***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 
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    ***EXAMPLES*** 
    Input: Background Development of longer term stroke rehabilitation services is limited by lack of evidence of effectiveness for specific interventions and service models . We describe the protocol for a multicentre r and omised controlled trial which is evaluating an extended stroke rehabilitation service . The extended service commences when routine ‘ organised stroke care ’ ( stroke unit and early supported discharge ( ESD ) ) ends . Methods / design This study is a multicentre r and omised controlled trial with health economic and process evaluations . It is set within NHS stroke services which provide ESD . Participants are adults who have experienced a new stroke ( and carer if appropriate ) , discharged from hospital under the care of an ESD team . The intervention group receives an extended stroke rehabilitation service provided for 18 months following completion of ESD . The extended rehabilitation service involves regular contact with a senior ESD team member who leads and coordinates further rehabilitation . Contact is usually by telephone . The control group receives usual stroke care post-ESD . Usual care may involve referral of patients to a range of rehabilitation services upon completion of ESD in accordance with local clinical practice . R and omisation is via a central independent web-based service . The primary outcome is extended activities of daily living ( Nottingham Extended Activities of Daily Living Scale ) at 24 months post-r and omisation . Secondary outcomes ( at 12 and 24 months post-r and omisation ) are health status , quality of life , mood and experience of services for patients , and quality of life , experience of services and carer stress for carers . Re source use and adverse events are also collected . Outcomes are undertaken by a blinded assessor . Implementation and delivery of the extended stroke rehabilitation service will also be described . Semi-structured interviews will be conducted with a sub sample of participants and staff to gain insight into perceptions and experiences of rehabilitation services delivered or received . Allowing for 25 % attrition , 510 participants are needed to provide 90 % power to detect a difference in mean Nottingham Extended Activities of Daily Living Scale score of 6 with a 5 % significance level . Discussion The provision of longer term support for stroke survivors is currently limited . The results from this trial will inform future stroke service planning and configuration . Trial registration This trial was registered with IS RCT N ( identifier : IS RCT N45203373 ) on 9 August 2012 Objective : To investigate the effect of community-based ambulation training on walking function of patients with post-stroke hemiparesis . Design : R and omized , single-blind , controlled pilot study . Setting : Inpatient rehabilitation hospital . Subjects : Twenty-five subjects were r and omly assigned to either the experimental group or the control group , with 13 and 12 subjects , respectively . Interventions : All subjects received a routine physical therapy . The subjects in the experimental group also received community-based ambulation training , which was performed for an hour , once a day , three times a week for a four-week period . Main measures : Ten-metre walk test , 6-minute walk test , community walk test , walking ability question naire and activities-specific balance confidence scale before and after the intervention . Results : The change values of the 10-m walk test ( 0.21 ± 0.12 m/s versus 0.07 ± 0.10 m/s ) , community walk test ( −13.61 ± 10.31 minutes versus −3.27 ± 11.99 minutes ) , walking ability question naire ( 6.15 ± 3.60 score versus 2.75 ± 2.38 score ) and activities-specific balance confidence scale ( 17.45 ± 11.55 score versus 2.55 ± 10.14 score ) were significantly higher in the experimental group than in the control group ( P < 0.05 ) . At post-test , the 10-m walk test was significantly higher in the experimental group than in the control group ( 0.72 ± 0.24 m/s versus 0.50 ± 0.23 m/s ) ( P < 0.05 ) . In the experimental group , there were significant differences for all variables between pre-test and post-test ( P < 0.01 ) , whereas the subjects of the control group showed a significant difference in only the walking ability question naire ( P < 0.01 ) . Conclusions : The findings demonstrate that community-based ambulation training can be helpful in improving walking ability of patients with post-stroke hemiparesis and may be used as a practical adjunct to routine rehabilitation therapy Objectives The objective of this study was to test the feasibility of conducting a r and omised controlled trial ( RCT ) of an intervention targeted at activities of daily living ( ADL ) , delivered by an occupational therapist , in homecare reablement . Design Feasibility parallel group RCT . Setting Single-site local authority homecare reablement service . Participants People referred for homecare reablement with ability to consent . Exclusion criteria were as follows : inability to speak English , receiving other community therapy services , needing two or more to assist transfer and receiving end-of-life care . Control ‘ Usual care ’ was 6 weeks of homecare reablement delivered by social care workers ( no routine health professional input ) . Intervention A targeted ADL programme , delivered by an occupational therapist incorporating goal setting , teaching/practising techniques , equipment/adaptations and provision of advice/support . This was in addition to usual care . Outcome measures Aspects of feasibility including eligibility , recruitment , intervention delivery , attrition and suitability and sensitivity of outcome measures . Participant outcomes were personal and extended ADL , quality of life , falls and use of health and social care services . Results 30 participants were recruited , 15 to each arm , which was 60 % of those eligible . Data from 22 ( 73 % ) were analysed at 6 months . Of the 15 participants , 13 ( 86 % ) received the intervention and were able to set one or more ADL goals . There were improvements from baseline in both groups , although overall improvements were greater in the occupational therapy ( OT ) intervention group . The biggest threat to feasibility was a change in service configuration during the trial , involving additional occupational therapy input , affecting usual care and recruitment . Conclusions Despite the service reconfiguration , it was feasible to recruit and retain participants , deliver the intervention and collect outcome data that were responsive to change . The choice of primary