human
***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 was design ed to evaluate the effects of whole body vibration ( WBV ) exercise , mental training ( MT ) , and the concurrent effect of WBV and MT on lower body balance , neuromuscular performance , and leg muscle strength in elderly men . In a r and omized control trial study with parallel group design , 42 older men ( mean±st and ard deviation age , 68±5.78 years ) were r and omly divided into four groups : WBV ( n=11 ) , MT ( n=12 ) , WBV+MT ( n=10 ) , and control ( n=9 ) groups . The protocol of training consisted of three sessions per week for 8 weeks and about 30 min for each session . The WBV exercise was performed on a vibration machine . In MT group , participants were asked to mentally visualize to do the Timed Up and Go and relaxation technics . postural stability , the Timed Up and Go test , 5-repetition chair-rising test , 6-m t and em gait test , 10-m walking , and leg isometric strength were measured in baseline and after 8-week intervention . Repeated measures - analysis of variance followed by post hoc was used to analyses the data . The results of this study showed that there were significant improvements ( P<0.05 ) in postural stability , Timed Up and Go , 5-repetition chair-rising , 6-m t and em gait test , 10-m walking , and leg isometric strength  in WBV , MT , and WBV+MT in comparison with baseline and in comparison with control group . It seems that older adults can take benefit from WBV and MT and WBV+MT exercise as a cost-effective and practical way without side effects to improve postural control , mobility , and functional performance & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy For consciously performed motor tasks executed in a defined and constant way , both motor imagery ( MI ) and action observation ( AO ) have been shown to promote motor learning . It is not known whether these forms of non-physical training also improve motor actions when these actions have to be variably applied in an unstable and unpredictable environment . The present study therefore investigated the influence of MI balance training ( MI_BT ) and a balance training combining AO and MI ( AO+MI_BT ) on postural control of undisturbed and disturbed upright stance on unstable ground . As spinal reflex excitability after classical ( i.e. , physical ) balance training ( BT ) is generally decreased , we tested whether non-physical BT also has an impact on spinal reflex circuits . Thirty-six participants were r and omly allocated into an MI_BT group  , in which participants imagined postural exercises , an AO+MI_BT group , in which participants observed videos of other people performing balance exercises and imagined being the person in the video , and a non-active control group ( CON ) . Before and after 4 weeks of non-physical training , balance performance was assessed on a free-moving platform during stance without perturbation and during perturbed stance . Soleus H-reflexes were recorded during stable and unstable stance . The post-measurement revealed significantly decreased postural sway during undisturbed and disturbed stance after both MI_BT and AO+MI_BT . Spinal reflex excitability remained unchanged . This is the first study showing that non-physical training ( MI_BT and AO+MI_BT ) not only promotes motor learning of “ rigid ” postural tasks but also improves performance of highly variable and unpredictable balance actions . These findings may be relevant to improve postural control and thus reduce the risk of falls in temporarily immobilized patients OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change Abstract Purpose : The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty .  Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries . Yet , whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study . Method : Twenty volunteers were r and omly assigned to either a motor imagery or a control group .  Pain , range of motion , knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test . Results : The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth , a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group . No effects of motor imagery on Timed Up and Go Test scores were observed . Conclusion : Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty . According to this pilot study , motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty . Partial effect-sizes should be conducted in the future . Implication s for rehabilitation Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty : • Enhances quadriceps strength . • Alleviates pain . • Enhances range of motion . • Does not have any effect on basic functional mobility . • Does not have any effect on knee girth Background and purpose . Mental practice ( MP ) , which involves cognitive rehearsal of physical movements , is a noninvasive , inexpensive method of enabling repetitive , task-specific practice ( RTP ) . Recent , r and omized controlled data suggest that MP , when combined with an RTP therapy program , increases affected arm use and function significantly more than RTP only . As a next step , this 10-subject case series examined the possibility that cortical plasticity is a mechanism underlying the treatment effect of MP when combined with RTP . Method . Ten chronic stroke patients ( mean = 36.7 months ) exhibiting stable , moderate motor deficits received 30-minute therapy sessions for their affected arms , occurring 3 days/week for 10 weeks , and emphasizing valued activities of daily living ( ADLs ) . Directly after therapy , subjects received 30-minute MP sessions , which required MP of the ADLs performed during therapy . Behavioral outcomes were blindly evaluated using the Action Research Arm Test ( ARAT ) and the Fugl-Meyer Assessment ( FM ) .  