***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: New insights into the phenotype of Joint Hypermobility Syndrome ( JHS ) and Ehlers‐Danlos Syndrome‐hypermobile type ( hEDS ) have raised many issues in relation to classification , diagnosis , assessment , and treatment . Within the multidisciplinary team , physical therapy plays a central role in management of individuals with hypermobility related disorders . However , many physical therapists are not familiar with the diagnostic criteria , prevalence , common clinical presentation , and management . This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children , adolescents , and adults with JHS/hEDS . Due to the complexity of the symptoms in the profile of JHS/hEDS , the International Classification of Functioning , Disability and Health ( ICF ) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions , activities and participation , as well as environmental and personal factors . The current evidence ‐based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions . Multicenter r and omized controlled trials are warranted to assess the clinical and cost‐effectiveness of interventions for children and adults . Until further multicenter trials are conducted , clinical decision‐making should be based on theoretical and the current limited research evidence . For all individuals diagnosed with JHS/hEDS , international consensus and combined efforts to identify risk profiles would create a better underst and ing of the pathological mechanisms and the potential for optimizing health care for affected individuals . © 2017 Wiley Periodicals , OBJECTIVE Joint hypermobility can lead to pain and motor developmental problems  in children and young people ( CYP ) .  Exercise programmes may help CYP with joint hypermobility strengthen core muscle groups . Non- adherence to home physiotherapy is common . The present study aim ed to underst and how families experienced an intensive multidisciplinary intervention . METHOD This was a qualitative study nested within a r and omized controlled trial of a multidisciplinary treatment intervention , including physiotherapy , for children aged five to 17 years . Twenty-eight families were recruited following the intervention .  Semi-structured interviews were used to examine the views and expectations of parents and CYP , and examine adherence to the exercise programme . Thematic analysis of data was used to develop findings . RESULTS Parents and CYP reported that exercise reduced the symptoms of hypermobility . Parental motivation , adapting family routines , making exercise a family activity and seeing benefit increased adherence to exercise .  Non-adherence to exercise was linked to lower levels of parental supervision , not underst and ing the treatment , not seeing benefit and not having specific time to dedicate to doing the exercises . CONCLUSION Even when exercise is seen to benefit a child 's well-being , families experience challenges in adhering to a physiotherapy programme for hypermobility . Therapists can utilize findings on what enhances adherence to help CYP effectively exercise in the home setting AIM Spinal instability is often disregarded as a cause of  chronic low back pain  and until now there has been no agreement as to its definition and on its nosologic importance or as to a conservative therapeutic protocol . The authors aim to verify whether possible symptomatological characteristics are reflected in radiological findings and , although there is no univocal opinion on the utilization of orthoses of containment for unstable segments , they also aim to verify their efficacy on pain control and neuromotor performance when employed in isolation or in association with the most reliable rehabilitation techniques . METHODS Forty-eight patients between the ages of 30 and 50 were entered in the study , selected with special exclusion criteria and appropriately r and omized to a group following kinesitherapy ( KT ) and orthoses ( O ) ( O+KT group ) and to a control group ( orthoses [ O ] group ) ; the symptomatological and instrumental characteristics were studied at time intervals 0 ( t0 ) , 3 months ( t3 ) , 6 months ( t6 ) , and 12 months ( 12 t ) . RESULTS The sample s examined present homogeneous characteristics . Lumbar instability pain is related to the presence of shift and not to hypermobility , when the latter is guided by efficient neuromotor feedback . In the O+KT group , treatment achieves the two-fold results of reducing shift and increasing mobility in the absence of pain . Both groups tend to increase the utilization of a brace over time . Furthermore , in the O+KT group , a marked reduction in the use of medicine is noticed . CONCLUSIONS Following treatment both groups report a decrease in pain even though the results of neuromotor performance prove to be better in the group following KT Developmental Coordination Disorder ( DCD ) is a neurodevelopmental disorder characterised by impaired motor co-ordination and awkward gait . Despite self-reported findings of pes planus and joint hypermobility in children with DCD , there is little objective evidence regarding the clinical management of the foot in children with DCD . The aims of this research were to report clinical findings of foot posture and lower limb hypermobility in children with DCD and to evaluate the impact of foot orthoses on spatio-temporal gait parameters . Children with DCD were recruited into the study . Participants were r and omly assigned to an intervention group who received foot orthoses at the start of their rehabilitation programme or to a second group who received foot orthoses at the end of their intervention programme . Foot posture was assessed with the Foot Posture Index and lower limb hypermobility assessed with the Lower Limb Assessment Score . The effect of foot orthoses  was evaluated through assessment of spatio-temporal gait characteristics at baseline and post-rehabilitation programme . Fourteen children were recruited ( mdn age 7.5 years ) with nine children assigned to the group receiving orthoses early ( mdn age 8 years ) and five children assigned to the post-rehabilitation orthoses group ( mdn age 6.5 years ) . A pes planus foot posture ( FPI score=8 ) and lower limb hypermobility ( LLAS score=11 ) were observed . Changes in spatio-temporal gait parameters failed to reach significance ( p>.012 ) following orthotic invention but demonstrated a trend towards a decreased cadence and increased double support duration . Despite non-significant findings this work offers preliminary support for podiatric intervention in the rehabilitation of children with DCD . Further work is required to underst and the biomechanics of gait in children with DCD and appreciate the role of podiatry as a component of multidisciplinary care Background Knee pain in children with Joint Hypermobility Syndrome ( JHS ) is traditionally managed with exercise , however the supporting evidence for this is scarce . No trial has previously examined whether exercising to neutral or into the hypermobile range affects outcomes . This study aim ed to ( i ) determine if a physiotherapist-prescribed exercise programme focused on knee joint strength and control is effective in reducing knee pain in children with JHS compared to no treatment , and ( ii ) whether the range in which these exercises are performed affects outcomes . Methods A prospect i ve , parallel-group , r and omised controlled trial conducted in a tertiary hospital in Sydney , Australia compared an 8 week exercise programme performed into either the full hypermobile range or only to neutral knee extension , following a minimum 2 week baseline period without treatment . R and omisation was computer-generated , with allocation concealed by sequentially numbered opaque sealed envelopes . Knee pain was the primary outcome . Quality of life , thigh muscle strength , and function were also measured at ( i ) initial assessment , ( ii ) following the baseline period and ( iii ) post treatment . Assessors were blinded to the participants ’ treatment allocation and participants blinded to the difference in the treatments . Results Children with JHS and knee pain ( n=26 ) aged 7 - 16 years were r and omly assigned to the hypermobile ( n=12 ) or neutral ( n=14 ) treatment group . Significant improvements in child-reported maximal knee pain were found following treatment , regardless of group allocation with a mean 14.5 mm reduction on the visual analogue scale ( 95 % CI 5.2 – 23.8 mm , p=0.003 ) . Significant differences between treatment groups were noted for parent-reported overall psychosocial health ( p=0.009 ) , specifically self-esteem ( p=0.034 ) , mental health ( p=0.001 ) and behaviour ( p=0.019 ) , in favour of exercising into the hypermobile range ( n=11 ) compared to neutral only ( n=14 ) . Conversely , parent-reported overall physical health significantly favoured exercising only to neutral ( p=0.037 ) . No other differences were found between groups and no adverse events occurred . Conclusions Parents perceive improved child psychosocial health when children exercise into the hypermobile range , while exercising to neutral only is perceived to favour the child ’s physical health . A physiotherapist prescribed , supervised , individualised and progressed exercise programme effectively reduces  knee pain in children with JHS.Trial registration Australia & New Zeal and Clinical Trials Registry ; ACTRN12606000109505 OBJECTIVES Joint hypermobility ( JH ) or " ligamentous laxity " is felt to be an underlying risk factor for many types of musculoskeletal presentation in paediatrics , and joint hypermobility syndrome ( JHS ) describes such disorders where symptoms become chronic , often more generalized and associated with functional impairment . Clinical features are felt