***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: PURPOSE To compare the effect of static holds and continuous passive motion on stiffness and force relaxation of the soft tissue structures resisting ankle joint dorsiflexion . METHODS This study used a r and omized repeated measures trial design . Twenty-four asymptomatic subjects ( 15 males and 8 females ) with a mean age of 26 yr participated . A Kin-Com dynamometer was used to measure the stiffness and force relaxation response of tissues about the ankle joint in response to a plantar flexor stretch . A comparison was made of the response for a 1 x 60-s hold , 2 x 30-s holds , 4 x 15-s holds , and continuous passive motion for 60 s. All subjects undertook all conditions . The main outcome measures were 1 ) stiffness at the ankle joint as it moved to 80 % of the maximum range of dorsiflexion , and 2 ) the decrease in force at 80 % of the maximum range of motion of the ankle joint . RESULTS Stiffness was decreased significantly ( P < 0.05 ) for the continuous passive motion condition only . The mean magnitude of the decrease in stiffness was 16 % . Across hold times , force decreased significantly ( P < 0.05 ) . Bonferonni contrasts indicated that there was a significant difference ( P < 0.05 ) between the continuous passive motion condition and all other hold conditions . There were no significant differences ( P > 0.05 ) between the 4 x 15-s , 2 x 30-s , and 1 x 60-s holds . The magnitude of the decline in force was 10.5 % , 21.5 % , 21.7 % , and 19 % for the 0- , 15- , 30- , and 60-s holds , respectively . The greatest decreases in tension were achieved in the first 20 s of a hold . CONCLUSION If decreasing stiffness is a key aim of a stretching program , the findings indicate that continuous motion is more effective than holds . In contrast , if relaxation of peak tension is the main aim , then holds are most effective Objective : To establish if isokinetic and isotonic muscle stretch ( with or without weight-bearing ) of the ankle plantar flexors improves gait in hemiplegic patients . A further aim was to compare the effectiveness of these treatment methods . Design : A r and omized , parallel group prospect i ve study . Setting : A stroke rehabilitation unit . Subjects : Ambulatory hemiparetic stroke patients with mild to moderately severe muscle hypertonia of the lower limb and a group of healthy control subjects . Intervention : Subjects were r and omized to receive a single 20-min session of isokinetic muscle stretch or isotonic muscle stretch with or without weight-bearing . Outcome measures : Selected kinematic , kinetic and spatio-temporal gait parameters were measured at baseline , immediately after the muscle stretch and 24 h later . Results : Sixty-six patients and 21 healthy control subjects were recruited and completed the study . There were statistically significant differences between the patient groups and the healthy subjects on most of the gait parameters studied . However , the differences between the patient groups or between the three measurements over time for each type of muscle stretch did not reach statistical significance . Conclusions : A single session of isokinetic or isotonic muscle stretch ( with or without weight-bearing ) of the ankle plantar flexors has no clinical ly observable effect on the gait of hemiplegic stroke patients The purpose of this study was to compare the effects of cyclic versus sustained passive stretching with a mechanical device on resting hamstring muscles ' length . Group 1 subjects ( 5 men , 17 women ) underwent cyclic stretching of their right hamstring musculature , and Group 2 subjects ( 5 men , 16 women ) underwent sustained stretching of their right hamstring musculature .  The stretching procedures were performed for 15 minutes on 5 consecutive days . A follow-up examination of the subjects ' relative knee flexion range of motion was made one week posttreatment . The Group 1 subjects had a mean ROM increase of 15.4 + /- 5.0 degrees after the five stretching treatments and maintained a mean ROM increase of 10.4 + /- 5.5 degrees on the follow-up examination ( p less than .001 ) . In Group 2 , the five stretching treatments result ed in a mean ROM increase of 13.4 + /- 4.4 degrees , and a mean increase of 7.9 + /- 4.0 degrees was maintained on the follow-up examination ( p less than .001 ) . Linear regression analysis revealed that initial ROM , sex , and treatment method significantly contributed to increases in ROM from Day 1 of treatment to the follow-up examination ( F = 6.04 ; df = 4,36 ; p less than .0008 ) . The cyclic stretching method result ed in a greater gain in ROM when the other variables were considered . Predicted