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: STUDY DESIGN R and omized controlled trial with pretraining , posttraining , and follow-up repeated measures . OBJECTIVE To determine the effectiveness of a 4-week elastic resistance exercise program on  balance  in subjects with and without a history of sprained ankles . BACKGROUND Several research ers have suggested that improving balance may help alleviate the symptoms of functional ankle instability and reduce the rate of recurrent ankle sprains . METHODS AND MEASURES Forty subjects ( 20 males , 20 females ; 20 subjects with chronic ankle instability [ CAI ] , 20 healthy ) participated in the study . Ten subjects ( 5 males , 5 females ) from each CAI and healthy group were r and omly assigned to either the exercise or control group , result ing in a total of 4 groups . Total travel distance of the center of pressure , monitored using a force platform , was measured before training , after 4 weeks of training , and at a 4-week follow-up . RESULTS There were no interactions between gender , ankle sprain history , or training groups . Balance significantly improved in subjects with and without a history of ankle sprains following 4 weeks of elastic resistance exercises . Mean improvement in balance for the exercise group following training , reflected through a decrease in total travel distance , was -11.1 cm ( 95 % confidence interval : -14.0 to -8.2 cm ) . These improvements in balance were retained 4 weeks after training . CONCLUSIONS Balance was improved after 4 weeks of elastic resistance exercise in subjects with and without a history of lateral ankle sprains . Balance improvements persisted 4 weeks following the treatment cessation 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 Background Ankle sprains are common injuries that often lead to functional ankle instability ( FAI ) , which is a pathology defined by sensations of instability at the ankle and recurrent ankle sprain injury . Poor postural stability has been associated with FAI , and sports medicine clinicians rehabilitate balance deficits to prevent ankle sprains . Subsensory electrical noise known as stochastic resonance ( SR ) stimulation has been used in conjunction with coordination training to improve dynamic postural instabilities associated with FAI . However , unlike static postural deficits , dynamic impairments have not been indicative of ankle sprain injury . Therefore , the purpose of this study was to examine the effects of coordination training with or without SR stimulation on static postural stability . Improving postural instabilities associated with FAI has implication s for increasing ankle joint stability and decreasing recurrent ankle sprains . Methods This study was conducted in a research laboratory . Thirty subjects with FAI were r and omly assigned to either a : 1 ) conventional coordination training group ( CCT ) ; 2 ) SR stimulation coordination training group ( SCT ) ; or 3 ) control group . Training groups performed coordination exercises for six weeks . The SCT group received SR stimulation during training , while the CCT group only performed coordination training .  Single leg postural stability was measured after the completion of balance training . Static postural stability was quantified on a force plate using anterior/posterior ( A/P ) and medial/lateral ( M/L ) center-of-pressure velocity ( COPvel ) , M/L COP st and ard deviation ( COPsd ) , M/L COP maximum excursion ( COPmax ) , and COP area ( COParea ) . Results Treatment effects comparing posttest to pretest COP measures were highest for the SCT group . At posttest , the SCT group had reduced A/P COPvel ( 2.3 ± 0.4 cm/s vs. 2.7 ± 0.6 cm/s ) , M/L COPvel ( 2.6 ± 0.5 cm/s vs. 2.9 ± 0.5 cm/s ) , M/L COPsd ( 0.63 ± 0.12 cm vs. 0.73 ± 0.11 cm ) , M/L COPmax ( 1.76 ± 0.25 cm vs. 1.98 ± 0.25 cm ) , and COParea ( 0.13 ± 0.03 cm2 vs. 0.16 ± 0.04 cm2 ) than the pooled means of the CCT and control groups ( P < 0.05 ) . Conclusion Reduced values in COP measures indicated postural stability improvements . Thus , six weeks of coordination training with SR stimulation enhanced postural stability . Future research should examine the use of SR stimulation for decreasing recurrent ankle sprain injury in physically active individuals with FAI Improvement of ankle proprioception through physiotherapy ( a.k.a . proprioceptive training ) is a widely accepted conservative treatment modality of chronic functional lateral ankle instability . Clinical studies provided controversial data on its proprioceptive effect . Aim of this study was to gain evidence on the efficacy of proprioceptive training on ankle joint position sense .  