCS ) .  Material s and Methods Fifty‐three subjects were implanted with a neurostimulator ( ReActiv8 , Mainstay Medical Limited , Dublin , Irel and ) . Leads were positioned bilaterally with electrodes close to the medial branch of the L2 dorsal ramus nerve . The primary outcome measure was low back pain evaluated on a 10‐Point Numerical Rating Scale ( NRS ) . Responders were defined as subjects with an improvement of at least the Minimal Clinical ly Important Difference ( MCID ) of ≥2‐point in low back pain NRS without a clinical ly meaningful increase in LBP medications at 90 days . Secondary outcome measures included Oswestry Disability Index ( ODI ) and Quality of Life ( QoL ; EQ‐5D ) . Results For 53 subjects with an average duration of CLBP of 14 years and average NRS of 7 and for whom no other therapies had provided  satisfactory pain relief  , the responder rate was 58 % . The percentage of subjects at 90 days , six months , and one year with ≥MCID improvement in single day NRS was 63 % , 61 % , and 57 % , respectively . Percentage of subjects with ≥MCID improvement in ODI was 52 % , 57 % , and 60 % while those with ≥MCID improvement in EQ‐5D was 88 % , 82 % , and 81 % . There were no unanticipated adverse events ( AEs ) or serious AEs related to the device , procedure , or therapy . The initial surgical approach led to a risk of lead fracture , which was mitigated by a modification to the surgical approach . Conclusions Electrical stimulation to elicit episodic lumbar multifidus contraction is a new treatment option for CMLBP . Results demonstrate clinical ly important , statistically significant , and lasting improvement in pain , disability , and Abstract The purpose of this investigation was to examine the effects of the combination of  chronic ankle instability ( CAI ) and altered visual focus on strategies for dynamic stability during a drop-jump task . Nineteen participants with self-reported CAI and 19 healthy participants performed a drop-jump task  in looking-up and looking-down conditions . For the looking-up condition , participants looked up and read a r and om number that flashed on a computer monitor . For the looking-down condition , participants focused their vision on the force plate . Sagittal- and frontal-plane kinematics in the hip , knee and ankle were calculated at the time points of 100 ms pre-initial foot contact to ground and at IC . The result ant vector time to stabilisation was calculated with ground reaction force data . The CAI group demonstrated less hip flexion at the point of 100 ms pre-initial contact ( P < 0.01 ) , and less hip flexion ( P = 0.03 ) and knee flexion at initial contact ( P = 0.047 ) compared to controls . No differences in kinematics or dynamic stability were observed in either looking-up or looking-down conditions ( P > 0.05 ) . Altered visual focus did not influence movement patterns during the drop-jump task , but the presence of CAI did . The current data suggests that central ly mediated changes associated with CAI may lead to global alterations in the sensorimotor control CONTEXT Focal ankle-joint cooling ( FAJC ) has been shown to increase Hoffmann ( H ) reflex amplitudes of select leg muscles while subjects lie prone , but it is unknown whether the neurophysiological cooling effects persist in st and ing . OBJECTIVE To assess the effects of FAJC on H-reflexes of the soleus and fibularis longus during 3 body positions ( prone , bipedal , and unipedal stances ) in individuals with and without chronic ankle instability ( CAI ) . DESIGN Crossover . SETTING Laboratory . PARTICIPANTS 15 young adults with CAI ( 9 male , 6 female ) and 15 healthy controls . INTERVENTION All subjects received both FAJC and sham treatments on separate days in a r and omized order . FAJC was accomplished by applying a 1.5-L plastic bag filled with crushed ice to the ankle for 20 min . Sham treatment involved room-temperature c and y corn . MAIN OUTCOME MEASURES Maximum amplitudes of H-reflexes and motor ( M ) waves were recorded while subjects lay prone and then stood in quiet bipedal and unipedal stances before and immediately after each treatment . Primary outcome measures were H(max):M(max ) ratios for the soleus and fibularis longus . Three-factor ( group × treatment condition × time ) repeated- measures ANOVAs and Fisher LSD tests were performed for statistical analyses . RESULTS Significant interactions of treatment condition by time for prone H(max):M(max ) ratios were found in the soleus ( P = .001 ) and fibularis longus ( P = .003 ) . In both muscles , prone H(max):M(max ) ratios moderately increased after FAJC but not after sham treatment . The CAI and healthy groups responded similarly to FAJC . In contrast , there were no significant interactions or main effects in the bipedal and unipedal stances in either muscle ( P > .05 ) . CONCLUSIONS FAJC moderately