***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 Motor imagery ( MI ) when combined with physiotherapy can offer functional benefits after stroke . Two MI integration strategies exist : added and embedded MI . Both approaches were compared when learning a complex motor task ( MT ) : ' Going down , laying on the floor , and getting up again ' . Methods Out patients after first stroke participated in a single-blinded , r and omised controlled trial with MI embedded into physiotherapy ( EG1 ) , MI added to physiotherapy ( EG2 ) , and a control group ( CG ) . All groups participated in six physiotherapy sessions . Primary study outcome was time ( sec ) to perform the motor task at pre and post-intervention . Secondary outcomes : level of help needed , stages of MT-completion , independence , balance , fear of falling ( FOF ) , MI ability . Data were collected four times : twice during one week baseline phase ( BL , T0 ) , following the two week intervention ( T1 ) , after a two week follow-up ( FU ) . Analysis of variance was performed . Results Thirty nine out patients were included ( 12 females , age : 63.4 ± 10 years ; time since stroke : 3.5 ± 2 years ; 29 with an ischemic event ) . All were able to complete the motor task using the st and ardised 7-step procedure and reduced FOF at T0 , T1 , and FU . Times to perform the MT at baseline were 44.2 ± 22s , 64.6 ± 50s , and 118.3 ± 93s for EG1 ( N = 13 ) , EG2 ( N = 12 ) , and CG ( N = 14 ) . All groups showed significant improvement in time to complete the MT ( p < 0.001 ) and degree of help needed to perform the task : minimal assistance to supervision ( CG ) and independent performance ( EG1 + 2 ) . No between group differences were found . Only EG1 demonstrated changes in MI ability over time with the visual indicator increasing from T0 to T1 and decreasing from T1 to FU . The kinaesthetic indicator increased from T1 to FU . Patients indicated to value the MI training and continued using MI for other difficult-to-perform tasks . Conclusions Embedded or added MI training combined with physiotherapy seem to be feasible and benefi-cial to learn the MT with emphasis on getting up independently . Based on their baseline level CG had the highest potential to improve outcomes . A patient study with 35 patients per group could give a conclusive answer of a superior MI integration strategy .Trial Registration Clinical Trials.gov : Objective : To compare the effect of visual and kinesthetic locomotor imagery training on walking performance and to determine the clinical feasibility of incorporating auditory step rhythm into the training . Design : R and omized crossover trial . Setting : Laboratory of a Department of Physical Therapy . Subjects : Fifteen subjects with post-stroke hemiparesis . Intervention : Four locomotor imagery trainings on walking performance : visual locomotor imagery training , kinesthetic locomotor imagery training , visual locomotor imagery training with auditory step rhythm and kinesthetic locomotor imagery training with auditory step rhythm . Main outcome measures : The timed up- and -go test and electromyographic and kinematic analyses of the affected lower limb during one gait cycle . Results : After the interventions , significant differences were found in the timed up- and -go test results between the visual locomotor imagery training ( 25.69 ± 16.16 to 23.97 ± 14.30 ) and the kinesthetic locomotor imagery training with auditory step rhythm ( 22.68 ± 12.35 to 15.77 ± 8.58 ) ( P<0.05 ) . During the swing and stance phases , the kinesthetic locomotor imagery training exhibited significantly increased activation in a greater number of muscles and increased angular displacement of the knee and ankle joints compared with the visual locomotor imagery training , and these effects were more prominent when auditory step rhythm was integrated into each form of locomotor imagery training . The activation of the hamstring during the swing phase and the gastrocnemius during the stance phase , as well as kinematic data of the knee joint , were significantly different for posttest values between the visual locomotor imagery training and the kinesthetic locomotor imagery training with auditory step rhythm ( P<0.05 ) . Conclusions : The therapeutic effect may be further enhanced in the kinesthetic locomotor imagery training than in the visual locomotor imagery training . The auditory step rhythm together with the locomotor imagery training produces a greater positive effect in improving the walking performance of patients with post-stroke hemiparesis This r and omized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness . There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements . Imagining h and movements could stimulate restitution and redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to method ological limitations . This r and omized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke ( on average <3 months post-stroke ) . R and omization was performed using an automated statistical minimizing procedure . The primary outcome measure was a blinded rating on the Action Research Arm test . The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week , compared to 31 patients who performed equally intensive non-motor mental rehearsal , and 32 patients receiving normal care without additional training . No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test ( ANCOVA statistical P = 0.77 , and effect size partial η2 = 0.005 ) or any of the secondary outcome measures . Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke . In light of the evidence , it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right OBJECTIVE The purpose of this study was to examine the effect of presence or absence of an object ( goal -directed action vs. rote exercise ) and the effect of functional specificity of the object on the organization of reaching movements of persons who have had a stroke . METHOD A repeated-measure counterbalanced design was used in each of two experiments . Eighteen persons who had been hospitalized after stroke were recruited from the roster of a rehabilitation hospital and through stroke clubs and volunteered to participate . Fourteen of these became the data -producing sample . In Experiment 1 , the OPTO-TRAK/3020 motion analysis system was used to record movement when the participants reached for preferred food ( goal -directed action ) or to a spatial location ( rote exercise ) . In Experiment 2 , the system recorded movement when participants reached to pick up the receiver of an active telephone ( natural context ) , a detached receiver ( partial context ) , and a stick ( simulated context ) . The organization of the reach movement was described kinematically as the number of zero crossings of the acceleration profile ( smoothness ) , movement time ( speed ) , displacement , peak velocity ( an indication of force ) , and location of peak velocity in the velocity profile ( planning strategy ) . RESULTS Goal -directed action produced significantly smoother , faster , more forceful , and more preplanned movement than did the rote exercise condition . Functional specificity of the context did not significantly affect organization of the reach . CONCLUSION Goal -directed reach enabled persons with stroke to display characteristics typical of reach to a target by persons who have not had a stroke better than reaching out in space . These findings support the occupational therapy practice of using objects in a functional context to improve coordinated movement . However , the nature of the objects to be used requires further study Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home . Design R and omised controlled trial with follow-up to 24 weeks . Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherl and s Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic . Patients were r and omly allocated to circuit training or usual physiotherapy , after stratification by rehabilitation centre , with an online r and omisation procedure . Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks . The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency . The control group received usual outpatient physiotherapy . Main outcome measures The primary outcome was the mobility domain of the stroke impact scale ( SIS , version 3.0 ) . Secondary outcomes were st and ing balance , self reported abilities , gait speed , walking distance , stair climbing , instrumental activities of daily living , fatigue , anxiety , and depression . Differences between groups were analysed according to the intention to treat principle . All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks . Results 126 patients were included in the circuit training group and 124 in the usual care group ( control ) , with data from 125 and 117 , respectively , available for analysis . One patient from the circuit training  group and seven from the control group dropped out . Circuit training was a safe intervention , and no serious adverse events were reported . There were no significant differences between groups for the stroke impact scale mobility domain ( β=0.05 ( SE 0.68 ) , P=0.943 ) at 12 weeks . Circuit training was associated with significantly higher scores in terms of gait speed ( 0.09 m/s ( SE 0.02 ) , P<0.001 ) , walking distance ( 20.0 m ( SE 7.4 ) , P=0.007 ) , and modified stairs test ( −1.6 s ( SE 0.7 ) , P=0.015 ) . There were no significant differences between groups for the other secondary outcomes , except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale . With the exception of gait speed ( −0.04 m/s ( SE 0.02 ) , P=0.040 ) , there were no significant differences between groups at follow-up . Conclusion Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient . Trial registration Dutch Trial Register ( NTR1534 ) Objective : The purpose of this study was to evaluate whether locomotor imagery training leads to clinical improvements in gait after stroke . Design : Pretest — posttest matched control design . Participants : A total of 24 people with chronic hemiparetic stroke ( 13 for experimental and 11 for control ) were recruited in this study . Interventions : The subjects in the experimental group participated in videotape-based locomotor imagery training five days a week for four weeks . They also conducted regular physical therapy . Outcome measures : Kinematic gait parameters were collected using a three-dimensional motion analysis system . Functional gait performance was assessed using clinical measures : Activities-specific Balance Confidence Scale , Berg Balance Test , Dynamic Gait Index and modified Emory Functional Ambulation Profile . Results : After training , walking velocity increased 0.07 ± 0.06 m/s in the experimental group and 0.01 ± 0.07 m/s in the control group . In the experimental group , the affected and less affected limb stride lengths increased by 0.09 ± 0.12 m and 0.10 ± 0.07 m respectively , whereas in the control group they decreased by 0.00 ± 0.04 m and increased by 0.02 ± 0.06 m , respectively . Kinematic parameters in the lower extremity joints during walking were more improved after the training in the experimental group . Confidence in balance , postural control , dynamic balance and performance time for different environmental walking situations were also improved more in the experimental group . Conclusion : Locomotor imagery training can be considered as a useful option for restoration of ambulation for individuals with chronic hemiparetic stroke who are unable to participate in physical gait training Background and Purpose . The application of motor imagery practice in the treatment of Parkinson ’s disease ( PD ) is a novel treatment approach for improving motor function . The purpose of this study was to compare group treatment using a combination of physical and motor imagery practice with group treatment using only physical practice in subjects with PD . Methods . Of 23 patients with idiopathic PD , 12 received combined therapy  , whereas 11 received physical therapy alone . Exercises for both groups were applied during 1-h sessions held twice a week for 12 weeks . Comparable motor tasks provided to both groups included callisthenic exercises , functional tasks , and relaxation exercises . However , the experimental group was treated with both imagery and real practice , whereas the control group received only physical exercises . Outcome measures included the time required to complete sequences of movements , the performance of balance tasks , impairment and functional scores on the Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , and specific cognitive abilities ( Stroop and clock drawing tests ) . Results . Following the intervention , the combined treatment group exhibited significantly faster performance of movement sequences than the control group . In addition , the experimental subjects demonstrated higher gains in the mental and motor subsets of the UPDRS and in the cognitive tests . Both groups improved on the activities of daily living scale . Conclusions . The combination of motor imagery and real practice may be effective in the treatment of PD , especially for reducing bradykinesia . The implementation of this treatment regimen allows for the extension of practice time with negligible risk and low cost OBJECTIVE To study the efficacy of mental imagery at promoting relearning for people after a stroke . DESIGN Prospect i ve , r and omized controlled trial . SETTING An inpatient reh 
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CONCLUSIONS Mental practice might have positive effects on performance of activities in patients with neurological diseases , but this review reports less positive results than earlier published ones .