***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 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 Background Most stroke survivors continue to experience motor impairments even after hospital discharge . Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments . Here we assess the impact of at-home VR-based motor training on functional motor recovery , corticospinal excitability and cortical reorganization . Objective The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on ( 1 ) cortical reorganization , ( 2 ) corticospinal tract , and ( 3 ) functional recovery after stroke in comparison to home-based occupational therapy . Methods We conducted a parallel-group , controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities . A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment . A group of subjects was trained using a VR-based system for motor rehabilitation , while the control group followed a conventional therapy .  Motor function was evaluated at baseline , after the intervention , and at 12-weeks follow-up . In a subgroup of subjects , we used Navigated Brain Stimulation ( NBS ) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization . Results Results from the system ’s recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group ( 1.53 , SD 2.4 in Chedoke Arm and H and Activity Inventory ) . However , functional improvements did not reach clinical significance . After the therapy , physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere , that is , abductor pollicis brevis . We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere , which strongly correlated with improvements in clinical scales . Conclusions These findings suggest that , in chronic stages , remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes . Trial Registration International St and ard R and omized Controlled Trial Number NCT02699398 ( Archived by Clinical Trials.gov at https:// clinical trials.gov/ct2/show/NCT02699398?term=NCT02699398&rank=1 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 Late-life depression is associated with high rates of morbidity , premature mortality , disability , functional decline , caregiver burden and increased health care costs . While clinical and public health approaches are focused on prevention or early intervention strategies , the ideal method of intervention remains unclear . No study has set out to evaluate the role of neurobiological agents in preventing depressive symptoms in older population s at risk of depression . Methods / Design Subjects with previously reported sub-threshold depressive symptoms , aged 60 to 74 years , will be screened to participate in a single-centre , double-blind , r and omised controlled trial with three parallel groups involving omega-3 fatty acid supplementation or sertraline hydrochloride , compared with matching placebo .  Subjects will be excluded if they have current depression or suicide ideation ; are taking antidepressants or any supplement containing omega-3 fatty acid ; or have a prior history of stroke or other serious cerebrovascular or cardiovascular disease , neurological disease , significant psychiatric disease ( other than depression ) or neurodegenerative disease . The trial will consist of a 12 month treatment phase with follow-up at three months and 12 months to assess outcome events . At three months , subjects will undergo structural neuroimaging to assess whether treatment effects on depressive symptoms correlate with brain changes . Additionally , proton spectroscopy techniques will be used to capture brain-imaging markers of the biological effects of the interventions . The trial will be conducted in urban New South Wales , Australia , and will recruit a community-based sample of 450 adults . Using intention-to-treat methods , the primary endpoint is an absence of clinical ly relevant depression scores at 12 months between the omega-3 fatty acid and sertraline interventions and the placebo condition . Discussion The current health , social and economic costs of late-life depression make prevention imperative from a public health perspective . This innovative trial aims to address the long-neglected area of prevention of depression in older adults . The interventions are targeted to the pathophysiology of disease , and regardless of the effect size of treatment , the outcomes will offer major scientific advances regarding the neurobiological action of these agents . The main results are expected to be available in 2017.Trial Registration Australian and New Zeal and Clinical Trials Registry ACTRN12610000032055 ( 12 January 2010 Background . Timely provision of an ankle-foot orthosis ( AFO ) orthotist customized for individuals early after stroke can be problematic . Objective . To evaluate the efficacy of a therapist-made AFO ( SWIFT Cast ) for walking recovery . Methods . This was a r and omized controlled , observer-blind trial . Participants ( n = 105 ) were recruited 3 to 42 days poststroke . All received conventional physical therapy ( CPT 
    Output:
    
Other Interventions for Motor Therapy The remaining studies compared various interventions for rehabilitation of motor deficits with control