***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 In a r and omized controlled type Ib study , the effectiveness of three different forms of therapy for the treatment of visual neglect was assessed by comparing therapy outcomes in three groups of patients after cerebrovascular accidents . METHODS A control group received only st and ard exploration training , whilst the second and third group received exploration training combined with either contralateral transcutaneous electrical nerve stimulation ( TENS ) or optokinetic stimulation ( OKS ) respectively . RESULTS It was found that exploration training alone result ed in no improvement on both st and ard neglect tests ( NTs ) and everyday-relevant measures of reading and writing performance . In contrast , the groups receiving TENS or OKS showed significant improvements in both sets of measures with the difference that for the TENS group the improvement in NT scores at the end of therapy had disappeared 1-week later . However , both treatments result ed in significant improvements in reading and writing which were still present upon retesting 1-week after the end of therapy . CONCLUSION Both methods can be recommended for neglect therapy and are superior to exploration therapy alone OBJECTIVE To assess the effectiveness of a rehabilitative training program for patients with limb apraxia . DESIGN R and omized , controlled trial . SETTING Neurologic rehabilitation unit of a university hospital . PATIENTS Thirteen patients with acquired brain injury and limb apraxia ( lasting more than 2 months ) as a result of lesions involving the left cerebral hemisphere . Patients were assigned to a study group or to a control group following a r and omization scheme . The study group underwent an experimental training for limb apraxia . The control group received conventional treatment for aphasia . INTERVENTION A behavioral training program consisting of gesture-production exercises . The rehabilitative program was made up of 3 sections dedicated to the treatment of gestures with or without symbolic value and related or nonrelated to the use of objects . Thirty-five experimental sessions , each lasting 50 minutes , were given . MAIN OUTCOME MEASURES Neuropsychologic tests for assessment of aphasia , verbal comprehension , " general intelligence , " oral apraxia , constructional apraxia , and 3 tests concerning limb praxic function ( ideational apraxia , ideomotor apraxia , gesture recognition ) . Scores related to each test were used to measure the outcome . Video recordings of ideational and ideomotor apraxia tests allowed us to register type and number of praxic errors . All outcome measures , except the aphasia test , were recorded before and after the experimental ( or control ) treatment time interval . RESULTS The patients in the study group achieved a significant improvement of performance in both ideational ( p = .039 ) and ideomotor ( p = .043 ) apraxia tests . They also showed a significant reduction of errors in ideational ( p = .001 ) and ideomotor ( p < .001 ) apraxia tests . A trend toward improvement was found in the gesture comprehension test ( p = .058 ) , while other outcome measures did not show any significant amelioration . Control patients did not show any significant change in performance . CONCLUSIONS The results show the possible effectiveness of a specific training program for the treatment of limb apraxia Aim : To examine the effects of working memory ( WM ) training in adult patients with stroke . Methods : A r and omized pilot study with a treatment group and a passive control group ; 18 participants ( 12 males ) in a vocational age group ( mean age 54 years ) were r and omized to either the treatment or the control condition . The intervention consisted of computerized training on various WM tasks for five weeks . A neuropsychological test battery and self-rating on cognitive functioning in daily life ( the CFQ ) were administered both before and after the treatment . Results : Statistically significant training effects were found on the non-trainedtests for WM and attention , i.e. , tests that measure related cognitive functions but are not identical to tasks in the training programme ( Span board p < 0.05 ; PASAT p < 0.001 ; Ruff 2&7 p < 0.005 ) . There was a significant decrease in symptoms of cognitive problems as measured by the CFQ ( p < 0.005 ) . Conclusion : More than one year after a stroke , systematic WM training can significantly improve WM and attention Prism adaptation has been shown to alleviate the symptoms of unilateral spatial neglect following stroke in single case and small group studies . The purpose s of this single blinded pilot r and omised controlled trial were to determine the feasibility of delivering prism adaptation treatment in a clinical ly valid sample and to assess its impact on self-care . Thirty seven right hemisphere stroke patients with unilateral spatial neglect were r and omised into either prism adaptation ( using 10 dioptre , 6 degree prisms ) or sham treatment ( using plain glasses ) groups . Treatment was delivered each weekday for two weeks . Pointing accuracy , without vision of the finger , was recorded each day before treatment . Outcome was measured , by blinded assessors , four days and eight weeks after the end of treatment using the Catherine Bergego Scale ( CBS ) and the conventional neuropsychological tests from the Behavioural Inattention Test ( BIT ) . Thirty four patients received treatment : 16 with prisms , 18 sham .  