outcome measure remains unclear . A further powered study is feasible and warranted ; however , the design will require careful consideration because of ongoing national changes in service configurations . Trial registration number IS RCT N21710246 ; Results Background and Purpose — Current theories of motor control in rehabilitation focus on how the nervous system responds to many types of external and internal constraints to execute motor behavior to accomplish a task . However , the dynamic interplay between these 2 constraints remains unclear . This study examined the impact of some aspects of internal and external constraints on motor performance in persons with stroke . Methods — Twenty-seven persons with stroke used the uninvolved arms  to perform an upper-extremity reaching task under 4 experimental conditions , formed by the crossing of functional goals and personal preferences . For the higher level of a functional goal , subjects took a drink from a can of beverage . For the lower level of a functional goal , subjects brought the can to the mouth without drinking . The level of personal preferences was determined , by interview , by the degree of predilection for particular beverages . Results — Significant and large effects of functional goals and personal preference were found in the variables of movement time and reaction time . However , the data trend of the 4 testing conditions varied according to presence of visuospatial neglect and side of lesion . Conclusions — Offering choices for the treatment activities and incorporating functional goals to therapeutic tasks might enhance response rate or movement efficiency , depending on the side of the lesion and presence of visuospatial neglect . The findings suggest that the consideration of the neglect phenomenon is a necessity when rehabilitative treatment planning incorporates constraint factors 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 OBJECTIVES To compare the benefits of a short-term occupational therapy intervention ( OTI ) when added to the conventional treatment model ( CTM ) in the functional recovery of patients admitted to an acute geriatric unit ( AGU ) . STUDY DESIGN Non-pharmacological r and omized clinical trial . 400 patients were r and omized to OTI ( n = 198 ) or CTM ( n = 202 ) group . Mean age 83.5 . Interventions included needs assessment , iatrogenic prevention , retraining in activities of daily living , and instructions for caregivers in three groups of patients defined a priori ( cardiopulmonary disease , stroke , other conditions ) 5 days a week , 30 - 45 min a day . MAIN OUTCOME MEASURE Recovery of ≥ 10 Barthel index points by discharge . Secondary outcome was the reduction in confusional episodes . RESULTS The adjusted relative risk ( RR ) of functional recovery in the OTI group was 1.16 ( 95%CI 0.91 - 1.47 ) . In participants with cardiopulmonary disease was 1.57 ( 95%CI 1.06 - 2.32 ) , number needed to treat ( NNT ) 5 . Participants with other conditions assigned to OTI had a reduction in acute confusional episodes ; RR 0.48 ( 95 % CI 0.26 - 0.87 ) , NNT 7 . CONCLUSIONS Although overall there were no significant differences , patients with cardiopulmonary disease or non-stroke pathologies admitted to an AGU , may benefit from a short-term OTI The objective of this study was to develop and examine the effectiveness of an individual home rehabilitation program for patients with ischemic stroke . This was a r and omized controlled trial in 60 patients with recent middle cerebral artery infa rct ion . After hospital discharge for acute stroke care , they were r and omly assigned to receive either a home rehabilitation program for three months ( intervention group ) or usual care ( control group ) . We collected outcome data over three months after their discharge from the hospital .  The Barthel Index ( BI ) , the Modified Rankin Scale ( MRS ) , the health-related quality -of-life index ( EQ-5D ) , the Hospital Anxiety and Depression score ( HADs ) , and the Thai Mental State Examination ( TMSE ) were used to analyze the outcomes . In the intervention group , all outcomes were significantly better ( p<0.05 ) than in the control group , except in the case of TMSE . A favorable outcome , which was defined as minimal or no disability as measured by BI ( score 95–100 ) , was achieved by 93.33 % of patients in the intervention group , and 90 % had favorable scores ( 0 or 1 ) on the MRS . This showed a benefit in reducing disability , with two being the number of patients considered as needed-to-treat ( NNT ) ( 95 % CI , 1.0–1.2 ) . All dimensions of EQ-5D in the intervention group were significantly better for quality of life and generic health status than in the control group ( p=0.001 ) . Depression was found in one patient ( 3.33 % ) in the intervention group and in two patients ( 6.67 % ) in the control group . Dementia was found in three patients ( 10 % ) in the intervention group and in four patients ( 13.33 % ) in the control group . We concluded that an early home rehabilitation program for patients with ischemic stroke in the first three-month period provides significantly better outcomes in improving function , reducing disability , increasing quality of life , and reducing depression than a program of usual care does Objective : To assess the effectiveness of community-based rehabilitation for stroke patients who were not admitted to hospital in South London . Design : R and omized controlled trial . Setting : Patients ' homes in South London . Subjects : Stroke patients not admitted to hospital after a stroke . Intervention : Rehabilitation at home by rehabilitation team for up to three months or usual care . Main outcome measures : The primary outcome measure was the Barthel score . Secondary measures included the Motricity Index , Rivermead ADL , Hospital Anxiety and Depression score and Nottingham Health Profile . Results : Forty-three patients who remained at home were r and omized to rehabilitation team ( 23 ) or ‘ usual ’ care ( 20 ) . The mean number of physiotherapy sessions was three ( range 1–14 ) for the rehabilitation team group and two for the usual care group . Patients ( with a deficit ) in the rehabilitation arm of the trial were more likely to receive  occupational , physical and speech therapy  than those 
    Output:
    
We found low- quality evidence that occupational therapy targeted towards activities of daily living after stroke can improve performance in activities of daily living and reduce the risk of deterioration in these abilities .
Because the included studies had method ological flaws , this research does not provide a reliable indication of the likely effect of occupational therapy for adults with stroke