***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 and Purpose — The effectiveness of functional electrical stimulation ( FES ) has been investigated in chronic hemiplegia . The present study examines whether FES , given during acute stroke , was more effective in promoting motor recovery of the lower extremity and walking ability than st and ard rehabilitation alone . Methods — Forty-six subjects , 70.9±8.0 years old and 9.2±4.1 days after stroke , were assigned r and omly to 1 of 3 groups receiving st and ard rehabilitation with FES or placebo stimulation or alone ( control ) . FES was applied 30 minutes and placebo stimulation 60 minutes , 5 days per week for 3 weeks . Outcome measurements included composite spasticity score , maximum isometric voluntary contraction of ankle dorsi-flexors and planter-flexors , and walking ability . They were recorded before treatment , weekly during the 3-week treatment , and at week 8 after stroke . Results — No significant differences were found in the baseline measurements . After 3 weeks of treatment , there was a significant reduction in the percentage of composite spasticity score , and a significant improvement in the ankle dorsiflexion torque , accompanied by an increase in agonist electromyogram and a reduction in electromyogram cocontraction ratio in the FES group , when compared with the other 2 groups ( P<0.05 ) . All subjects in the FES group were able to walk after treatment , and 84.6 % of them returned home , in comparison with the placebo ( 53.3 % ) and control ( 46.2 % , P<0.05 ) groups . Conclusions — Fifteen sessions of FES , applied to subjects with acute stroke plus st and ard rehabilitation , improved their motor and walking ability to the degree that more subjects were able to return to home Background and Purpose — Severe upper limb paresis is a major contributor to disability after stroke . This study investigated the efficacy of a new nonrobotic training device , the Sensorimotor Active Rehabilitation Training ( SMART ) Arm , that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension , permitting stroke survivors with severe paresis to practice a constrained reaching task . Methods — A single-blind , r and omized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis . Thirty-three participants completed the study , of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation , 13 received training using the SMART Arm alone , and 10 received no intervention ( control ) . Training consisted of 12 1-hour sessions over 4 weeks . The primary outcome measure was “ upper arm function , ” item 6 of the Motor Assessment Scale . Secondary outcome measures included impairment measures ; triceps muscle strength , reaching force , modified Ashworth scale ; and activity measures : reaching distance and Motor Assessment Scale . Assessment s were administered before ( 0 weeks ) and after training ( 4 weeks ) and at 2 months follow-up ( 12 weeks ) . Results — Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up . There was no significant difference between these 2 groups . There was no change in the control group . Conclusions — Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis , highlighting the benefits of intensive task-oriented practice , even in the context of severe paresis To compare the efficacy of electromyography (EMG)-triggered ( active ) neuromuscular electrical stimulation ( NMES ) and passive NMES in enhancing the upper extremity ( UE ) motor and functional recovery of subacute and chronic stage stroke patients . Thirty-one hemiplegic patients were r and omly assigned to active NMES ( n=11 ) , passive NMES ( n=10 ) , and control ( sham stimulation ) ( n=10 ) groups . Each treatment regimen was applied five times per week for 45 min for 3 weeks . All of the patients performed the same neurophysiologic exercise program for 45 min five times per week for 3 weeks . Patients were assessed by the UE component of the Fugl-Meyer Motor Assessment ( UE-FMA ) , the self-care component of the Functional Independence Measure ( self-care FIM ) , the Motor Activity Log ( MAL ) , goniometric measurements