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: The functional effects of three types of therapy for subjects with long-term incomplete cervical spinal cord injuries were investigated . Men and women , aged 18 to 45 years , were assigned to one of four groups using a restricted r and omization process . The training period was divided into two consecutive eight-week time blocks where subjects received either ( 1 ) supervised physical exercise therapy ( PET ) , ( 2 ) neuromuscular stimulation ( NMS ) , or ( 3 ) electromyographic ( EMG ) biofeedback . Group 1 received EMG biofeedback followed by PET ; Group 2 received EMG biofeedback followed by NMS ; Group 3 received NMS followed by PET ; and Group 4 received 16 weeks of PET . Dependent measures ( manual muscle tests , self-care scores , mobility measures , and voluntary EMG activity ) were assessed before training , at eight weeks , and after 16 weeks of training . A significant improvement ( p less than .05 ) across time was found on all dependent measures except voluntary EMG . No difference was found on comparisons between groups Background and Purpose Body weight supported ( BWS ) locomotor training improves overground walking ability in individuals with motor-incomplete spinal cord injury ( SCI ) . While there are various approaches available for locomotor training , there is no consensus regarding which of these is optimal . The purpose of this ongoing investigation is to compare outcomes associated with these different training approaches . Subjects and Methods Twenty-seven subjects with chronic motor-incomplete SCI have completed training and initial and final testing at the time of this preliminary report . Subjects were r and omly assigned to 1 of 4 different BWS assisted-stepping groups , including : ( 1 ) treadmill training with manual assistance ( TM ) , ( 2 ) treadmill training with stimulation ( TS ) , ( 3 ) overground training with stimulation ( OG ) , or ( 4 ) treadmill training with robotic assistance ( LR ) . Prior to and following participation we assessed walking-related outcome measures including overground walking speed , training speed , step length , and step symmetry . Results Data pooled across all subject groups showed a significant effect of training on walking speed . While the differences between groups were not statistically significant , there was a trend toward greater improvement in the TS and OG groups . Post hoc subgroup analysis of outcomes from subjects with slower initial walking speed ( < 0.1 m/s ; n = 15 ) compared to those with faster initial walking speeds ( ≥ 0.1 m/s ; n = 12 ) identified meaningful differences in outcomes with walking speed increasing by 85 % in the slower group and by only 9 % in the faster group . Step length of both stronger and weaker limb increased in all groups with the exception of those in the LR group . Step symmetry was increased in the TM and LR groups . Discussion and Conclusion These results represent preliminary findings of changes in walking-related function associated with different forms of BWS locomotor training for individuals with chronic , motor-incomplete SCI . Early data indicates that locomotor outcomes in these individuals appear to be comparable across training approaches . For the individuals in this study sample , those with the greatest deficits in walking function benefitted the most from locomotor training Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials To determine the effect of massed practice ( MP ) versus massed practice combined with somatosensory stimulation ( MP+SS ) on cortical plasticity and function in persons with incomplete tetraplegia . Methods . Ten subjects were assigned to either MP or MP+SS . Median nerve stimulation ( 500 ms train , 10 Hz , 1 ms pulse duration ) was delivered at the intensity eliciting a motor threshold response . Training sessions were 5 d/week for 3 weeks at 2 h/session . Outcome measures included 1 ) motor-evoked potentials ( MEPs ) elicited via transcranial magnetic stimulation ( TMS ) , motor threshold ( MT ) and MEP amplitude at 1.2 MT ; 2 ) maximal pinch grip force ; 3 ) Wolf Motor Function Test ( WMFT ) and Jebsen H and Function Test . Results . The MP+SS group demonstrated significant improvements ( P < 0.05 ) in pinch grip strength ( 190 % ) , WMFT scores ( 52 % ) , and Jebsen test scores ( 33 % ) , whereas the MP group demonstrated significant improvement ( P < 0.05 ) only in Jebsen test scores ( 11 % ) . No significant changes were detected in cortical excitability in the MP+SS or MP group . Conclusions . The findings of this preliminary study suggest that MP+SS results in greater increases in pinch strength and timed functional test scores than MP . Optimal stimulation paradigms and training methods are needed to further test this strategy Severe muscle atrophy occurs rapidly following traumatic spinal cord injury ( SCI ) . Previous research shows that neuromuscular or ‘ functional ’ electrical stimulation ( FES ) , particularly FES-cycle ergometry ( FES-CE ) can cause muscle hypertrophy in individuals with chronic SCI ( > 1 year post-injury ) . However , the modest degree of hypertrophy in these already