***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: There is emerging evidence that feedback techniques based on contingent electrical stimulation ( CES ) have an inhibitory effect on the electromyogram ( EMG ) activity of jaw-closing muscles and therefore could be useful in the management of sleep bruxism . This polysomnographic ( PSG ) study was design ed to investigate the effect of CES on PSG parameters in subjects with self-reported bruxism . Fourteen subjects underwent a full PSG investigation in the laboratory for three consecutive nights - one night of adaptation , one night without CES  , and one night with CES - in a r and omized order . During all sessions the EMG activity was recorded by a portable feedback device from the temporalis muscle . An electrical pulse , which was adjusted to a moderate , but non-painful , intensity , was applied to subjects during the session with CES , if jaw-muscle activity was detected . The total sleep time , the number of micro-arousals per hour of sleep , the time spent in sleep stages 3 and 4 and in rapid eye movement ( REM ) sleep , and the number of periodic limb movements , were not influenced by CES . The number of EMG episodes per hour of sleep during the nights with and without CES was not significantly different . The present study suggests that CES at non-painful intensities does not cause major arousal responses in any of the sleep parameters assessed in this study Background The grading of recommendation , assessment , development and evaluation ( GRADE ) approach is widely implemented in health technology assessment and guideline development organisations throughout the world . GRADE provides a transparent approach to reaching judgements about the quality of evidence on the effects of a health care intervention , but is complex and therefore challenging to apply in a consistent manner . Methods We developed a checklist to guide the research er to extract the data required to make a GRADE assessment . We applied the checklist to 29 meta-analyses of r and omised controlled trials on the effectiveness of health care interventions . Two review ers used the checklist for each paper and used these data to rate the quality of evidence for a particular outcome . Results For most ( 70 % ) checklist items , there was good agreement between review ers . The main problems were for items relating to indirectness where considerable judgement is required . Conclusions There was consistent agreement between review ers on most items in the checklist . The use of this checklist may be an aid to improving the consistency and reproducibility of GRADE assessment s , particularly for inexperienced users or in rapid review s without the re sources to conduct assessment s by two research ers independently AIMS To determine whether an intervention reduces oromotor activity and masticatory muscle pain in myofascial temporom and ibular disorder ( M/TMD ) patients with high levels of masticatory muscle activity associated with sleep bruxism . METHODS Fourteen women with M/TMD and prior polysomnographic evidence consistent with sleep bruxism participated in a 10-week single-group pre-test/ post-test mechanistic clinical trial . A 2-week period of baseline monitoring of individually biocalibrated electromyographic ( EMG ) events associated with sleep bruxism was followed by 6 weeks of EMG-event-contingent treatment via an innocuous electrical pulse to the skin overlying the temporalis muscle . Treatment was discontinued during 2-week follow-up monitoring . Each night before sleep , subjects recorded their average daily pain . RESULTS Mixed-model analysis of variance showed a reliable reduction of EMG events during contingent stimulation treatment periods , but frequency of EMG events returned to baseline levels during follow-up ( linear term , P = .002 ; quadratic term , P = .001 ) . In contrast , nightly pain reports failed to show any systematic changes during treatment ( linear and quadratic trends , both P > .10 ) . CONCLUSION Spontaneous pain severity and nighttime oromotor activity vary independently over nights , even in M/TMD patients selected for relatively high levels of both characteristics Bruxism contributes to the development of temporom and ibular disorders as well as causes dental problems . Although it is an important issue in clinical dentistry , no treatment approaches have been proven effective . This study aim ed to use electromyogram ( EMG ) biofeedback ( BF ) training to improve awake bruxism ( AB ) and examine its effect on sleep bruxism ( SB ) .  Twelve male participants ( mean age , 26·8 ± 2·5 years ) with subjective symptoms of AB or a diagnosis of SB were r and omly divided into BF ( n = 7 ) and control ( CO , n = 5 ) groups to undergo 5-h daytime and night-time EMG measurements for three consecutive weeks . EMG electrodes were placed over the temporalis muscle on the habitual masticatory side . Those in the BF group underwent BF training to remind them of the occurrence of undesirable clenching activity when excessive EMG activity of certain burst duration was generated in week 2 . Then , EMGs were recorded at week 3 as the post-BF test . Those in the CO group underwent EMG measurement without any EMG BF training throughout the study period . Although the number of tonic EMG events did not show statistically significant differences among weeks 1 - 3 in the CO group , events in weeks 2 and 3 decreased significantly compared with those in week 1 , both daytime and night-time , in the BF group ( P < 0·05 , Scheffé 's test ) . This study results suggest that EMG BF to improve AB tonic EMG events can also provide an effective approach to regulate SB tonic EMG events Abstract Objective . To determine the effect of contingent electrical stimulation ( CES ) on jaw muscle activity during sleep in a double-blinded r and omized controlled trial ( RCT ) . Material s and methods . Eleven patients with myofascial TMD ( mean age 37 years ) and with a clinical diagnosis of bruxism were included .  EMG activity ( Grindcare ® ) was recorded from the anterior temporalis muscle during sleep and analyzed online . Jaw muscle activity related to clenching or grinding triggered an electrical square-wave pulse train ( 450 ms ) adjusted to a clear , but non-painful intensity . TMD patients were r and omized into two groups : active treatment with CES or no CES ( placebo ) . Number of EMG episodes/hour sleep was the primary outcome parameter . The following variables were assessed as secondary outcome parameters ; number of painful muscles , maximum pain-free jaw opening , characteristic pain intensity , depression scores and Oral Health Impact Profile scores . Numerical Rating Scale scores for self-reported pain and muscle tension were registered for at least 4 nights per week during the experiment . Results . The number of EMG episodes/hour sleep was significantly reduced ( 52 ± 12 % ) in the CES group during the sessions with CES ( ANOVA : p = 0.021 ) compared to baseline . There were no significant differences in the secondary outcome parameters ( ANOVA : p > 0.513 ) or pain or muscle tension scores between groups ( p = 0.645 ) . The average duration of sleep hours during the nights with and without CES was not significantly different ( p = 0.646 ) . Conclusions . These results demonstrate a significant inhibitory effect of CES on jaw muscle EMG activity during sleep in a RCT , but with no effects on self-reported pain 
    Output:
    
The meta- analysis indicated a non-significant difference in electromyographic-measured SB episodes per hour after one night of contingent electrical stimulation ( CES ) compared with placebo control , yet a significant difference was shown after five nights of CES .
Qualitative synthesis did not present a reliable reduction in clinical pain levels ; however , no substantial sleep disturbances were indicated following the intervention .
In conclusion , one of the biofeedback modalities , CES , is effective in reducing SB-related motor activities after a short-term treatment period .
However , evidence of long-term effects is lacking .