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: OBJECTIVE To determine the point prevalence of chronic musculoskeletal ankle disorders in the community . DESIGN Cross-sectional stratified ( metropolitan vs regional ) r and om sample . SETTING General community . PARTICIPANTS  Population -based computer-aided telephone survey of people ( N=2078 ) aged 18 to 65 years in New South Wales , Australia . Of those contacted , 751 participants provided data . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Point prevalence for no history of ankle injury or chronic ankle problems ( no ankle problems ) , history of ankle injury without residual problems , and chronic ankle disorders . Chronic musculoskeletal ankle disorders due to ankle sprain , fracture , arthritis , or other disorder compared by chi-square test for the presence of pain , weakness , giving way , swelling and instability , activity limitation , and health care use in the past year . RESULTS There were 231 ( 30.8 % ) participants with no ankle problems , 342 ( 45.5 % ) with a history of ankle injury but no chronic problems , and 178 ( 23.7 % ) with chronic ankle disorders . The major component of chronic ankle disorders was musculoskeletal disorders ( n=147 , 19.6 % of the total sample ) , most of which were due to ankle injury ( n=117 , 15.6 % of the total ) . There was no difference among the arthritis , fracture , sprain , and other groups in the prevalence of the specific complaints , or health care use . Significantly more participants with arthritis had to limit activity than in the sprain group ( Chi-square test , P=.035 ) . CONCLUSIONS Chronic musculoskeletal ankle disorders affected almost 20 % of the Australian community . The majority were due to a previous ankle injury , and most people had to limit or change their physical activity because of the ankle disorder CONTEXT Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability ( CAI ) , strength-training rehabilitation protocol s may improve the deficits often associated with CAI . OBJECTIVE To determine whether strength-training protocol s affect strength , dynamic balance , functional performance , and perceived instability in individuals with CAI . DESIGN R and omized controlled trial . SETTING Athletic training research laboratory . PATIENTS OR OTHER PARTICIPANTS A total of 39 individuals with CAI ( 17 men [ 44 % ] , 22 women [ 56 % ] ) participated in this study . Chronic ankle instability was determined by the Identification of Functional Ankle Instability Question naire , and participants were r and omly assigned to a resistance-b and - protocol group ( n = 13 [ 33 % ] age = 19.7 ± 2.2 years , height = 172.9 ± 12.8 cm , weight = 69.1 ± 13.5 kg ) , a proprioceptive neuromuscular facilitation strength- protocol group  ( n = 13 [ 33 % ] , age = 18.9 ± 1.3 years , height = 172.5 ± 5.9 cm , weight = 72.7 ± 14.6 kg ) , or a control group  ( n = 13 [ 33 % ] , age = 20.5 ± 2.1 years , height = 175.2 ± 8.1 cm , weight = 70.2 ± 11.1 kg ) . INTERVENTION(S ) Both rehabilitation groups completed their protocol s 3 times/wk for 6 weeks . The control group did not attend rehabilitation sessions . MAIN OUTCOME MEASURE(S ) Before the interventions , participants were pretested by completing the figure-8 hop test for time , the triple-crossover hop test for distance , isometric strength tests ( dorsiflexion , plantar flexion , inversion , and eversion ) , the Y-Balance test , and the visual analog scale for perceived ankle instability . Participants were again tested 6 weeks later . We conducted 2 separate , multivariate , repeated- measures analyses of variance , followed by univariate analyses on any significant findings . RESULTS The resistance-b and protocol group improved in strength ( dorsiflexion , inversion , and eversion ) and on the visual analog scale ( P < .05 ) ; the proprioceptive neuromuscular facilitation group improved in strength ( inversion and eversion ) and on the visual analog scale ( P < .05 ) as well . No improvements were seen in the triple-crossover hop or the Y-Balance tests for either intervention group or in the control group for any dependent variable ( P > .05 ) . CONCLUSIONS Although the resistance-b and protocol is common in rehabilitation , the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI . Both protocol s showed clinical benefits in strength and perceived instability . To improve functional outcomes , clinicians should consider using additional