***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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    Input: OBJECTIVE To examine rehabilitation interventions and result ing physical activity patterns of patients managed in acute stroke units to help inform development of a r and omized controlled trial of very early rehabilitation . DESIGN An open observational study of patient activity and therapist report of patient interventions . A survey of stroke unit re sources . METHODS Patients less than 14 days post-stroke from 5 metropolitan stroke units were observed over 2 consecutive weekdays at 10-minute intervals between 08.00 h and 17.00 h. Physical activity , location and person(s ) present were ascertained at each observation . Therapists completed treatment records . Senior staff completed stroke unit surveys . RESULTS Patients after stroke ( n=58 ) were with therapists 5.2 % of the observed day . Few patients ( 17.1 % ) received  daily therapy  by more than one therapist . When patients received therapy , average session times were 24 minutes of physiotherapy , 23 minutes of occupational therapy and 33 minutes of speech pathology .  The more time that family members were present , the longer the treatment time . Four to 11 min of upper-limb therapy was provided . Muscle weakness and left hemiparesis were associated with less upper-limb activity . CONCLUSION These acute stroke care units were re source d according to recommended staff-patient ratios . Patients received little therapy and had low levels of physical activity Background and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 13 days ) . Only 9 patients were restricted to bed . During the therapeutic day , patients spent > 50 % resting in bed , 28 % sitting out of bed , and only 13 % engaged in activities with the potential to prevent complications and improve recovery of mobility . Patients were alone > 60 % of the time . Conclusions — This is the first multicenter study of physical activity early after stroke . We believe the next step is to conduct a r and omized controlled trial to evaluate the effect of increased levels of  physical activity  early after stroke compared with current st and ards of care Summary Exercise may be a viable way to promote bone health in stroke survivors . This study used the osteogenic index to evaluate the osteogenic potential of selected exercises for stroke survivors . The results show that brisk walking and stepping may be good skeletal loading exercises for this population . Introduction Exercise may induce positive effects on bone health in stroke patients . The purpose of this study was to evaluate the osteogenic potential of selected exercises for stroke survivors . Methods Sixty stroke patients were categorized into group 1 ( moderate to severe leg motor impairment ) and group 2 ( mild to moderate impairment ) . Each subject performed five exercises in r and om order : walking at self-selected speed , walking at maximal speed , stepping onto a 6-in . riser , sit-to-st and , and jumping . The peak ground reaction force ( GRF ) on the hemiparetic side and the number of loading cycles achieved in 1 min were determined . The osteogenic index ( OI ) was computed for each exercise , based on the formula : OI = Peak GRF ( in body weight ) × In ( number of loading cycles + 1 ) . Two-way analysis of variance was used to compare the OI among the five exercises between the two groups . Results For group 1 , stepping had significantly higher OI than other exercises ( p < 0.001 ) . For group 2 , both walking at maximal speed and stepping had significantly higher OI than other exercises ( p < 0.001 ) . Conclusions Stepping had the highest OI for those with more severe leg motor impairment . Both stepping and brisk walking had superior OI for those with mild leg motor impairment Background and Purpose — Insulin resistance and glucose intolerance are highly prevalent after stroke , contributing to worsening cardiovascular disease risk and a predisposition to recurrent stroke . Treadmill exercise training ( T-AEX ) increases aerobic capacity ( Vo2 peak ) in chronic stroke patients , suggesting intensity levels that may be adequate to improve glucose metabolism . We compared the effects of a progressive T-AEX intervention to an attention-matched stretching intervention ( CONTROL ) on glucose tolerance and indices of insulin sensitivity in stroke survivors . Methods — Participants had hemiparetic gait after remote ( > 6 months ) ischemic stroke . They were r and omized to 6-month T-AEX or a duration matched reference CONTROL program of supervised stretching exercises . Main outcome measures were glucose and insulin responses during a 3-hour oral glucose tolerance test ( OGTT ) . Results — Forty-six subjects ( T-AEX=26 , CONTROL=20 ) completed OGTT testing before and after the interventions . T-AEX  increased Vo2 peak ( + 15 % versus −3 % & Dgr ; , P<0.01 ) compared with CONTROL . There were significant reductions in fasting insulin ( −23 % versus + 9 % & Dgr ; , P<0.05 ) and the total integrated 3-hour insulin response ( −24 % versus + 3 % & Dgr ; , P<0.01 ) in T-AEX compared with CONTROL . In patients with abnormal glucose tolerance at baseline , T-AEX result ed in a significant 14 % decrease in 3-hour glucose response ( n=12 , P<0.05 ) . Fifty-eight percent of T-AEX participants with abnormal baseline OGTT ( 7 of 12 ) improved glucose tolerance status at 2 hours compared with < 10 % ( 1 of 11 ) of impaired CONTROLS ( P<0.05 ) . Conclusions — These preliminary findings suggest that progressive aerobic exercise can reduce insulin resistance and prevent diabetes in hemiparetic stroke survivors . Larger clinical trials are needed to definitively establish the use of structured exercise training for stimulating metabolic improvement poststroke Background and Purpose — Stroke patients may have an increased risk of fractures because of weak bones or an increased risk of falling . Our goal was to estimate the frequency of fracture after stroke and to identify those at greatest risk . Methods — This study incorporated 2 complementary strategies : a prospect i ve , single-center , cohort study and an analysis of Scottish routine hospital discharge data  . Results — Eighty-eight fractures ( 30 % hip ) occurred in 2696 hospital-referred stroke patients . The proportions sustaining any fracture or hip fracture within 2 years were 4 % and 1.1 % , respectively , 1.4 ( 95 % CI , 0.92 to 2.07 ) times the rate of hip fracture in the general population ( ie , observed number divided by expected