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: BACKGROUND AND PURPOSE The Bobath neurodevelopmental treatment approach advised against the use of resistive exercise , as proponents felt that increased effort would increase spasticity . The purpose of this study was to test the premise that the performance of exercises with maximum efforts will increase spasticity in people with cerebral palsy ( CP ) . Spasticity , in the present study , was defined as a velocity-dependent hyperexcitability of the muscle stretch reflex . SUBJECTS Twenty-four subjects with the spastic diplegic form of CP ( mean age=11.4 years , SD=3.0 , range=7 - 17 ) and 12 subjects without known neurological impairments ( mean age=11.6 years , SD=3.5 , range=7 - 17 ) were assessed . METHODS Knee muscle spasticity was assessed bilaterally using the pendulum test to elicit a stretch reflex immediately before and after 3 different forms of right quadriceps femoris muscle exercise ( isometric , isotonic , and isokinetic ) during a single bout of exercise training . Pendulum test outcome measures were : ( 1 ) first swing excursion , ( 2 ) number of lower leg oscillations , and ( 3 ) duration of the oscillations . RESULTS There were no changes in spasticity following exercise between the 2 groups of subjects . DISCUSSION AND CONCLUSION These results do not support the premise that exercises with maximum efforts increase spasticity in people with CP OBJECTIVE To determine clinical effectiveness of strength training in children with spastic cerebral palsy . DESIGN Prospect i ve before and after trial in which subjects participated in a 6-week strength training program . All received before and after isometric strength evaluation of eight muscle groups in both lower extremities with a h and -held dynamometer , 3-D gait analysis at free and fast speeds , administration of the Gross Motor Function Measure ( GMFM ) , and assessment of energy expenditure during gait . SETTING Pediatric rehabilitation center at a tertiary care hospital . PATIENTS Eleven children met inclusion criteria for participation . Six had spastic diplegia , were limited community ambulators , and demonstrated less than 50 % of normal muscle strength . Five had spastic hemiplegia and demonstrated a 20 % strength asymmetry in at least two muscles across extremities . RESULTS Each group had significant strength gains in the muscles targeted . The entire cohort had higher gait velocity primarily as a result of increased cadence , with greater capacity to walk faster . GMFM Dimension 5 also improved , with no change in energy expenditure . Asymmetry in strength improved in hemiplegia , with no change in asymmetry in support times or joint motion across extremities . CONCLUSIONS This study reinforced the relationship of strength to motor function in cerebral palsy and further demonstrated the effectiveness of strengthening in this population This matched‐pairs , clinical controlled trial evaluated the effects of a school‐based , partial body‐weight‐supported treadmill training ( PBWSTT ) programme , conducted twice a week for 6 weeks , on the walking speed and endurance of children with cerebral palsy ( CP ) . Pairs of children ( 10 males , four females ; mean age 8y 10mo [ SD 2y 6mo ] , range 5–14y ) matched for sex , age , type of CP ( athetoid quadriplegia , n=6 ; spastic quadriplegia , n=6 ; spastic diplegia , n=2 ) , and Gross Motor Function Classification System level ( 10 at Level I V , four at Level III ) were allocated to the experimental or control group . Compared with the control group , the seven treadmill‐training participants  increased their self‐selected walking speed over 10 metres ( Mann‐Whitney U=9.00 , z=−1.98 , p=0.048 ; mean difference 4.21m/min ) . A trend was also found for increased distance walked over ground in 10 minutes ( t[12]=1.88 , p=0.083 ; mean difference 19.81 m ) . A relatively short PBWSTT programme can improve the walking speed of children with CP and moderate to severe disabilities . Walking endurance might also improve in some children . Treadmill training seems to be a useful gait training option for children with C P , and it seems feasible to conduct such a programme within a school environment BACKGROUND / PURPOSE Improvement in mobility function has been the primary goal in the rehabilitation of children with cerebral palsy . Few studies have examined the effectiveness of task-oriented strength training for children with cerebral palsy . The purpose of this study was to examine the effects of task-oriented strength training on mobility function in children with cerebral palsy . STUDY DESIGN A single-blind , r and omized controlled trial with pre-training and post-training evaluations . MATERIAL S AND METHODS Ten children with cerebral palsy ( GMFCS levels I-III ) were r and omly assigned to an experimental group ( N = 5 ) or control group ( N = 5 ) . Mobility function was assessed using the Gross Motor Function Measure ( GMFM ) and the Timed " Up and Go " ( TUG ) test . Participants in the control group received conventional physical therapy focused on improving walking and balance through facilitation and normalization of movement patterns . Participants in the experiment group received task-oriented strength training focused on strengthening the lower extremities and practicing functional tasks similar to those the child performs during daily activities . RESULTS After the 5-week training period there were significant improvements