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 The purpose of this study was to investigate local paraspinal cutaneous temperature ( CT ) modifications after spinal manipulative therapy at L5 . METHODS Twenty subjects with acute low back symptoms were r and omly assigned to either a treatment or a sham group ( n = 10 per group ) . Subjects underwent an 8-minute acclimatizing period . Temperature was measured bilaterally with infrared cameras at the L5 level . In the treatment group , a traditional chiropractic manipulation ( lumbar roll technique with a pisiform contact on the ipsilateral mamillary of L5 ) was delivered , whereas with the sham group , the same technique was used , but no thrust was applied . Cutaneous temperature control measurements were taken 2 minutes before ( t(-2 ) ) and immediately after the intervention ( t(0 ) ) and at 1 , 3 , 5 , and 10 minutes postintervention ( t(1 ) , t(3 ) , t(5 ) , and t(10 ) , respectively ) . RESULTS At t(0 ) , CT in the treatment group on the treatment side ( ipsilateral side ) warmed up by 0.2 degrees F , whereas in the sham group , there were no significant temperature modifications on either side . At t(3 ) relative to t(0 ) , CT in the treatment group on the treatment side warmed by approximately 0.6 degrees F , whereas the contralateral side ( nontreatment side ) cooled . In the treatment group , significant differences were noted between sides ( F = 13.36 , P = .002 , P = .932 ) and sides x times ( F = 2.97 , P = .016 , P = .838 ) . CONCLUSION The effects of a lumbar spine manipulation appear noticeable by changes in paraspinal CT measurements at the level of L5 . However , the meaning and mechanisms of CT modifications at L5 are still being investigated Joint mobilisation to the T4 vertebra has been advocated as a treatment for T4 syndrome . To date no controlled studies have investigated the effects of thoracic spinal manual therapy ( SMT ) applied to T4 on sympathetic activity in the h and s. This study investigated whether a grade III postero-anterior rotatory joint mobilisation technique applied to the T4 vertebra at a frequency of 0.5 Hz had demonstrably greater effects than a vali date d placebo intervention on skin conductance ( SC ) in the h and s of healthy subjects . A power analysis calculation was performed and using a double blind , placebo-controlled , independent groups design , 36 healthy subjects ( 18 - 35 years ) were r and omly assigned to two groups ( placebo intervention or treatment intervention ) . A BioPac unit recorded continuous SC measures before , during and after each experimental intervention . An exit question naire was used to vali date the expectancy effects of the placebo intervention . Results demonstrated a significant difference between groups in SC in the right h and during the post-treatment rest period ( F = 4.888 , p = 0.034 ) ; with the treatment intervention being sympathoexcitatory in nature . A trend towards a significant difference between groups was also demonstrated in the left h and during the rest period ( F = 4.072 , p = 0.052 ) . This study provides preliminary evidence that joint mobilisation applied to the T4 vertebra at a frequency of 0.5 Hz can produce sympathoexcitatory effects in the h and . Further research is recommended in a patient population to test early  nutritional interventions  and prospect i ve observational cohorts . RCTs are generally accepted as method ologically the best approach for informing health policy . They can equalise unknown as well as known confounding factors and so can demonstrate causation ; they permit estimation of effect size and so can be used to assess likely Two commonly utilised manual therapy techniques ; McKenzie 's lumbar extension exercises ( EE ) ; and segmental rotational grade V manipulation were investigated to determine their magnitude of neurophysiological effect . Proxy measures of sympathetic nervous system ( SNS ) activity ( skin conductance ) were utilised to ascertaining neurophysiological response . This study determined the neurological effects of these two treatment techniques in addition to establishing the Biopac System as a reliable measure of neurophysiological changes . A quasi-experimental , independent group 's design was utilised , with r and om allocation of 50 normal , healthy participants into a manipulation or an EE group .  