number or st and ardized morbidity ratio ) . Female sex , older age , low abbreviated mental test score , and prestroke dependence were associated with an increased hip fracture rate . Routine data identified 129 935 acute stroke patients admitted to Scottish hospitals . During 363 447 patient-years , 4528 patients had hip fractures  , 2.0 % had fractures by 1 year , and 10.6 % had fractures by 10 years . This is 1.7 times the rate of hip fracture in the general population and 2.3 times that in patients with myocardial infa rct ion . Older patients predictably had the highest rate of poststroke hip fractures but a lower st and ardized morbidity ratio than younger patients . Conclusions — Fractures after stroke are probably frequent and serious enough to justify the development of preventive strategies , but the modest event rate would mean that r and omized , controlled trials to test these strategies specifically in stroke patients would need to enroll thous and s of patients There are no studies in the literature on the effect of exercise in reversing osteoporosis of the upper extremities for people with neurological disorders . The purpose of this study was to explore what conditions respond to a home exercise program for the upper extremities . Sixteen patients , divided r and omly into experimental and control groups , were recruited for this trial for at least one year . Both upper extremities of the patients , affected and unaffected , were tested pre and post trial with the Hologic QDR for bone area , bone mineral content ( BMC ) , bone mineral density ( BMD ) , fat , muscle mass , muscle mass plus BMD , total weight , and relative fat content ( percent ) . The home exercise program involved the subject squeezing a ball , one h and at a time , 20 times each , three times a day , at least three times a week , while sitting with the elbow flexed and the arm resting comfortably at the side of the trunk or on an armrest . A significant difference ( p < 0.02 ) was found in bone area , BMC , BMD or relative fat content between the affected and sound sides both before and after the study , although all parameters were much different for each patient . We found a statistically significant difference in a change in the bone area for the affected upper extremities of the control group , but not of the experimental group . Subjective reactions of the subjects were positive . They stated that they felt they were improving and contributing to their recovery . Patients with Parkinson 's disease , but not those with cerebral infa rct ion , seemed to react to the exercise with an increase in bone mineral content , although the difference was not significant due to the scarce number of subjects . This is a preliminary pilot study to help develop further research on what condition is likely to respond to exercise for protection against osteoporosis Summary A large population -based r and om sample of Australian white men was used to provide normative bone mineral density ( BMD ) data at multiple anatomical sites . The femoral neck BMD data are very similar to those obtained in USA non-Hispanic white males participating in the National Health and Nutrition Examination Survey III ( NHANES III ) . The reference ranges will be suitable for similar population s. Introduction To provide normative BMD data for Australian men derived from a large population -based r and om sample . Methods An age-stratified r and om sample of men was recruited from the Australian electoral rolls ( n = 1,467 aged 20–97 years ) .  BMD was quantified at multiple sites using Lunar densitometers . Results Age-related differences in BMD were best predicted by linear relationships at the spine and hip and by quadratic functions at the whole body and forearm . At the spine , a small age-related increase in mean BMD was observed . Although in the subset with no spinal abnormalities , there was a decrease of 0.003 g/cm2 per year from age 20 . At the hip sites , mean BMD decreased at 0.001–0.006 g/cm2 per year from age 20 . At the forearm and whole body , BMD peaked at 41–47 years . Apart from a small difference in men greater than or equal to 80 years , the Australian femoral neck BMD data are not different to those obtained in USA non-Hispanic white males participating in NHANES III and were generally similar to those of large studies from Canada ( CaMos ) and Spain . Conclusions These data supply BMD reference ranges at multiple anatomical sites that will be applicable to white Australian men and similar population s such as USA non-Hispanic white men Abstract : Fractures are a common and serious complication after stroke and the risk of hip fractures among stroke patients is 2 to 4 times greater than among other elderly people . The aim of this study was to investigate prospect ively the change in bone mineral density ( BMD ) after severe stroke and to study the association between motor impairment , disability and the development of hemiosteoporosis . The study comprised 24 stroke patients , with no persistent paresis from previous strokes or previous osteoporotic fractures , included 1 month after stroke onset .  BMD , motor function , ambulation and activities of daily living ( ADL )  were assessed at 1 , 4 , 7 and 12 months after stroke onset . At inclusion , the patients ’ BMD was normal for their age . During the study , there was a significant loss of BMD in the total body ( −2.0 % ; p<0.05 ) , but not in the head or spine . BMD differed significantly between the paretic and the non-paretic arm at inclusion ( −4.8 % ; p<0.001 ) . Decrease in BMD was most pronounced in the affected humerus ( −17.4 % ; p<0.001 ) and proximal femur ( −12.2 % ; p<0.01 ) . BMD decreased significantly in both lower extremities during follow-up , but the losses were more pronounced on the paretic side ( p<0.01 ) . In the nonaffected ultradistal radius there was a significant increase in BMD from inclusion to the end of the study ( + 5.8 % ; p<0.01 ) . There was no pattern in the bone losses correlating with presumptive risk factors for hemiosteoporosis such as motor function , ability to perform ADL or ambulation . Two patients had fractures at follow-up , both on the paretic side . Loss of bone mineral density in the paretic extremities is thus pronounced and progressive during the first year after stroke , indicating that loss of BMD is probably an important risk factor for post-stroke f 
    Output:
    
Interventions are likely to be beneficial if implemented soon after stroke , when bone loss appears to be rapid and pronounced