Ten patients ( five males and five females , aged 23.3±5.4 years ) were treated conservatively for chronic lateral ankle instability with a special training programme over 6 weeks . For the assessment of joint position sense we used the slope-box test , first applied and described by Robbins et al. ( Br J Sports Med 29:242–247 , 1995 ) . The test was performed before the start and after the end of the training programme , measuring joint position sense on 11 different slope amplitudes in four directions ( anterior , posterior , lateral and medial ) in r and om order each on both ankles . Comparisons were made between pre- and post-training results as well as versus a control-group of ten healthy athletes . Overall the proprioceptive sensory function of the studied group has improved , but this improvement was not significant in all directions . Only two patients have shown significant improvement of joint position sense in all directions ( mean estimate error improvement : 2.47 ° ) , while conservative treatment was partially successful in five others ( mean estimate error improvement : 0.73 ° ) . The follow-up results of these seven patients were comparable with the values measured in the control-group . Three patients did not show any improvements ( mean estimate error improvement : −0.55 ° ) ( overall difference between improving and non-improving patients : P<0.0001 ) . Mean absolute estimate error profiles of the seven improving patients became similar to the profiles of healthy athletes , while these changes could not be observed in the case of the three non-improving participants . Proprioceptive rehabilitation programme can be an effective method in order to improve impaired joint position sense function . After 6 weeks non-responding patients can be well identified , and considered for other treatment modalities . The determination of the effective length of the programme however needs further evaluation . Still , changes in the proprioceptive sensory function of the ankle plantarflectors indicate the preventive effect of the training programme . Furthermore , our results support the theory of simultaneous function of different mechanoreceptor-systems 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 deficits and to restore ankle joint stability , presumably by retraining altered afferent neuromuscular pathways . The effectiveness of such programs on individuals with functionally unstable ankles has yet to be established . METHODS AND MEASURES Prior to and following training , subjects with self-reported functionally unstable ankles ( 5 women and 8 men , mean age = 21.9 + /- 3.1 years ) and nonimpaired subjects ( 6 women and 7 men , mean age = 21.2 + /- 2.5 years ) completed a  static balance assessment  for both limbs as well as the  ankle joint functional assessment tool question naire ( AJFAT ) . The subjects from both groups participated in a unilateral , multilevel , static and dynamic balance training program 3 times a week for 4 weeks . Subjects from the experimental group trained only the involved limb , and the nonimpaired group  trained a r and omly selected limb . A stability index ( SI ) was calculated during the balance assessment to indicate the amount of platform motion . Compared to low stability indices , high stability indices indicate greater platform motion during stance and therefore less stability . RESULTS Following training , subjects from both groups demonstrated significant improvements in balance ability . When balance was assessed at a low resistance to platform tilt ( stability level 2 ) , the posttraining scores of both the subjects with unstable ankles ( mean SI = 2.63 + /- 1.92 ) and the nonimpaired subjects ( mean SI = 2.69 + /- 2.32 ) were significantly better than their pretraining scores ( mean SIs = 5.93 + /- 3.65 and 4.67 + /- 3.43 , respectively ) . Assessed at a high resistance to platform tilt ( stability level 6 ) , the posttraining scores of both subjects with unstable ankles ( mean SI = 1.27 + /- 0.66 ) and the nonimpaired subjects ( mean SI = 1.37 + /- 0.66 ) were significantly better than their pretraining scores ( mean SIs = 2.30 + /- 1.88 and 2.04 + /- 1.43 , respectively ) . Additionally , the posttraining AJFAT scores of subjects with unstable ankles ( 25.78 + /- 3.80 ) and the nonimpaired subjects ( 29.15 + /- 5.27 ) were significantly greater than their pretraining scores ( 17.11 + /- 3.44 and 22.92 + /- 5.22 , respectively ) , indicating an overall improvement in perceived ankle joint functional stability . CONCLUSIONS This study suggests that balance training is an effective means of improving joint proprioception and single-leg st and ing ability in subjects with unstable and nonimpaired ankles Objectives : To examine