atrophied muscles has lessened earlier hopes that FES therapy would reduce secondary impairments of SCI . It is not known whether FES treatments are effective when used to prevent , rather than reverse , muscle atrophy in individuals with acute SCI . This study explored whether unloaded isometric FES contractions ( FES-IC ) or FES-CE decreased subsequent muscle atrophy in individual with acute SCI ( <3 months post-injury ) . Twenty-six subjects , 14–15 weeks post-traumatic SCI , were assigned to control , FES-IC , or FES-CE against progessively increasing resistance . Subjects were involved in the study for 3 or 6 months . Total body lean body mass ( TB-LBM ) , lower limb lean body mass ( LL-LBM ) , and gluteal lean body mass ( G-LBM ) were determined before the study , and at 3 and 6 months using dual energy X-ray absorptiometry ( DEXA ) . Controls lost an average of 6.1 % , 10.1 % , 12.4 % , after 3 months and 9.5 % , 21.4 % , 26.8 % after 6 months in TB-LBM , LL-LBM and G-LBM respectively . Subjects in the FES-IC group consistently lost less lean body mass than controls , however , only 6 month G-LBM loss was significantly attenuated in this group relative to the controls . In the FES-CE group , LL-LBM and G-LBM loss were prevented at both 3 and 6 months , and TB-LBM loss was prevented at 6 months . In addition , FES-CE significantly increased G-LBM and LL-LBM after 6 months of training relative to pre-training levels . Within the control group , there was no significant relationship between LL-LBM loss ( 3 and 6 months ) and the number of days between injury and baseline measurement . In summary , this study shows that FES-CE , but not FES-IC , training prevents muscle atrophy in acute SCI after 3 months of training , and causes significant hypertrophy after 6 months . The magnitude of differences in regionalized LBM between controls and FES-CE subject raises hopes that such treatment may indeed be beneficial in preventing secondary impairments of SCI if employed before extensive post-injury atrophy occurs Study design : R and omized controlled trial of exercise training in persons with spinal cord injury . Objective : The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength , arm ergometry performance , and indices of psychological well-being and quality of life . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Thirty-four men and women ( aged 19–65 years ) with traumatic spinal cord injury ( C4–L1 ; ASIA A – D ) of 1–24 years duration volunteered to participate , and were r and omized into exercise ( EX ; n=21 ) and control ( CON ; n=13 ) groups . Twenty-three subjects ( 11 EX ; 12 CON ) successfully completed the 9-month study . Subjects were assessed for one repetition maximum ( 1RM ) strength , arm ergometry performance , and several indices of quality of life and psychological well-being at baseline , 3 , 6 , and 9 months . Results : At baseline , there were no significant differences between groups in age , submaximal arm ergometry performance , muscle strength , or psychological well-being . Following training , the EX group had significant increases in submaximal arm ergometry power output ( 81 % ; P<0.05 ) , and significant increases in upper body muscle strength ( 19–34 % ; P<0.05 ) ; no significant changes occurred in CON . Participants in EX reported significantly less pain , stress and depression after training , and scored higher than CON in indices of satisfaction with physical function , level of perceived health and overall quality of life ( P<0.05 ) . Exercise adherence ( per cent of prescribed sessions attended ) in those subjects who completed the 9 months of training was 82.5 % . Conclusions : These results demonstrate that long-term twice-weekly exercise training in this population is feasible , and results in significant gains in both physical and psychological well-being Objective : To determine the clinical efficacy of functional electrical therapy in the rehabilitation of grasping function for quadriplegics . Study design : R and omized intervention-versus-control trial . Setting : Rehabilitation hospital for spinal cord injury in Toronto , Canada . Methods : A total of 21 people with new spinal cord injuries ranging from C3 to C7 were r and omly assigned to two groups : Control ( N=9 ) and Intervention ( N=12 ) . The intervention was functional electrical therapy , which consisted of repetitive grasping exercises using a neuroprosthesis that applied surface electrical stimulation to the arm to generate and /or assist grasping movements . It was applied by registered Occupational Therapists in a clinical setting . Main outcome measures were : Functional Independence Measure ( FIM ) , Spinal Cord Independence Measure ( SCIM ) , and the Rehabilitation Engineering Laboratory H and Function Test . Consumer perceptions of functional electrical therapy  were assessed via qualitative interviews . Results : Differences between the Control and Intervention groups could be observed although they are not significant due to an insufficient number of participants . Consumer perceptions were positive , including improved Activities of Daily Living and self-satisfaction . Conclusion : Functional electrical therapy has the potential to be an effective treatment modality to restore grasping function in quadriplegia . It can be implemented by occupational therapists in a clinical setting . Further research is required to establish suitable indications for participant selection . In addition , a larger number of participants is needed to demonstrate statistical significance of the Functional Electrical Therapy OBJECTIVE To study the application of partial weight-bearing ( PWB ) supported treadmill gait training augmented by functional electric stimulation ( FES ) in subjects with acute incomplete spinal cord injury ( SCI ) . DESIGN Before-after crossover trial with control ( A ) and intervention ( B ) periods . SETTING Physiotherapy ( PT ) department of a spinal injuries unit in Scotl and . PARTICIPANTS Fourteen in patients with acute incomplete SCI with American Spinal Injury Association class C or D injury . INTERVENTION Training consisted of treadmill walking with PWB support augmented by FES . Subjects walked on the treadmill for up to 25 minutes a day , 5 days a week for 4 weeks . The intervention was compared with a 4-week control period in which st and ard PT was given . MAIN OUTCOME MEASURES Overground walking endurance and speed , cadence , stride length , and observational gait analysis and walking speed , distance , and percentage PWB support on the treadmill . RESULTS A greater increase in overground walking endurance was achieved after the intervention ( AB group mean , 72.2 m ; confidence interval [ CI ] , 39.8 - 104.6 m ; BA group mean , 63.8 m ; CI , -10.2 to 137.9 m ) , as compared with after st and ard PT ( AB group mean , 38.4 m ; CI , 1.8 - 75.0 m ; BA group mean , 60.1 m ; CI , 9.2 - 110.9 m ) . A similar pattern was observed for overground walking speed . CONCLUSIONS This pilot study indicated that PWB supported treadmill training with FES had a positive effect on overground gait parameters and could potentially accelerate gait training in subjects with incomplete SCI . A larger r and omized trial is required to substantiate these findings The purpose of the present investigation was to study the effects of an arm ergometer training programme on several physiological variables of recreational wheelchair subjects . Ten paraplegics ( 5 experimental , 5 control ) were tested prior to and immediately after a 2 month exercise regimen at 80 % of peak heart rate ( 30 min per day , 5 days per week , for 8 consecutive weeks at 50 rev/min ) . The results demonstrated significant increases ( P<0.05 ) in VO2max (  
    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: The functional effects of three types of therapy for subjects with long-term incomplete cervical spinal cord injuries were investigated . Men and women , aged 18 to 45 years , were assigned to one of four groups using a restricted r and omization process . The training period was divided into two consecutive eight-week time blocks where subjects received either ( 1 ) supervised physical exercise therapy ( PET ) , ( 2 ) neuromuscular stimulation ( NMS ) , or ( 3 ) electromyographic ( EMG ) biofeedback . Group 1 received EMG biofeedback followed by PET ; Group 2 received EMG biofeedback followed by NMS ; Group 3 received NMS followed by PET ; and Group 4 received 16 weeks of PET . Dependent measures ( manual muscle tests , self-care scores , mobility measures , and voluntary EMG activity ) were assessed before training , at eight weeks , and after 16 weeks of training . A significant improvement ( p less than .05 ) across time was found on all dependent measures except voluntary EMG . No difference was found on comparisons between groups Background and Purpose Body weight supported ( BWS ) locomotor training improves overground walking ability in individuals with motor-incomplete spinal cord injury ( SCI ) . While there are various approaches available for locomotor training , there is no consensus regarding which of these is optimal . The purpose of this ongoing investigation is to compare outcomes associated with these different training approaches . Subjects and Methods Twenty-seven subjects with chronic motor-incomplete SCI have completed training and initial and final testing at the time of this preliminary report . Subjects were r and omly assigned to 1 of 4 different BWS assisted-stepping groups , including : ( 1 ) treadmill training with manual assistance ( TM ) , ( 2 ) treadmill training with stimulation ( TS ) , ( 3 ) overground training with stimulation ( OG ) , or ( 4 ) treadmill training with robotic assistance ( LR ) . Prior to and following participation we assessed walking-related outcome measures including overground walking speed , training speed , step length , and step symmetry . Results Data pooled across all subject groups showed a significant effect of training on walking speed . While the differences between groups were not statistically significant , there was a trend toward greater improvement in the TS and OG groups . Post hoc subgroup analysis of outcomes from subjects with slower initial walking speed ( < 0.1 m/s ; n = 15 ) compared to those with faster initial walking speeds ( ≥ 