***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 . No rehabilitation intervention has effectively improved functional use of the arm and h and in patients with severe upper limb paresis after stroke . Pilot studies suggest the potential for transcranial direct current stimulation and bilateral robotic training to enhance gains . Objective . In a double-blind , r and omized trial the combination of these interventions was tested . Methods . This study r and omized 96 patients with an ischemic supratentorial lesion of 3 to 8 weeks ’ duration with severe impairment of motor control with a Fugl-Meyer score ( FMS ) for the upper limb < 18 into 3 groups . For 6 weeks , group A received anodal stimulation of the lesioned hemisphere , group B received cathodal stimulation of the nonlesioned side for 20 minutes at 2.0 mA , and group C received sham stimulation . The electrodes were placed over the h and area and above the contralateral orbit . Contemporaneously , the subjects practice d 400 repetitions each of 2 different bilateral movements on a robotic assistive device . Results . The groups were matched at onset . The FMS improved in all patients at 6 weeks ( P < .001 ) . No between-group differences were found ; initial versus finish FMS scores were 7.8 ± 3.8 versus 19.1 ± 14.4 in group A , 7.9 ± 3.4 versus 18.8 ± 10.5 in group B , and 8.2 ± 4.4 versus 19.2 ± 15.0 in group C. No significant changes between groups were present at 3 months . Conclusions . Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness . Unilateral h and training and upregulation of the nonlesioned hemisphere might also be tried in this population Surface electrical stimulation has been applied on a large scale to treat oropharyngeal dysphagia . Patients suffering from oropharyngeal dysphagia in the presence of Parkinson ’s disease have been treated with surface electrical stimulation . Because of controversial reports on this treatment , a pilot study was set up . This study describes the effects of a single session of surface electrical stimulation using different electrode positions in ten patients with idiopathic Parkinson ’s disease ( median Hoehn and Yahr score : II ) and oropharyngeal dysphagia compared to ten age- and gender-matched healthy control subjects during videofluoroscopy of swallowing . Three different electrode positions were applied in r and om order per subject . For each electrode position , the electrical current was respectively turned “ on ” and “ off ” in r and om order . Temporal , spatial , and visuoperceptual variables were scored by experienced raters who were blinded to the group , electrode position , and status ( on/off ) of the electrical current . Interrater and interrater reliabilities were calculated . Only a few significant effects of a single session of surface electrical stimulation using different electrode positions in dysphagic Parkinson patients could be observed in this study . Furthermore , significant results for temporal and spatial variables were found regardless of the status of the electrical current in both groups suggesting placebo effects . Following adjustment for electrical current status as well as electrode positions ( both not significant , P > 0.05 ) in the statistical model , significant group differences between Parkinson patients and healthy control subjects emerged . Further studies are necessary to evaluate the potential therapeutic effect and mechanism of electrical stimulation in dysphagic patients with Parkinson ’s disease Background Progression of Parkinson 's disease ( PD ) is characterised by motor deficits which eventually respond less to dopaminergic therapy and thus pose a therapeutic challenge . Deep brain stimulation has proven efficacy but carries risks and is not possible in all patients . Non-invasive brain stimulation has shown promising results and may provide a therapeutic alternative . Objective To investigate the efficacy of transcranial direct current stimulation ( tDCS ) in the treatment of PD . Design R and omised , double blind , sham controlled study . Setting Research institution . Methods The efficacy of anodal tDCS applied to the motor and prefrontal cortices was investigated in eight sessions over 2.5 weeks . Assessment over a 3 month period included timed tests of gait ( primary outcome measure ) and bradykinesia in the upper extremities , Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Serial Reaction Time Task , Beck Depression Inventory , Health Survey and self- assessment of mobility . Results Twenty-five PD patients were investigated , 13 receiving tDCS and 12 sham stimulation . tDCS improved gait by some measures for a short time and improved