***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: Recent research has suggested that enhanced retraining for stroke patients using haptics ( robotic forces ) and graphics ( visual display ) to generate a practice environment that can artificially enhance error rather than reducing it , can stimulate new learning and foster accelerated recovery . We present an evaluation of early results of this novel  post-stroke robotic-aided therapy trial that incorporates these ideas in a large VR system and simultaneously employs the patient , the therapist , and the technology to accomplish effective therapy Background . The 10-meter walk test and 6-minute walk test are increasingly used to evaluate the recovery of walking in patients with incomplete spinal cord injury . So far , there is no evidence whether the application of different walking distances provides complementary information about ambulatory capacity in patients with incomplete spinal cord injury . Studies about testing preferred and maximum speeds in subjects with incomplete spinal cord injury are lacking . Objective . To determine whether the combined testing of short and long distances as well as preferred and maximum speeds provides additional information about walking capacity in subjects with incomplete spinal cord injury . Methods . Depending on the objective , the subjects with incomplete spinal cord injury and age-matched control subjects had to perform the 10-meter walk test or 6-minute walk test at preferred and /or maximum walking speed . Results . During recovery , the preferred walking speed increased but did not differ when assessed during short or long distances in 51 subjects with incomplete spinal cord injury at 1 , 3 , and 6 months after injury ( mean and SD , 6-minute walk test : 0.37 ± 0.52 , 0.87 ± 0.56 , and 1.14 ± 0.52 ms —1 ; 10-meter walk test : 0.40 ± 0.53 , 0.88 ± 0.51 , and 1.12 ± 0.51 ms—1 , respectively ) . In 18 subjects with incomplete spinal cord injury , both preferred and maximum walking speeds assessed with the 10-meter walk test predicted the walking speeds of the 6-minute walk test well . Subjects with incomplete spinal cord injury prefer to walk closer to their maximum walking speed ( 74 % ± 10 % ) compared to control subjects ( 59 % ± 8 % ) . Conclusions . The velocity used for the 6-minute walking distance and the 10-meter walking speed provides comparable information in patients with incomplete spinal cord injury who can perform both tests . However , tests of the preferred and maximum walking speed add information about walking capacity . Due to the easier applicability of the 10-meter walk test in the clinical setting , the authors suggest performing this test at the preferred and maximum speeds for the assessment of walking capacity by 1 month after incomplete spinal cord injury Fifty individuals with incomplete tetraplegia due to trauma underwent serial prospect i ve examinations to quantify motor and sensory recovery . None of 5 patients who were motor complete with the presence of sacral ( S4-S5 ) sharp/dull touch sensation unilaterally recovered any lower extremity motor function . However , in 8 motor complete subjects having bilateral sacral sharp/dull sensation present , the mean lower extremity motor score increased to 12.1 + /- 7.8 at 1 year . In 3 of the 8 cases , functional ( > or = 3/5 ) recovery was seen in some muscles at 1 year . Though mean upper and lower extremity ASIA Motor Scores increased significantly ( p < .001 ) between 1 month and 1 year for the entire sample , the annualized rate of motor recovery rapidly declined in the first 6 months and then subsequently approached plateau . Eighty-seven percent ( 20 of 23 ) of patients having a lower extremity motor score > or = 10 at 1 month were community ambulators using crutches and orthoses at 1 year follow-up We used a lower limb robotic exoskeleton controlled by the wearer 's muscle activity to study human locomotor adaptation to disrupted muscular coordination . Ten healthy subjects walked while wearing a pneumatically powered ankle exoskeleton on one limb that effectively increased plantar flexor strength of the soleus muscle . Soleus electromyography amplitude controlled plantar flexion assistance from the exoskeleton in real time . We hypothesized that subjects ' gait kinematics would be initially distorted by the added exoskeleton power , but that subjects would reduce soleus muscle recruitment with practice to return to gait kinematics more similar to normal . We also examined the ability of subjects to recall their adapted motor pattern for exoskeleton walking by testing subjects on two separate sessions , 3 days apart . The mechanical power added by the exoskeleton greatly perturbed ankle joint movements at first , causing subjects to walk with significantly increased plantar flexion during stance . With practice , subjects reduced soleus recruitment by approximately 35 % and learned to use the exoskeleton to perform almost exclusively positive work about the ankle . Subjects demonstrated the ability to retain the adapted locomotor pattern between testing sessions as evidence d by similar muscle activity , kinematic and kinetic patterns between the end of the first test day and the beginning of the second . These results demonstrate that robotic exoskeletons controlled by muscle activity could be useful tools for testing neural mechanisms of human locomotor adaptation An active ankle-foot orthoses ( AAFO ) is presented where the impedance of the orthotic joint is modulated throughout the walking cycle to treat drop-foot gait . During controlled plantar flexion , a biomimetic torsional spring control is applied where orthotic joint stiffness is actively adjusted to minimize forefoot collisions with the ground . Throughout late stance , joint impedance is minimized so as not to impede powered plantar flexion movements , and during the swing phase , a torsional spring-damper control lifts the foot to provide toe clearance . To assess the clinical effects of variable-impedance control , kinetic and kinematic gait data were collected on two drop-foot participants wearing the AAFO .  For each participant , zero , constant , and variable impedance control strategies were evaluated and the results were compared to the mechanics of three age , weight , and height matched normals . We find that actively adjusting joint impedance reduces the occurrence of slap foot allows greater powered plantar flexion and provides for less kinematic difference during swing when compared to normals . These results indicate that a variable-impedance orthosis may have certain clinical benefits for the treatment of drop-foot gait compared to conventional ankle-foot orthoses having zero or constant stiffness joint behaviors The Spinal Cord Independence Measure ( SCIM ) is a new disability scale developed specifically for patients with spinal cord lesions in order to make the functional assessment s of patients with paraplegia or tetraplegia more sensitive to changes . The SCIM includes the following areas of function : self-care ( subscore 0 – 20 ) , respiration and sphincter management ( 0 – 40 ) and mobility ( 0 – 40 ) . Each area is scored according to its proportional weight in these patients ' general activity . The final score ranges from 0 to 100 . This study was performed to evaluate the reliability of the SCIM and its sensitivity to functional changes in spinal cord lesion patients compared with the Functional Independence Measure ( FIM ) .  Thirty patients were included . Scores were recorded one week after admission and thereafter every month during hospitalization . Each area of function was assessed by a pair of staff members from the relevant discipline . The comparison of scores between each pair of raters revealed a remarkable consistency ( r=0.91 – 0.99 ; P<0.0001 ; slope≈1 ; constant≈0 ) . The total SCIM score ( mean=51 , SD=21 ) was lower than the total FIM score ( mean=87 , SD=23 ) owing to the difference in scale range structure and the relatively high cognitive scores of our patients ; however , a relationship was noted between the scores of both scales ( r=0.85 , P<0.01 ) . The SCIM was more sensitive than the FIM to changes in function of spinal cord lesion patients : the SCIM detected all the functional changes detected by the FIM total scoring , but the FIM missed 26 % of the changes detected by the SCIM total scoring . The mean difference between consecutive scores was higher for the SCIM ( P<0.01 ) . We conclude that the SCIM is a reliable disability scale and is more sensitive to changes in function in spinal cord lesion patients than the FIM . The SCIM when administered by a multidisciplinary team , may be a useful instrument for assessing changes in everyday performance in patients with spinal cord lesion 
    Output:
    
RESULTS The actuated ankle-foot orthoses currently available are characterized by several combinations of an actuator and a control mechanism .
Both the actuator and the control strategy substantially influence human-machine interaction and therefore the potential of the device to assist in modifying locomotor function and potentially modify the underlying motor control mechanisms .
CONCLUSION Due to small sample sizes , limited studies in patients with spinal cord injury , and limitations in study design , it is difficult to draw firm conclusions on the effect of different types of actuated ankle-foot orthoses .
Based on the limited data available , pneumatic artificial muscles in combination with proportional myoelectric control are suggested to have the potential to meet most of the preconditions to restore the attributes of normal gait and therefore facilitate neuroplasticity