to have much in common with more severe disorders , including Ehlers-Danlos syndrome ( EDS ) , osteogenesis imperfecta and Marfan syndrome , although this has not been formally studied in children . We defined the clinical characteristics of all patients with joint hypermobility-related presentations seen from 1999 to 2002 in a tertiary referral paediatric rheumatology unit . METHODS Patients were identified and recruited from paediatric rheumatology clinic and ward , and a dedicated paediatric rheumatology hypermobility clinic at Great Ormond Street Hospital . Data were collected retrospectively on the patients from the paediatric rheumatology clinics ( 1999 - 2002 ) and prospect ively on patients seen in the hypermobility clinic ( 2000 - 2002 ) . Specifically , historical details of developmental milestones , musculoskeletal or soft tissue diagnoses and symptoms , and significant past medical history were recorded . Examination features sought included measurements of joint and soft tissue laxity , and associated conditions such as scoliosis , dysmorphic features , cardiac murmurs and eye problems . RESULTS One hundred and twenty-five children ( 64 females ) were included on whom sufficient clinical data could be identified and who had clinical problems ascribed to JH present for longer than 3 months . Sixty-four were from the paediatric rheumatology clinic and 61 from the hypermobility clinic . No differences were found in any of the measures between the two population s and results are presented in a combined fashion . Three-quarters of referrals came from paediatricians and general practitioners but in only 10 % was hypermobility recognized as a possible cause of joint complaint . The average age at onset of symptoms was 6.2 yr and age at diagnosis 9.0 yr , indicating a 2- to 3-yr delay in diagnosis . The major presenting complaint was arthralgia in 74 % , abnormal gait in 10 % , apparent joint deformity in 10 % and back pain in 6 % . Mean age at first walking was 15.0 months ; 48 % were considered " clumsy " and 36 % as having poor coordination in early childhood . Twelve per cent had " clicky " hips at birth and 4 % actual congenital dislocatable hip . Urinary tract infections were present in 13 and 6 % of the female and male cases , respectively . Thirteen and 14 % , respectively , had speech and learning difficulties diagnosed . A history of recurrent joint sprains was seen in 20 % and actual subluxation/dislocation of joints in 10 % . Forty per cent had experienced problems with  h and writing tasks  , 48 % had major limitations of school-based physical education activities , 67 % other physical activities and 41 % had missed significant periods of schooling because of symptoms . Forty-three per cent described a history of easy bruising . Examination revealed that 94 % scored > or = 4/9 on the Beighton scale for generalized hypermobility , with knees ( 92 % ) , elbows ( 87 % ) , wrists ( 82 % ) , h and metacarpophalangeal joints ( 79 % ) , and ankles ( 75 % ) being most frequently involved . CONCLUSIONS JHS is poorly recognized in children with a long delay in the time to diagnosis . Although there is a referral bias towards joint symptoms , a surprisingly large proportion is associated with significant neuromuscular and motor development problems . Our patients with JHS also show many overlap features with genetic disorders such as EDS and Marfan syndrome . The delay in diagnosis results in poor control of pain and disruption of normal home life , schooling and physical activities . Knowledge of the diagnosis and simple interventions are likely to be highly effective in reducing the morbidity and cost to the health and social services The first aim is to show if there is a disorder in proprioception in cases with benign joint hypermobility syndrome ( BJHS ) when compared to healthy subjects . The second aim is to evaluate the effect of proprioception exercise in BJHS cases . To evaluate the proprioceptive sensibility of the knee joint with 40 BJHS and 30 healthy subjects enrolled in the study . Then , cases with BJHS were r and omized into two groups ; proprioceptive exercises were applied to 15 patients for 8 weeks in clinic and 25 patients were taken as controls . Outcome measures included proprioceptive sensation , AIMS 2 and VAS . Proprioception is significantly impaired in cases with BJHS 
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Conclusion There is very limited evidence to guide the use of physical and mechanical therapies for lower limb problems in children with Hypermobility Spectrum Disorder and Hypermobile Ehlers Danlos Syndrome .
Mechanical therapies have not been evaluated in RCTs and results of the two RCTs of physical therapies do not definitively guide physical therapy prescriptions .
No physical therapy has been compared to a sham intervention no intervention or no intervention , so overall effectiveness is unknown