Functional magnetic resonance imaging ( fMRI ) was administered before and after intervention to assess cortical changes . Results . Before intervention , subjects exhibited stable motor deficits . After intervention , subjects exhibited ARAT and FM score increases ( + 5.3 and + 4.2 , respectively ) and clinical ly significant gains in ADLs . Postintervention fMRI revealed significant increases in activation to wrist flexion and extension of the affected h and in the premotor area and primary motor cortex ipsilateral and contralateral to the affected h and , as well as in superior parietal cortex ipsilateral to the affected h and . Decreased activation was noted in parietal cortex of the hemisphere ipsilateral to the affected h and . These changes correlated with anatomical regions in which behavioral changes were observed in the ARAT and FM . Conclusions . MP is an easy to use , cost-effective strategy that was again shown to improve affected arm outcomes after stroke . This is the first study to demonstrate alteration in the cortical map in response to MP training Purpose To investigate the influence of a single session of locomotor-based motor imagery training on motor learning and physical performance . Patients and methods Thirty independent adults aged > 65 years took part in the r and omized controlled trial . The study was conducted within an exercise science laboratory . Participants were r and omly divided into three groups following baseline locomotor testing : motor imagery training , physical training , and control groups . The motor imagery training group completed 20 imagined repetitions of a locomotor task , the physical training group completed 20 physical repetitions of a locomotor task , and the control group spent 25 minutes playing mentally stimulating games on an iPad .  Imagined and physical performance times were measured for each training repetition . Gait speed ( preferred and fast ) , timed-up- and -go , gait variability and the time to complete an obstacle course were completed before and after the single training session . Results Motor learning occurred in both the motor imagery training and physical training groups . Motor imagery training led to refinements in motor planning result ing in imagined movements better matching the physically performed movement at the end of training . Motor imagery and physical training also promoted improvements in some locomotion outcomes as demonstrated by medium to large effect size improvements after training for fast gait speed and timed-up- and -go . There were no training effects on gait variability . Conclusion A single session of motor imagery training promoted motor learning of locomotion in independent older adults .  Motor imagery training of a specific locomotor task also had a positive transfer effect on related physical locomotor performance outcomes This study aim ed at determining whether the combination of action observation and motor imagery ( AO + MI ) of locomotor tasks could positively affect rehabilitation outcome  after hip replacement surgery . Of initially 405 screened participants , 21 were r and omly split into  intervention group ( N = 10 ; mean age = 64 y ; AO + MI of locomotor tasks : 30 min/day in the hospital , then 3 × /week in their homes for two months ) and  control group ( N = 11 , mean age = 63 y , active controls ) . The functional outcomes ( Timed Up and Go , TUG ; Four Step Square Test , FSST ; and single- and dual-task gait and postural control ) were measured before ( PRE ) and 2 months after surgery ( POST ) . Significant interactions indicated better rehabilitation outcome for the intervention group as compared to the control group : at POST , the intervention group revealed faster TUG ( p = 0.042 ) , FSST ( p = 0.004 ) , and dual-task fast-paced gait speed ( p = 0.022 ) , reduced swing-time variability ( p = 0.005 ) , and enhanced cognitive performance during dual tasks while walking or balancing ( p < 0.05 ) . In contrast , no changes were observed for body sway parameters ( p ≥ 0.229 ) . These results demonstrate that AO + MI is efficient to improve motor-cognitive performance after hip surgery . Moreover , only parameters associated with locomotor activities improved whereas balance skills that were not part of the AO + MI intervention were not affected , demonstrating the specificity of training intervention . Overall , utilizing AO + MI during rehabilitation is advised , especially when physical practice is limited OBJECTIVES To determine the effect of guided imagery ( GI ) on functional outcomes of total knee replacement ( TKR ) , explore psychological and neuroimmune mediators , and assess feasibility of study implementation . DESIGN Investigator-blinded , r and omized , placebo-controlled pilot study . SETTING S Hospital , surgeon 's office , participant 's home . PARTICIPANTS 82 persons undergoing TKR . INTERVENTIONS Audiorecordings of TKR-specific GI scripts or placebo-control audiorecordings of audiobook segments . OUTCOME MEASURES Gait velocity and Western Ontario and McMaster Universities Arthritis Index 
    Output:
    
agent
Motor imagery training improves balance and mobility in older adults who do not have a neurological condition .