bradykinesia in both the on and off states for longer than 3 months . Changes in UPDRS , reaction time , physical and mental well being , and self-assessed mobility did not differ between the tDCS and sham interventions . Conclusion tDCS of the motor and prefrontal cortices may have therapeutic potential in PD but better stimulation parameters need to be established to make the technique clinical ly viable . This study was publicly registered ( clinical trials.org : NCT00082342 ) Few detailed clinico-pathological correlations of Parkinson 's disease have been published . The pathological findings in 100 patients diagnosed prospect ively by a group of consultant neurologists as having idiopathic Parkinson 's disease are reported . Seventy six had nigral Lewy bodies , and in all of these Lewy bodies were also found in the cerebral cortex . In 24 cases without Lewy bodies , diagnoses included progressive supranuclear palsy , multiple system atrophy , Alzheimer 's disease , Alzheimer-type pathology , and basal ganglia vascular disease . The retrospective application of recommended diagnostic criteria improved the diagnostic accuracy to 82 % . These observations call into question current concepts of Parkinson 's disease as a single distinct morbid entity Transcranial direct current stimulation ( tDCS ) of the primary motor h and area ( M1 ) can produce lasting polarity-specific effects on corticospinal excitability and motor learning in humans . In 16 healthy volunteers , O positron emission tomography ( PET ) of regional cerebral blood flow ( rCBF ) at rest and during finger movements was used to map lasting changes in regional synaptic activity following 10 min of tDCS ( + /-1 mA ) . Bipolar tDCS was given through electrodes placed over the left M1 and right frontopolar cortex . Eight subjects received anodal or cathodal tDCS  of the left M1 , respectively . When compared to sham tDCS , anodal and cathodal tDCS induced widespread increases and decreases in rCBF in cortical and subcortical areas . These changes in rCBF were of the same magnitude as task-related rCBF changes during finger movements and remained stable throughout the 50-min period of PET scanning . Relative increases in rCBF after real tDCS compared to sham tDCS were found in the left M1 , right frontal pole , right primary sensorimotor cortex and posterior brain regions irrespective of polarity . With the exception of some posterior and ventral areas , anodal tDCS increased rCBF in many cortical and subcortical regions compared to cathodal tDCS . Only the left dorsal premotor cortex demonstrated an increase in movement related activity after cathodal tDCS , however , modest compared with the relatively strong movement-independent effects of tDCS . Otherwise , movement related activity was unaffected by tDCS . Our results indicate that tDCS is an effective means of provoking sustained and widespread changes in regional neuronal activity . The extensive spatial and temporal effects of tDCS need to be taken into account when tDCS is used to modify brain function BACKGROUND Verbal fluency relies on the coordinated activity between left frontal and temporal areas . Patients with Parkinson 's disease ( PD ) present phonemic and semantic fluency deficits . Recent studies suggest that transcranial direct current stimulation ( tDCS ) enhances adaptative patterns of brain activity between functionally connected areas . OBJECTIVE The aim of this study was to assess the differences in the effects induced by tDCS applied to frontal and temporo-parietal areas on phonemic and semantic fluency functional networks in patients with PD . METHOD Sixteen patients were r and omized to receive tDCS to left dorsolateral prefrontal cortex ( DLPFC ) and left temporo-parietal cortex ( TPC ) in a counterbalanced order . Immediately following stimulation , patients underwent a verbal fluency paradigm inside a fMRI scanner . Changes induced by tDCS in activation and deactivation task-related pattern networks were studied using free-model independent component analyses ( ICA ) . RESULTS Functional connectivity in verbal fluency and deactivation task-related networks was significantly more enhanced by tDCS to DLPFC than to TPC . In addition , DLPFC tDCS increased performance on the phonemic fluency task , after adjusting for baseline phonemic performance . CONCLUSIONS These findings provide evidence that tDCS to specific brain regions induces changes in large scale functional networks that underlay behavioural effects , and suggest that tDCS might be useful to enhance phonemic fluency in PD OBJECTIVE Brain polarization in the form of transcranial direct current stimulation ( tDCS ) , which influences motor function and learning processes , has been proposed as an adjuvant strategy to enhance training effects in Neurorehabilitation . Proper testing in Neurorehabilitation requires double-blind sham-controlled study design s. Here , we evaluated the effects of tDCS and sham stimulation ( SHAM ) on healthy subjects and stroke patients ' self-report measures of attention , fatigue , duration of elicited sensations and discomfort . METHODS tDCS or SHAM was in all cases applied over the motor cortex . Attention , fatigue , and discomfort were self rated by study participants using visual analog scales . Duration of perceived sensations and the ability to distinguish tDCS from Sham sessions were determined . Investigators question ing the patients were blind to the intervention type . RESULTS tDCS and SHAM elicited comparably minimal discomfort and duration of sensations in the absence of differences in attention or fatigue , and could not be distinguished from SHAM by study participants nor investigators . CONCLUSIONS Successful blinding of subjects and investigators and ease of application simultaneously with training protocol s supports the feasibility of using tDCS in double-blind , sham-controlled r and omized trials in clinical Neurorehabilitation . SIGNIFICANCE tDCS could evolve into a useful tool , in addition to TMS , to modulate cortical activity in Neurorehabilitation Background Although levodopa is the most common drug prescribed to relieve the symptoms of Parkinson 's disease it is associated with motor and psychiatric side-effects . Consequently , interest has turned to alternative drugs with improved side-effect profiles to replace or augment levodopa . Amantadine , originally used as an antiviral drug , has been shown to improve the symptoms of Parkinson 's disease . Objectives To compare the efficacy and safety of amantadine therapy ( monotherapy or adjuvant therapy ) versus placebo in treating people with Parkinson 's disease . Search methods Electronic search es of The Cochrane Controlled Trials Register ( The Cochrane Library Issue 3 , 2001 ) , MEDLINE ( 1966 - 2001 ) , EMBASE ( 1974 - 2001 ) , SCI SEARCH ( 1974 - 2001 ) , BIOSIS ( 1993 - 2001 ) , GEROLIT ( 1979 - 2001 ) , OLD MEDLINE ( 1957 - 1965 ) , LILACS ( 1982 - 2001 ) , MedCarib ( 17th Century - 2001 ) , PASCAL ( 1973 - 2001 ) , JICST-EPLUS ( 1985 - 2001 ) , RUSSMED ( 1973 - 2001 ) , DISSERTATION ABSTRACT S ( 2000 - 2001 ) , SIGLE ( 1980 - 2001 ) , ISI-ISTP ( 1990 - 2001 ) , Aslib Index to Theses ( 2001 ) , Clinical trials.gov ( 2001 ) , metaRegister of Controlled Trials ( 2001 ) , NIDRR ( 2001 ) and NRR ( 2001 ) were conducted . Grey literature was h and search ed and the reference lists of identified studies and review s examined . The manufacturers of amantadine were contacted . Selection criteria R and omised controlled trials comparing amantadine with placebo in the treatment of patients with a clinical diagnosis of idiopathic Parkinson 's disease . Data collection and analysis Data was abstract ed independently by NC and KD onto st and ardised forms and disagreements were resolved by discussion . Main results Six r and omised controlled trials were found comparing  amantadine monotherapy or adjuvant therapy with placebo  in the treatment of idiopathic Parkinson 's disease . Five examined amantadine as adjuvant therapy with optimal levels of levodopa or anticholinergics and one examined amantadine as an adjuvant  therapy with minimum tolerated levels of anticholinergics or as a monotherapy .  Five were double-blind cross-over studies and one was a double-blind parallel group study . In total they examined 215 patients . The parallel group study allowed the r and omisation codes to be broken and allowed patients in the placebo group to then receive amantadine . This could have led to bias . One study did not present the results of the placebo arm of the trial , hence we could not determine the difference between the two treatment groups . Two cross-over studies presented the results of the combined data from both treatment and placebo arms . The risk of carry-over effect into the second arm meant that these results could not 
    Output:
    
There is insufficient evidence to determine the effects of tDCS for reducing off time ( when the symptoms are not controlled by the medication ) and on time with dyskinesia ( time that symptoms are controlled but the person still experiences involuntary muscle movements ) , and for improving health- related quality of life , disability , and impairment in patients with IPD .
Evidence of very low quality indicates no difference in dropouts and adverse events between tDCS and control groups