Neurophysiological measurements of skin conductance were taken in the lower limbs before , during and after the administration of the techniques . Results were converted into percentage change calculations for the intervention and the post-intervention periods . Both treatments increased SNS activity during the intervention period , 63 % for the manipulation group ( p = 0.0005 ) and 42 % for EE group ( p = 0.0005 ) with the manipulative technique having significantly greater effect ( p = 0.012 ) . Further analysis of the manipulation group found no difference between the ' opening ' and the ' closing ' side of the technique ( p = 0.76 ) . Biopac System is a reliable method for measuring SNS activity with minimum measurement variability . Preliminary evidence now exists supporting the neurophysiological effects of two lumbar techniques Spinal manipulative therapy techniques are commonly employed by physiotherapists in the clinical setting for the management of neuromusculoskeletal pain and dysfunction , although their underlying mechanism is not fully understood . Mulligan 's sustained natural apophyseal glides ( SNAGs ) constitute one of these techniques . This preliminary investigation was undertaken to investigate the relationship between the application of cervical SNAGs to the C5/6 intervertebral joint ( with cervical right rotation ) and indirect measures of sympathetic nervous system ( SNS ) activity . Previous investigations have suggested that cervical manipulative therapy techniques , separate to cervical SNAGs , result in a sympatheoexcitatory effect and that this may be instrumental in producing an analgesic response . Sixteen asymptomatic subjects participated in a laboratory-based experiment . A single blind , r and omized , within subject , repeated measures study design which included control , placebo and treatment comparisons was used . Measures of skin conductance ( SC ) and skin temperature ( ST ) in the right and left upper limbs were used as indicators of SNS activity . The cervical SNAG technique produced a sympathoexcitatory response demonstrated by a significant increase in SC during application of the treatment intervention ( P<0.0005 ) and for a 2-min period after the intervention ( P=0.001 ) compared with control . There was also a significant increase in SC for the placebo condition , both during intervention ( P=0.015 ) and after intervention ( P=0.011 ) compared with control . There was a statistically significant difference in SC between placebo and treatment conditions for the 2-min period after the intervention had been applied ( P=0.01 ) . A trend did emerge for ST change , illustrating a decrease in ST for the treatment and placebo conditions compared with control , however this did not reach statistically significant levels . There were no apparent left/right upper limb differences for SC and ST for each condition . The results of this study suggest that cervical SNAG techniques , performed on naïve asymptomatic subjects , have a sympathoexcitatory effect as measured by changes in SC and ST . The importance of this sympathoexcitatory effect in relation to potential mechanisms for manipulation induced analgesia are discussed , and further areas of research proposed SUMMARY . The aim of this study was to compare the effects of different rates of application of a commonly used physiotherapeutic spinal manipulative therapy technique on sympathetic function in normal pain-free volunteers . A r and omized , repeated measures , double blind , controlled study design was used to investigate the effects of two different rates of a C5 grade III central postero-anterior mobilization technique on skin conductance ( SC ) and skin temperature ( ST ) in the distal C6 dermatome of asymptomatic subjects . Sixteen asymptomatic male volunteers participated in the study . Application of a C5 central postero-anterior grade III mobilization at the rate of 2Hz produced significantly greater increases in SC values than that at the rate of 0.5 Hz and control . The results of this study suggest that mobilization with the rate which is commonly used clinical ly causes a greater increase in sympathetic efferent activity in the upper limb of normal pain-free volunteers than a slower rate . These results may also provide a basis for further investigation into the physiological effects of different rates of mobilization and in particular exploration of the relationship between changes in sympathetic function following mobilization and manipulation-induced analgesia . Copyright 1996 Harcourt Publishers OBJECTIVE The purpose of this study was to investigate the effects of a manual mobilization technique on indirect measures of sympathetic nervous system activity . METHODS Forty-five healthy volunteers participated in this r and omized , single-blinded , parallel-group 3-arm design ( experimental , sham [ placebo ] , and control group ) , comprising 15 subjects each . For the experimental group , lumbar mobilization involving an active movement , the Mulligan sustained natural apophyseal glide ( SNAG ) , was applied on L4 spinous process by an experienced manual therapist . Sustained natural apophyseal glides were performed in sitting with active flexion ( 6 times × 3 sets ) . The sham technique simulated the SNAG without applying any force . In the control group , participants were placed in a static sitting position throughout the experiment . Measures of skin conductance in the lower limbs ( L4 dermatome ) were recorded to reflect sympathetic nervous system activity in the preintervention , periintervention , and postintervention periods . Differences in percentage change of skin conductance were analyzed with analysis of variance