multiplanar and multijoint exercises BACKGROUND AND PURPOSE Passive joint mobilization is commonly used by physical therapists as an intervention for acute ankle inversion sprains . A r and omized controlled trial with blinded assessors was conducted to investigate the effect of a specific joint mobilization , the anteroposterior glide on the talus , on increasing pain-free dorsiflexion and 3 gait variables : stride speed ( gait speed ) , step length , and single support time . SUBJECTS Forty-one subjects with acute ankle inversion sprains ( < 72 hours ) and no other injury to the lower limb entered the trial . METHODS Subjects were r and omly assigned to 1 of 2 treatment groups . The control group received a protocol of rest , ice , compression , and elevation ( RICE ) . The experimental group received the anteroposterior mobilization , using a force that avoided incurring any increase in pain , in addition to the RICE protocol . Subjects in both groups were treated every second day for a maximum of 2 weeks or until the discharge criteria were met , and all subjects were given a home program of continued RICE application . Outcomes were measured before and after each treatment . RESULTS The results showed that the experimental group required fewer treatment sessions than the control group to achieve full pain-free dorsiflexion . The experimental group had greater improvement in range of movement before and after each of the first 3 treatment sessions . The experimental group also had greater increases in stride speed during the first and third treatment sessions . DISCUSSION AND CONCLUSION Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone . Improvement in step length symmetry and single support time was similar in both groups STUDY DESIGN Prospect i ve cohort study . OBJECTIVE To assess the effect of 6 weeks of balance training on sensorimotor measures previously found to be deficient in participants with chronic ankle instability ( CAI ) . BACKGROUND CAI is the tendency toward repeated ankle sprains and recurring symptoms , occurring in 40 % to 70 % of individuals who have previously sustained a lateral ankle sprain . Recent studies have found deficits in sensorimotor measures in individuals with CAI . As balance training is a common component of ankle rehabilitation , underst and ing its effect on the sensorimotorsystem in individuals with CAI may enable us to optimize protocol s to better utilize this rehabilitation method . METHODS Twelve participants with CAI and 9 healthy volunteers participated . Independent variables were group ( CAI , control ) and time ( pretraining , posttraining ) . Participants with CAI who completed a 6-week balance training program and healthy controls who did not get any training were pretested and posttested at the beginning and at the end of 6 weeks . RESULTS The individuals in the CAI group who performed balance training demonstrated better performance than control participants on baseline adjusted posttraining measures of dynamic balance in the anterior medial ( P = .021 ) , medial ( P = .048 ) , and posterior medial directions ( P = .030 ) ; motoneuron pool excitability Hmax/Mmax ratio ( P = .044 ) and single-limb presynaptic inhibition ( P = .012 ) ; and joint position sense inversion variable error ( P = .017 ) . It may be of note that no systematic differences were detected for static balance or plantar flexion joint position sense tasks . CONCLUSIONS After 6 weeks of balance training , individuals with CAI demonstrated enhanced dynamic balance , inversion joint position sense , and changes in motoneuron pool excitability compared to healthy controls who did not train . LEVEL OF EVIDENCE Therapy , level 2b Objective : To examine the effects of a four-week balance training programme on ankle kinematics during walking and jogging in those with chronic ankle instability . A secondary objective was to evaluate the effect of balance training on the mechanical properties of the lateral ligaments in those with chronic ankle instability . Design : R and omized controlled trial . Setting : Laboratory . Subjects/ patients : Twenty-nine participants ( 12 males , 17 females ) with self-reported chronic ankle instability were r and omly assigned to a balance training group or a control group . Intervention : Four weeks of supervised rehabilitation that emphasized dynamic balance stabilization in single-limb stance . The control group received no intervention . Main