the effect of six weeks of strength and proprioception training on eversion to inversion isokinetic strength ratios ( E/I ratios ) in subjects with unilateral functional ankle instability . Methods : Thirty eight subjects were r and omly assigned to one of four treatment groups : strength training ( S ) ; proprioception training ( P ) ; strength + proprioception training ( B ) ; control ( C ) . Isokinetic strength was tested before and after training using a Kin Com 125 automatic positioning isokinetic dynamometer . Subtalar joint eversion and inversion motions  were tested both concentrically and eccentrically through a range of motion involving 40 ° . All peak torque and average torque values were normalised for body mass . E/I ratios were calculated from average torque and peak torque measures by taking the concentric eversion value and combining it with the eccentric inversion value . Data were analysed using a mixed model analysis of variance with repeated measures on the test factor . Average torque and peak torque E/I ratios at 30 and 120 ° /s were analysed separately . Results : There were no significant differences in average torque and peak torque E/I ratios of the functionally unstable ankle for any of the groups after training compared with before . Conclusions : Six weeks of strength and proprioception training ( either alone or combined ) had no effect on isokinetic measures of strength in subjects with self reported unilateral functional instability . Further studies examining this agonist ( concentric ) to antagonist ( eccentric ) muscle group strength ratio are needed Exercises to improve joint proprioception and coordination of the functionally unstable ankle are advocated throughout the literature , yet there is little evidence that these exercise have any effect on proprioception and balance . The purpose of this study was to determine the effects of a 6-week coordination and balance training program on proprioception of subjects with functional ankle instability . Forty-five subjects ( age = 22.53 + /- 3.95 years , height = 172.04 + /- 10.0 cm , weight = 71.72 + /- 15.7 kg ) were r and omly placed into a control ( Group 1 ) , sham ( Group 2 ) , or experimental ( Group 3 ) group . The experimental group trained 3 days per week , 10 minutes each day , performing various balance and proprioception exer 
    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: STUDY DESIGN R and omized controlled trial with pretraining , posttraining , and follow-up repeated measures . OBJECTIVE To determine the effectiveness of a 4-week elastic resistance exercise program on  balance  in subjects with and without a history of sprained ankles . BACKGROUND Several research ers have suggested that improving balance may help alleviate the symptoms of functional ankle instability and reduce the rate of recurrent ankle sprains . METHODS AND MEASURES Forty subjects ( 20 males , 20 females ; 20 subjects with chronic ankle instability [ CAI ] , 20 healthy ) participated in the study . Ten subjects ( 5 males , 5 females ) from each CAI and healthy group were r and omly assigned to either the exercise or control group , result ing in a total of 4 groups . Total travel distance of the center of pressure , monitored using a force platform , was measured before training , after 4 weeks of training , and at a 4-week follow-up . RESULTS There were no interactions between gender , ankle sprain history , or training groups . Balance significantly improved in subjects with and without a history of ankle sprains following 4 weeks of elastic resistance exercises . Mean improvement in balance for the exercise group following training , reflected through a decrease in total travel distance , was -11.1 cm ( 95 % confidence interval : -14.0 to -8.2 cm ) . These improvements in balance were retained 4 weeks after training . CONCLUSIONS Balance was improved after 4 weeks of elastic resistance exercise in subjects with and without a history of lateral ankle sprains . Balance improvements persisted 4 weeks following the treatment cessation 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 Background Ankle sprains are common injuries that often lead to functional ankle instability ( FAI ) , which is a pathology defined by sensations of instability at the ankle and recurrent ankle sprain injury . Poor postural stability has been associated with FAI , and sports medicine clinicians rehabilitate balance deficits to prevent ankle sprains . Subsensory electrical noise known as stochastic resonance ( SR ) stimulation has been used in conjunction with coordination training to improve dynamic postural instabilities associated with FAI . However , unlike static postural deficits , dynamic