***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 : Sensory assessment to estimate spread and effectiveness of a peripheral nerve block is difficult because no clinical test is specific for small sensory fibers . Occurrence of a swelling illusion ( SI ) during a peripheral nerve block corresponds to the impairment of small sensory fibers . The authors investigated the usefulness of SI in predicting successful peripheral nerve block by assessing the temporospatial correlation between progression of sensory impairment in cutaneous distributions anesthetized and localization of SI during peripheral nerve block installation . Methods :  Interscalene , infracoracoid , or sciatic nerve blocks  were performed using a nerve stimulator and 1.5 % mepivacaine in 53 patients , with a total of 201 nerves to be anesthetized .  Pinprick , cold , warm , touch , and proprioception were assessed every 3 min , while patients were asked to describe their perception of size and shape of their anesthetized limb and localization of these illusions . Data are presented as mean ± SD and percentage ( 95 % confidence interval ) . Results : Failure occurred in 12 cutaneous distributions out of a total of 201 theoretically blocked nerves . SI appeared earlier than warmth impairment ( 4.3 ± 2.7 vs. 6.2 ± 2.0 min ; P < 0.05 ) , always corresponding to successfully anesthetized cutaneous distributions , with the exception of 1 patient , who developed SI in 2 cutaneous distributions while sensory testing indicated failure in 1 distribution . SI successfully predicted the blockade of a cutaneous distribution with a sensitivity of 1.00 ( 0.98–1.00 ) , a specificity of 0.92 ( 0.65–0.99 ) , and an accuracy of 0.99 ( 0.97–1.00 ) . Conclusions : Swelling illusion may provide an early assessment of the success of a peripheral nerve block in unse date d patients Objective : To characterize the nature of sensory impairments after stroke , identify associated factors , and assess the relationships between sensory impairment , disability , and recovery . Methods : Prospect i ve cross-sectional survey of 102 people with hemiparesis following their first stroke .  Tactile and proprioceptive sensation  in the affected arm and leg were measured using the Rivermead Assessment of Somatosensory Perception 2 - 4 weeks post-stroke . Demographics , stroke pathology , weakness , neglect , disability , and recovery were documented . Results : Tactile impairment was more common than proprioceptive ( P < .000 ) , impairment of discrimination was more common than detection ( P < .000 ) , and tactile sensation was more severely impaired in the leg than the arm ( P < .000 ) . No difference in proprioception between the arm and leg ( P = .703 ) or between proximal and distal joints ( P = .589 , P = .705 ) was found . The degree of weakness and the degree of stroke severity were significantly associated with sensory impairment ; demographics , stroke side and type , and neglect were not associated . All the sensory modalities were significantly related to independence , mobility , and recovery ( r = 0.287 [ P < .011 ] to r = 0.533 [ P < .000 ] ) . Conclusion : Sensory impairments of all modalities are common after stroke , although tactile impairment is more frequent than proprioceptive loss , especially in the leg . They are associated with the degree of weakness and the degree of stroke severity but not demographics , stroke pathology , or neglect , and they are related to mobility , independence in activities of daily living , and recovery The role of proprioception as a protective mechanism has gained interest in recent years . From the clinical st and point , several studies have dealt with ways to enhance proprioception following surgery and during rehabilitation . If kinesthesia ( ability to detect passive motion ) can be enhanced as a consequence of long-term athletic training , such training must be included as a part of the rehabilitation process to protect the patient from reinjury . Consequently , the purpose of this study was to compare the kinesthetic knee pattern between trained gymnasts and healthy nongymnasts . The proprioception testing device ( PTD ) was used to evaluate knee kinesthesia . From 45 ° of flexion , the knee was passively extended with the PTD . The device was stopped by the subject when this passive motion was detected . Fifteen healthy college-age female gymnasts ( mean age 19.3 years ) and 30 normal volunteers ( mean age 20.7 years ) comprised our study sample . A one-way analysis of variance ( ANOVA ) was used to compare the mean values of the dominant gymnastic knee to the dominant knee in the control group . Results revealed statistically significant mean differences between the trained gymnastic group and the untrained control group ( F1.34 (.95)=7.17.P=0.011 ) . The results of this study suggest that extensive training has a positive influence on knee kinesthesia in addition to increasing muscle tone . According to the findings of this and other studies , highly trained athletes possess enhanced neurosensory pathways which are speculated to develop as a result of long-term athletic training . Although definite conclusions can not be made from our investigation , prospect i ve studies can determine the true role of athletic training in proprioceptive patterns The effect of glenohumeral arthritis and subsequent  total shoulder arthroplasty ( TSA ) on shoulder proprioception has not been evaluated previously . A prospect i ve analysis of 20 consecutive patients with unilateral advanced glenohumeral arthritis who underwent TSA was undertaken .  