of active wrist and metacarpophalangeal joint extension , surface EMG potentials , grip strength , and the modified Ashworth scale in a blinded manner . Data were obtained before and at the end of the treatment . Participants were similar in all clinical and demographic features ( P>0.05 ) . All groups were comparable with respect to UE-FMA , MAL , self-care FIM , wrist and finger flexor spasticity , active range of motion ( ROM ) , grip strength , and surface EMG potentials before treatment ( P>0.05 ) . The active ROM , grip strength , FMA , FIM , surface EMG potentials , and MAL : amount of use were significantly improved in the EMG-triggered NMES group compared with the controls ( P<0.05 ) . The active wrist extension ROM and FMA scores were significantly improved in the passive NMES group compared with the controls ( P<0.05 ) . There were no statistically significant differences between active and passive NMES groups in any of the parameters evaluated at the end of the treatment ( P>0.05 ) . Both active and passive NMES as adjuvant therapy in the neurophysiologic exercise program effectively enhanced the UE motor and functional recovery of stroke survivors . Vergleich der Wirksamkeit der elektromyographisch (EMG)-getriggerten ( aktiven ) neuromuskulären Elektrostimulation ( NMES ) und passiven NMES zur Verbesserung der motorischen und funktionellen Erholung der oberen Extremitäten bei Schlaganfallpatienten in der subakuten und chronischen Phase . Insgesamt 31 einseitig gelähmte Patienten wurden r and omisiert den aktiven NMES- ( n=11 ) , passiven NMES- ( n=10 ) und Kontrollgruppen ( Sham-Stimulation ) ( n=10 ) zugeordnet . Jede Therapie wurde fünfmal pro Woche jeweils 45 Minuten lang über drei Wochen hinweg angew and t. Alle Patienten unterzogen sich fünfmal pro Woche jeweils 45 Minuten lang über drei Wochen hinweg dem gleichen neurophysiologischen Übungsprogramm . Die Beurteilung der Patienten erfolgte anh and der Komponente “ obere Extremitäten ” des motorischen Funktionstests nach Fugl-Meyer ( UE-FMA ) , der Selbstversorgungskomponente des funktionalen Selbständigkeitsindexes ( Selbstversorgung FIM ) , des Motor Activity Log ( MAL ) , der goniometrischen  Messung der aktiven H and gelenk- und Fingergrundgelenkextension , der Oberflächen-EMG-Potenziale , der Griffstärke und der modifizierten Ashworth-Skala in verblindeter Form . Date n wurden vor und nach Abschluss der Beh and lung erfasst . Die Teilnehmer schnitten bei allen klinischen und demographischen Merkmalen ähnlich ab ( P<0.05 ) . Alle Gruppen waren vergleichbar hinsichtlich UE-FMA , MAL , Selbstversorgungs-FIM , Spastizität der H and gelenks- und Fingerbeuger , aktiver Bewegungsamplitude ( ROM ) , Griffstärke und Oberflächen-EMG-Potenziale vor der Beh and lung ( P>0.05 ) . Aktive ROM , Griffstärke , FMA , FIM , Oberflächen-EMG-Potenziale und MAL : Das Ausmaß der Anwendung war in der EMG-getriggerten NMES-Gruppe verglichen mit den Teilnehmern der Kontrollgruppe signifikant verbessert ( P<0.05 ) . Die ROM- und FMA-Scores der aktiven H and gelenkextension waren in der passiven NMES-Gruppe verglichen mit der Kontrollgruppe signifikant verbessert ( P<0.05 ) . Es lagen keine statistisch signifikanten Unterschiede zwischen den aktiven und passiven NMES-Gruppen bei den zu Ende der Beh and lung beurteilten Parametern vor ( P>0.05 ) . Die aktive und passive NMES als Begleittherapie des neurophysiologischen Übungsprogramms verbesserte die motorische und funktionelle Genesung der oberen Extremitäten von Überlebenden eines Schlaganfalls effektiv . El objetivo de este estudio fue comparar la eficacia de la estimulación eléctrica neuromuscular ( EENM ) ( activa ) mediante electromiografía ( EMG ) y EENM pasiva con respecto a la mejora de la recuperación motora y funcional de las extremidades superiores ( ES ) en pacientes con accidente cerebrovascular subagudo y crónico . Treinta y un pacientes hemiplégicos fueron asignados de forma aleatoria al grupo de EENM activa ( n=11 ) , al grupo de EENM pasiva ( n=10 ) y al grupo control ( estímulo falso ) ( n=10 ) . Cada uno de los tratamientos se aplicó cinco