impairments have not been indicative of ankle sprain injury . Therefore , the purpose of this study was to examine the effects of coordination training with or without SR stimulation on static postural stability . Improving postural instabilities associated with FAI has implication s for increasing ankle joint stability and decreasing recurrent ankle sprains . Methods This study was conducted in a research laboratory . Thirty subjects with FAI were r and omly assigned to either a : 1 ) conventional coordination training group ( CCT ) ; 2 ) SR stimulation coordination training group ( SCT ) ; or 3 ) control group . Training groups performed coordination exercises for six weeks . The SCT group received SR stimulation during training , while the CCT group only performed coordination training .  Single leg postural stability was measured after the completion of balance training . Static postural stability was quantified on a force plate using anterior/posterior ( A/P ) and medial/lateral ( M/L ) center-of-pressure velocity ( COPvel ) , M/L COP st and ard deviation ( COPsd ) , M/L COP maximum excursion ( COPmax ) , and COP area ( COParea ) . Results Treatment effects comparing posttest to pretest COP measures were highest for the SCT group . At posttest , the SCT group had reduced A/P COPvel ( 2.3 ± 0.4 cm/s vs. 2.7 ± 0.6 cm/s ) , M/L COPvel ( 2.6 ± 0.5 cm/s vs. 2.9 ± 0.5 cm/s ) , M/L COPsd ( 0.63 ± 0.12 cm vs. 0.73 ± 0.11 cm ) , M/L COPmax ( 1.76 ± 0.25 cm vs. 1.98 ± 0.25 cm ) , and COParea ( 0.13 ± 0.03 cm2 vs. 0.16 ± 0.04 cm2 ) than the pooled means of the CCT and control groups ( P < 0.05 ) . Conclusion Reduced values in COP measures indicated postural stability improvements . Thus , six weeks of coordination training with SR stimulation enhanced postural stability . Future research should examine the use of SR stimulation for decreasing recurrent ankle sprain injury in physically active individuals with FAI Improvement of ankle proprioception through physiotherapy ( a.k.a . proprioceptive training ) is a widely accepted conservative treatment modality of chronic functional lateral ankle instability . Clinical studies provided controversial data on its proprioceptive effect . Aim of this study was to gain evidence on the efficacy of proprioceptive training on ankle joint position sense .  Ten patients ( five males and five females , aged 23.3±5.4 years ) were treated conservatively for chronic lateral ankle instability with a special training programme over 6 weeks . For the assessment of joint position sense we used the slope-box test , first applied and described by Robbins et al. ( Br J Sports Med 29:242–247 , 1995 ) . The test was performed before the start and after the end of the training programme , measuring joint position sense on 11 different slope amplitudes in four directions ( anterior , posterior , lateral and medial ) in r and om order each on both ankles . Comparisons were made between pre- and post-training results as well as versus a control-group of ten healthy athletes . Overall the proprioceptive sensory function of the studied group has improved , but this improvement was not significant in all directions . Only two patients have shown significant improvement of joint position sense in all directions ( mean estimate error improvement : 2.47 ° ) , while conservative treatment was partially successful in five others ( mean estimate error improvement : 0.73 ° ) . The follow-up results of these seven patients were comparable with the values measured in the control-group . Three patients did not show any improvements ( mean estimate error improvement : −0.55 ° ) ( overall difference between improving and non-improving patients : P<0.0001 ) . Mean absolute estimate error profiles of the seven improving patients became similar to the profiles of healthy athletes , while these changes could not be observed in the case of the three non-improving participants . Proprioceptive rehabilitation programme can be an effective method in order to improve impaired joint position sense function . After 6 weeks non-responding patients can be well identified , and considered for other treatment modalities . The determination of the effective length of the programme however needs further evaluation . Still , changes in the proprioceptive sensory function of the ankle plantarflectors indicate the preventive effect of the training programme . Furthermore , our results support the theory of simultaneous function of different mechanoreceptor-systems 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 deficits and to restore ankle joint stability , presumably by retraining altered afferent neuromuscular pathways . The effectiveness of such programs on