Shoulder proprioception testing for passive position sense and detection of motion was performed 1 week before surgery and 6 months after TSA . The presence of glenohumeral arthritis had a significant effect on position sense for all 3 planes tested ( flexion , abduction , and external rotation ) . There were significant differences ( P < .05 ) compared with the uninvolved shoulder and with a group of 20 age- and gender-matched subjects without a history of shoulder problems . Six months after TSA , position sense was significantly improved ( P < .05 ) and was not significantly different from that in the contralateral shoulder or the comparison group . Detection of motion was also significantly worse in the arthritic group compared with that in the uninvolved contralateral side ( P < .05 ) . Six months after TSA , the sensitivity to detection of motion improved ( P < .01 ) and was not significantly different than that in the uninvolved contralateral shoulder . In addition , the postoperative values for the involved shoulder were not significantly different than those in the age- and gender-matched comparison group . This study demonstrates a significant decrease in proprioceptive function in patients with advanced glenohumeral arthritis . After TSA , there was a marked improvement in proprioception STUDY DESIGN A cross-sectional study in patients with recurrent/chronic low back trouble and healthy control subjects . OBJECTIVE To evaluate the effect of paraspinal muscle fatigue on the ability to sense a change in lumbar position . SUMMARY OF BACKGROUND DATA Protection against spinal injury requires proper anticipation of events , appropriate sensation of body position , and reasonable muscular responses . Lumbar fatigue is known to delay lumbar muscle responses to sudden loads . It is not known whether the delay is because of failure in the sensation of position , output of the response , or both . METHODS Altogether , 106 subjects ( 57 patients with low back trouble [ 27 men and 30 women ] and 49 healthy control subjects [ 28 men and 21 women ] ) participated in the study . Their ability to sense a change in lumbar position while seated on a special trunk rotation unit was assessed . A motor rotated the seat with an angular velocity of 1 degree per second . The task in the test involved reacting to the perception of lumbar movement ( rotation ) by releasing a button with a finger movement . The test was performed twice , before and immediately after a fatiguing procedure . During the endurance task , the participants performed upper trunk repetitive extensions against a resistance , with a movement amplitude adjusted between 25 degrees flexion and 5 degrees extension , until exhaustion . RESULTS Patients with chronic low back trouble had significantly poorer ability than control subjects on the average to sense a change in lumbar position ( P = 0.007 ) , which was noticed before and after the fatiguing procedure . Lumbar fatigue induced significant impairment in the sensation of position change ( P < 0.000001 ) . CONCLUSIONS Lumbar fatigue impairs the ability to sense a change in lumbar position . This feature was found in patients and control subjects , but patients with low back trouble had poorer ability to sense a change in lumbar position than control subjects even when they were not fatigued . There seems to be a period after a fatiguing task during which the available information on lumbar position and its changes is inaccurate Study Design . A clinical trial comparing a  back pain group with a pain‐free group .  Objectives . To investigate whether proprioceptive deficits existed in a group of individuals reporting low back pain . Summary of Background Data . Little work has so far been conducted on the measurement of proprioception in the spine . Those studies that have been carried out , however , have failed to identify proprioceptive deficits in individuals with back pain . Previous work on peripheral joints has revealed that proprioception is affected with muscular or joint injury or degeneration . Methods . Forty individuals took part in the study , 20 with back pain and 20 with no pain . Participants were required to reproduce a predetermined target position , in st and ing and four‐point kneeling , 10 times in 30 seconds . A computer screen was used to provide visual feedback on position . A mean deviation from the target position was obtained for each individual . A measurement of left elbow position sense was conducted in five individuals from each group to establish