increased H-reflex amplitudes of the soleus and fibularis longus while subjects were prone but not during bipedal or unipedal st and ing . These results were not different between groups with and without CAI OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity We do not know the impact an ankle sprain has on physical activity levels across the lifespan . With the negative consequences of physical inactivity well established , underst and ing the effect of an ankle sprain on this outcome is critical . The objective of this study was to measure physical activity across the lifespan after a single ankle sprain in an animal model . Thirty male mice ( CBA/J ) were r and omly placed into one of three groups : the transected calcaneofibular ligament ( CFL ) group , the transected anterior talofibular ligament (ATFL)/CFL group , and a SHAM group . Three days after surgery , all of the mice were individually housed in a cage containing a solid surface running wheel . Physical activity levels were recorded and averaged every week across the mouse 's lifespan . The SHAM mice ran significantly more distance each day compared to the remaining two running groups ( post hoc p = 0.011 ) . Daily duration was different between the three running groups ( p = 0.048 ) . The SHAM mice ran significantly more minutes each day compared to the remaining two running groups ( post hoc p=0.046 ) while the ATFL/CFL mice ran significantly less minutes each day ( post hoc p = 0.028 ) compared to both the SHAM and CFL only group . The SHAM mice ran at a faster daily speed versus the remaining two groups of mice ( post hoc p = 0.019 ) and the ATFL/CFL mice ran significantly slower each day compared to the SHAM and CFL group ( post hoc p = 0.005 ) . The results of this study indicate that a single ankle sprain significantly decreases physical activity across the lifespan in mice . This decrease in physical activity can potentially lead to the development of numerous chronic diseases . An ankle sprain thus has the potential to lead to significant long term health risks if not treated appropriately . Key pointsA single ankle significantly decreased physical activity levels in mice across the lifespan . Decreased physical activity could significantly negatively impact overall health if not modified . Initial treatment and rehabilitation of ankle sprains needs to be studied to determine ways to keep physical activity levels up after injury While GABA(B ) receptors are thought to have an important role in mediating long interval intracortical inhibition ( LICI ) in the human motor cortex , the effect of a selective GABA(B ) receptor agonist on this measure has not been directly tested . Nine healthy volunteers ingested either 50 mg baclofen ( BAC ) or placebo ( PBO ) in a r and omized , double blind crossover design , with the second session one week later . We used transcranial magnetic stimulation to assess motor threshold , motor evoked potential ( MEP ) amplitude , cortical silent period ( CSP ) duration , short interval intracortical inhibition ( SICI ) and LICI before and 90 min following drug intake . There was no specific effect of drug on motor threshold , MEP amplitude or CSP duration . BAC result ed in a significant increase in LICI ( P=0.002 ) and a significant decrease in SICI ( P=0.046 ) while PBO had no effect . Our findings demonstrate that the enhanced GABA(B ) receptor activation results in differential effects on these two measures of intracortical inhibition in the human motor cortex . The increase in LICI is likely to be a result of increased GABA(B ) receptor mediated inhibitory post-synaptic potentials , while the reduction in SICI may relate to the activation of pre-synaptic GABA(B ) receptors reducing GABA release OBJECTIVES We aim ed to present a unique prospect i ve neurological data set for participants who experienced an ACL injury . DESIGN Prospect i ve longitudinal case-control . METHODS High school female soccer athletes were evaluated using functional magnetic resonance imaging to capture resting-state brain connectivity prior to their competitive season . Two of these athletes later experienced an ACL injury ( ACLI ) . We matched these ACLI participants with eight teammates who did not go on to sustain an ACL injury ( uninjured controls , Con )  based on age , grade , sex , height , and weight to examine differences in preseason connectivity . K 
    Output:
    
There was no evidence for changes in the CMT .
This systematic review is the first to demonstrate evidence that patients with CAI present decreased spinal reflex excitability in the soleus and fibularis longus .
However , there is no evidence of changes in supraspinal excitability when considering only the CMT .
The latter result needs to be interpreted with caution as all except one study demonstrate some changes at the supraspinal level with CAI