***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: CONTEXT Traumatic brain injury ( TBI ) is a principal cause of death and disability in young adults . Rehabilitation for TBI has not received the same level of scientific scrutiny for efficacy and cost-efficiency that is expected in other medical fields . OBJECTIVE To evaluate the efficacy of inpatient cognitive rehabilitation for patients with TBI . DESIGN AND SETTING Single-center , parallel-group , r and omized trial conducted from January 1992 through February 1997 at a US military medical referral center . PATIENTS One hundred twenty active-duty military personnel who had sustained a moderate-to-severe closed head injury , manifested by a Glasgow Coma Scale score of 13 or less , or posttraumatic amnesia lasting at least 24 hours , or focal cerebral contusion or hemorrhage on computed tomography or magnetic resonance imaging . INTERVENTIONS Patients were r and omly assigned to an intensive , st and ardized , 8-week , in-hospital cognitive rehabilitation program ( n=67 ) or a limited home rehabilitation program with weekly telephone support from a psychiatric nurse ( n=53 ) . MAIN OUTCOME MEASURES Return to gainful employment and fitness for military duty at 1-year follow-up , compared by intervention group . RESULTS At 1-year follow-up , there was no significant difference between patients who had received the intensive in-hospital cognitive rehabilitation program vs the limited home rehabilitation program in return to employment ( 90 % vs 94 % , respectively ; P=.51 ; difference , 4 % [ 95 % confidence interval ¿ CI ¿ , -5 % to 14 % ] ) or fitness for duty ( 73 % vs 66 % , respectively ; P=. 43 ; difference , 7 % [ 95 % CI , -10 % to 24 % ] ) . There also were no significant differences in cognitive , behavioral , or quality -of-life measures . In a post-hoc subset analysis of patients who were unconscious for more than 1 hour ( n = 75 ) following TBI , the in-hospital group had a greater return-to-duty rate ( 80 % vs 58 % ; P=. 05 ) . CONCLUSIONS In this study , the overall benefit of in-hospital cognitive rehabilitation for patients with moderate-to-severe TBI was similar to that of home rehabilitation . These findings emphasize the importance of conducting r and omized trials to evaluate TBI rehabilitation interventions . JAMA . 2000;283:3075 - Thirty-five right brain-damaged ( RBD ) stroke patients , enrolled in active rehabilitation programs , participated in this study . Patients were selected on the basis of their evidence d deficits in performing complex visuo-cognitive tasks and the absence of overt evidence of unilateral visual-spatial neglect . Seventeen of the 35 patients were r and omly chosen to receive a training program ( lasting approximately 1 month ) design ed to establish a systematic strategy of organizing complex visual material . The remaining 18 patients were re-examined after 1 month , and served as controls . The design of the treatment program was based on the hypothesis that nonneglected RBD patients fail to appreciate and synthesize elements of complex visual material due to a breakdown in compensation for a persistent lateral bias in visual-spatial attention . Upon posttesting , it was found that those patients who received training exhibited significantly improved performance , as compared to controls , on a subgroup of visuo-cognitive tasks . These results are discussed in terms of : ( 1 ) offering indirect support for the argument that pathological asymmetries in attention play a significant role in the failure of RBD patients on many visuo-cognitive tasks ; and , ( 2 ) offering a basis for extending the treatment of perceptual problems in RBD patients OBJECTIVE To investigate whether a computer-assisted training ( CAT ) program for patients with left unilateral neglect would decrease symptoms of this disorder . DESIGN Case-control study . SETTING Inpatient rehabilitation unit of a government medical center . PATIENTS Twenty right-h and ed patients who showed left unilateral neglect on screening measures ( Rey-Osterrieth Complex Figure , R and om Letter Cancellation Test ) were assigned to a CAT treatment group ; and 20 patients who showed similar levels of unilateral neglect on the screening measures were assigned to a control group .  INTERVENTIONS All subjects were in patients in an acute rehabilitation unit and received rehabilitation therapy , including physical and occupational therapy . The treatment group received the experimental , CAT program , 12 to 20 sessions of about 45 minutes each . Treatment consisted of 5 modules , each of increasing complexity , to improve attention to stimuli in the left hemisphere , and 2 simulated wheelchair obstacle courses to propel a wheelchair while avoiding obstacles . MAIN OUTCOME MEASURES Computer tasks design ed for this study ( Video Tracking Test , Video Obstacle Course Test ) , a real-life wheelchair obstacle course ( WCOC ) , and incident reports indicating falls and accidents . RESULTS Trained subjects performed significantly better on the WCOC than control subjects ( F(1,36 ) = 23.41 , p = .00003 ) . Also , trained subjects had fewer incident reports than control subjects during their hospitalization ( chi(2)(1,)(n)(=38 ) = 5.15 , p = .023 ) . CONCLUSIONS CAT can reduce unilateral neglect symptoms on experimental tasks and some measures of accident risk Five Veterans Administration Medical Centers participated in an investigation design ed to compare individual with group treatment for aphasic patients who had suffered a left hemisphere cerebral vascular accident . Patients who met selection criteria were assigned r and omly to either traditional , individual , stimulus-response type treatment of specific language deficits or group therapy design ed to improve communication through group interaction and discussion with no direct treatment of specific language deficits . All patients received eight hours of therapy each week beginning at four weeks postonset and continuing until 48 weeks postonset or until they dropped out of the study . A battery of language measures and a clinical neurologic evaluation were administered at intake and every 11 weeks a patient was in the study . Results show both individually and group-treated patients made significant improvement in language abilities . Individual treatment result ed in significantly better overall performance on the Porch Index of Communicative Ability ; however , no significant differences were observed between groups on the other language measures . If the traditional belief is correct that significant spontaneous recovery is complete by three to six months postonset , significant improvement in both groups beyond 26 weeks postonset indicates both individual and group treatment are efficacious methods for managing aphasic patients This report describes NeuroPage , a simple and portable paging system , developed in California by the engineer father of a son with head injury working together with a neuropsychologist . Using an ABA single case experimental design , the efficacy of NeuroPage was evaluated with 15 neurologically impaired subjects all of whom had significant everyday memory problems because of organic memory impairment or because of problems with planning and organisation consequent on frontal lobe damage . Data were analysed with an odds ratio test which takes into account different underlying success rates for each target and calculates an average improvement factor . This test showed a significant improvement between the baseline and the treatment phases for each subject ( P<0.05 ) OBJECTIVES To evaluate comprehensive day treatment ( CDT ) for survivors of brain injury by time since injury and to identify outcome predictors . DESIGN Before and after . SETTING Rehabilitation center . PARTICIPANTS Ninety-six program graduates ; 17 dropouts with acquired brain injury . INTERVENTIONS Comprehensive Day Treatment Program : daily group sessions to build cognitive and behavioral skills through a transdisciplinary approach , supportive feedback , and a variety of therapeutic modalities . Obtained outcome measures before and after the program , and at 1-year follow-up . MAIN OUTCOME MEASURES OUTCOME Independent living status , vocational independence scale at program end and 1-year follow-up ; and Rasch-analyzed Mayo-Portl and Adaptability Inventory ( MPAI-22 ) and goal attainment scaling ( GAS ) at program end . PREDICTORS age , education , severity of initial injury , time since injury , and preadmission MPAI-22 . RESULTS Significant goal achievement on GAS and improvement on MPAI-22 ; increased societal participation at 1-year follow-up for those treated postacutely and many years after injury : 72 % of graduates living independently ; 39 % working independently , 10 % in transitional placements , and 18 % in supported or volunteer work . Long-term outcomes were modestly related linearly to preadmission MPAI-22 and nonlinearly to time since injury . CONCLUSIONS CDT improves societal participation even among persons with a long history of limited participation after brain injury . This de facto extended baseline analysis indicates the effectiveness of CDT and paves the way for r and omized control trials of active treatment components . Relationships of predictors to outcomes are not sufficiently strong for patient selection . More effective interventions for vocational reintegration are needed for those most severely disabled after brain injury We examined the effects of group communication treatment on linguistic and communicative performance in adults with chronic aphasia . Participants were r and omly assigned to two treatment and two deferred treatment groups . Groups were balanced for age , education level , and initial aphasia severity . Twenty-four participants completed the 4-month treatment trial . While in the treatment condition , all participants received 5 hours of group communication treatment weekly , provided by a speech- language pathologist . The focus of treatment included increasing initiation of conversation and exchanging information using whatever communicative means possible . While awaiting group communication treatment , participants in the deferred treatment groups engaged in such activities as support , performance , or movement groups in order to control for the effects of social contact . Linguistic and communicative measures were administered to all participants at entry , after 2 and 4 months of treatment , and following 4 to 6 weeks of no treatment . In addition , participants in the deferred treatment groups received an additional administration of all measures just before their treatment trial . Results revealed that participants receiving group communication treatment had significantly higher scores on communicative and linguistic measures than participants not receiving treatment . In addition , significant increases were revealed after 2 months of treatment and after 4 months of treatment . No significant decline in performance occurred at time of follow-up Two studies assessed the effects of a training procedure ( Goal Management Training , GMT ) , derived from Duncan 's theory of goal neglect , on disorganized behavior following TBI . In Study 1 , patients with traumatic brain injury ( TBI ) were r and omly assigned to brief trials of GMT or motor skills training . GMT , but not motor skills training , was associated with significant gains on everyday paper- and -pencil tasks design ed to mimic tasks that are problematic for patients with goal neglect . In Study 2 , GMT was applied in a postencephalitic patient seeking to improve her meal-preparation abilities . Both naturalistic observation and self-report measures revealed improved meal preparation performance following GMT . These studies provide both experimental and clinical support for the efficacy of GMT toward the treatment of executive functioning deficits that compromise independence in patients with brain damage Objective : To empirically evaluate a method of treating adolescents with cognitive communication disorders , including pragmatic deficits , secondary to acquired brain injury ( ABO in a group setting by objective ly measuring outcomes before treatment and immediately after treatment and at 6 months posttreatment . Design : A before-after trial with follow-up in a consecutive sample , with no control group . Setting : Inpatlent and outpatient pcdiatric rehabilitation center . Subjects : Adolescents who demonstrated pragmatic deficits and scored a rating of 3 or less on each subdomain of the Rehabilitation Institute of Chicago Rating Scale of Pragmatic Communication Skills ( R1CE-RSPCS ) were eligible for the study . Eight subjects were recruited into the study , and two subjects were lost to follow-up . Thus , six of the eight completed the study . Main Outcome Measures : RICE-RSPCS , Communication Performance Scale ( CPS ) . Results : Clinical ly relevant and statistically significant ( P<.01 ) changes occurred during the treatment and were maintained at follow-up for the four RICE-RSPCS subscales and the CPS . Conclusion : These results suggest that the potential and often typical long-term pragmatic and subsequent social difficulties associated with ABI can possibly be lessened through effective intervention This study investigated the remediation and assessment of everyday memory impairment in a sample of long-term acquired brain injury ( ABI ) subjects . The Rivermead Behavioural Memory Test ( RBMT ) and subtests of the Wechsler Memory Scale-Revised ( WMS-R ) were selected to measure global memory performance . A memory question naire and a daily memory checklist were developed from a review of existing self-report question naires . The interrelationships among self-report measures and st and ardized psychometric tests of memory were examined and the findings suggest that self-report measures may be used to obtain relatively accurate information about everyday memory performance . A baseline across groups ' design evaluated the relative effectiveness of two different approaches in training subjects to use a diary to compensate for memory problems . There was a Diary Only ( DO ) approach , which emphasized compensation based upon task specific learning , and a Diary and Self-Instructional Training ( DSIT ) approach , which taught compensation using higher cognitive skills of self-awareness and self-regulation . The results obtained show that , during the treatment phase , the DSIT group more consistently made diary entries , reported less memory problems , and made more positive ratings associated with treatment efficacy . The implication s arising from the current study are that : ( 1 ) the choice of memory assessment procedures need to be guided by the patients ' real daily living needs ; and ( 2 ) an approach based upon self-instructional training has greater ecological validity than an approach that focuses on task specific learning . In general , successful assessment and rehabilitation of memory deficits requires a well-established theoretical basis and sound ecological validity Objective : Evaluate changes in community integration for survivors of traumatic brain injury ( TBI ) who participated in a post-acute rehabilitation programme .  Design : Cohort , prospect i ve study investigating change 
    Output:
    
Treatment effects were moderated by cognitive domain treated , time postinjury , type of brain injury , and age .
The meta- analysis revealed sufficient evidence for the effectiveness of attention training after traumatic brain injury and of language and visuospatial training for aphasia and neglect syndromes after stroke .