in the experimental group for dimension D ( p = 0.009 ) , and dimension E ( p = 0.009 ) of the GMFM . The experimental group significantly reduced the time taken to complete the TUG ( p = 0.017 ) . CONCLUSION / SIGNIFICANCE This study supports the efficacy of task-oriented strength training for improving mobility function in children with cerebral palsy . The findings demonstrate that the application of a task-oriented strength training program is linked to positive functional outcomes . The results suggest that children with cerebral palsy may benefit from a task-oriented strength training program . Further studies with a larger r and omized sample and longer post-intervention follow-up are necessary to document the long-term effects of participation in task-oriented strength training programs in the cerebral palsy population This study aim ed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal - setting in children with cerebral palsy ( CP ) . Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System ( GMFCS ) , aged between 3 and 12 years . A 2 x 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts , and to compare the use of generalized aims set by the child 's physiotherapist with the use of specific , measurable goals negotiated by the child 's physiotherapist with each child , carer , and teacher . Following the six-month treatment period there was a further six-month period of observation . Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure ( GMFM ) and the Gross Motor Performance Measure ( GMPM ) at three-month intervals . There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim -directed and goal -directed therapy  in either function or performance . Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period . This advantage declined over the subsequent six months during which therapy had reverted to its usual amount . Differences in goal - setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance This r and omized clinical trial evaluated the effects of a home-based , six-week strength-training programme on lower limb strength and physical activity of 21 young people ( 11 females , 10 males ; mean age 13 years 1 month , SD 3 years 1 month ; range 8 to 18 years ) with spastic diplegic cerebral palsy ( CP ) with independent ambulation , with or without gait aids ; ( Gross Motor Function Classification System levels I to III ) . Compared with the 10 controls , the 11 participants in the strength-training programme increased their lower limb strength ( combined ankle plantarflexor and knee extensor strength as measured by a h and -held dynamometer ) at 6 weeks ( F(1,19)=4.58 , p=0.046 ) and at a follow-up 12 weeks later ( F(1,18)=6.25 , p=0.041 ) . At 6 weeks , trends were also evident for improved scores in Gross Motor Function Measure dimensions D and E for st and ing , running and jumping , and faster stair climbing . A relatively short clinical ly feasible home-based training programme can lead to lasting changes in the strength of key lower-limb muscles that may impact on the daily function of young people with CP Objective : To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy . Design : A nonr and omized ABA trial . Setting : Sydney school . Subjects : Eight children with cerebral palsy , aged 4–8 years , seven with diagnosis of spastic diplegia , one of spastic/ataxic quadriplegia . Intervention : Four weeks of after-school exercise class , conducted for one hour twice weekly as group circuit training . Each work station was set up for intensive repetitive practice of an exercise . Children moved between stations , practising functionally based exercises including treadmill walking , step-ups , sit-to-st and s and leg presses . Main outcome measures : Baseline test obtained two weeks before training , a pre-test immediately before and a post-test following training , with follow-up eight weeks later . Lower limb muscle strength was tested by dynamometry and Lateral Step-up Test ; functional performance by Motor Assessment Scale ( Sit-to-St and ) , minimum chair height test , timed 10-m test , and 2-minute walk test . Results : Isometric strength improved pre- to post-training by a mean of 47 % ( SD 16 ) and functional strength , on Lateral Step-up Test , by 150 % ( SD 15 ) . Children walked faster over 10 m , with longer strides , improvements of 22 % and 38 % respectively . Sit-to-st and performance had improved , with a reduction of seat height from 27 ( SD 15 ) to 17 ( SD 11 ) cm . Eight weeks following cessation of training all improvements had been maintained . Conclusions : A short programme of task-specific strengthening exercise and training for children with cerebral palsy , run as a group circuit class , result ed in improved strength and functional performance that was maintained over time Cherng R-J , Liu C-F , Lau T-W , Hong R-B : Effect of treadmill training with body weight support on gait and gross motor function in children with spastic cerebral palsy . Am J Phys Med Rehabil 2007;86:548–555 . Objective : To examine the effect of treadmill training with body weight support ( TBWS ) on gait and gross motor function in children with spastic cerebral palsy ( CP ) . Design : Eight children with spastic CP participated in the study . Their temporal-distance gait parameters , Gross Motor Function Measure , muscle tone , and selective motor control were assessed three times : two times under their regular therapeutic treatment ( condition A ) , and one time