and post hoc tests . RESULTS Lumbar SNAG produced sympathoexcitation compared with the control group in the intervention period ( P = .04 ) . No significant difference was found between SNAG and sham groups , and no statistically significant difference was found between groups in the final rest period . CONCLUSION The results of this study showed that , in asymptomatic participants , both lumbar SNAG and sham techniques performed on L4/5 intervertebral joint with active flexion induced a sympathoexcitatory response in lower limbs compared with the control group BACKGROUND AND PURPOSE Mulligan has proposed the use of mobilization with movement for lateral epicondylalgia . In this study , mobilization with movement for the elbow was examined to determine whether this intervention was capable of inducing physiological effects similar to those reported for some forms of spinal manipulation . PARTICIPANTS Seven women and 17 men ( mean age=48.5 years , SD=7.2 ) with chronic lateral epicondylalgia participated in the study . METHODS A placebo , control , repeated- measures study was conducted to evaluate whether mobilization with movement at the elbow produced concurrent hypoalgesia and sympathoexcitation . RESULTS The treatment demonstrated an initial hypoalgesic effect and concurrent sympathoexcitation . Improvements in pain result ed in increased pain-free grip force and pressure pain thresholds . Sympathoexcitation was indicated by changes in heart rate , blood pressure , and cutaneous sudomotor and vasomotor function . DISCUSSION AND CONCLUSION This study showed that a mobilization with movement treatment technique exerted a physiological effect similar to that reported for some spinal manipulations Physiotherapy management of lumbar disorders , based on Mulligan 's mobilization techniques , is a treatment of choice by many physiotherapists , however , there is only limited evidence of any neurophysiological effects and much of this has focused on the cervical spine and upper limbs . This study aims to extend the knowledge base underpinning the use of a modified Mulligan 's spinal mobilisation with leg movement technique ( SMWLM ) by exploring its effects on the peripheral sympathetic nervous system ( SNS ) of the lower limbs . Using a single blind , placebo controlled , independent groups study design , 45 normal naive healthy males were r and omly assigned to one of three experimental groups ( control , placebo or treatment ; SMWLM ) . SNS activity was determined by recording skin conductance ( SC ) obtained from lower limb electrodes connected to a BioPac unit . Validation of the placebo technique was performed by post- intervention question naire . Results indicated that there was a significant change in SC from baseline levels ( 30 % ) that was specific to the side treated for the treatment group during the intervention period ( compared to placebo and control conditions ) . This study provides preliminary evidence that a modified SMWLM technique results in side-specific peripheral SNS changes in the lower limbs The use of cervical manipulation presents concerns because of a risk of devastating side effects of trauma to the vertebral artery . Little is known about the frequency of use of cervical manipulation versus passive mobilisation by physiotherapists . A recent national , multi-centre r and omised clinical trial of the physiotherapy management of  cervicogenic headache provided an opportunity to gain an insight into practice s of a sample of manipulative physiotherapists across Australia . The treatment records for the 100 subjects who received only manipulative therapy , or manipulative therapy with exercise as per the trial protocol , were audited . The results revealed that  cervical manipulation  was used in 20.2 % of the 1090 treatments provided to these subjects but  cervical joint mobilisation  only was used in the vast majority of treatments ( 77.6 % ) . Nevertheless , 42 % of subjects were treated with  cervical manipulation  at some time . In most instances , manipulation was accompanied by passive mobilisation in the same treatment session . Patients were manipulated on one to six occasions and this occurred predominantly in the latter half of the 12-treatment program .  Cervical manipulation  was used less frequently in the group who also received exercise . The data suggest that the physiotherapists participating in this study used  cervical manipulation  selectively and relatively conservatively considering the high use of cervical mobilisation techniques . This may reflect their due regard to safety in the treatment of the cervical region Physiotherapeutic management of lumbar disorders often utilises specific segmental joint mobilisation techniques ; however , there is only limited evidence of any neurophysiological effects and much of this has focused on the cervical spine and upper limbs . This study aims to extend the knowledge base underpinning the use of a unilaterally applied lumbar spinal mobilisation technique by exploring its 
