***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: OBJECTIVES The effectiveness of an exercise intervention for people in early and midstage Parkinson 's disease ( stages 2 and 3 of Hoehn and Yahr ) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described . DESIGN AND SETTING Fifty-one men and women , aged 55 - 84 years , identified through advertisement , local support groups , and local neurologists were enrolled into a r and omized , controlled trial . Subjects were assigned r and omly to an intervention or a usual care arm ( i.e. , no specific exercise ) . Of the original 51 participants , 46 completed the r and omized , controlled trial . Participants in the exercise arm ( n = 23 ) received individual instruction three times per week for 10 weeks . Participants in the usual care arm ( n = 23 ) were " wait listed " for intervention . MEASUREMENTS Changes over 10 weeks in spinal flexibility ( i.e. , functional axial rotation ) and physical performance ( i.e. , functional reach , timed supine to st and ) were the primary outcome measures . RESULTS MANOVA conducted for the three primary outcome variables demonstrated significant differences ( P < or = .05 ) between the two groups . Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group . There was no significant difference in supine to sit time . CONCLUSION Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD The purpose of this study was to determine if a balance and strength training program could improve equilibrium and strength in persons with stage I-III Parkinsonism . Subjects were pre-tested on strength and balance ( EquiTest ) and r and omized into either a treatment or a control group . The treatment subjects participated in 10 weeks of lower limb strength training and balance exercises design ed to challenge a stable posture and increase limits of stability . Both groups were then posttested on balance , knee flexion , knee extension , and ankle inversion strength . Subjects who received strength and balance training demonstrated significantly improved equilibrium and modest gains in knee flexion and extension strength , while the control group showed no improvement in conditions of destabilizing balance environments and significant declines in strength . Results indicate that 10 weeks of balance and strength training lead to improved equilibrium by producing positive changes in two different control mechanisms . One , training altered the ability to control the motor system when vestibular cues had to be the primary source of reliable feedback ; and two , training helped subjects to override faulty proprioceptive feedback and utilize reliable visual or vestibular cues The aim of this study was to evaluate the effects of orofacial physiotherapeutic treatment ( OPT ) on the facial mobility of Parkinson 's disease ( PD ) sufferers . Sixteen participants with PD were allocated r and omly to either the Treatment group or the Control group . A short interview between the physiotherapist and each subject was videotaped , and 10 r and om frames of the videotape were selected to be used in the facial expression assessment . The quantification of facial expressions was achieved by using an objective microcomputer-based measurement system , based on a mathematical model of the face ( FACEM ) . A facial outline is obtained , as well as 12 facial measures , which represent distances between key facial l and marks . The facial assessment was performed on 3 separate occasions , that is , baseline ( pretreatment ) , posttreatment , and follow-up ( 4 weeks later ) . A repeated measures analysis of variance ( MANOVA ) revealed a significant main effect of Time and a significant interaction effect between Time and Group for the Mouth-Opening Measure , suggesting that after treatment , members of the Treatment group opened their mouths to a greater degree than members of the Control group . Within the Treatment group , significant differences between pretreatment and posttreatment scores ( MANOVA ) were found for Mouth-Opening Measure and Mid-Top-Lip Measure . Similarly , Mouth-Opening Measure , Mid-Top-Lip Measure , Lower-Lip Thickness Measure , Top Eyelid/Iris Intersect Measure and Lower Eyelid/Iris Intersect Measure were significant across time from baseline to follow-up in the Treatment group only . No significant differences were found on any of the facial measures during the same period for members of the Control group . These findings suggest that OPT can improve facial movement and that this benefit extends in time , beyond the period of OPT itself . Such an increase in facial mobility can be expected to modify the " Parkinsonian facies " and facilitate the display of facial expressions Perceptual ratings of hoarseness and breathiness were used to assess the efficacy of two intensive methods for treating dysarthrophonia in individuals with idiopathic Parkinson disease . One method emphasized phonatory-respiratory effort ( the Lee Silverman Voice Treatment , LSVT ) and the