***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 effects of long-term functional electrical stimulation (FES)-assisted walking on ankle dynamic stiffness were examined in spinal cord-injured ( SCI ) subjects with incomplete motor function loss . A parallel-cascade system identification method was used to identify intrinsic and reflex contributions to dynamic ankle stiffness at different ankle positions while subjects remained relaxed . Intrinsic stiffness dynamics were well modeled by a linear second-order model relating intrinsic torque to joint position . Reflex stiffness dynamics were accurately described by a linear third-order model relating halfwave rectified velocity to reflex torque . We examined four SCI subjects before and after long-term FES-assisted walking ( > 16 mo ) . Another SCI subject , who used FES for only five months was examined 12 mo latter to serve as a non-FES , SCI control . Reflex stiffness decreased in FES subjects by an average of 53 % following FES-assisted walking , intrinsic stiffness also dropped by 45 % . In contrast , both reflex and intrinsic stiffness increased in the non-FES , SCI control . These findings suggest that FES-assisted walking may have therapeutic effects , helping to reduce abnormal joint stiffness Among the objectives of spinal cord injury ( SCI ) rehabilitation , ( i ) prevention of bony , muscular and joint trophism and ( ii ) limitation of spastic hypertone represent important goals to be achieved . The aim of this study is to use functional electrical stimulation ( FES ) to activate pedaling on cycle-ergometer and analyse effects of this technique for a rehabilitation training in SCI persons . Five spinal cord injured subjects were recruited and underwent a two months FES-cycling training . Our results show an increase of thigh muscular area and endurance after the FES-cycling training , without any increase of spasticity . This approach , which is being vali date d on a larger pool of patients , represents a potential tool for improving the rehabilitation outcome of complete and incomplete SCI persons The goal of this research was to determine if cutaneous electrotherapy would temporarily reduce muscle spasticity .  Five traumatically brain injured ( TBI ) and five spinal cord injured ( SCI ) subjects , all with clinical ly evident spasticity , received surface electrical stimulation over the tibialis anterior muscle . Using the Spasticity Measurement System , stiffness around the ankle was measured before , immediately after , and 24 hours after treatment . With stimulation , ipsilateral ankle viscoelastic stiffness immediately decreased in 9 of 10 subjects and remained significantly depressed for up to 24 hours . Contralateral ankle spasticity did not significantly change . Using the same subjects under sham conditions , no significant decrements in spasticity occurred . In a subjective survey , only SCI participants reported functionally evident spasticity reductions . Also within this subgroup , efficacy of treatment was directly proportional to the severity of pre-stimulation clonus . We conclude that ( 1 ) cutaneous electrotherapy transiently decreases both TBI and SCI related spasticity and ( 2 ) pre-stimulation clonus may function as a clinical indicator of SCI patients most likely to benefit from this process This study examined the effects of altering surface neuromuscular electrical stimulation ( SNMES ) parameters on the specific tension of the quadriceps femoris muscle . Seven able-bodied subjects had magnetic resonance images taken of both thighs prior to and immediately after four SNMES protocol s to determine the activated muscle cross-sectional area ( CSA ) . The four protocol s were : ( 1 ) research ( RES , 100 Hz , 450 μs , and amplitude set to evoke 75 % of maximal voluntary isometric torque , MVIT ) ; ( 2 ) pulse duration ( PD , 100 Hz , 150 μs , same current as in RES ) ; ( 3 ) frequency ( FREQ , 25 Hz , 450 μs , and same current as in RES ) ; ( 4 ) amplitude ( AMP , 100 Hz , 450 μs , and current set to evoke the average of the initial torques of PD and FREQ , 45 ± 9 % of MVIT ) . Reducing the amplitude of the current from 75 to 45 % of MVIT did not alter specific tension , 25 ± 8 N/cm2 , suggesting that the amplitude probably affects torque and the area of activated muscle proportionally . Shortening the pulse duration from 450 to 150 μs caused specific tension to drop from 25 ± 6 to 20 ± 6 N/cm2 ( P < 0.05 ) , indicating that pulse duration increased torque and the activated CSA disproportionally . Alternatively , reducing the frequency from 100 to 25 Hz decreased specific tension from 25 ± 6 to 17 ± 4 N/cm2 ( P < 0.05 ) , suggesting that the frequency increased torque without affecting the activated CSA . Clinicians who administer SNMES should be aware of the magnitude of adaptations to a given amplitude , pulse duration , and frequency The objective of this prospect i ve cohort study was to investigate alterations in body composition variables and spasticity following subtetanic neuromuscular electrical stimulation ( NMES ) training in an adult population with spinal cord injury ( SCI ) . Fourteen sedentary adults with SCI ( thoracic [T]4-T11 ; American Spinal Injury Association Impairment Scale A/B ; time since injury : 10.17 + /- 11.17 yr ) were recruited from the National SCI data base .  Four adhesive electrodes ( 175 cm2 each ) were placed bilaterally on the proximal and distal quadriceps and hamstrings muscle groups and subtetanic contractions were elicited using a h and held NMES device .  