0.1 m/s ; n = 12 ) identified meaningful differences in outcomes with walking speed increasing by 85 % in the slower group and by only 9 % in the faster group . Step length of both stronger and weaker limb increased in all groups with the exception of those in the LR group . Step symmetry was increased in the TM and LR groups . Discussion and Conclusion These results represent preliminary findings of changes in walking-related function associated with different forms of BWS locomotor training for individuals with chronic , motor-incomplete SCI . Early data indicates that locomotor outcomes in these individuals appear to be comparable across training approaches . For the individuals in this study sample , those with the greatest deficits in walking function benefitted the most from locomotor training Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials To determine the effect of massed practice ( MP ) versus massed practice combined with somatosensory stimulation ( MP+SS ) on cortical plasticity and function in persons with incomplete tetraplegia . Methods . Ten subjects were assigned to either MP or MP+SS . Median nerve stimulation ( 500 ms train , 10 Hz , 1 ms pulse duration ) was delivered at the intensity eliciting a motor threshold response . Training sessions were 5 d/week for 3 weeks at 2 h/session . Outcome measures included 1 ) motor-evoked potentials ( MEPs ) elicited via transcranial magnetic stimulation ( TMS ) , motor threshold ( MT ) and MEP amplitude at 1.2 MT ; 2 ) maximal pinch grip force ; 3 ) Wolf Motor Function Test ( WMFT ) and Jebsen H and Function Test . Results . The MP+SS group demonstrated significant improvements ( P < 0.05 ) in pinch grip strength ( 190 % ) , WMFT scores ( 52 % ) , and Jebsen test scores ( 33 % ) , whereas the MP group demonstrated significant improvement ( P < 0.05 ) only in Jebsen test scores ( 11 % ) . No significant changes were detected in cortical excitability in the MP+SS or MP group . Conclusions . The findings of this preliminary study suggest that MP+SS results in greater increases in pinch strength and timed functional test scores than MP . Optimal stimulation paradigms and training methods are needed to further test this strategy Severe muscle atrophy occurs rapidly following traumatic spinal cord injury ( SCI ) . Previous research shows that neuromuscular or ‘ functional ’ electrical stimulation ( FES ) , particularly FES-cycle ergometry ( FES-CE ) can cause muscle hypertrophy in individuals with chronic SCI ( > 1 year post-injury ) . However , the modest degree of hypertrophy in these already atrophied muscles has lessened earlier hopes that FES therapy would reduce secondary impairments of SCI . It is not known whether FES treatments are effective when used to prevent , rather than reverse , muscle atrophy in individuals with acute SCI . This study explored whether unloaded isometric FES contractions ( FES-IC ) or FES-CE decreased subsequent muscle atrophy in individual with acute SCI ( <3 months post-injury ) . Twenty-six subjects , 14–15 weeks post-traumatic SCI , were assigned to control , FES-IC , or FES-CE against progessively increasing resistance . Subjects were involved in the study for 3 or 6 months . Total body lean body mass ( TB-LBM ) , lower limb lean body mass ( LL-LBM ) , and gluteal lean body mass ( G-LBM ) were determined before the study , and at 3 and 6 months using dual energy X-ray absorptiometry ( DEXA ) . Controls lost an average of 6.1 % , 10.1 % , 12.4 % , after 3 months and 9.5 % , 21.4 % , 26.8 % after 6 months in TB-LBM , LL-LBM and G-LBM respectively . Subjects in the FES-IC group consistently lost less lean body mass than controls , however , only 6 month G-LBM loss was significantly attenuated in this group relative to the controls . In the FES-CE group , LL-LBM and G-LBM loss were prevented at both 3 and 6 months , and TB-LBM loss was prevented at 6 months . In addition , FES-CE significantly increased G-LBM and LL-LBM after 6 months of training relative to pre-training levels . Within the control group , there was no significant relationship between LL-LBM loss ( 3 and 6 months ) and the number of days between injury and baseline measurement . In summary , this study shows that FES-CE , but not FES-IC , training prevents muscle atrophy in acute SCI after 3 months of training , and causes significant hypertrophy after 6 months . The magnitude of differences in regionalized LBM between controls and FES-CE subject raises hopes that such treatment may indeed be beneficial in preventing secondary impairments of SCI if employed before extensive post-injury atrophy occurs Study design : R and omized controlled trial of exercise training in persons with spinal cord injury . Objective : The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength , arm ergometry performance , and indices of psychological well-being and quality of life . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Thirty-four men and women ( aged 19–65 years ) with traumatic spinal cord injury ( C4–L1 ; ASIA A – D ) of 1–24 years duration volunteered to participate , and were r and omized into exercise ( EX ; n=21 ) and control ( CON ; n=13 ) groups . Twenty-three subjects ( 11 EX ; 12 CON ) successfully completed the 9-month study . Subjects were assessed for one repetition maximum ( 1RM ) strength , arm ergometry performance , and several indices of quality of life and psychological well-being at baseline , 3 , 6 , and 9 months . Results : At baseline , there were no significant differences between groups in age , submaximal arm ergometry performance , muscle strength , or psychological well-being . Following training , the EX group had significant increases in submaximal arm ergometry power output ( 81 % ; P<0.05 ) , and significant increases in upper body muscle strength ( 19–34 % ; P<0.05 ) ; no significant changes occurred in CON . Participants in EX reported significantly less pain , stress and depression after training , and scored higher than CON in indices of satisfaction with physical function , level of perceived health and overall quality of life ( P<0.05 ) . Exercise adherence ( per cent of prescribed sessions attended ) in those subjects who completed the 9 months of training was 82.5 % . Conclusions : These results demonstrate that long-term twice-weekly exercise training in this population is feasible , and results in significant gains in both physical and psychological well-being Objective : To determine the clinical efficacy of functional electrical therapy in the rehabilitation of grasping function for quadriplegics . Study design : R and omized intervention-versus-control trial . Setting : Rehabilitation hospital for spinal cord injury in Toronto , Canada . Methods : A total of 21 people with new spinal cord injuries ranging from C3 to C7 were r and omly assigned to two groups : Control ( N=9 ) and Intervention ( N=12 ) . The intervention was functional electrical therapy , which consisted of repetitive grasping exercises using a neuroprosthesis that applied surface electrical stimulation to the arm to generate and /or assist grasping movements . It was applied by registered Occupational Therapists in a clinical setting . Main outcome measures were : Functional Independence Measure ( FIM ) , Spinal Cord Independence Measure ( SCIM ) , and the Rehabilitation Engineering Laboratory H and Function Test . Consumer perceptions of functional electrical therapy  were assessed via qualitative interviews . Results : Differences between the Control and Intervention groups could be observed although they are not significant due to an insufficient number of participants . Consumer perceptions were positive , including improved Activities of Daily Living and self-satisfaction . Conclusion : Functional electrical therapy has the potential to be an effective treatment modality to restore grasping function in quadriplegia . It can be implemented by occupational therapists in a clinical setting . Further research is required to establish suitable indications for participant selection . In addition , a larger number of participants is needed to demonstrate statistical significance of the Functional Electrical Therapy OBJECTIVE To study the application of partial weight-bearing ( PWB ) supported treadmill gait training augmented by functional electric stimulation ( FES ) in subjects with acute incomplete spinal cord injury ( SCI ) . DESIGN Before-after crossover trial with control ( A ) and intervention ( B ) periods . SETTING Physiotherapy ( PT ) department of a spinal injuries unit in Scotl and . PARTICIPANTS Fourteen in patients with acute incomplete SCI with American Spinal Injury Association class C or D injury . INTERVENTION Training consisted of treadmill walking with PWB support augmented by FES . Subjects walked on the treadmill for up to 25 minutes a day , 5 days a week for 4 weeks . The intervention was compared with a 4-week control period in which st and ard PT was given . MAIN OUTCOME MEASURES Overground walking endurance and speed , cadence , stride length , and observational gait analysis and walking speed , distance , and percentage PWB support on the treadmill . RESULTS A greater increase in overground walking endurance was achieved after the intervention ( AB group mean , 72.2 m ; confidence interval [ CI ] , 39.8 - 104.6 m ; BA group mean , 63.8 m ; CI , -10.2 to 137.9 m ) , as compared with after st and ard PT ( AB group mean , 38.4 m ; CI , 1.8 - 75.0 m ; BA group mean , 60.1 m ; CI , 9.2 - 110.9 m ) . A similar pattern was observed for overground walking speed . CONCLUSIONS This pilot study indicated that PWB supported treadmill training with FES had a positive effect on overground gait parameters and could potentially accelerate gait training in subjects with incomplete SCI . A larger r and omized trial is required to substantiate these findings The purpose of the present investigation was to study the effects of an arm ergometer training programme on several physiological variables of recreational wheelchair subjects . Ten paraplegics ( 5 experimental , 5 control ) were tested prior to and immediately after a 2 month exercise regimen at 80 % of peak heart rate ( 30 min per day , 5 days per week , for 8 consecutive weeks at 50 rev/min ) . The results demonstrated significant increases ( P<0.05 ) in VO2max (  
    Output:
    