other emphasized respiratory effort alone ( RET ) . Perceptual ratings were performed by two expert listeners based on r and om order presentation of the patients ' pretreatment and posttreatment recordings of the " Rainbow Passage . " The listeners were blinded to the patients and their treatment group . Statistically significant pretreatment to posttreatment improvement in hoarseness and breathiness was observed in the LSVT group but not in the RET group . The present findings are consistent with acoustic and physiologic findings reported previously , providing further evidence for the efficacy of the LSVT Rhythmic auditory stimulation ( RAS ) was used as a pacemaker during a 3-week home-based gait-training program for Parkinson 's disease ( PD ) patients ( n = 15 ) .  Electromyogram ( EMG ) patterns and stride parameters were assessed before and after the test without RAS to evaluate changes in gait patterns . Data were compared with those of two control groups ( n = 11 ) , who either did not participate in any gait training or who participated in an internally self-paced training program . RAS consisted of audiotapes with metronome-pulse patterns embedded into the on/off beat structure of rhythmically accentuated instrumental music . Patients who trained with RAS significantly ( p < 0.05 ) improved their gait velocity by 25 % , stride length by 12 % , and step cadence by 10 % more than self-paced subjects who improved their velocity by 7 % and no-training subjects whose velocity decreased by 7 % . In the RAS-group , timing of EMG patterns changed significantly ( p < 0.05 ) in the anterior tibialis and vastus lateralis muscles . Evidence for rhythmic entrainment of gait patterns was shown by the ability of the RAS group to reproduce the speed of the last training tape within a 2 % margin of error without RAS The medical treatment of idiopathic Parkinson 's disease has improved the quality of life and increased survival of patients with Parkinson 's disease . However , as the illness progresses , impairments in daily living activities occur . A clinical trial for a group rehabilitation program was initiated to maintain the functional status of these patients . The research protocol consisted of a pretreatment evaluation , r and om assignment to experimental or control groups , and posttreatment evaluations after therapy , at 6 months and at 1 year . The results showed that the subjects of the treated experimental group maintained their functional status after 1 year , demonstrated a significant decrease of bradykinesia , and perceived a significant improvement in their psychological well-being . This study confirms the value of an occupational therapy group approach and its benefits to the functional independence , to the improvement of physical and motor symptoms , and to the quality of life of persons with Parkinson 's disease In a controlled clinical study , we investigated the effects of behavioral treatment on postural and gait initiation problems idiopathic Parkinson 's disease ( PD ) . Comparable groups of patients received therapy ( experimental group , n = 15 ) and nonspecific psychological treatment ( control group , n = 14 ) for 10 weeks . We monitored various variables reflecting properties of posture and gait initiation by using an optoelectronic motion analyzer ( electronic movement analysis system , ELITE ) . A clinician blind to group membership of the patients assessed PD severity with the United Parkinson 's Disease Rating Scale ( UPDRS ) before and after the treatment period . ELITE measures of postural stability and movement initiation revealed treatment-specific effects . In addition , UPDRS motor scores showed significant improvement only after behavioral treatment . We conclude that behavioral treatment in Parkinson 's disease may improve motor disabilities in moderately advanced PD patients The purpose of this study was to evaluate the long-term ( 12 months ) effects of two forms of speech treatment on the speech and voice deficits that occur in Parkinson 's disease . Thirty-five patients with idiopathic Parkinson 's disease were assigned to one of two speech treatment groups : voice and respiration ( The Lee Silverman Voice Treatment [ LSVT ] ) or placebo ( respiration ) treatment .  