***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: This study investigated cervicocephalic kinesthetic sensibility in patients with whiplash injury and the effects of a rehabilitation programme . Fourteen patients with a whiplash injury and 34 healthy subjects participated in this study . The ability to appreciate both movement and the position of the head with respect to the trunk was investigated .  Active head repositioning  was significantly less precise in the whiplash subjects compared to the control group . Repositioning was more precise in whiplash subjects after the 5-week rehabilitation programme . There was no correlation between error of repositioning in patients and pain intensity . It is probable that cervicocephalic kinesthesia is linked to sensory information from the extensive muscular and articular proprioceptive system . A flexion-extension injury to the neck may result in dysfunction of this system OBJECTIVE To investigate cervicocephalic kinesthetic sensibility ( head repositioning accuracy to subjective straight ahead ) in patients with chronic , nontraumatic cervical spine pain . DESIGN A prospect i ve , 2-group , observational design . SETTING An outpatient chiropractic clinic in the United Kingdom . PARTICIPANTS Eleven patients ( 6 men , 5 women ; mean age + /- st and ard deviation , 41.1 + /- 13.3 yr ; range , 18 - 55 yr ) with chronic , nontraumatic cervical spine pain ( mean duration , 24 + /- 18 mo ) , with no evidence of cervical radiculopathy and /or myelopathy or any other neurologic disorder . Eleven asymptomatic , unimpaired volunteers ( 5 men , 6 women ; mean age , 39.3 + /- 10.3 yr ; range , 28 - 54 yr ) with no history of whiplash or other cervical spine injury or pain served as controls . MAIN OUTCOME MEASURES Cervicocephalic kinesthetic sensibility was investigated by testing the ability of blindfolded participants to relocate accurately the head on the trunk , to a subjective straight-ahead position , after a near-maximal active movement of the head in the horizontal or vertical plane . The active cervical range of motion and the duration and intensity of neck pain were also recorded . RESULTS Mann-Whitney U testing indicated that the patient ( P ) group was no less accurate in head repositioning than the control ( C ) group for all movement directions except flexion ( median global positioning error [ 95 % confidence interval ] , P = 5.7 degrees [ 5.03 - 9.10 ] , C = 4.2 degrees [ 3.17 - 5.32 ] ; p < .05 ) . CONCLUSIONS Nontraumatic neck pain patients show little evidence of impaired cervicocephalic kinesthetic sensibility . These results contrast with studies of chronic cervical pain patients in which the origin was not controlled or involved a cervical whiplash injury OBJECTIVE To investigate the reliability and discriminative ability of a new test design ed to detect accuracy of neck movements . DESIGN Repeated- measures . Case-control . SETTING University musculoskeletal research clinic in Icel and . PARTICIPANTS Twenty women ( mean age + /- st and ard deviation [ SD ] , 30.8+/-9.1 y ; range , 18 - 49 y ) with chronic whiplash-associated disorders ( WAD ) grade s I and II ( duration , 6 mo-6 y ) , with current pain score on a visual analog scale of 46.8+/-21.8 , and a disability score on the Northwick Park Neck Pain Disability Index of 45%+/-14 % . Twenty asymptomatic women ( mean age + /- SD , 29.3+/-8.6 y ; range , 18 - 48 y ) with no history of whiplash or insidious onset neck pain served as controls . INTERVENTION A slowly moving object appeared on a computer screen and traced an unpredictable movement path that the subjects were required to follow by moving their heads . Three r and omly ordered movement patterns were tested . MAIN OUTCOME MEASURE A new software program connected to a 3Space Fastrak system  was used to measure the mean absolute error ( in millimeters ) of 3 trials in each movement pattern . RESULTS The mean differences ( + /-2 SD ) between days 1 and 2 were.01+/-.64 mm for the asymptomatic group and .33+/-1.80 mm for the WAD group . The between-day intraclass correlation coefficients were between.60 and .77 for the asymptomatic group and .79 and .86 for the WAD group . Repeated- measures analysis of variance revealed a significant difference between groups ( P=.02 ) . The Tukey post hoc test showed significant between-group differences for each movement pattern ( P</=.05 ) . In each successive trial , a slight improvement for the asymptomatic group and a slight worsening for the WAD group were detected . CONCLUSIONS Better reliability was detected for the asymptomatic group than for the WAD group . The test could discriminate between the asymptomatic group versus the chronic WAD group The test-retest reliability of both the head-to-neutral head position ( NHP ) and head-to-target repositioning tests in three cardinal planes has been examined in this study . Twenty young adults underwent both head repositioning tests and retests with 10 min rest intervals . Root mean square error ( RMSE , total error ) , constant error ( CE , directional bias ) , variable error ( VE , variability ) , and st and ard error of measurement ( SEM ) were calculated from the position data recorded by an ultrasound-based motion analysis system . Intra-class correlation coefficients ( ICC ) were used to examine reliability . The results showed fair to excellent reliability of RMSE during head-to-NHP ( ICC=0.45 - 0.80 ) and head-to-target tests ( ICC=0.42 - 0.90 ) , except during the head-to-NHP test ( ICC=0.29 ) from a head extended position . Low reliability of VE associated with the neck motion toward left side bending indicated a direction-dependent effect . The SEM of RMSE ( 0.7 - 2.6 degrees ) , CE ( 0.3 - 4.0 degrees ) and VE ( 0.4 - 1.5 degrees ) indicated an acceptable range of error . The present study indicated acceptable and reliable RMSE measurements with a motion analysis system in healthy young adults . Furthermore , examining the CE and VE could contribute to the interpretation of whether the subject performed the reposition tests with directional bias and repositioning variability , respectively Study Design . Test-retest and case-control study design ed to detect accuracy of cervical spine movements by comparing 3 incrementally difficult movement patterns . An asymptomatic group , a nontrauma neck pain group , and a group with whiplash-associated disorders , Grade II , were tested ( n = 18 in each group ) . Objective . To determine the test-retest reliability and the discriminative validity of the new Fly method . Summary of Background Data . A lack of reliable and valid measures for grading the deficits of movement control in the cervical spine makes it impossible to prescribe treatment appropriate to each patient 's respective impairment level . Methods . Head tracking of a moving fly which appeared on a computer screen . Easy , medium , and difficult patterns , each of which was repeated 3 times in r and om order , were tested . Amplitude accuracy ( deviation of movements ) , directional accuracy ( time on target , undershoots vs. overshoots ) were compared across patterns and groups on 2 occasions , 1 week apart . Results . The intraclass correlation coefficient2,1 ranged from 0.53 to 0.82 for both variables , except for the subvariable “ overshoots ” ( 0.14–0.42 ) . The limits of agreement ( LOA ) were progressively wider across patterns ( easy – medium – difficult ) and groups ( asymptomatic – nontrauma – whiplash-associated disorder ) . Analysis of variance with repeated measures revealed significant differences between patterns within each group and between groups respectively for both outcome variables ( P < 0.001 ) . Conclusion . The Fly method provides reliable and valid measures for movement control of the cervical spine . Higher means and wider LOA across patterns and subject groups are reasoned to be inherent in the new Fly method and the subject groups tested . The wide LOA in the symptomatic groups supports the development of a normative data base . The new Fly method can be used both as an assessment and a treatment method and ensures gradual progression in the treatment for deficits of movement control in patients with neck pain In a single-subject experiment undertaken on 14 consecutive patients , the effects of acupuncture , cervical manipulation , no therapy , and NSAID-percutan application on kinesthetic sensibility , dizziness/vertigo and pain were studied in patients with dizziness/vertigo of suspected cervical origin . The ability to perceive position of the head with respect to the trunk was studied . The effects of different forms of therapy- and none-on dizziness and neck pain were compared , using a 100 mm visual analogue scale ( VAS ) . Active head relocation by subjects with dizziness was significantly less precise than in the control group . Manipulation was the only treatment to diminish the duration of dizziness/vertigo complaints during the past 7 days and increased the cervical range of motion . Both acupuncture and manipulation reduced dizziness/vertigo on the VAS scale and had positive effects on active head repositioning .  Ketoprofen percutan application and acupuncture both alleviated pain . The results of this study would suggest that spinal manipulation may impact most efficiently on the complex process of proprioception and dizziness of cervical origin This study compared the effects of conventional proprioceptive training and craniocervical flexion ( C-CF ) training on cervical joint position error ( JPE ) in people with persistent neck pain . The aim was to evaluate whether proprioceptive training was superior in improving proprioceptive acuity compared to another form of exercise , which has been shown to be effective in reducing neck pain . This may help to differentiate the mechanisms of effect of such interventions . Sixty-four female subjects with persistent neck pain and deficits in JPE were r and omized into two exercise groups : proprioceptive training or C-CF training . Exercise regimes were conducted over a 6-week period , and all patients received personal instruction by an experienced physiotherapist once per week . A significant pre- to postintervention decrease in JPE , neck pain intensity , and perceived disability was identified for both the proprioceptive training group ( p < 0.001 ) and the C-CF training group ( p < 0.05 ) . Patients who participated in the proprioceptive training demonstrated a greater reduction in JPE from right rotation compared to the C-CF training group ( p < 0.05 ) . No other significant differences were observed between the two groups . The results demonstrated that both proprioceptive training and C-CF training have a demonstrable benefit on impaired cervical JPE  in people with neck pain , with marginally more benefit gained from proprioceptive training . The results suggest that improved proprioceptive acuity following intervention with either exercise protocol may occur through an improved quality of cervical afferent input or by addressing input through direct training of relocation sense Objective : To compare head relocation accuracy in traumatic ( whiplash ) , insidious onset neck pain patients and asymptomatic subjects when targeting a natural head posture ( NHP ) and complex predetermined positions . Design : A case – control study . Setting : University-based musculoskeletal research clinic . Participants : Sixty-three volunteers divided into three groups of similar gender and age : Group 1 ( n = 21 ) an asymptomatic group ; group 2 ( n = 20 ) insidious onset neck pain ; group 3 ( n = 22 ) a history of whiplash injury . Intervention : Five r and omly ordered tests design ed to detect relocation accuracy of the head . Outcome measures : A 3-Space Fastrak system measured the mean absolute relocation error of three trials of each relocation test . Results : A significant difference was found between groups in one of the tests targeting the NHP ( p = 0.001 ) . Post-hoc pairwise comparisons revealed a significant difference ( p £ 0.05 ) between the asymptomatic group and each symptomatic group . The difference between the symptomatic groups just failed to reach significance ( p = 0.07 ) . None of the other four tests revealed significant differences . Conclusion : The test of targeting the NHP indicates that relocation inaccuracy exists in patients with neck pain with a trend to suggest that the deficit may be greater in whiplash patients . Tests employing unfamiliar postures or more complex movement were not successful in differentiating subject groups 
    Output:
    
The HRA-to-NHP , The Fly ™ and the CLMT can discriminate between patients with neck complaints and controls ( discriminant validity ) .
Currently , only The Fly ™ can discriminate between different patient population s ( post-traumatic and non-traumatic neck pain ) .