individuals with functionally unstable ankles has yet to be established . METHODS AND MEASURES Prior to and following training , subjects with self-reported functionally unstable ankles ( 5 women and 8 men , mean age = 21.9 + /- 3.1 years ) and nonimpaired subjects ( 6 women and 7 men , mean age = 21.2 + /- 2.5 years ) completed a  static balance assessment  for both limbs as well as the  ankle joint functional assessment tool question naire ( AJFAT ) . The subjects from both groups participated in a unilateral , multilevel , static and dynamic balance training program 3 times a week for 4 weeks . Subjects from the experimental group trained only the involved limb , and the nonimpaired group  trained a r and omly selected limb . A stability index ( SI ) was calculated during the balance assessment to indicate the amount of platform motion . Compared to low stability indices , high stability indices indicate greater platform motion during stance and therefore less stability . RESULTS Following training , subjects from both groups demonstrated significant improvements in balance ability . When balance was assessed at a low resistance to platform tilt ( stability level 2 ) , the posttraining scores of both the subjects with unstable ankles ( mean SI = 2.63 + /- 1.92 ) and the nonimpaired subjects ( mean SI = 2.69 + /- 2.32 ) were significantly better than their pretraining scores ( mean SIs = 5.93 + /- 3.65 and 4.67 + /- 3.43 , respectively ) . Assessed at a high resistance to platform tilt ( stability level 6 ) , the posttraining scores of both subjects with unstable ankles ( mean SI = 1.27 + /- 0.66 ) and the nonimpaired subjects ( mean SI = 1.37 + /- 0.66 ) were significantly better than their pretraining scores ( mean SIs = 2.30 + /- 1.88 and 2.04 + /- 1.43 , respectively ) . Additionally , the posttraining AJFAT scores of subjects with unstable ankles ( 25.78 + /- 3.80 ) and the nonimpaired subjects ( 29.15 + /- 5.27 ) were significantly greater than their pretraining scores ( 17.11 + /- 3.44 and 22.92 + /- 5.22 , respectively ) , indicating an overall improvement in perceived ankle joint functional stability . CONCLUSIONS This study suggests that balance training is an effective means of improving joint proprioception and single-leg st and ing ability in subjects with unstable and nonimpaired ankles Objectives : To examine the effect of six weeks of strength and proprioception training on eversion to inversion isokinetic strength ratios ( E/I ratios ) in subjects with unilateral functional ankle instability . Methods : Thirty eight subjects were r and omly assigned to one of four treatment groups : strength training ( S ) ; proprioception training ( P ) ; strength + proprioception training ( B ) ; control ( C ) . Isokinetic strength was tested before and after training using a Kin Com 125 automatic positioning isokinetic dynamometer . Subtalar joint eversion and inversion motions  were tested both concentrically and eccentrically through a range of motion involving 40 ° . All peak torque and average torque values were normalised for body mass . E/I ratios were calculated from average torque and peak torque measures by taking the concentric eversion value and combining it with the eccentric inversion value . Data were analysed using a mixed model analysis of variance with repeated measures on the test factor . Average torque and peak torque E/I ratios at 30 and 120 ° /s were analysed separately . Results : There were no significant differences in average torque and peak torque E/I ratios of the functionally unstable ankle for any of the groups after training compared with before . Conclusions : Six weeks of strength and proprioception training ( either alone or combined ) had no effect on isokinetic measures of strength in subjects with self reported unilateral functional instability . Further studies examining this agonist ( concentric ) to antagonist ( eccentric ) muscle group strength ratio are needed Exercises to improve joint proprioception and coordination of the functionally unstable ankle are advocated throughout the literature , yet there is little evidence that these exercise have any effect on proprioception and balance . The purpose of this study was to determine the effects of a 6-week coordination and balance training program on proprioception of subjects with functional ankle instability . Forty-five subjects ( age = 22.53 + /- 3.95 years , height = 172.04 + /- 10.0 cm , weight = 71.72 + /- 15.7 kg ) were r and omly placed into a control ( Group 1 ) , sham ( Group 2 ) , or experimental ( Group 3 ) group . The experimental group trained 3 days per week , 10 minutes each day , performing various balance and proprioception exer 
    Output:
    