Vocal intensity data from before , immediately after , and at 6 and 12 months after speech treatment revealed statistically significant differences between the treatment groups . Only subjects in the LSVT group improved or maintained vocal intensity above pretreatment levels by 12 months after treatment . The placebo group had statistically significant deterioration of vocal intensity levels from before to 12 months after treatment during conversational monologue . The LSVT group did not deteriorate to levels below pretreatment in vocal intensity over the 12-month period . This study is the first to document the short- and long-term effects of intensive speech treatment ( LSVT ) , which focuses on the voice , for patients with Parkinson 's disease compared with a placebo speech treatment group . NEUROLOGY 1996;47 : 1496 - Gibberd and others ( 11 April , p 1196 ) and sympathise over the problems they encountered . In a similar controlled trial ' we had difficulty in making due allowance for spontaneous fluctuations in motor performance and concentration which characterise this illness and particularly in assessing the influence of depression and motivation . We had to ab and on attempts to measure the latter factors with appropriate question naires because we often found that the patients fell asleep during assessment . Transport difficulties can prove a major obstacle and tend to influence selection of patients . Exhausting journeys to hospital made some patients underst and ably reluctant to attend twice weekly for outpatient physiotherapy and some became so rigid in anticipation of belated transport that they were unable to leave their home . In addition to organisational difficulties , there seems to be little agreement concerning the principles and methods of physiotherapy appropriate for Parkinsonian disabilities . Nevertheless , we found modest but unequivocal improvement in 10 of 21 patients , and in seven benefit was sustained for at least five weeks after the cessation of treatment . We could not determine whether improvement was physical , psychological , or both . Now that the limitations as well as the potential of antiParkinsonian medication has been determined , clinicians will want to know how best to use diminishing physiotherapy re sources . Clearly there is a need for further trials to clarify these common practical problems of management As part of ongoing research to investigate and document the efficacy of intensive voice therapy to improve functional communication in patients with idiopathic Parkinson disease , 45 patients were enrolled in a controlled , r and omized , prospect i ve study . Pre- to posttreatment comparisons are presented here on 22 of those patients who underwent laryngeal imaging examination . Of the 22 patients , 13 patients received intensive therapy aim ed at increasing vocal and respiratory effort ( VR ) , whereas nine received intensive therapy aim ed at increasing respiratory effort ( R ) only . All patients had a pretreatment evaluation that included two ( but sometimes only one ) voice recordings and an  otolaryngologic examination with  laryngostroboscopy .  At the completion of 4 weeks of therapy ( 16 sessions ) , two voice recordings were made , and laryngostroboscopy was again performed . The pre- and posttherapy videolaryngostroboscopy tapes were then r and omized and rated by four judges . Raters ' findings were then compared with vocal intensity measured before and after therapy . The VR therapy group showed improvements on laryngostroboscopic variables : less glottal incompetence and no significant change in supraglottal hyperfunction after therapy . No differences were observed in the R-only group . The mean intensity increase in the VR therapy group was 12.5 dB , compared with a decrease of 1.9 dB in the R-only group . These findings suggest that in patients with Parkinson disease , intensive therapy focusing on phonatory effort improves adduction of the vocal folds as assessed by laryngostroboscopy . Differences in laryngeal function in these patients observed with fiberoptic laryngoscopy and rigid telescopic laryngoscopy are discussed We devised a single-blind study to assess the role of providing external sensory cues in the rehabilitation of patients with idiopathic Parkinson 's disease ( PD ) . Twenty stable , nondemented patients with PD entered a 6-week rehabilitation program and were r and omly assigned to two balanced protocol s which were differentiated by the use of external sensory cues ( " non-cued " vs " cued " ) . Patients were evaluated by a neurologist , who was blind to group membership , with the Unified Parkinson 's Disease Rating Scale ( UPDRS ) at baseline , end of treatment , and after 6 weeks . Patient groups were comparable for age , disease duration , and severity . A significant reduction of UPDRS scores ( activities of daily living and motor sections ) was present after the rehabilitation phase in both groups . However , at follow up , while this clinical improvement had largely faded in the " non-cued " group , mean UPDRS scores of the " cued " group were still significantly lower than baseline values . The incorporation of external sensory cues in the rehabilitation protocol can extend the short-term benefit of physical therapy in moderately disabled patients with PD , possibly as a result of the learning of new motor strategies . " Cued " physical therapy for PD should be targeted to compensate for the defective physiological mechanisms 
    Output:
    
In summary , we failed to find conclusive evidence of benefit for any form of paramedical therapy sufficient to recommend them in routine clinical practice .
However , this lack of evidence is not proof of a lack of effect .