veces a la semana durante 45 minutos , durante 3 semanas . Todos los pacientes fueron sometidos al mismo programa de ejercicios neurofisiológicos , con una duración de 45 minutos , cinco veces a la semana durante 3 semanas . Los pacientes fueron analizados mediante el componente de extremidades superiores de la puntuación de Fugl-Meyer ( FM-ES ) , el componente de cuidado personal de la Medida de Independencia Funcional ( MIF-CP ) , el Registro de Actividad Motora ( MAL , por sus siglas en inglés ) , las medidas goniométricas de la extensión articular activa metacarpofalángica y de la muñeca , los potenciales de EMG de superficie , la fuerza de prensión y la escala modificada de Ashworth con enmascaramiento . Se recopilaron datos previamente y posteriormente al tratamiento . Los participantes poseían características clínicas y demográficas similares ( P<0.05 ) . Todos los grupos eran comparables con respecto a FM-ES , MAL , MIF-CP , la espasticidad flexora de la muñeca y el dedo , el rango activo de movimiento ( RM ) , la fuerza de prensión y los potenciales de EMG de superficie antes de comenzar el tratamiento ( P>0.05 ) . El RM activo , la fuerza de prensión , la puntuación de FM , MIF , los potenciales de EMG de superficie y MAL mejoraron significativamente en el grupo de EENM mediante EMG en comparación con el grupo control ( P<0.05 ) . Las puntuaciones de FM y RM activo de la extensión de la muñeca mejoraron significativamente en el grupo de EENM pasiva en comparación con el grupo control ( P<0.05 ) . No se observaron diferencias estadísticamente significativas entre los grupos de EENM activa y pasiva en ninguno de los parámetros evaluados al finalizar el tratamiento ( P>0.05 ) . Tanto la EENM activa como la EENM pasiva , como tratamientos adyuvantes dentro del programa de ejercicios neurofisiológicos , mejoraron efectivamente la recuperación motora y funcional de los supervivientes de accidente cerebrovascular . Comparer l’efficacité de la stimulation électrique neuromusculaire ( NMES ) déclenchée par électromyographie ( EMG ) ( active ) et de la NMES passive dans l’amélioration de la récupération motrice et fonctionnelle des extrémités supérieures ( UE ) chez les patients victimes d’AVC en phase subaiguë et chronique . Trente et un patients hémiplégiques ont été assignés de manière aléatoire à des groupes de NMES active ( n=11 ) , passive ( n=10 ) et de contrôle ( stimulation leurre ) ( n=10 ) . Chaque traitement a été appliqué cinq fois par semaine pendant 45 min pendant 3 semaines . Tous les patients ont suivi le même programme d’exercice neurophysiologique pendant 45 min , cinq fois par semaine , pendant 3 semaines . Les patients ont été évalués en aveugle par la composante UE de l'évaluation motrice de Fugl-Meyer ( UE-FMA ) , la composante de soins auto-administrés de la mesure d’indépendance fonctionnelle ( FIM soins auto-administrés ) , le  Motor Activity Log ( MAL ) , les mesures goniométriques du poignet actif et de l’extension de l’articulation métacarpophalangienne , les potentiels EMG de surface , la force de préhension et l'échelle Ashworth modifiée . Les données ont été recueillies avant et à la fin du traitement . Les participants présentaient des caractéristiques cliniques et démographiques semblables ( P<0.05 ) . Tous les groupes étaient comparables en ce qui concerne les paramètres UE-FMA , MAL , FIM soins auto-administrés , spasticité des fléchisseurs du poignet et des doigts , amplitude active des mouvements ( ROM ) , force de préhension et potentiels EMG de surface avant le traitement ( P>0.05 ) . ROM active , force de préhension , FMA , FIM , potentiels EMG de surface et MAL : volume d’utilisation significativement amélioré chez le groupe NMES déclenchée par EMG par rapport au groupe témoin ( P<0.05 ) . Les scores ROM et FMA d’extension du poignet actif ont été considérablement améliorés chez le groupe NMES passive par rapport au groupe témoin ( 
    Output:
    
NMES combined with other intervention modalities can be considered as a treatment option that provides improvements in spasticity and range of motion in patients after stroke .