These results suggest that motor imagery training could be an adjunct to st and ard physiotherapy care in older adults , although it is unclear whether or not the effects are clinical ly worthwhile .
***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 was design ed to evaluate the effects of whole body vibration ( WBV ) exercise , mental training ( MT ) , and the concurrent effect of WBV and MT on lower body balance , neuromuscular performance , and leg muscle strength in elderly men . In a r and omized control trial study with parallel group design , 42 older men ( mean±st and ard deviation age , 68±5.78 years ) were r and omly divided into four groups : WBV ( n=11 ) , MT ( n=12 ) , WBV+MT ( n=10 ) , and control ( n=9 ) groups . The protocol of training consisted of three sessions per week for 8 weeks and about 30 min for each session . The WBV exercise was performed on a vibration machine . In MT group , participants were asked to mentally visualize to do the Timed Up and Go and relaxation technics . postural stability , the Timed Up and Go test , 5-repetition chair-rising test , 6-m t and em gait test , 10-m walking , and leg isometric strength were measured in baseline and after 8-week intervention . Repeated measures - analysis of variance followed by post hoc was used to analyses the data . The results of this study showed that there were significant improvements ( P<0.05 ) in postural stability , Timed Up and Go , 5-repetition chair-rising , 6-m t and em gait test , 10-m walking , and leg isometric strength  in WBV , MT , and WBV+MT in comparison with baseline and in comparison with control group . It seems that older adults can take benefit from WBV and MT and WBV+MT exercise as a cost-effective and practical way without side effects to improve postural control , mobility , and functional performance & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy For consciously performed motor tasks executed in a defined and constant way , both motor imagery ( MI ) and action observation ( AO ) have been shown to promote motor learning . It is not known whether these forms of non-physical training also improve motor actions when these actions have to be variably applied in an unstable and unpredictable environment . The present study therefore investigated the influence of MI balance training ( MI_BT ) and a balance training combining AO and MI ( AO+MI_BT ) on postural control of undisturbed and disturbed upright stance on unstable ground . As spinal reflex excitability after classical ( i.e. , physical ) balance training ( BT ) is generally decreased , we tested whether non-physical BT also has an impact on spinal reflex circuits . Thirty-six participants were r and omly allocated into an MI_BT group  , in which participants imagined postural exercises , an AO+MI_BT group , in which participants observed videos of other people performing balance exercises and imagined being the person in the video , and a non-active control group ( CON ) . Before and after 4 weeks of non-physical training , balance performance was assessed on a free-moving platform during stance without perturbation and during perturbed stance . Soleus H-reflexes were recorded during stable and unstable stance . The post-measurement revealed significantly decreased postural sway during undisturbed and disturbed stance after both MI_BT and AO+MI_BT . Spinal reflex excitability remained unchanged . This is the first study showing that non-physical training ( MI_BT and AO+MI_BT ) not only promotes motor learning of “ rigid ” postural tasks but also improves performance of highly variable and unpredictable balance actions . These findings may be relevant to improve postural control and thus reduce the risk of falls in temporarily immobilized patients OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change Abstract Purpose : The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty .  Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries . Yet , whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study . Method : Twenty volunteers were r and omly assigned to either a motor imagery or a control group .  Pain , range of motion , knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test . Results : The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth , a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group . No effects of motor imagery on Timed Up and Go Test scores were observed . Conclusion : Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty . According to this pilot study , motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty . Partial effect-sizes should be conducted in the future . Implication s for rehabilitation Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty : • Enhances quadriceps strength . • Alleviates pain . • Enhances range of motion . • Does not have any effect on basic functional mobility . • Does not have any effect on knee girth Background and purpose . Mental practice ( MP ) , which involves cognitive rehearsal of physical movements , is a noninvasive , inexpensive method of enabling repetitive , task-specific practice ( RTP ) . Recent , r and omized controlled data suggest that MP , when combined with an RTP therapy program , increases affected arm use and function significantly more than RTP only . As a next step , this 10-subject case series examined the possibility that cortical plasticity is a mechanism underlying the treatment effect of MP when combined with RTP . Method . Ten chronic stroke patients ( mean = 36.7 months ) exhibiting stable , moderate motor deficits received 30-minute therapy sessions for their affected arms , occurring 3 days/week for 10 weeks , and emphasizing valued activities of daily living ( ADLs ) . Directly after therapy , subjects received 30-minute MP sessions , which required MP of the ADLs performed during therapy . Behavioral outcomes were blindly evaluated using the Action Research Arm Test ( ARAT ) and the Fugl-Meyer Assessment ( FM ) .  