after receiving the TBWS treatment in addition to their regular therapeutic treatments ( condition B ) . There were two treatment schedules , AAB and ABA . Except for the first one ( taken at study entry ) , the assessment s were always taken after 12 wks of treatment . The children were equally divided into two groups and r and omly assigned to the two schedules . The two groups were matched according to category of the Gross Motor Function Classification System . Results : The TBWS treatment significantly improved the children ’s gait ( increases in stride length and decreases in double-limb support percentage of gait cycle ) and their Gross Motor Function Measure ( dimension D and E scores as well as the total score ) . No significant improvements on muscle tone or selective motor control were noted . Conclusions : The TBWS treatment improved some gait parameters and gross motor functions in children with spastic CP Forty-four children aged 3 to 11 years with quadriplegic cerebral palsy were prospect ively stratified and r and omised into four treatment groups . The acquisition of motor skills was assessed in a 2 x 2 factorial design using the Gross Motor Function Measure . The two factors were conventional amounts of physiotherapy vs intensive amounts of physiotherapy , and the use of broad , generalised aims vs the use of specific measurable goals directed at motor skill acquisition . 82 % of the children improved . Over the two-week period , intensive physiotherapy produced a slightly greater effect than conventional physiotherapy but the factor more strongly associated with increased motor skill acquisition was the use of specific measurable goals OBJECTIVE To examine the potential role of treadmill training with partial body weight support in nonambulatory children with cerebral palsy . STUDY DESIGN Open , nonr and omized , baseline-treatment study . SETTING An outpatient rehabilitation clinic . SUBJECTS Ten children with cerebral palsy . Six children ( group A ) were nonambulatory , and four children ( group B ) either required continuous physical help ( two cases ) or were able to walk short distances with a st and -by or independently ( one case each ) . INTERVENTION Three months of additional treadmill training , three times a week , 25 minutes a session . MAIN OUTCOME MEASURES Functional Ambulation Categories , st and ing and walking section of the Gross Motor Function Measure , assessed at two baseline measurements 6 and 3 weeks before the study onset , at the beginning , and at the end of therapy . RESULTS Measurements during baseline and at the study onset did not differ . During therapy , the mean Functional Ambulation Category improved significantly from 1.1 to 1 
    Output:
    
agent
***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: BACKGROUND AND PURPOSE The Bobath neurodevelopmental treatment approach advised against the use of resistive exercise , as proponents felt that increased effort would increase spasticity . The purpose of this study was to test the premise that the performance of exercises with maximum efforts will increase spasticity in people with cerebral palsy ( CP ) . Spasticity , in the present study , was defined as a velocity-dependent hyperexcitability of the muscle stretch reflex . SUBJECTS Twenty-four subjects with the spastic diplegic form of CP ( mean age=11.4 years , SD=3.0 , range=7 - 17 ) and 12 subjects without known neurological impairments ( mean age=11.6 years , SD=3.5 , range=7 - 17 ) were assessed . METHODS Knee muscle spasticity was assessed bilaterally using the pendulum test to elicit a stretch reflex immediately before and after 3 different forms of right quadriceps femoris muscle exercise ( isometric , isotonic , and isokinetic ) during a single bout of exercise training . Pendulum test outcome measures were : ( 1 ) first swing excursion , ( 2 ) number of lower leg oscillations , and ( 3 ) duration of the oscillations . RESULTS There were no changes in spasticity following exercise between the 2 groups of subjects . DISCUSSION AND CONCLUSION These results do not support the premise that exercises with maximum efforts increase spasticity in people with CP OBJECTIVE To determine clinical effectiveness of strength training in children with spastic cerebral palsy . DESIGN Prospect i ve before and after trial in which subjects participated in a 6-week strength training program . All received before and after isometric strength evaluation of eight muscle groups in both lower extremities with a h and -held dynamometer , 3-D gait analysis at free and fast speeds , administration of the Gross Motor Function Measure ( GMFM ) , and assessment of energy expenditure during gait . SETTING Pediatric rehabilitation center at a tertiary care hospital . PATIENTS Eleven children met inclusion criteria for participation . Six had spastic diplegia , were limited community ambulators , and demonstrated less than 50 % of normal muscle strength . Five had spastic hemiplegia and demonstrated a 20 % strength asymmetry in at least two muscles across extremities . RESULTS Each group had significant strength gains in the muscles targeted . The entire cohort had higher gait velocity primarily as a result of increased cadence , with greater capacity to walk faster . GMFM Dimension 5 also improved , with no change in energy expenditure . Asymmetry in strength improved in hemiplegia , with no change in asymmetry in support times or joint motion across extremities . CONCLUSIONS This study reinforced the relationship of strength to motor function in cerebral palsy and further demonstrated the effectiveness of strengthening in this population This matched‐pairs , clinical controlled trial evaluated the effects of a school‐based , partial body‐weight‐supported treadmill training ( PBWSTT ) programme , conducted twice a week for 6 weeks , on the walking speed and endurance of children with cerebral palsy ( CP ) . Pairs of children ( 10 males , four females ; mean age 8y 10mo [ SD 2y 6mo ] , range 5–14y ) matched for sex , age , type of CP ( athetoid quadriplegia , n=6 ; spastic quadriplegia , n=6 ; spastic diplegia , n=2 ) , and Gross Motor Function Classification System level ( 10 at Level I V , four at Level III ) were allocated to the experimental or control group . Compared with the control group , the seven treadmill‐training participants  increased their self‐selected walking speed over 10 metres ( Mann‐Whitney U=9.00 , z=−1.98 , p=0.048 ; mean difference 4.21m/min ) . A trend was also found for increased distance walked over ground in 10 minutes ( t[12]=1.88 , p=0.083 ; mean difference 19.81 m ) . A relatively short PBWSTT programme can improve the walking speed of children with CP and moderate to severe disabilities . Walking endurance might also improve in some children . Treadmill training seems to be a useful gait training option for children with C P , and it seems feasible to conduct such a programme within a school environment BACKGROUND / PURPOSE Improvement in mobility function has been the primary goal in the rehabilitation of children with cerebral palsy . Few studies have examined the effectiveness of task-oriented strength training for children with cerebral palsy . The purpose of this study was to examine the effects of task-oriented strength training on mobility function in children with cerebral palsy . STUDY DESIGN A single-blind , r and omized controlled trial with pre-training and post-training evaluations . MATERIAL S AND METHODS Ten children with cerebral palsy ( GMFCS levels I-III ) were r and omly assigned to an experimental group ( N = 5 ) or control group ( N = 5 ) . Mobility function was assessed using the Gross Motor Function Measure ( GMFM ) and the Timed " Up and Go " ( TUG ) test . Participants in the control group received conventional physical therapy focused on improving walking and balance through facilitation and normalization of movement patterns . Participants in the experiment group received task-oriented strength training focused on strengthening the lower extremities and practicing functional tasks similar to those the child performs during daily activities . RESULTS After the 5-week training period there were significant improvements in the experimental group for dimension D ( p = 0.009 ) , and dimension E ( p = 0.009 ) of the GMFM . The experimental group significantly reduced the time taken to complete the TUG ( p = 0.017 ) . CONCLUSION / SIGNIFICANCE This study supports the efficacy of task-oriented strength training for improving mobility function in children with cerebral palsy . The findings demonstrate that the application of a task-oriented strength training program is linked to positive functional outcomes . The results suggest that children with cerebral palsy may benefit from a task-oriented strength training program . Further studies with a larger r and omized sample and longer post-intervention follow-up are necessary to document the long-term effects of participation in task-oriented strength training programs in the cerebral palsy population This study aim ed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal - setting in children with cerebral palsy ( CP ) . Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System ( GMFCS ) , aged between 3 and 12 years . A 2 x 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts , and to compare the use of generalized aims set by the child 's physiotherapist with the use of specific , measurable goals negotiated by the child 's physiotherapist with each child , carer , and teacher . Following the six-month treatment period there was a further six-month period of observation . Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure ( GMFM ) and the Gross Motor Performance Measure ( GMPM ) at three-month intervals . There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim -directed and goal -directed therapy  in either function or performance . Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period . This advantage declined over the subsequent six months during which therapy had reverted to its usual amount . Differences in goal - setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance This r and omized clinical trial evaluated the effects of a home-based , six-week strength-training programme on lower limb strength and physical activity of 21 young people ( 11 females , 10 males ; mean age 13 years 1 month , SD 3 years 1 month ; range 8 to 18 years ) with spastic diplegic cerebral palsy ( CP ) with independent ambulation , with or without gait aids ; ( Gross Motor Function Classification System levels I to III ) . Compared with the 10 controls , the 11 participants in the strength-training programme increased their lower limb strength ( combined ankle plantarflexor and knee extensor strength as measured by a h and -held dynamometer ) at 6 weeks ( F(1,19)=4.58 , p=0.046 ) and at a follow-up 12 weeks later ( F(1,18)=6.25 , p=0.041 ) . At 6 weeks , trends were