    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: OBJECTIVE The purpose of this study was to investigate local paraspinal cutaneous temperature ( CT ) modifications after spinal manipulative therapy at L5 . METHODS Twenty subjects with acute low back symptoms were r and omly assigned to either a treatment or a sham group ( n = 10 per group ) . Subjects underwent an 8-minute acclimatizing period . Temperature was measured bilaterally with infrared cameras at the L5 level . In the treatment group , a traditional chiropractic manipulation ( lumbar roll technique with a pisiform contact on the ipsilateral mamillary of L5 ) was delivered , whereas with the sham group , the same technique was used , but no thrust was applied . Cutaneous temperature control measurements were taken 2 minutes before ( t(-2 ) ) and immediately after the intervention ( t(0 ) ) and at 1 , 3 , 5 , and 10 minutes postintervention ( t(1 ) , t(3 ) , t(5 ) , and t(10 ) , respectively ) . RESULTS At t(0 ) , CT in the treatment group on the treatment side ( ipsilateral side ) warmed up by 0.2 degrees F , whereas in the sham group , there were no significant temperature modifications on either side . At t(3 ) relative to t(0 ) , CT in the treatment group on the treatment side warmed by approximately 0.6 degrees F , whereas the contralateral side ( nontreatment side ) cooled . In the treatment group , significant differences were noted between sides ( F = 13.36 , P = .002 , P = .932 ) and sides x times ( F = 2.97 , P = .016 , P = .838 ) . CONCLUSION The effects of a lumbar spine manipulation appear noticeable by changes in paraspinal CT measurements at the level of L5 . However , the meaning and mechanisms of CT modifications at L5 are still being investigated Joint mobilisation to the T4 vertebra has been advocated as a treatment for T4 syndrome . To date no controlled studies have investigated the effects of thoracic spinal manual therapy ( SMT ) applied to T4 on sympathetic activity in the h and s. This study investigated whether a grade III postero-anterior rotatory joint mobilisation technique applied to the T4 vertebra at a frequency of 0.5 Hz had demonstrably greater effects than a vali date d placebo intervention on skin conductance ( SC ) in the h and s of healthy subjects . A power analysis calculation was performed and using a double blind , placebo-controlled , independent groups design , 36 healthy subjects ( 18 - 35 years ) were r and omly assigned to two groups ( placebo intervention or treatment intervention ) . A BioPac unit recorded continuous SC measures before , during and after each experimental intervention . An exit question naire was used to vali date the expectancy effects of the placebo intervention . Results demonstrated a significant difference between groups in SC in the right h and during the post-treatment rest period ( F = 4.888 , p = 0.034 ) ; with the treatment intervention being sympathoexcitatory in nature . A trend towards a significant difference between groups was also demonstrated in the left h and during the rest period ( F = 4.072 , p = 0.052 ) . This study provides preliminary evidence that joint mobilisation applied to the T4 vertebra at a frequency of 0.5 Hz can produce sympathoexcitatory effects in the h and . Further research is recommended in a patient population to test early  nutritional interventions  and prospect i ve observational cohorts . RCTs are generally accepted as method ologically the best approach for informing health policy . They can equalise unknown as well as known confounding factors and so can demonstrate causation ; they permit estimation of effect size and so can be used to assess likely Two commonly utilised manual therapy techniques ; McKenzie 's lumbar extension exercises ( EE ) ; and segmental rotational grade V manipulation were investigated to determine their magnitude of neurophysiological effect . Proxy measures of sympathetic nervous system ( SNS ) activity ( skin conductance ) were utilised to ascertaining neurophysiological response . This study determined the neurological effects of these two treatment techniques in addition to establishing the Biopac System as a reliable measure of neurophysiological changes . A quasi-experimental , independent group 's design was utilised , with r and om allocation of 50 normal , healthy participants into a manipulation or an EE group .  