outcome measures : Kinematic measures of rearfoot inversion/eversion , shank rotation , and the coupling relationship between these two segments throughout the gait cycle during walking and jogging on a treadmill . Instrumented ankle arthrometer measures were taken to assess anterior drawer and inversion talar tilt laxity and stiffness . Results : No significant alterations in the inversion/eversion or shank rotation kinematics were found during walking and jogging after balance training . There was , however , a significant decrease in the shank/rearfoot coupling variability during walking as measured by deviation phase after balance training ( balance training posttest : 13.1 ° ± 6.2 ° , balance training pretest : 16.2 ° ± 3.3 ° , P = 0.03 ) , indicating improved shank/rearfoot coupling stability . The control group did not significantly change . ( posttest : 16.30 ° ± 4.4 ° , pretest : 18.6 ° ± 7.1 ° , P40.05 ) There were no significant changes in laxity measures for either group . Conclusions : Balance training significantly altered the relationship between shank rotation and rearfoot inversion/eversion in those with chronic ankle instability OBJECTIVE To determine how gluteus medius ( Gmed ) and maximus ( Gmax ) activate during closed-chain functional rehabilitative exercises in those with and without chronic ankle instability ( CAI ) . DESIGN Cohort study . Subjects performed ten repetitions of a rotational lunge and single-leg rotational squat while surface electromyography was used to collect mean muscle activity  of the Gmed and Gmax . MAIN OUTCOME MEASURES Mean electromyography activity of the Gmed and Gmax at maximum excursion was compared between Groups and Exercises using a separate 2-way repeated measures analysis of variance design for each muscle . SETTING University biomechanics lab . PARTICIPANTS Nine healthy ( 8F , 1 M ) and nine CAI subjects ( 8F , 1 M ) RESULTS : For Gmax activation , there was a statistically significant Group by Exercise interaction ( F(3,48 ) = 4.84 , p = 0.043 ) . A Scheffe 's post-hoc test revealed that during the rotational squat , the CAI group had significantly lower Gmax activation ( 51.1 ± 31.0 % ) than the healthy group ( 78.6 ± 44.8 % ) . There were no statistically significant findings for the Gmed . In the healthy group , the Gmax produced significantly higher activation during rotational squat ( 78.6 ± 44.8 % ) compared to the rotational lunge ( 57.6 ± 31.9 % ) . CONCLUSION Because the CAI group had significantly less Gmax activation than the healthy group during the rotational squat at the point of maximum excursion , and because the rotational squat showed significantly higher Gmax activation compared to the rotational lunge , it may be important for clinicians to implement the rotational squat during rehabilitation for those with CAI . Future prospect i ve and intervention research involving hip musculature in those with CAI is recommended The purpose of this study was to compare alterations in peroneal latency and electromechanical delay ( EMD ) following an inversion perturbation during walking in patients with functional ankle instability ( FAI ) and with a matched control group .  Peroneal latency and EMD  were measured from 21 patients with unilateral FAI and 21 controls .  Latencies were collected during a r and om inversion perturbation while walking . EMD measures  were collected during stance using a percutaneous stimulus . Two-way ANOVAs were used to detect differences between leg ( affected , unaffected ) and group ( FAI , Control ) . Functionally unstable ankles displayed delayed peroneus longus ( PL ) latencies and EMD when compared to the unaffected leg and a matched control group . Peroneal latency and EMD deficits could contribute to recurrence of ankle injury in FAI subjects . How these deficits are associated with the chronic symptoms associated with FAI remains unclear , but gamma activation and subsequent muscle spindle sensitivity likely play a role STUDY DESIGN A nonr and omized 2-group pretest-posttest design . OBJECTIVES To determine the effects of a 4-week balance training program during stance on a single leg . BACKGROUND Individuals who have experienced multiple episodes of inversion ankle sprains often participate in balance training programs . Balance training is performed to treat existing proprioceptive defic 
    Output:
    
agent
