***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 . A recent Cochrane Review showed that early robotic training of the upper limb in stroke survivors can be more effective than other interventions when improving activities of daily living involving the arm function is the aim of therapy . Objective . We tested for efficacy of the study a protocol which involved the use of the NeReBot therapy in partial substitution of st and ard upper limb rehabilitation in post – acute stroke patients . Methods . In this dose-matched , r and omized controlled clinical trial , 34 hemiparetic participants with movement against gravity in shoulder , elbow , and wrist muscle groups were enrolled within 15 days of the onset of stroke . All participants received a total daily rehabilitation treatment for 120 minutes , 5 days per week for 5 weeks . The control group received st and ard therapy for the upper limb . The experimental group received st and ard therapy ( 65 % of exercise time ) associated with robotic training ( 35 % of exercise time ) . Muscle tone ( Modified Ashworth Scale ) , strength ( Medical Research Council ) , and synergism ( Fugl-Meyer motor scores ) were measured at impairment level , whereas dexterity ( Box and Block Test and Frenchay Arm Test ) and activities of daily living ( Functional Independence Measure ) were measured at activity level . All assessment s were performed at baseline , at the end of therapy ( time T1 ) , at 3 months ( time T2 ) , and at 7 months ( time T3 ) after entry . All between-group analyses were tested using nonparametric test with Bonferroni ’s adjustments for multiple testing . Results . No significant between-group differences were found with respect to demographic characteristics , motor , dexterity , and ADLs at baseline , postintervention ( T1 ) and at follow-up ( T2 and T3 ) . Conclusions . The robot therapy by NeReBot did not lead to better outcomes compared with conventional inpatient rehabilitation Background and Purpose — It is unknown whether one method of neuromuscular electrical stimulation for poststroke upper limb rehabilitation is more effective than another . Our aim was to compare the effects of contralaterally controlled functional electrical stimulation ( CCFES ) with cyclic neuromuscular electrical stimulation ( cNMES ) . Methods — Stroke patients with chronic ( > 6 months ) moderate to severe upper extremity hemiparesis ( n=80 ) were r and omized to receive 10 sessions/wk of CCFES- or cNMES-assisted h and opening exercise at home plus 20 sessions of functional task practice in the laboratory for 12 weeks . The task practice for the CCFES group was stimulation assisted . The primary outcome was change in Box and Block Test ( BBT ) score at 6 months post treatment . Upper extremity Fugl – Meyer and Arm Motor Abilities Test were also measured . Results — At 6 months post treatment , the CCFES group had greater improvement on the BBT , 4.6 ( 95 % confidence interval [ CI ] , 2.2–7.0 ) , than the cNMES group , 1.8 ( 95 % CI , 0.6–3.0 ) , between-group difference of 2.8 ( 95 % CI , 0.1–5.5 ) , P=0.045 . No significant between-group difference was found for the upper extremity Fugl – Meyer ( P=0.888 ) or Arm Motor Abilities Test ( P=0.096 ) . Participants who had the largest improvements on BBT were < 2 years post stroke with moderate ( ie , not severe ) h and impairment at baseline . Among these , the 6-month post-treatment BBT gains of the CCFES group , 9.6 ( 95 % CI , 5.6–13.6 ) , were greater than those of the cNMES group , 4.1 ( 95 % CI , 1.7–6.5 ) , between-group difference of 5.5 ( 95 % CI , 0.8–10.2 ) , P=0.023 . Conclusions — CCFES improved h and dexterity more than cNMES in chronic stroke survivors . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00891319 Background and Purpose — Right hemisphere stroke patients frequently experience spatial neglect , a severe lack of awareness for contralesional hemispace . Although neglect counts among the strongest predictors for poor functional outcome after stroke , there is no established therapy , particularly not for the acute stage . Methods — In a r and omized controlled trial , we compared the combined treatment of hemifield eye patching and repetitive optokinetic stimulation in acute stroke patients with neglect to the spontaneous course . Outcome measures were a neuropsychological test battery for neglect as well as scales of functional independence and clinical impairment . Outcomes were assessed at baseline ( day 1 ) , post treatment ( day 8) , and at 1-month follow-up ( day 30 ) . Results — Final analysis included 21 acute right hemisphere stroke patients with neglect ( 23 enrolled , 2 lost to follow-up ) allocated either to the treatment ( 1 week hemifield eye patching and daily sessions of optokinetic stimulation , n=11 ) or the control group ( no neglect-specific treatment , n=10 ) . At baseline , both groups did not differ in neuropsychological test performance , clinical impairment , or functional disability . At the post treatment session , both groups had improved in all these measures , and results were stable or further improved at follow-up . However , there was no significant difference in this change between the treatment and the control group . Conclusions — An early intervention of combined hemifield eye patching and optokinetic stimulation in acute stroke patients with spatial neglect has no additive effect to the spontaneous remitting course of the disorder . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01617343 Background Effective poststroke motor rehabilitation depends on repeated limb practice with voluntary efforts . An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robot arm was design ed for the multi-joint physical training on the elbow , the wrist , and the fingers . Objectives To investigate the training effects of the device-assisted approach on subacute stroke patients and to compare the effects with those achieved by the traditional physical treatments . Method This study was a pilot r and omized controlled trial with a 3-month follow-up . Subacute stroke participants were r and omly assigned into two groups , and then received 20-session upper limb training with the EMG-driven NMES-robotic arm ( NMES-robot group , n = 14 ) or the time-matched traditional therapy ( the control , n = 10 ) . For the evaluation of the training effects , clinical assessment s including Fugl-Meyer Assessment ( FMA ) , Modified Ashworth Score ( MAS ) , Action Research Arm Test ( ARAT ) , and Function Independence Measurement ( FIM ) were conducted before , after the rehabilitation training , and 3 months later . Session-by-session EMG parameters in the NMES-robot group , including normalized co-contraction Indexes ( CI ) and EMG activation level of target muscles , were used to monitor the progress in muscular coordination patterns . Results Significant improvements were obtained in FMA ( full score and shoulder/elbow ) , ARAT , and FIM [ P < 0.001 , effect sizes ( EFs ) > 0.279 ] for both groups . Significant improvement in FMA wrist/h and was only observed in the NMES-robot group ( P < 0.001 , EFs = 0.435 ) after the treatments . Significant reduction in MAS wrist was observed in the NMES-robot group after the training ( P < 0.05 , EFs = 0.145 ) and the effects were maintained for 3 months . MAS scores in the control group were elevated following training ( P < 0.05 , EFs > 0.24 ) , and remained at an elevated level when assessed 3 months later . The EMG parameters indicated a release of muscle co-contraction in the muscle pairs of biceps brachii and flexor carpi radialis and biceps brachii and triceps brachii , as well as a reduction of muscle activation level in the wrist flexor in the NMES-robot group . Conclusion The NMES-robot-assisted training was effective for early stroke upper limb rehabilitation and promoted independence in the daily living comparable to the traditional physical therapy . It could achieve higher motor outcomes at the distal joints and more effective release in muscle tones than the traditional therapy . Clinical Trial Registration Clinical Trials.gov , identifier NCT02117089 ; date of registration : April 10 , 2014 OBJECTIVE To investigate the effectiveness of neuromuscular electrical stimulation ( NMES ) with or without other interventions in improving lower limb activity  after chronic stroke . DATA SOURCES Electronic data bases , including PubMed , EMBase , Cochrane Library , PEDro ( Physiotherapy Evidence Data base ) , and PsycINFO , were search ed from the inception to January 2017 . STUDY SELECTION We selected the r and omized controlled trials ( RCTs ) involving chronic stroke survivors with lower limb dysfunction and comparing NMES or combined with other interventions with a control group of no electrical stimulation treatment . DATA EXTRACTION The primary outcome was defined as lower limb motor function , and the secondary outcomes included gait speed , Berg Balance Scale , timed Up and Go , 6-minute walk test , Modified Ashworth Scale , and range of motion . DATA SYNTHESIS Twenty-one RCTs involving 1481 participants were identified from 5759 retrieved articles . Pooled analysis showed that NMES had a moderate but statistically significant benefit on lower limb motor function ( st and ard mean difference 0.42 , 95 % confidence interval 0.26 - 0.58 ) , especially when NMES was combined with other interventions or treatment time within either 6 or 12 weeks . NMES also had significant benefits on gait speed , balance , spasticity , and range of motion but had no significant difference in walking endurance after NMES . CONCLUSIONS NMES combined with or without other interventions has beneficial effects in lower limb motor function in chronic stroke survivors . These data suggest that NMES should be a promising therapy to apply in chronic stroke rehabilitation to improve the capability of lower extremity in performing activities Background and Purpose — This study assessed whether cycling induced by functional electrical stimulation ( FES ) was more effective than passive cycling with placebo stimulation in promoting motor recovery and walking ability in postacute hemiparetic patients . Methods — In a double-blind , r and omized , controlled trial , 35 patients were included and r and omized to receive FES-induced cycling training or placebo FES cycling .  