values of ROM increases were also examined and discussed OBJECTIVE To determine the effect of 4 weeks of 30 minutes of daily stretching on ankle mobility in patients with recent spinal cord injuries ( SCIs ) . DESIGN Assessor-blinded r and omized controlled trial . SETTING Two spinal injury units in Sydney , Australia . PATIENTS Consecutive sample of 14 recently injured patients with paraplegia and quadriplegia . INTERVENTION Treated ankles were stretched continuously into dorsiflexion with a torque of 7.5 N x m for 30 minutes each weekday for 4 weeks . Contralateral ankles received no stretches . MAIN OUTCOME MEASURES Passive torque-angle curves for both ankles were obtained at study commencement , then at weeks 2 , 4 , and 5 ( ie , during , at the end of , and 1 week after the stretching program ) . Torque-angle measurements were obtained with the knee extended and flexed . Mean values for parameters ( baseline angle , angle at 10 N x m , slope ) describing the characteristics of the torque-angle curves were derived for each knee position . Changes from pretest to each subsequent test were calculated , as well as 95 % confidence intervals ( CIs ) for differences in these changes between stretched and controlled ankles . RESULTS The stretching intervention did not significantly change any of the 3 parameters describing the torque-angle curves of the ankle in either knee position . At the beginning of the study , the mean ( + /-SD ) angles obtained with the application of a st and ardized torque with the knee extended for the control and stretch ankles were 105 degrees ( + /- 10.4 degrees ) and 106 degrees ( + /- 9.8 degrees ) , respectively . After 4 weeks , these values were 106 degrees ( + /- 10.6 degrees ) and 107 degrees ( + /- 10.6 degrees ) ( mean difference in change of angle = 0 degrees ; 95 % CI , -3.3 degrees to 3.3 degrees ) . CONCLUSION Thirty minutes of daily stretching for 4 weeks does not significantly change ankle mobility in recently injured patients with SCIs BACKGROUND AND PURPOSE Ankle plantar-flexion contractures are a common problem following traumatic head injury . Although serial casting is used to correct and prevent ankle plantar-flexion contractures , treatment efficacy has not been evaluated using an experimental design . The aim of this research was to establish the effect of a regimen of casting combined with stretching on passive ankle dorsiflexion motion . SUBJECTS Nine people who had sustained traumatic closed head injuries and had limited dorsiflexion motion participated in the study . METHODS A crossover design was used in the study . Subjects were assigned to both experimental and control groups . Torque-controlled measurements of passive ankle dorsiflexion motion were obtained for all subjects before and after 1 week of casting combined with stretching , as well as before and after a 1-week control period . The order of the experimental and control conditions was r and omized . RESULTS Passive ankle dorsiflexion increased by a mean of 13.5 degrees ( SD = 9.3 ) during the experimental condition , as compared with a mean decrease of 1.9 degrees ( SD = 10.2 ) during the control condition . The difference between the experimental and control conditions was statistically significant . CONCLUSION AND DISCUSSION These findings suggest that casting combined with stretching is an effective method of correcting ankle plantar-flexion contractures in patients with traumatic head injuries The aims of this study are to vali date the hypertonia treatment/ assessment system and to quantify the immediate effect of prolonged muscle stretch ( PMS ) on the inhibition of ankle hypertonia in stroke patients . For PMS treatment , ankle plantarflexors were stretched with a constant torque in 25 subjects with hemiplegia and ankle plantarflexors hypertonia . Using the developed hypertonia treatment/ assessment system , the effects of the PMS treatment were quantified by comparing the reactive torque measurements of the ankle joint before and after the treatment sessions in terms of elastic ( elastic-inertia ) ( K(ei ) ) and viscous ( K(v ) ) components . It was shown that an application of PMS for 30 min using a constant stretching force , approximately 80 % of the torque measured at the maximal passive ROM dorsiflexion position , significantly reduces both components of the ankle joint torque ( P < 0.05 ) . The present results suggested that the application of PMS with a constant torque could reduce not only the elasticity of the hypertonic muscles , but also their viscosity in the stroke patients Reflex behavior and tension development in upper limb muscles were analyzed and comparisons made between the unaffected and spastic sides