Conclusions The main findings from this systematic review were balance training provided the most consistent improvements in self-reported function for patients with CAI
***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: OBJECTIVE To determine the point prevalence of chronic musculoskeletal ankle disorders in the community . DESIGN Cross-sectional stratified ( metropolitan vs regional ) r and om sample . SETTING General community . PARTICIPANTS  Population -based computer-aided telephone survey of people ( N=2078 ) aged 18 to 65 years in New South Wales , Australia . Of those contacted , 751 participants provided data . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Point prevalence for no history of ankle injury or chronic ankle problems ( no ankle problems ) , history of ankle injury without residual problems , and chronic ankle disorders . Chronic musculoskeletal ankle disorders due to ankle sprain , fracture , arthritis , or other disorder compared by chi-square test for the presence of pain , weakness , giving way , swelling and instability , activity limitation , and health care use in the past year . RESULTS There were 231 ( 30.8 % ) participants with no ankle problems , 342 ( 45.5 % ) with a history of ankle injury but no chronic problems , and 178 ( 23.7 % ) with chronic ankle disorders . The major component of chronic ankle disorders was musculoskeletal disorders ( n=147 , 19.6 % of the total sample ) , most of which were due to ankle injury ( n=117 , 15.6 % of the total ) . There was no difference among the arthritis , fracture , sprain , and other groups in the prevalence of the specific complaints , or health care use . Significantly more participants with arthritis had to limit activity than in the sprain group ( Chi-square test , P=.035 ) . CONCLUSIONS Chronic musculoskeletal ankle disorders affected almost 20 % of the Australian community . The majority were due to a previous ankle injury , and most people had to limit or change their physical activity because of the ankle disorder CONTEXT Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability ( CAI ) , strength-training rehabilitation protocol s may improve the deficits often associated with CAI . OBJECTIVE To determine whether strength-training protocol s affect strength , dynamic balance , functional performance , and perceived instability in individuals with CAI . DESIGN R and omized controlled trial . SETTING Athletic training research laboratory . PATIENTS OR OTHER PARTICIPANTS A total of 39 individuals with CAI ( 17 men [ 44 % ] , 22 women [ 56 % ] ) participated in this study . Chronic ankle instability was determined by the Identification of Functional Ankle Instability Question naire , and participants were r and omly assigned to a resistance-b and - protocol group ( n = 13 [ 33 % ] age = 19.7 ± 2.2 years , height = 172.9 ± 12.8 cm , weight = 69.1 ± 13.5 kg ) , a proprioceptive neuromuscular facilitation strength- protocol group  ( n = 13 [ 33 % ] , age = 18.9 ± 1.3 years , height = 172.5 ± 5.9 cm , weight = 72.7 ± 14.6 kg ) , or a control group  ( n = 13 [ 33 % ] , age = 20.5 ± 2.1 years , height = 175.2 ± 8.1 cm , weight = 70.2 ± 11.1 kg ) . INTERVENTION(S ) Both rehabilitation groups completed their protocol s 3 times/wk for 6 weeks . The control group did not attend rehabilitation sessions . MAIN OUTCOME MEASURE(S ) Before the interventions , participants were pretested by completing the figure-8 hop test for time , the triple-crossover hop test for distance , isometric strength tests ( dorsiflexion , plantar flexion , inversion , and eversion ) , the Y-Balance test , and the visual analog scale for perceived ankle instability . Participants were again tested 6 weeks later . We conducted 2 separate , multivariate , repeated- measures analyses of variance , followed by univariate analyses on any significant findings . RESULTS The resistance-b and protocol group improved in strength ( dorsiflexion , inversion , and eversion ) and on the visual analog scale ( P < .05 ) ; the proprioceptive neuromuscular facilitation group improved in strength ( inversion and eversion ) and on the visual analog scale ( P < .05 ) as well . No improvements were seen in the triple-crossover hop or the Y-Balance tests for either intervention group or in the control group for any dependent variable ( P > .05 ) . CONCLUSIONS Although the resistance-b and protocol is common in rehabilitation , the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI . Both protocol s showed clinical benefits in strength and perceived