***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: Aim : To examine the effects of an awareness training protocol embedded within the practice of instrumental activities of daily living ( IADLs ) in participants with acquired brain injury on levels of self-awareness and functional performance . Methods : This study used a r and omized control trial design : 10 participants with moderate-to-severe brain injury received six sessions of the self-awareness training while they performed IADLs ( experimental group ) and 10 participants performed the same IADLs but received conventional therapeutic practice ( control group ) . In the experimental group , participants were asked to predict their performance before each task performance and to estimate their performance level after the performance . Outcome measures : Pre- and post-intervention outcome measures taken from the two groups were compared . Instruments were st and ardized measures of ‘ general ’ self-awareness with collateral reports by informants ( e.g. Awareness Question naire ) ; ‘ task-specific ’ self-awareness ( e.g. Assessment of Awareness of Disability ) and Self-Regulation Skills Inventory ( SRSI ) . Performance on IADLs was assessed using the Assessment of Motor and Process Skills ( AMPS ) . Results : Compared to the control group , the intervention significantly improved IADL performances and self-regulation . No significant treatment effect was observed for task-specific self-awareness , general self-awareness or community integration . Conclusions : The self-awareness intervention significantly but selectively improved self-awareness during IADL task performance as well as functional performance . The need for a larger study with more treatment sessions is discussed OBJECTIVES To evaluate a paging system design ed to improve independence in people with memory problems and executive deficits . METHODS After a successful pilot study , a r and omised control trial was conducted involving a crossover design with 143 people aged between 8 and 83 years . All had one or more of the following : memory , planning , attention , or organisation problems . Most had sustained a traumatic head injury or a stroke although a few had developmental learning difficulties or other conditions . The crossover design ensured that some people received a pager after a 2 week baseline whereas others were required to wait for 7 weeks after the baseline before receiving the pager . Participants were assessed at three time periods — namely , at baseline , 7 weeks , and at 14 weeks postbaseline . RESULTS More than 80 % of those who completed the 16 week trial were significantly more successful in carrying out everyday activities ( such as self care , self medication , and keeping appointments ) when using the pager in comparison with the baseline period . For most of these , significant improvement was maintained when they were monitored 7 weeks after returning the pager . CONCLUSIONS This particular paging system significantly reduces everyday failures of memory and planning in people with brain injury Deficits in attention and executive control are some of the most common , debilitating and persistent consequences of brain injuries . Underst and ing neural mechanisms that support clinical ly significant improvements , when they do occur , may help advance treatment development . Intervening via rehabilitation provides an opportunity to probe such mechanisms . Our objective was to identify neural mechanisms that underlie improvements in attention and executive control with rehabilitation training . We tested the hypothesis that intensive training enhances modulatory control of neural processing of perceptual information in patients with acquired brain injuries . Patients ( n=12 ) participated either in st and ardized training design ed to target goal -directed attention regulation , or a comparison condition ( brief education ) . Training result ed in significant improvements on behavioural measures of attention and executive control . Functional magnetic resonance imaging methods adapted for testing the effects of intervention for patients with varied injury pathology were used to index modulatory control of neural processing . Pattern classification was utilized to decode individual functional magnetic resonance imaging data acquired during a visual selective attention task . Results showed that modulation of neural processing in extrastriate cortex was significantly enhanced by attention regulation training .  Neural changes in prefrontal cortex , a c and i date mediator for attention regulation , appeared to depend on individual baseline state . These behavioural and neural effects did not occur with the comparison condition . These results suggest that enhanced modulatory control over visual processing and a rebalancing of prefrontal functioning may underlie improvements in attention and executive control 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 Objective : Study short- and long-term transfer effects of a computerized working memory ( WM ) training programme for patients suffering from working memory deficits after acquired brain injury . Research design : A controlled experimental study with a cross-over design . Methods : A consecutive sample of 21 subjects . Mean age 43.2 years , time since injury/illness onset 37 months ( median ) . The subjects were r and omly selected into two groups where one group served as controls . All subjects trained daily for 5 weeks in a computer WM task program . They were followed-up at 4 and 20 weeks after the training . Results : A significant improvement in the trained WM tasks , significant improvements in neuropsychological WM-test results at 4 and 20 weeks after training compared to baseline . Improvement in the subjects ’ rated occupational performance and satisfaction with performance in pre-defined occupational problems . Rated quality -of-life did not change . However , rated overall health increased 20 weeks after training . Conclusions : Structured and intense computerized WM training improves subjects ’ cognitive functioning as measured by neuropsychological WM-dem and ing tests , rated occupational performance , satisfaction with performance and rated overall health . The training probably has an impact on the rehabilitation outcome , returning to work , as well as on daily activities for individuals with verified WM impairments 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 - OBJECTIVE To evaluate the effectiveness of a 2-D virtual reality ( 2DVR ) programme in the training of people with stroke on how to access and use the station facilities of the Mass Transit Railway ( MTR ) . METHOD A flat-screen 2DVR based training programme and a corresponding , typical psycho-educational programme with video modelling were developed for comparison through a research design that involved a r and omised control group pre-test and post-test . RESULTS Twenty and sixteen subjects respectively received 10 training sessions using the 2DVR strategy and a video-based psycho-educational programme .  An additional 22 subjects formed the control group . They were assessed by using a behavioural checklist of MTR skills and a newly vali date d MTR self-efficacy scale . The subjects of both training groups showed a significant improvement in their knowledge , skills and self-efficacy in using the MTR ( p<0.01 ) , whereas , the MTR skills and self-efficacy of the control group remained stable over a four-week interval . CONCLUSION Though both training programmes were effective in training the patients with stroke , they demonstrated differential improvements in MTR skills and related self-efficacy . Additional studies are recommended to identify the most effective training procedures for maintaining these skills and the best transfer ratio in the training of VR-based community living skills of people with stroke 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 Jo JM , Kim Y-H , Ko M-H , Ohn SH , Joen B , Lee KH : Enhancing the working memory of stroke patients using tDCS . Am J Phys Med Rehabil 2009;88:404–409 . Objectives : We investigated whether anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex affected the working memory performance of patients after a stroke . Design : Ten patients ( mean age 47.7 yrs ) with cognitive deficits after a first-ever stroke participated in this single-blind , crossover , and sham-controlled experiment . Each patient was r and omly assigned to undergo two transcranial direct current stimulation sessions : anodal dorsolateral prefrontal cortex and sham stimulation within 48 hrs of a washout period . All participants performed a two-back working memory task before and after the administration of the transcranial direct current stimulation . Accuracy ( correction rate ) , recognition accuracy ( correction rate-commission error rate ) , and response time were measured during each experiment . Results : Repeated- measures analysis of variance indicated a significant interaction effect of transcranial direct current stimulation type and time on the recognition accuracy . Post hoc analyses revealed a significant difference between prestimulation and poststimulation in the anodal stimulation group but not in the sham stimulation group . Regarding the accuracy , the paired t test indicated significant improvement only after anodal transcranial direct current stimulation without a significant interaction effect between the two transcran 
    Output:
    
We identified insufficient high- quality evidence to reach any generalised conclusions about the effect of cognitive rehabilitation on executive function , or other secondary outcome measures .