Neurophysiological measurements of skin conductance were taken in the lower limbs before , during and after the administration of the techniques . Results were converted into percentage change calculations for the intervention and the post-intervention periods . Both treatments increased SNS activity during the intervention period , 63 % for the manipulation group ( p = 0.0005 ) and 42 % for EE group ( p = 0.0005 ) with the manipulative technique having significantly greater effect ( p = 0.012 ) . Further analysis of the manipulation group found no difference between the ' opening ' and the ' closing ' side of the technique ( p = 0.76 ) . Biopac System is a reliable method for measuring SNS activity with minimum measurement variability . Preliminary evidence now exists supporting the neurophysiological effects of two lumbar techniques Spinal manipulative therapy techniques are commonly employed by physiotherapists in the clinical setting for the management of neuromusculoskeletal pain and dysfunction , although their underlying mechanism is not fully understood . Mulligan 's sustained natural apophyseal glides ( SNAGs ) constitute one of these techniques . This preliminary investigation was undertaken to investigate the relationship between the application of cervical SNAGs to the C5/6 intervertebral joint ( with cervical right rotation ) and indirect measures of sympathetic nervous system ( SNS ) activity . Previous investigations have suggested that cervical manipulative therapy techniques , separate to cervical SNAGs , result in a sympatheoexcitatory effect and that this may be instrumental in producing an analgesic response . Sixteen asymptomatic subjects participated in a laboratory-based experiment . A single blind , r and omized , within subject , repeated measures study design which included control , placebo and treatment comparisons was used . Measures of skin conductance ( SC ) and skin temperature ( ST ) in the right and left upper limbs were used as indicators of SNS activity . The cervical SNAG technique produced a sympathoexcitatory response demonstrated by a significant increase in SC during application of the treatment intervention ( P<0.0005 ) and for a 2-min period after the intervention ( P=0.001 ) compared with control . There was also a significant increase in SC for the placebo condition , both during intervention ( P=0.015 ) and after intervention ( P=0.011 ) compared with control . There was a statistically significant difference in SC between placebo and treatment conditions for the 2-min period after the intervention had been applied ( P=0.01 ) . A trend did emerge for ST change , illustrating a decrease in ST for the treatment and placebo conditions compared with control , however this did not reach statistically significant levels . There were no apparent left/right upper limb differences for SC and ST for each condition . The results of this study suggest that cervical SNAG techniques , performed on naïve asymptomatic subjects , have a sympathoexcitatory effect as measured by changes in SC and ST . The importance of this sympathoexcitatory effect in relation to potential mechanisms for manipulation induced analgesia are discussed , and further areas of research proposed SUMMARY . The aim of this study was to compare the effects of different rates of application of a commonly used physiotherapeutic spinal manipulative therapy technique on sympathetic function in normal pain-free volunteers . A r and omized , repeated measures , double blind , controlled study design was used to investigate the effects of two different rates of a C5 grade III central postero-anterior mobilization technique on skin conductance ( SC ) and skin temperature ( ST ) in the distal C6 dermatome of asymptomatic subjects . Sixteen asymptomatic male volunteers participated in the study . Application of a C5 central postero-anterior grade III mobilization at the rate of 2Hz produced significantly greater increases in SC values than that at the rate of 0.5 Hz and control . The results of this study suggest that mobilization with the rate which is commonly used clinical ly causes a greater increase in sympathetic efferent activity in the upper limb of normal pain-free volunteers than a slower rate . These results may also provide a basis for further investigation into the physiological effects of different rates of mobilization and in particular exploration of the relationship between changes in sympathetic function following mobilization and manipulation-induced analgesia . Copyright 1996 Harcourt Publishers OBJECTIVE The purpose of this study was to investigate the effects of a manual mobilization technique on indirect measures of sympathetic nervous system activity . METHODS Forty-five healthy volunteers participated in this r and omized , single-blinded , parallel-group 3-arm design ( experimental , sham [ placebo ] , and control group ) , comprising 15 subjects each . For the experimental group , lumbar mobilization involving an active movement , the Mulligan sustained natural apophyseal glide ( SNAG ) , was applied on L4 spinous process by an experienced manual therapist . Sustained natural apophyseal glides were performed in sitting with active flexion ( 6 times × 3 sets ) . The sham technique simulated the SNAG without applying any force . In the control group , participants were placed in a static sitting position throughout the experiment . Measures of skin conductance in the lower limbs ( L4 dermatome ) were recorded to reflect sympathetic nervous system activity in the preintervention , periintervention , and postintervention periods . Differences in percentage change of skin conductance were analyzed with analysis of variance and