***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 aim of this study was to investigate the influence of reduced plantar sensation on gait patterns during walking in 20 healthy subjects ( 25.9 + /- years , 61.6 + /- 11.5 kg , 178 + /- 9.5 cm ) with no history of sensory disorders .  Force plate measurements , electromyography ( EMG ) measurements and a three-dimensional movement analysis  were performed simultaneously during barefoot walking before and after reduction of plantar sensation using an ice immersion technique . The results show that reduced plantar sensation leads to significant changes in gait patterns that are present at the ankle , knee and hip joint and indicate a more cautious ground contact and push-off with modified EMG and motion patterns Pressures under the foot during level walking were measured in 15 healthy young adults ( 8 females , 7 males , mean age 25.7 , S.D. 5.3 ) before and after immersing the feet in  ice-cold water ( 2 degrees C ) for 30 min to evaluate the role of plantar insensitivity on gait patterns . Following ice water immersion , there was a significant decrease in walking speed . Maximum forces and peak pressures under the foot decreased , with the exception of an increase in loading under the third to fifth metatarsal heads . Contact times increased under all regions of the foot , and force-time and pressure-time integrals increased under the second and third to fifth metatarsal head regions . It is concluded that plantar insensitivity significantly alters the distribution , duration , and to a lesser extent , the magnitude of forces and pressures under the foot when walking . These results suggest that in the neuropathic foot , gait changes caused by plantar insensitivity may be partly responsible for the redistribution and altered duration of loading , whereas the increase in the magnitude of forces and pressures are primarily due to other disease-related factors OBJECTIVE To test the hypothesis that vibrotactile detection thresholds in older adults , patients with stroke , and patients with diabetic neuropathy can be significantly reduced with the introduction of mechanical noise . DESIGN A r and omized controlled study . SETTING A university research laboratory . PARTICIPANTS Twelve healthy elderly subjects ( age range , 67 - 85y ) , 5 patients with stroke ( age range , 24 - 64y ) , and 8 patients with diabetic neuropathy ( age range , 53 - 77y ) . INTERVENTIONS Each subject 's detection thresholds ( ie , minimum level of stimulus to be detected ) for a vibrotactile stimulus without and with mechanical noise ( ie , r and om vibration with a small intensity ) were determined by using a 4- , 2- , and 1-stepping algorithm . The stimuli were applied to the fingertip and /or to the first metatarsal of the foot . MAIN OUTCOME MEASURE Detection threshold for a vibrotactile stimulus . RESULTS The detection threshold at the fingertip for the vibration stimulus with mechanical noise was significantly lower than that without mechanical noise for all 12 elderly subjects , for 4 of the 5 patients with stroke , and all 8 patients with diabetic neuropathy . For the 8 patients with diabetes , mechanical noise also significantly reduced the vibrotactile detection threshold at the foot . CONCLUSIONS Reduced vibrotactile sensitivity in older adults , patients with stroke , and patients with diabetic neuropathy can be significantly improved with input mechanical noise . Noise-based techniques and devices may prove useful in overcoming age- and disease-related losses in sensorimotor function IN linear information theory , electrical engineering and neurobiology , r and om noise has traditionally been viewed as a detriment to information transmission . Stochastic resonance ( SR ) is a nonlinear , statistical dynamics whereby information flow in a multistate system is enhanced by the presence of optimized , r and om noise14 . A major consequence of SR for signal reception is that it makes possible substantial improvements in the detection of weak periodic signals . Although SR has recently been demonstrated in several artificial physical systems5,6 , it may also occur naturally , and an intriguing possibility is that biological systems have evolved the capability to exploit SR by optimizing endogenous sources of noise . Sensory systems are an obvious place to look for SR , as they excel at detecting weak signals in a noisy environment . Here we demonstrate SR using  external noise applied to crayfish mechanoreceptor cells . Our results