of patients with spastic hemiparesis . During sinusoidal ( 0.3‐Hz ) isometric or isotonic elbow tracking , with a control either of joint position or of torque , r and omly timed displacements were induced ( at one of three velocities ) stretching either the activated flexor or the extensor muscles . On the spastic side , exaggerated short‐latency reflexes were apparent , but in contrast , the amplitude of long‐latency electromyography ( EMG ) responses was reduced . The latter responses were differentially modulated on the unaffected side , predominantly by the acceleration signal during control of position and more by the velocity signal during control of torque , while the mode of muscle contraction ( isometric or isotonic ) had little influence on this behavior . This difference in reflex modulation was lost on the spastic side . The functional consequence of this reduced EMG modulation could be difficulty in performing finely controlled arm movements . The ratio of torque to EMG activity during displacements was higher for both background and reflex‐induced EMG on the spastic limb than on the unaffected side . This effect was more pronounced for the flexor than for the extensor muscles . Consequently , the development of spastic muscle hypertonia can not be attributed to an increase in EMG activity . It is suggested that secondary to a supraspinal lesion , mechanical muscle properties change in such a way that the activated spastic muscle develops more tension when it is stretched OBJECTIVE To investigate the effect of repeated feedback-controlled and programmed " intelligent " stretching of the ankle plantar- and dorsiflexors to treat subjects with ankle spasticity and /or contracture in stroke . DESIGN Noncontrolled trial . SETTING Institutional research center . PARTICIPANTS Subjects with spasticity and /or contracture after stroke . INTERVENTIONS Stretching of the plantar- and dorsiflexors of the ankle 3 times a week for 45 minutes during a 4-week period by using a feedback-controlled and programmed stretching device . MAIN OUTCOME MEASURES Passive and active range of motion ( ROM ) , muscle strength , joint stiffness , joint viscous damping , reflex excitability , comfortable walking speed , and subjective experiences of the subjects . RESULTS Significant improvements were found in the passive ROM , maximum voluntary contraction , ankle stiffness , and comfortable walking speed . The visual analog scales indicated very positive subjective evaluation in terms of the comfort of stretching and the effect on their involved ankle . CONCLUSIONS Repeated feedback-controlled or intelligent stretching had a positive influence on the joint properties of the ankle with spasticity and /or contracture after stroke . The stretching device may be an effective and safe alternative to manual passive motion treatment by a therapist and has potential to be used to repeatedly and regularly stretch the ankle of subjects with spasticity and /or contracture without daily involvement of clinicians or physical therapists Application of eccentric contractions and muscle stretch are clinical ly effective in reducing  spasticity  and increasing ROM ( 7 ) . This may be explained by a change in the excitability of motoneurons supplying the spastic muscle . Excitability of motoneurons can be indirectly assessed using the H-reflex . Experiments were performed on 20 normal subjects and 17 subjects with spasticity result ing from neurological disorder . Subjects were seated in a secure position and the ankle joint was moved from 30 degrees plantarflexion to 20 degrees dorsiflexion at a velocity of 30 degrees/sec . Sixty eccentric contractions of the triceps surae muscle were performed using a Kin-Com dynamometer ( Chattanooga Corp , Tennessee ) . Two protocol s were used : ( 1 ) eccentric contractions only , and ( 2 ) eccentric contractions with a 5s stretch of the relaxed triceps surae after each contraction . Two sets of 10 H-reflexes were collected from the soleus muscle before ( trial 1 & 2 ) and after ( trial 3 & 4 ) eccentric and eccentric + stretch protocol s. The mean peak to peak H-reflex amplitude was calculated for each trial and compared using ANOVA . Eccentric contractions result ed in a significant and maintained increase in the H-reflex in neurological compared to normal subjects ( P < 0.05 ) . Eccentric contractions in subjects with spasticity result ed in an increase in motoneur 
    Output:
    
Results : There is a sufficient level of evidence to support the use of stretching as and effective techniques in rehabilitation .
Conclusion : The review adds stronger underst and ing with regard to stretching considerations in rehabilitation following UMNs .