The 4-week treatment consisted of 20 sessions lasting 25 minutes each . Primary outcome measures included the leg subscale of the Motricity Index and gait speed during a 50-meter walking test . Secondary outcomes were the Trunk Control Test , the Upright Motor Control Test , the mean work produced by the paretic leg , and the unbalance in mechanical work between paretic and nonparetic legs during voluntary pedaling . Participants were evaluated before training , after training , and at 3- to 5-month follow-up visits . Results — No significant differences were found between groups at baseline . Repeated- measures ANOVA ( P<0.05 ) revealed significant increases in Motricity Index , Trunk Control Test , Upright Motor Control Test , gait speed , and mean work of the paretic leg after training and at follow-up assessment s for FES-treated patients . No outcome measures demonstrated significant improvements after training in the placebo group . Both groups showed no significant differences between assessment s after training and at follow-up . A main effect favoring FES-treated patients was demonstrated by repeated- measures ANCOVA for Motricity Index ( P<0.001 ) , Trunk Control Test ( P=0.001 ) , Upright Motor Control Test ( P=0.005 ) , and pedaling unbalance ( P=0.038 ) . Conclusions — The study demonstrated that 20 sessions of FES cycling training significantly improved lower extremity motor functions and accelerated the recovery of overground locomotion in postacute hemiparetic patients . Improvements were maintained at follow-up OBJECTIVES To determine whether patches obscuring half the visual field affect eye movement in subjects with unilateral spatial neglect and whether there is consequent improvement in the subject 's everyday life , and to interpret the potential changes observed with the aid of a theoretical model . DESIGN Prospect i ve and r and omized study . SETTING Rehabilitation medicine department in an urban general hospital . PATIENTS Twenty-two subjects with left unilateral neglect . INTERVENTION Two eye-patching procedures -right half-field patches ( n = 7 ) and right mononuclar patch ( n = 7)- and control group ( n = 8) . MAIN OUTCOME MEASURES Functional tests ( FIM ) and analytical tests ( measurement of right eye movements by photo-oculography ) at admission and after 3 months . RESULTS Results of the paired comparison tests showed ( 1 ) significant differences between the control group and the group with the half-eye patches for total FIM score ( p = .01 ) and the displacements of the right eye in the left field ( p = .02 ) , and ( 2 ) no significant differences between the control group and the group with the right monocular patch . CONCLUSION Patching the right half-field helped subjects initially regain voluntary control over the deficit . The actual interpretation is based on physiologic and psychophysiologic models Objective . To investigate the effectiveness of four-channel FES based on a normal gait pattern on improving functional ability in subjects early after ischemic stroke . Methods . Forty-five subjects were r and omly assigned into a four-channel FES group ( n = 16 ) , a placebo group ( n = 15 
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Survivors of stroke who live outside of military medical center catchment areas can access community stroke re sources through the TRICARE network .
In addition , veterans and service members often have access to more health care re sources , including rehabilitation care services through community partnerships .
Our systematic review found strong evidence that the rehabilitation process should begin as soon as the patient is medically stable ( 1315 ) .
Despite general consistency in the evidence supporting rehabilitation therapy as soon as medical stability is reached , there may be some variability in provider and patient preferences regarding this treatment .
For example , while patients may want to mobilize as soon as possible , providers may be reluctant to recommend early mobilization due to medical concerns in the acute phase or the potential for falls .
There was also strong evidence that rehabilitation in the setting of an organized inpatient stroke unit ( in a single physical location with a dedicated rehabilitation team ) improved the likelihood of discharge to home in patients with a history of stroke ( 16 ) .
Outcomes from these units were consistently superior to outcomes after care on a general medical unit in terms of death , dependency , and discharge to home .
Key Area 2 : Motor Therapy Upper- and Lower-Limb Rehabilitation A review of the evidence for motor rehabilitation poststroke revealed evidence supporting task-specific practice for improving upper- and lower-extremity motor function , gait , posture , and ADLs .
Task-specific practice involves whole-task or pretask movements for an entire limb or limb segment , such as grasping , gripping , or moving along a trajectory to facilitate an ADL .
These movements can include upper- and lower-limb movements ,