instability . To improve functional outcomes , clinicians should consider using additional multiplanar and multijoint exercises BACKGROUND AND PURPOSE Passive joint mobilization is commonly used by physical therapists as an intervention for acute ankle inversion sprains . A r and omized controlled trial with blinded assessors was conducted to investigate the effect of a specific joint mobilization , the anteroposterior glide on the talus , on increasing pain-free dorsiflexion and 3 gait variables : stride speed ( gait speed ) , step length , and single support time . SUBJECTS Forty-one subjects with acute ankle inversion sprains ( < 72 hours ) and no other injury to the lower limb entered the trial . METHODS Subjects were r and omly assigned to 1 of 2 treatment groups . The control group received a protocol of rest , ice , compression , and elevation ( RICE ) . The experimental group received the anteroposterior mobilization , using a force that avoided incurring any increase in pain , in addition to the RICE protocol . Subjects in both groups were treated every second day for a maximum of 2 weeks or until the discharge criteria were met , and all subjects were given a home program of continued RICE application . Outcomes were measured before and after each treatment . RESULTS The results showed that the experimental group required fewer treatment sessions than the control group to achieve full pain-free dorsiflexion . The experimental group had greater improvement in range of movement before and after each of the first 3 treatment sessions . The experimental group also had greater increases in stride speed during the first and third treatment sessions . DISCUSSION AND CONCLUSION Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone . Improvement in step length symmetry and single support time was similar in both groups STUDY DESIGN Prospect i ve cohort study . OBJECTIVE To assess the effect of 6 weeks of balance training on sensorimotor measures previously found to be deficient in participants with chronic ankle instability ( CAI ) . BACKGROUND CAI is the tendency toward repeated ankle sprains and recurring symptoms , occurring in 40 % to 70 % of individuals who have previously sustained a lateral ankle sprain . Recent studies have found deficits in sensorimotor measures in individuals with CAI . As balance training is a common component of ankle rehabilitation , underst and ing its effect on the sensorimotorsystem in individuals with CAI may enable us to optimize protocol s to better utilize this rehabilitation method . METHODS Twelve participants with CAI and 9 healthy volunteers participated . Independent variables were group ( CAI , control ) and time ( pretraining , posttraining ) . Participants with CAI who completed a 6-week balance training program and healthy controls who did not get any training were pretested and posttested at the beginning and at the end of 6 weeks . RESULTS The individuals in the CAI group who performed balance training demonstrated better performance than control participants on baseline adjusted posttraining measures of dynamic balance in the anterior medial ( P = .021 ) , medial ( P = .048 ) , and posterior medial directions ( P = .030 ) ; motoneuron pool excitability Hmax/Mmax ratio ( P = .044 ) and single-limb presynaptic inhibition ( P = .012 ) ; and joint position sense inversion variable error ( P = .017 ) . It may be of note that no systematic differences were detected for static balance or plantar flexion joint position sense tasks . CONCLUSIONS After 6 weeks of balance training , individuals with CAI demonstrated enhanced dynamic balance , inversion joint position sense , and changes in motoneuron pool excitability compared to healthy controls who did not train . LEVEL OF EVIDENCE Therapy , level 2b Objective : To examine the effects of a four-week balance training programme on ankle kinematics during walking and jogging in those with chronic ankle instability . A secondary objective was to evaluate the effect of balance training on the mechanical properties of the lateral ligaments in those with chronic ankle instability . Design : R and omized controlled trial . Setting : Laboratory . Subjects/ patients : Twenty-nine participants ( 12 males , 17 females ) with self-reported chronic ankle instability were r and omly assigned to a balance training group or a control group . Intervention : Four weeks of supervised rehabilitation that emphasized dynamic