show that individual neurons can provide a physiological substrate for SR in sensory systems This study investigated the effects on st and ing balance of r and om vibrations applied to the plantar side of the feet by vibrating insoles in subjects with neuropathy and nondisabled subjects . In four different conditions ( eyes open or closed and with or without an attention-dem and ing task [ ATD ] ) , subjects with neuropathy secondary to diabetes mellitus ( n = 17 ) and nondisabled subjects ( n = 15 ) stood for 60 s on vibrating insoles placed on a force plate . During each condition , the insoles were turned on for 30 s and off for 30 s ( r and om order ) . The calculated balance measures were mean velocity of the center of pressure displacements and root-mean-square of the velocity of these displacements in the anteroposterior and mediolateral directions . In subjects with neuropathy , an interaction effect between vibration and an ADT was found for balance . No effects of vibration on balance were found in nondisabled subjects .  Vibrating insoles improved st and ing balance in subjects with neuropathy only when attention was distracted . Improvement of the insoles and their activation is needed to make their implementation in daily living possible and effective Noise is usually thought of as the enemy of order rather than as a constructive influence . In nonlinear systems that possess some sort of threshold , r and om noise plays a beneficial role in enhancing the detection of weak information-carrying signals . This phenomenon , termed stochastic resonance , does find useful applications in physical , biological , and biomedical context s. Certain biological systems may even use this effect for optimizing function and behavior OBJECTIVE The objective of the present study was to investigate the impact of incident falls on the balance , gait , and Activities of Daily Living functioning in community-dwelling older adults . METHODS This was a population -based , 1-year prospect i ve cohort study in older adults . We performed baseline assessment of potential predictors , the 1-year occurrence of falls , and then 1-year re assessment of the following outcome measures : the Barthel Index ( BI ) , Lawton 's Instrumental Activities of Daily Living ( IADL ) scale , gait speed , and Tinetti Balance and Gait Evaluation 's total mobility score ( TMS ) . At 1 year of follow-up , participants who had declined by > or = 1 st and ard deviation ( SD ) below the baseline mean value of each outcome measure were classified as " decliners . " RESULTS Of the 1517 participants , 93.5 % ( n = 1419 ) completed the 1-year follow-up re assessment of BI and IADL . For gait speed and TMS , respectively , 88.2 % ( n = 1338 ) and 88.3 % ( n = 1339 ) completed the 1-year outcome assessment . Fallers , particularly recurrent fallers , experienced significantly greater 1-year declines in the four functional measures . Multivariate logistic regression analyses showed that an incident fall was a significant independent predictor for decliners in the BI , Lawton 's IADL score , gait speed , and TMS after adjustment of all significant confounding factors . The relative risks of an incident fall as an independent predictor for decliners in the BI , IADL score , gait speed , and TMS were 2.4 ( 95 % confidence interval [ CI ] , 1.4 - 4.0 ; p = .01 ) , 2.9 ( 95 % CI , 1.7 - 5.2 ; p < .001 ) , 2.4 ( 95 % CI , 1.5 - 3.8 ; p < .001 ) , and 4.6 ( 95 % CI , 2.7 - 7.8 ; p < .001 ) , respectively . CONCLUSIONS Incident falls have a significant negative impact on the balance , gait , and Activities of Daily Living functioning in community-dwelling older adults OBJECTIVE To test the hypothesis that shoes with thick , soft midsoles , such as modern running shoes , provide better stability in older individuals than those with thin-hard midsoles . In addition , we examined the relation between footwear comfort and stability and stability when barefoot . DESIGN R and omized-order , cross-over , controlled comparison . SETTING Subjects were drawn from an internal medicine practice . PARTICIPANTS A r and om sample of 25 healthy men , minimum age 60 years . Additional selection criteria were absence of disabilities influencing ability to walk and lack of history of frequent falls . MEASUREMENTS Balance failure frequency , which was defined as falls from the beam per 100 meters of beam walking when 10 passes were made down a 9 M long balance beam .  