Mean compliance was 99 % and 97 % , respectively . Over the treatment days only the prism treated group showed increased leftward bias in open loop pointing to targets on a touch screen . However , despite the group level changes in pointing behaviour no overall effect of the treatment on self-care or BIT were found Feedback of  eye movements  was evaluated as a treatment for visual neglect in right hemisphere stroke patients . Patients with visual neglect identified on the Behavioural Inattention Test ( BIT ) were r and omly allocated to two groups . One group ( n = 9 ) was treated for 2 h 40 min a week for 4 weeks , by wearing glasses which provided a reminder bleep if patients failed to move their eyes to the left in a 15 s interval . The control group ( n = 9 ) received no treatment for their  visual inattention  . Comparison of the groups after 4 weeks treatment and a further 4 weeks follow-up showed no significant difference either in eye movements or on the BIT . However , there was a trend towards a difference between eye movements in the two groups at 8 weeks , suggesting treatment may have influenced eye movements without changing neglect Background Many interventions delivered within the stroke rehabilitation setting could be considered complex , though some are more complex than others . The degree of complexity might be based on the number of and interactions between levels , components and actions targeted within the intervention . The number of ( and variation within ) participant groups and the context s in which it is delivered might also reflect the extent of complexity . Similarly , design ing the evaluation of a complex intervention can be challenging . Considerations include the necessity for intervention st and ardisation , the multiplicity of outcome measures employed to capture the impact of a multifaceted intervention and the delivery of the intervention across different clinical setting s operating within varying healthcare context s. Our aim was to develop and evaluate the implementation of a complex , multidimensional oral health care ( OHC ) intervention for people in stroke rehabilitation setting s which would inform the development of a r and omised controlled trial . Methods After review ing the evidence for the provision of OHC following stroke , multi-disciplinary experts informed the development of our intervention . Using both quantitative and qualitative methods we evaluated the implementation of the complex OHC intervention across patients , staff and service levels of care . We also adopted a pragmatic approach to patient recruitment , the completion of assessment tools and delivery of OHC , alongside an attention to the context in which it was delivered . Results We demonstrated the feasibility of implementing a  complex OHC intervention  across three levels of care . The complementary nature of the mixed methods approach to data gathering provided a complete picture of the implementation of the intervention and a detailed underst and ing of the variations within and interactions between the components of the intervention . Information on the feasibility of the outcome measures used to capture impact across a range of components was also collected , though some process orientated uncertainties including eligibility and recruitment rates remain to be further explored within a Phase II exploratory trial . Conclusions Complex interventions can be captured and described in a manner which facilitates evaluation in the form of exploratory and subsequently definitive clinical trials . If effective , the evidence captured relating to the intervention context will facilitate translation into clinical practice BACKGROUND AND PURPOSE Patients with poststroke major depression have a greater severity of cognitive impairment than nondepressed patients even when matched for size and location of stroke lesion . Prior treatment studies have consistently failed to show an improvement in cognitive function even when poststroke mood disorders responded to antidepressant therapy . We examined the response of cognitive function to treatment with nortriptyline or placebo in a double-blind trial . METHODS Patients with major ( n=33 ) or minor ( n=14 ) depression participated in a double-blind treatment study with nortriptyline or placebo . They were examined for change in depressive mood , measured by the Hamilton Rating Scale for Depression ( HAM-D ) , and change in cognitive impairment , assessed by the Mini-Mental State Examination ( MMSE ) , after treatment with nortriptyline or placebo .  