balance stabilization in single-limb stance . The control group received no intervention . Main outcome measures : Kinematic measures of rearfoot inversion/eversion , shank rotation , and the coupling relationship between these two segments throughout the gait cycle during walking and jogging on a treadmill . Instrumented ankle arthrometer measures were taken to assess anterior drawer and inversion talar tilt laxity and stiffness . Results : No significant alterations in the inversion/eversion or shank rotation kinematics were found during walking and jogging after balance training . There was , however , a significant decrease in the shank/rearfoot coupling variability during walking as measured by deviation phase after balance training ( balance training posttest : 13.1 ° ± 6.2 ° , balance training pretest : 16.2 ° ± 3.3 ° , P = 0.03 ) , indicating improved shank/rearfoot coupling stability . The control group did not significantly change . ( posttest : 16.30 ° ± 4.4 ° , pretest : 18.6 ° ± 7.1 ° , P40.05 ) There were no significant changes in laxity measures for either group . Conclusions : Balance training significantly altered the relationship between shank rotation and rearfoot inversion/eversion in those with chronic ankle instability OBJECTIVE To determine how gluteus medius ( Gmed ) and maximus ( Gmax ) activate during closed-chain functional rehabilitative exercises in those with and without chronic ankle instability ( CAI ) . DESIGN Cohort study . Subjects performed ten repetitions of a rotational lunge and single-leg rotational squat while surface electromyography was used to collect mean muscle activity  of the Gmed and Gmax . MAIN OUTCOME MEASURES Mean electromyography activity of the Gmed and Gmax at maximum excursion was compared between Groups and Exercises using a separate 2-way repeated measures analysis of variance design for each muscle . SETTING University biomechanics lab . PARTICIPANTS Nine healthy ( 8F , 1 M ) and nine CAI subjects ( 8F , 1 M ) RESULTS : For Gmax activation , there was a statistically significant Group by Exercise interaction ( F(3,48 ) = 4.84 , p = 0.043 ) . A Scheffe 's post-hoc test revealed that during the rotational squat , the CAI group had significantly lower Gmax activation ( 51.1 ± 31.0 % ) than the healthy group ( 78.6 ± 44.8 % ) . There were no statistically significant findings for the Gmed . In the healthy group , the Gmax produced significantly higher activation during rotational squat ( 78.6 ± 44.8 % ) compared to the rotational lunge ( 57.6 ± 31.9 % ) . CONCLUSION Because the CAI group had significantly less Gmax activation than the healthy group during the rotational squat at the point of maximum excursion , and because the rotational squat showed significantly higher Gmax activation compared to the rotational lunge , it may be important for clinicians to implement the rotational squat during rehabilitation for those with CAI . Future prospect i ve and intervention research involving hip musculature in those with CAI is recommended The purpose of this study was to compare alterations in peroneal latency and electromechanical delay ( EMD ) following an inversion perturbation during walking in patients with functional ankle instability ( FAI ) and with a matched control group .  Peroneal latency and EMD  were measured from 21 patients with unilateral FAI and 21 controls .  Latencies were collected during a r and om inversion perturbation while walking . EMD measures  were collected during stance using a percutaneous stimulus . Two-way ANOVAs were used to detect differences between leg ( affected , unaffected ) and group ( FAI , Control ) . Functionally unstable ankles displayed delayed peroneus longus ( PL ) latencies and EMD when compared to the unaffected leg and a matched control group . Peroneal latency and EMD deficits could contribute to recurrence of ankle injury in FAI subjects . How these deficits are associated with the chronic symptoms associated with FAI remains unclear , but gamma activation and subsequent muscle spindle sensitivity likely play a role STUDY DESIGN A nonr and omized 2-group pretest-posttest design . OBJECTIVES To determine the effects of a 4-week balance training program during stance on a single leg . BACKGROUND Individuals who have experienced multiple episodes of inversion ankle sprains often participate in balance training programs . Balance training is performed to treat existing proprioceptive defic 
    Output:
    