also evident for improved scores in Gross Motor Function Measure dimensions D and E for st and ing , running and jumping , and faster stair climbing . A relatively short clinical ly feasible home-based training programme can lead to lasting changes in the strength of key lower-limb muscles that may impact on the daily function of young people with CP Objective : To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy . Design : A nonr and omized ABA trial . Setting : Sydney school . Subjects : Eight children with cerebral palsy , aged 4–8 years , seven with diagnosis of spastic diplegia , one of spastic/ataxic quadriplegia . Intervention : Four weeks of after-school exercise class , conducted for one hour twice weekly as group circuit training . Each work station was set up for intensive repetitive practice of an exercise . Children moved between stations , practising functionally based exercises including treadmill walking , step-ups , sit-to-st and s and leg presses . Main outcome measures : Baseline test obtained two weeks before training , a pre-test immediately before and a post-test following training , with follow-up eight weeks later . Lower limb muscle strength was tested by dynamometry and Lateral Step-up Test ; functional performance by Motor Assessment Scale ( Sit-to-St and ) , minimum chair height test , timed 10-m test , and 2-minute walk test . Results : Isometric strength improved pre- to post-training by a mean of 47 % ( SD 16 ) and functional strength , on Lateral Step-up Test , by 150 % ( SD 15 ) . Children walked faster over 10 m , with longer strides , improvements of 22 % and 38 % respectively . Sit-to-st and performance had improved , with a reduction of seat height from 27 ( SD 15 ) to 17 ( SD 11 ) cm . Eight weeks following cessation of training all improvements had been maintained . Conclusions : A short programme of task-specific strengthening exercise and training for children with cerebral palsy , run as a group circuit class , result ed in improved strength and functional performance that was maintained over time Cherng R-J , Liu C-F , Lau T-W , Hong R-B : Effect of treadmill training with body weight support on gait and gross motor function in children with spastic cerebral palsy . Am J Phys Med Rehabil 2007;86:548–555 . Objective : To examine the effect of treadmill training with body weight support ( TBWS ) on gait and gross motor function in children with spastic cerebral palsy ( CP ) . Design : Eight children with spastic CP participated in the study . Their temporal-distance gait parameters , Gross Motor Function Measure , muscle tone , and selective motor control were assessed three times : two times under their regular therapeutic treatment ( condition A ) , and one time after receiving the TBWS treatment in addition to their regular therapeutic treatments ( condition B ) . There were two treatment schedules , AAB and ABA . Except for the first one ( taken at study entry ) , the assessment s were always taken after 12 wks of treatment . The children were equally divided into two groups and r and omly assigned to the two schedules . The two groups were matched according to category of the Gross Motor Function Classification System . Results : The TBWS treatment significantly improved the children ’s gait ( increases in stride length and decreases in double-limb support percentage of gait cycle ) and their Gross Motor Function Measure ( dimension D and E scores as well as the total score ) . No significant improvements on muscle tone or selective motor control were noted . Conclusions : The TBWS treatment improved some gait parameters and gross motor functions in children with spastic CP Forty-four children aged 3 to 11 years with quadriplegic cerebral palsy were prospect ively stratified and r and omised into four treatment groups . The acquisition of motor skills was assessed in a 2 x 2 factorial design using the Gross Motor Function Measure . The two factors were conventional amounts of physiotherapy vs intensive amounts of physiotherapy , and the use of broad , generalised aims vs the use of specific measurable goals directed at motor skill acquisition . 82 % of the children improved . Over the two-week period , intensive physiotherapy produced a slightly greater effect than conventional physiotherapy but the factor more strongly associated with increased motor skill acquisition was the use of specific measurable goals OBJECTIVE To examine the potential role of treadmill training with partial body weight support in nonambulatory children with cerebral palsy . STUDY DESIGN Open , nonr and omized , baseline-treatment study . SETTING An outpatient rehabilitation clinic . SUBJECTS Ten children with cerebral palsy . Six children ( group A ) were nonambulatory , and four children ( group B ) either required continuous physical help ( two cases ) or were able to walk short distances with a st and -by or independently ( one case each ) . INTERVENTION Three months of additional treadmill training , three times a week , 25 minutes a session . MAIN OUTCOME MEASURES Functional Ambulation Categories , st and ing and walking section of the Gross Motor Function Measure , assessed at two baseline measurements 6 and 3 weeks before the study onset , at the beginning , and at the end of therapy . RESULTS Measurements during baseline and at the study onset did not differ . During therapy , the mean Functional Ambulation Category improved significantly from 1.1 to 1 
    Output:
    