Cognitive treatment response , as measured by the MMSE , was compared between patients whose depression did and did not respond to treatment . RESULTS Patients whose poststroke depression remitted ( predominantly associated with nortriptyline treatment ) had significantly greater recovery in cognitive function over the course of the treatment study than patients whose mood disorder did not remit ( predominantly associated with placebo treatment ) . CONCLUSIONS Our findings support the contention that poststroke major depression leads to a " dementia of depression . " Prior studies failed to show an effect of treatment because the effect size was too small . Successful treatment of depression may constitute one of the major methods of promoting cognitive recovery in victims of stroke The aim of this r and omised , double-blind study was to investigate the therapeutic effectiveness of left-h and electrical stimulation for patients with post-stroke left visuo-spatial neglect . This approach was hypothesised to enhance activation of the right hemisphere attention system and to improve visual exploration of extrapersonal space .  Participants ( n = 40 ) in the study were in a relatively early stage of recovery from their first right hemisphere stroke , and were r and omly assigned to the experimental ( E ) or control ( C ) group . Group E received conventional visual scanning training combined with electrostimulation of the left h and , while Group C received scanning training with sham stimulation . Their visuo-spatial neglect was assessed twice , prior to the rehabilitation programme and on its completion , using cancellation tests and a letter-reading task . The effect of electrostimulation on hemineglect was assessed following a single administration and after a month-long rehabilitation programme . Although the immediate effect of stimulation was poor , after a month-long rehabilitation period we found significantly greater improvement in Group E patients than in Group C patients . Interestingly , the presence of hemisensory loss did not weaken the observed effect . Therefore , we cl aim that contralesional h and stimulation combined with visual scanning was a more effective treatment for hemineglect rehabilitation than scanning training alone CONTEXT Adjunctive restorative therapies administered during the first few months after stroke , the period with the greatest degree of spontaneous recovery , reduce the number of stroke patients with significant disability . OBJECTIVE To examine the effect of escitalopram on cognitive outcome . We hypothesized that patients who received escitalopram would show improved performance in neuropsychological tests assessing memory and executive functions than patients who received placebo or underwent Problem Solving Therapy . DESIGN R and omized trial . SETTING Stroke center . PARTICIPANTS One hundred twenty-nine patients were treated within 3 months following stroke . The 12-month trial included 3 arms : a double-blind placebo-controlled comparison of escitalopram ( n = 43 ) with placebo ( n = 45 ) , and a nonblinded arm of Problem Solving Therapy ( n = 41 ) . OUTCOME MEASURES Change in scores from baseline to the end of treatment for the Repeatable Battery for the Assessment of Neuropsychological Status ( RBANS ) and Trail-Making , Controlled Oral Word Association , Wechsler Adult Intelligence Scale-III Similarities , and Stroop tests . RESULTS We found a difference among the 3 treatment groups in change in RBANS total score ( P < .01 ) and RBANS delayed memory score ( P < .01 ) . After adjusting for possible confounders , there was a significant effect of escitalopram treatment on the change in RBANS total score ( P < .01 , adjusted mean change in score : escitalopram group , 10.0 ; nonescitalopram group , 3.1 ) and the change in RBANS delayed memory score ( P < .01 , adjusted mean change in score : escitalopram group , 11.3 ; nonescitalopram group , 2.5 ) . We did not observe treatment effects in other neuropsychological measures . CONCLUSIONS When compared with patients who received placebo or underwent Problem Solving Therapy , stroke patients who received escitalopram showed improvement in global cognitive functioning , specifically in verbal and visual memory functions . This beneficial effect of escitalopram was independent of its effect on depression . The utility of antidepressants in the process of poststroke recovery should be further investigated . Trial Registration clinical trials.gov Identifier : NCT00071643 Objective : To investigate the effectiveness of voluntary trunk rotation and half-field eye-patching to treat patients with unilateral neglect in stroke . Design : Pre — post , day 60 follow-up , single-blinded r and omized controlled trial . Setting : Single-centre inpatient rehabilitation hospital . Subjects : Sixty subacute patients with right hemisphere stroke having unilateral neglect within eight weeks post stroke consented to participate between November 2003 and July 2005 . They were r and omly assigned to three comparison groups . Interventions : Nineteen patients received daily experimental training in voluntary trunk rotation ( TR ) for 1 hour five times a week for 30 days . Twenty patients received the same kind of treatment together with half-field eye-patching ( 
    Output:
    
Though there was support for the effectiveness of  cognitive rehabilitation for some cognitive impairments , significant gaps were found in the current evidence base .