Comfort rating was based on an ordinal scale . RESULTS Contrary to the hypothesis : ( 1 ) midsole softness was associated with poor stability ( F(2,48 ) = 17.9 , P < 0.0001 ) ; ( 2 ) thick midsoles also provided poor stability ( F(1,24 ) = 7.36 , P < 0.01 ) . When barefoot , subjects showed 19 % higher balance failure frequency than with the poorest shoe and 171 % greater than the best shoe ( t = 5.33 , P < 0.0001 ) . Higher comfort was generally found in shoe types associated with higher balance failure frequency . CONCLUSIONS For optimal stability , shoes with thin , hard soles are preferable for older individuals . Health professionals should exercise caution when recommending shoes with thick , yielding midsoles , such as running shoes , to unstable elderly individuals . Older men and women with a history of falls or who are obviously unstable , should avoid barefoot locomotion OBJECTIVE To test the hypothesis that increased gait variability predicts falls among community-living older adults attending an outpatient clinic . DESIGN Prospect i ve , cohort study . SETTING Three outpatient geriatric clinics . PARTICIPANTS Fifty-two community-living , ambulatory men and women aged > or = 70 years . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Subjects walked at a normal pace for up to 6 minutes wearing force-sensitive insoles that measured the gait rhythm on a stride-to-stride basis . Afterward , subjects reported fall status on a weekly basis for 1 year . The primary outcomes were the association between measures of the stride-to-stride fluctuations in gait rhythm and ( 1 ) subsequent falls during a 12-month follow-up period and ( 2 ) potential contributing factors . RESULTS Almost 40 % of the subjects reported falling during the 12-month follow-up period . Stride time variability was 106 + /- 30 ms in subjects who subsequently fell ( n = 20 ) and 49 + /- 4 ms in those who did not experience a fall ( n = 32 ) during the 12-month follow-up period ( p < .04 ) . Logistic regression also showed that stride time variability predicted falls ( p < .05 ) . Stride time variability correlated significantly with multiple factors including strength , balance , gait speed , functional status , and even mental health , but these other measures did not discriminate future fallers from nonfallers . CONCLUSIONS These findings show both the feasibility of obtaining stride-to-stride measures of gait timing in the ambulatory setting and the potential use of gait variability measures in augmenting the prospect i ve evaluation of fall risk in community-living older adults OBJECTIVE We have previously demonstrated that high plantar pressures can predict foot ulceration  in diabetic patients . The aim of the present study was to evaluate both the relationship between forefoot and rearfoot plantar pressure  in diabetic patients with different degrees of peripheral neuropathy and their role in ulcer development . RESEARCH DESIGN AND METHODS Diabetic patients of a 30-month prospect i ve study were classified according to the neuropathy disability score : scores of 0 , 1 - 5 , 6 - 16 , and 17 - 28 are defined as absent ( n = 20 ) , mild ( n = 66 ) , moderate ( n = 95 ) , and severe ( n = 57 ) neuropathy , respectively . The F-Scan mat system was used to measure dynamic plantar pressures .  The peak pressures under the forefoot and the rearfoot were selectively measured for each foot , and the forefoot-to-rearfoot ratio ( F/R ratio ) was calculated . RESULTS Foot ulcers developed in 73 ( 19 % ) feet . The peak pressures were increased in the forefoot of the severe and moderate neuropathic groups compared with the mild neuropathic and non-neuropathic groups ( 6.2 + /- 4.5 and 3.8 + /- 2.7 vs. 3.0 + /- 2.1 and 3.3 + /- 2.1 kg/cm(2 ) [ mean + /- SD ] , respectively ; P < 0.0001 ) . The rearfoot pressures were also higher in the severe and moderate neuropathic groups compared with the mild neuropathic and non-neuropathic groups ( 3.2 + /- 2.0 and 3.2 + /- 1.9 vs. 2.5 + /- 1.3 and 2.3 + /- 1.0 , respectively ; P < 0.0001 ) . The F/R ratio was increased only in the severe group compared with the moderate and mild neuropathic and non-neuropathic groups ( 2.3 + /- 2.4 vs. 1.5 + /- 1.2 , 1.3 + /- 0.9 , and 1.6 + /- 1.0 , respectively ; P < 0.0001 ) . In a logistic regression analysis , both forefoot pressure ( odds ratio  
    Output:
    
Conclusion : The results indicated that subthreshold r and om noise improves balance and sensation in diabetic patients and elder people .
Also gait variables can be improved in elder people with  subthreshold r and om noise .