post hoc tests . RESULTS Lumbar SNAG produced sympathoexcitation compared with the control group in the intervention period ( P = .04 ) . No significant difference was found between SNAG and sham groups , and no statistically significant difference was found between groups in the final rest period . CONCLUSION The results of this study showed that , in asymptomatic participants , both lumbar SNAG and sham techniques performed on L4/5 intervertebral joint with active flexion induced a sympathoexcitatory response in lower limbs compared with the control group BACKGROUND AND PURPOSE Mulligan has proposed the use of mobilization with movement for lateral epicondylalgia . In this study , mobilization with movement for the elbow was examined to determine whether this intervention was capable of inducing physiological effects similar to those reported for some forms of spinal manipulation . PARTICIPANTS Seven women and 17 men ( mean age=48.5 years , SD=7.2 ) with chronic lateral epicondylalgia participated in the study . METHODS A placebo , control , repeated- measures study was conducted to evaluate whether mobilization with movement at the elbow produced concurrent hypoalgesia and sympathoexcitation . RESULTS The treatment demonstrated an initial hypoalgesic effect and concurrent sympathoexcitation . Improvements in pain result ed in increased pain-free grip force and pressure pain thresholds . Sympathoexcitation was indicated by changes in heart rate , blood pressure , and cutaneous sudomotor and vasomotor function . DISCUSSION AND CONCLUSION This study showed that a mobilization with movement treatment technique exerted a physiological effect similar to that reported for some spinal manipulations Physiotherapy management of lumbar disorders , based on Mulligan 's mobilization techniques , is a treatment of choice by many physiotherapists , however , there is only limited evidence of any neurophysiological effects and much of this has focused on the cervical spine and upper limbs . This study aims to extend the knowledge base underpinning the use of a modified Mulligan 's spinal mobilisation with leg movement technique ( SMWLM ) by exploring its effects on the peripheral sympathetic nervous system ( SNS ) of the lower limbs . Using a single blind , placebo controlled , independent groups study design , 45 normal naive healthy males were r and omly assigned to one of three experimental groups ( control , placebo or treatment ; SMWLM ) . SNS activity was determined by recording skin conductance ( SC ) obtained from lower limb electrodes connected to a BioPac unit . Validation of the placebo technique was performed by post- intervention question naire . Results indicated that there was a significant change in SC from baseline levels ( 30 % ) that was specific to the side treated for the treatment group during the intervention period ( compared to placebo and control conditions ) . This study provides preliminary evidence that a modified SMWLM technique results in side-specific peripheral SNS changes in the lower limbs The use of cervical manipulation presents concerns because of a risk of devastating side effects of trauma to the vertebral artery . Little is known about the frequency of use of cervical manipulation versus passive mobilisation by physiotherapists . A recent national , multi-centre r and omised clinical trial of the physiotherapy management of  cervicogenic headache provided an opportunity to gain an insight into practice s of a sample of manipulative physiotherapists across Australia . The treatment records for the 100 subjects who received only manipulative therapy , or manipulative therapy with exercise as per the trial protocol , were audited . The results revealed that  cervical manipulation  was used in 20.2 % of the 1090 treatments provided to these subjects but  cervical joint mobilisation  only was used in the vast majority of treatments ( 77.6 % ) . Nevertheless , 42 % of subjects were treated with  cervical manipulation  at some time . In most instances , manipulation was accompanied by passive mobilisation in the same treatment session . Patients were manipulated on one to six occasions and this occurred predominantly in the latter half of the 12-treatment program .  Cervical manipulation  was used less frequently in the group who also received exercise . The data suggest that the physiotherapists participating in this study used  cervical manipulation  selectively and relatively conservatively considering the high use of cervical mobilisation techniques . This may reflect their due regard to safety in the treatment of the cervical region Physiotherapeutic management of lumbar disorders often utilises specific segmental joint mobilisation techniques ; however , there is only limited evidence of any neurophysiological effects and much of this has focused on the cervical spine and upper limbs . This study aims to extend the knowledge base underpinning the use of a unilaterally applied lumbar spinal mobilisation technique by exploring its 
    Output:
    