Functional magnetic resonance imaging ( fMRI ) was administered before and after intervention to assess cortical changes . Results . Before intervention , subjects exhibited stable motor deficits . After intervention , subjects exhibited ARAT and FM score increases ( + 5.3 and + 4.2 , respectively ) and clinical ly significant gains in ADLs . Postintervention fMRI revealed significant increases in activation to wrist flexion and extension of the affected h and in the premotor area and primary motor cortex ipsilateral and contralateral to the affected h and , as well as in superior parietal cortex ipsilateral to the affected h and . Decreased activation was noted in parietal cortex of the hemisphere ipsilateral to the affected h and . These changes correlated with anatomical regions in which behavioral changes were observed in the ARAT and FM . Conclusions . MP is an easy to use , cost-effective strategy that was again shown to improve affected arm outcomes after stroke . This is the first study to demonstrate alteration in the cortical map in response to MP training Purpose To investigate the influence of a single session of locomotor-based motor imagery training on motor learning and physical performance . Patients and methods Thirty independent adults aged > 65 years took part in the r and omized controlled trial . The study was conducted within an exercise science laboratory . Participants were r and omly divided into three groups following baseline locomotor testing : motor imagery training , physical training , and control groups . The motor imagery training group completed 20 imagined repetitions of a locomotor task , the physical training group completed 20 physical repetitions of a locomotor task , and the control group spent 25 minutes playing mentally stimulating games on an iPad .  Imagined and physical performance times were measured for each training repetition . Gait speed ( preferred and fast ) , timed-up- and -go , gait variability and the time to complete an obstacle course were completed before and after the single training session . Results Motor learning occurred in both the motor imagery training and physical training groups . Motor imagery training led to refinements in motor planning result ing in imagined movements better matching the physically performed movement at the end of training . Motor imagery and physical training also promoted improvements in some locomotion outcomes as demonstrated by medium to large effect size improvements after training for fast gait speed and timed-up- and -go . There were no training effects on gait variability . Conclusion A single session of motor imagery training promoted motor learning of locomotion in independent older adults .  Motor imagery training of a specific locomotor task also had a positive transfer effect on related physical locomotor performance outcomes This study aim ed at determining whether the combination of action observation and motor imagery ( AO + MI ) of locomotor tasks could positively affect rehabilitation outcome  after hip replacement surgery . Of initially 405 screened participants , 21 were r and omly split into  intervention group ( N = 10 ; mean age = 64 y ; AO + MI of locomotor tasks : 30 min/day in the hospital , then 3 × /week in their homes for two months ) and  control group ( N = 11 , mean age = 63 y , active controls ) . The functional outcomes ( Timed Up and Go , TUG ; Four Step Square Test , FSST ; and single- and dual-task gait and postural control ) were measured before ( PRE ) and 2 months after surgery ( POST ) . Significant interactions indicated better rehabilitation outcome for the intervention group as compared to the control group : at POST , the intervention group revealed faster TUG ( p = 0.042 ) , FSST ( p = 0.004 ) , and dual-task fast-paced gait speed ( p = 0.022 ) , reduced swing-time variability ( p = 0.005 ) , and enhanced cognitive performance during dual tasks while walking or balancing ( p < 0.05 ) . In contrast , no changes were observed for body sway parameters ( p ≥ 0.229 ) . These results demonstrate that AO + MI is efficient to improve motor-cognitive performance after hip surgery . Moreover , only parameters associated with locomotor activities improved whereas balance skills that were not part of the AO + MI intervention were not affected , demonstrating the specificity of training intervention . Overall , utilizing AO + MI during rehabilitation is advised , especially when physical practice is limited OBJECTIVES To determine the effect of guided imagery ( GI ) on functional outcomes of total knee replacement ( TKR ) , explore psychological and neuroimmune mediators , and assess feasibility of study implementation . DESIGN Investigator-blinded , r and omized , placebo-controlled pilot study . SETTING S Hospital , surgeon 's office , participant 's home . PARTICIPANTS 82 persons undergoing TKR . INTERVENTIONS Audiorecordings of TKR-specific GI scripts or placebo-control audiorecordings of audiobook segments . OUTCOME MEASURES Gait velocity and Western Ontario and McMaster Universities Arthritis Index 
    Output:
    