differences in short‐term motor memory between the groups . Results . There were no differences between the subject groups in terms of short‐term motor memory ( P > 0.05 ) . A two‐way analysis of variance between subject groups and position to identify differences in accuracy ( deviation from the target ) found that there were differences between subject groups in either position ( P < 0.05 ) . There was no significant difference in accuracy between the positions used ( P > 0.05 ) . Conclusions . Differences in proprioception do exist between individuals with back pain and those free from back pain . Further research needs to be undertaken on proprioceptive exercise programs and their effect on back pain Objective : To develop a st and ardized , clinical ly relevant , quantitative assessment of somatosensory performance in patients with stroke . Design : Prospect i ve observational study and test evaluation . Setting : Local Oxford hospitals and a regional neurological rehabilitation centre . Subjects : Stroke patients with a ” rst , lateralized acute stroke in hospital , and age-matched control subjects . Method : Each patient was assessed in a structured way using a new battery of formal tests of somatosensory performance . Results : A total of 100 patients and 50 controls were fully investigated . Control subjects performed at or near ceiling on all tests , but patients showed impaired performance on all tests . The Rivermead Assessment of Somatosensory Performance ( RASP ) showed good intra-rater and inter-rater reliability for all subtests . There were however only weak relationships between scores of sensory impairment and scores of motor impairment or mobility and dependence . Conclusions : The RASP provides a practical and reliable assessment of sensory loss , which provides the clinician with a comprehensive picture of the patient ’s performance and can be used to inform and monitor rehabilitation and recovery OBJECTIVES To identify a battery of tests that predicts safe and unsafe performance on an on-road assessment of driving . DESIGN Prospect i ve cohort study . SETTING University laboratory assessment and an on-road driving test . PARTICIPANTS Two hundred seventy community-living adults aged 70 to 88 recruited through the electoral roll . MEASUREMENTS Performance on a battery of multidisciplinary tests and on a st and ardized measure of on-road driving performance . RESULTS A combination of three tests from the vision , cognitive , and motor domains , including motion sensitivity , color choice reaction time , postural sway on a compliant foam rubber surface , and a self-reported measure of driving exposure , was able to classify participants into safe and unsafe driver groups with sensitivity of 91 % and specificity of 70 % . CONCLUSION In a sample of licensed older drivers , a short battery of tests and a self-reported measure of driving exposure were able to accurately predict driving safety Background Female athletes are at significantly greater risk of anterior cruciate ligament ( ACL ) injury than male athletes in the same high-risk sports . Decreased trunk ( core ) neuromuscular control may compromise dynamic knee stability . Hypotheses ( 1 ) Increased trunk displacement after sudden force release would be associated with increased knee injury risk ; ( 2 ) coronal ( lateral ) , not sagittal , plane displacement would be the strongest predictor of knee ligament injury ; ( 3 ) logistic regression of factors related to core stability would accurately predict knee , ligament , and ACL injury risk ; and ( 4 ) the predictive value of these models would differ between genders . Study Design Cohort study ( prognosis ) ; Level of evidence , 2 . Methods In this study , 277 collegiate athletes ( 140 female and 137 male ) were prospect ively tested for trunk displacement after a sudden force release . Analysis of variance and multivariate logistic regression identified predictors of risk in athletes who sustained knee injury . Results Twenty-five athletes ( 11 female and 14 male ) sustained knee injuries over a 3-year period . Trunk displacement was greater in athletes with knee , ligament , and ACL injuries than in uninjured athletes ( P < .05 ) . Lateral displacement was the strongest predictor of ligament injury ( P = .009 ) . A logistic regression model , consisting of trunk displacements , proprioception , and history of low back pain , predicted knee ligament injury with 91 % sensitivity and 68 % specificity ( P = .001 ) . This model predicted knee , ligament , and ACL injury risk in female athletes with 84 % , 89 % 
    Output:
    
There was wide variation in methods , the joints able to be tested , and the population s sample d. The predominant construct was active or passive joint position detection , followed by passive motion detection and motion direction discrimination .
The Rivermead Assessment of Somatosensory Perception was generally considered to be a valid and reliable tool but with low precision ; other tools with higher precision are potentially not clinical ly feasible .