Lean body mass ( LBM ) and other body composition variables were measured using dual-energy X-ray absorptiometry . Spasticity was measured using the Spinal Cord Assessment Tool for Spastic Reflexes ( SCATs ) and visual analog scales . Verbal and written feedback was obtained to subjectively evaluate spasticity . LBM and spasticity measurements were taken before and after an 8 wk NMES training program in order to assess change . A statistically significant increase in lower-limb LBM , i.e. , muscle tissue ( p > 0.001 ) , and a reduction in SCATs ( p < 0.001 ) score , indicating reduced spasticity , was observed . Subjective responses were positive . Improvements in body composition and SCATs scores indicate that subtetanic NMES training elicits favorable responses and may have important clinical implication s for an SCI population 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 QUESTION Does functional electrical stimulation ( FES ) cycling increase urine output and decrease lower limb swelling and spasticity in people with recent spinal cord injury ? DESIGN R and omised cross-over trial . PARTICIPANTS Fourteen participants with a recent motor complete spinal cord injury were consecutively recruited from two spinal cord injury units in Sydney . INTERVENTION Participants were r and omised to an experimental phase followed by a control phase or vice versa , with a 1-week washout period in between . The experimental phase involved FES cycling four times a week for two weeks and the control phase involved st and ard rehabilitation for two weeks . Assessment s by a blinded assessor occurred at the beginning and end of each phase . Allocation was concealed and an intention-to-treat analysis was performed . OUTCOME MEASURES The primary outcome was urine output ( mL/hr ) and the secondary outcomes were lower limb circumference , and spasticity using the Ashworth Scale , and the Patient Reported Impact of Spasticity Measure ( PRISM ) . In addition , participants were asked open-ended questions to explore their perceptions about treatment effectiveness . RESULTS All participants completed the study . The mean between-group difference ( 95 % CI ) for urine output was 82mL/hr ( -35 to 199 ) . The mean between-group differences ( 95 % CI ) for lower limb swelling , spasticity ( Ashworth ) , and PRISM were -0.1 cm ( -1.5 to 1.2 ) , -1.9 points ( -4.9 to 1.2 ) and -5 points ( -13 to 2 ) , respectively . All point estimates of treatment effects favoured FES cycling . Participants reported many benefits from FES cycling . CONCLUSION There were no clear effects of FES cycling on urine output , swelling and spasticity even though all point estimates of treatment effects favoured FES cycling and participants perceived therapeutic effects . TRIAL REGISTRATION ACTRN12611000923965 Objective : Spasticity following spinal cord injury ( SCI ) can impair function and affect quality of life . This study compared the effects of transcutaneous electrical nerve stimulation ( TENS ) and functional electrical stimulation ( FES ) on lower limb spasticity in patients with SCI . Design : Double blind r and omized crossover design . Setting : Neuro-rehabilitation unit , Manipal University , India . Participants : Ten participants ( age : 39 ± 13.6 years , C1–T11 , 1–26 months post SCI ) with lower limb spasticity were enrolled in this study . Interventions : Participants were administered electrical stimulation with TENS and FES ( duration - 30 minutes ) in a cross over manner separated by 24 hours . Outcome Measures : Spasticity was measured using modified Ashworth scale ( MAS ) [ for hip abductors , knee extensors and ankle plantar flexors ] and spinal cord assessment tool for spastic reflexes ( SCATS ) . Assessment s were performed at baseline , immediately , 1 hour , 4 hours , and 24 hours post intervention . Results : A between group analysis did not show statistically significant differences between FES and TENS ( P > 0.05 ) . In the within group analyses , TENS and FES significantly reduced spasticity up to 4 hours in hip adductors and knee extensors ( P < 0.01 ) . SCATS values showed significant reductions at 1 hour ( P = 0.01 ) following TENS and 4 hours following FES ( P = 0.01 ) . Conclusion : A single session of electrical stimulation with FES and TENS appears to have similar anti-spasticity effects that last for 4 hours . The findings of this preliminary study suggest that both TENS and FES have the potential to be used as therapeutic adjuncts to relieve spasticity in the clinic . In addition , FES may have better effects on patients presenting with spastic reflexes STUDY DESIGN Experimental laboratory study . OBJECTIVES The primary purpose was to investigate the independent effects of current amplitude , pulse duration , and current frequency on  muscle fatigue during neuromuscular electrical stimulation ( NMES ) .  A second purpose was to determine if the ratio of the evoked torque to the activated area could explain muscle fatigue . BACKGROUND Parameters of NMES have been shown to differently affect the evoked torque and the activated area . The efficacy of NMES is limited by the rapid onset of muscle fatigue . METHODS AND MEASURES Seven healthy participants underwent 4 NMES protocol s that were r and omly applied to the knee extensor muscle group . The NMES protocol s were as follows : st and ard protocol ( Std ) , defined as 100-Hz , 450-micros pulses and amplitude set to evoke 75 % of maximal voluntary isometric torque ( MVIT ) ; short pulse duration protocol ( SP ) , defined as 100-Hz , 150-micros pulses and amplitude set to evoke 75 % of MVIT ; low-frequency protocol ( LF ) 
    Output:
    
The identified stimulation parameters were frequency of 20–30 Hz , pulse duration of 300–350 & mgr;s , and amplitude of the current greater than 100 mA. Neuromuscular electrical stimulation/functional electrical stimulation provides an effective rehabilitation strategy in managing spasticity .