human
***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 When people with stroke recover gait speed , they report improved function and reduced disability . However , the minimal amount of change in gait speed that is clinical ly meaningful and associated with an important difference in function for people poststroke has not been determined . Objective The purpose of this study was to determine the minimal clinical ly important difference ( MCID ) for comfortable gait speed ( CGS ) associated with an improvement in the modified Rankin Scale ( mRS ) score for people between 20 to 60 days poststroke . Design This was a prospect i ve , longitudinal , cohort study . Methods The participants in this study were 283 people with first-time stroke prospect ively enrolled in the ongoing Locomotor Experience Applied Post Stroke ( LEAPS ) multi-site r and omized clinical trial . Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke . Improvement of ≥1 on the mRS was used to detect meaningful change in disability level . Results Mean ( SD ) CGS was 0.18 ( 0.16 ) m/s at 20 days and 0.39 ( 0.22 ) m/s at 60 days poststroke . Among all participants , 47.3 % experienced an improvement in disability level ≥1 . The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS . Limitations Because the mRS is not a gait-specific measure of disability , the estimated MCID for CGS was only 73.9 % sensitive and 57.0 % specific for detecting improvement in mRS scores . Conclusions We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s . Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not . Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke OBJECTIVE To evaluate gait biomechanics after training with a virtual reality ( VR ) system and to eluci date underlying mechanisms that contributed to the observed functional improvement in gait speed and distance . DESIGN A single blind r and omized control study . SETTING Gait analysis laboratory in a rehabilitation hospital and the community . PARTICIPANTS Fifteen men and three women with hemiparesis caused by stroke . INTERVENTIONS Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation . Subjects were r and omized to either a VR group ( n=9 ) or non-VR group ( NVR , n=9 ) . Training was performed three times a week for 4 weeks for approximately 1h each visit . MAIN OUTCOME MEASURES Kinematic and kinetic gait parameters . RESULTS Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training ( p=0.036 ) . The VR group had greater change in ankle ROM post-training ( 19.5 % ) as compared to the NVR group ( 3.3 % ) . Significant differences were found in knee ROM on the affected side during stance and swing , with greater change in the VR group . No significant changes were observed in kinematics or kinetics of the hip post-training . CONCLUSIONS These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis . It is likely that the effects of training included improved motor control at the ankle , which enabled the cascade of changes that produced the functional improvements seen after training Background and Purpose — Gait velocity is a powerful indicator of function and prognosis after stroke . Gait velocity can be stratified into clinical ly meaningful functional ambulation classes , such as household ambulation ( < 0.4 m/s ) , limited community ambulation ( 0.4 to 0.8 m/s ) , and full community ambulation ( > 0.8 m/s ) . The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinical ly meaningful changes in stroke-related function and quality of life . Methods — In subacute stroke survivors with mild to moderate deficits who participated in a r and omized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less , we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale ( SIS ) . Results — Of 64 eligible participants , 19 were initially household ambulators , and 12 of them ( 68 % ) transitioned to limited community ambulation , whereas of 45 initially limited community ambulators , 17 ( 38 % ) became full community ambulators . Function and quality -of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not . Among household ambulators , those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility ( P=0.0299 ) and participation ( P=0.0277 ) . Among limited community ambulators , those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation ( P=0.0085 ) . Conclusions — A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life , especially for household ambulators . Household ambulators possibly had more severe stroke deficits , reducing the risk of “ ceiling ” effects in SIS-measured activities of daily living and instrumental activities of daily living . Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit . Outcomes should be selected that are clinical ly meaningful for all levels of severity Background and Purpose — Training of the lower extremity ( LE ) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion . The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone . Methods — A single , blind , r and omized clinical trial was conducted . Eighteen individuals poststroke participated in a 4-week training protocol . One group trained with the robot virtual reality ( VR ) system and the other group trained with the robot alone . Outcome measures were temporal features of gait measured in a laboratory setting and the community . Results — Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone . Similarly , significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR . These differences were maintained at 3 months ’ follow-up . Conclusions — The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone Background and Purpose — Hemiparesis result ing in functional limitation of an upper extremity is common among stroke survivors . Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery , limited evidence is available on the efficacy of virtual reality for stroke rehabilitation . Methods — In this pilot , r and omized , single-blinded clinical trial with 2 parallel groups involving stroke patients within 2 months , we compared the feasibility , safety , and efficacy of virtual reality using the Nintendo Wii gaming system ( VRWii ) versus recreational therapy ( playing cards , bingo , or “ Jenga ” ) among those receiving st and ard rehabilitation to evaluate arm motor improvement . The primary feasibility outcome was the total time receiving the intervention . The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period . Efficacy , a secondary outcome measure , was evaluated with the Wolf Motor Function Test , Box and Block Test , and Stroke Impact Scale at 4 weeks after intervention . Results — Overall , 22 of 110 ( 20 % ) of screened patients were r and omized . The mean age ( range ) was 61.3 ( 41 to 83 ) years . Two participants dropped out after a training session . The interventions were successfully delivered in 9 of 10 participants in the VRWii and 8 of 10 in the recreational therapy arm . The mean total session time was 388 minutes in the recreational therapy group compared with 364 minutes in the VRWii group ( P=0.75 ) . There were no serious adverse events in any group . Relative to the recreational therapy group , participants in the VRWii arm had a significant improvement in mean motor function of 7 seconds ( Wolf Motor Function Test , 7.4 seconds ; 95 % CI , −14.5 , −0.2 ) after adjustment for age , baseline functional status ( Wolf Motor Function Test ) , and stroke severity . Conclusions — VRWii gaming technology represents a safe , feasible , and potentially effective alternative to facilitate rehabilitation therapy and promote motor recovery after stroke OBJECTIVES To investigate the effect of Nintendo Wii ™ -based motor cognitive training versus balance exercise therapy on activities of daily living in patients with Parkinson 's disease . DESIGN Parallel , prospect i ve , single-blind , r and omised clinical trial . SETTING Brazilian Parkinson Association . PARTICIPANTS Thirty-two patients with Parkinson 's disease ( Hoehn and Yahr stages 1 and 2 ) . INTERVENTIONS Fourteen training sessions consisting of 30 minutes of stretching , strengthening and axial mobility exercises , plus 30 minutes of balance training . The control group performed balance exercises without feedback or cognitive stimulation , and the experimental group performed 10 Wii Fit ™ games . MAIN OUTCOME MEASURE Section II of the Unified Parkinson 's Disease Rating Scale ( UPDRS-II ) . R AND OMISATION Participants were r and omised into a control group ( n=16 ) and an experimental group ( n=16 ) through blinded drawing of names . STATISTICAL ANALYSIS Repeated- measures analysis of variance ( RM-ANOVA ) . RESULTS Both groups showed improvement in the UPDRS-II with assessment effect ( RM-ANOVA P<0.001 , observed power=0.999 ) . There was no difference between the control group and the experimental group before training { 8.9 [ st and ard deviation ( SD ) 2.9 ] vs 10.1 ( SD 3.8 ) } , after training [ 7.6 ( SD 2.9 ) vs 8.1 ( SD 3.5 ) ] or 60 days after training [ 8.1 ( SD 3.2 ) vs 8.3 ( SD 3.6 ) ] . The mean difference of the whole group between before training and after training was -0.9 ( SD 2.3 , 95 % confidence interval -1.7 to -0.6 ) . CONCLUSION Patients with Parkinson 's disease showed improved performance in activities of daily living after 14 sessions of balance training , with no additional advantages associated with the Wii-based motor and cognitive training . Registered on http://www . clinical trials.gov ( identifier : NCT01580787 ) Purpose . This study examined the association between impaired physical function and participation in  community ambulation  following stroke . We hypothesised that participation would be significantly less following stroke , and that physical impairments would be associated with participation . Method . Using a case – control design 30 survivors of stroke aged 45 and older and 30 controls provided health status information and a self-report of participation in community ambulation  ( number of trips and walking-related activities ( WRA ) reported prospect ively over a 12-day period ) . The association of physical impairments ( strength , range of motion , sensation , muscle tone , vision , and activity limitations ( gait speed and performance on complex walking tasks ) ) with level of participation was analysed using negative binomial regression and goodness of fit . Results . Participants included 30 individuals with and 30 without stroke , average age 68 years , majority were Caucasian women . Average time  since stroke was 40 months . Participation in survivors of stroke was characterised by fewer trips and WRA and lower satisfaction ( p < 0.001 ) . Usual gait speed , balance , muscle strength and muscle length were impaired ( p < 0.001 ) in stroke vs. controls , and associated with number of trips and WRA ( p < 0.05 ) . However , these factors explained less than very little of the variance in participation . Conclusions . While individual factors were associated with level of participation , results failed to accurately predict participation in community ambulation following stroke . Other factors , such as depression , cognition and self-efficacy may be stronger determinants of participation Objective : This study examined the effects of treadmill training with optic flow on the functional recovery of balance and gait in stroke patients . Design : R and omized controlled experimental study . Participants : Thirty patients following stroke were divided r and omly into the treadmill with optic flow group ( n = 10 ) , treadmill group ( n = 10 ) and control group ( n = 10 ) . Interventions : The subjects in the experimental group wore a head-mounted display to receive speed-modulated optic flow during treadmill training for 30 minutes , while those in the treadmill group and control group received treadmill training and regular therapy for the same time , three times a week for four weeks . Main measures : The data were collected using timed up- and -go test , functional reach test , 10-m walk test , and six-minute walk test before and after treatment . Results : The timed up- and -go test in the treadmill with optic flow group ( 5.55 ± 2.04 ) improved significantly greater than the treadmill ( 1.50 ± 0.93 ) and control ( 0.40 ± 0.84 ) groups . The functional reach test in the treadmill with optic flow group ( 2.78 ± 1.44 ) was significantly higher than the control group ( 0.20 ± 0.16 ) only . The gait velocity in the treadmill with optic flow group ( 0.21 ± 0.06 ) showed a significant decrease compared to the treadmill ( 0 
    Output:
    
agent
CONCLUSIONS : This review provided evidence that walking training associated with virtual reality-based training was effective in increasing walking speed after stroke , and result ed in better results than non-virtual reality interventions
***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 When people with stroke recover gait speed , they report improved function and reduced disability . However , the minimal amount of change in gait speed that is clinical ly meaningful and associated with an important difference in function for people poststroke has not been determined . Objective The purpose of this study was to determine the minimal clinical ly important difference ( MCID ) for comfortable gait speed ( CGS ) associated with an improvement in the modified Rankin Scale ( mRS ) score for people between 20 to 60 days poststroke . Design This was a prospect i ve , longitudinal , cohort study . Methods The participants in this study were 283 people with first-time stroke prospect ively enrolled in the ongoing Locomotor Experience Applied Post Stroke ( LEAPS ) multi-site r and omized clinical trial . Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke . Improvement of ≥1 on the mRS was used to detect meaningful change in disability level . Results Mean ( SD ) CGS was 0.18 ( 0.16 ) m/s at 20 days and 0.39 ( 0.22 ) m/s at 60 days poststroke . Among all participants , 47.3 % experienced an improvement in disability level ≥1 . The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS . Limitations Because the mRS is not a gait-specific measure of disability , the estimated MCID for CGS was only 73.9 % sensitive and 57.0 % specific for detecting improvement in mRS scores . Conclusions We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s . Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not . Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke OBJECTIVE To evaluate gait biomechanics after training with a virtual reality ( VR ) system and to eluci date underlying mechanisms that contributed to the observed functional improvement in gait speed and distance . DESIGN A single blind r and omized control study . SETTING Gait analysis laboratory in a rehabilitation hospital and the community . PARTICIPANTS Fifteen men and three women with hemiparesis caused by stroke . INTERVENTIONS Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation . Subjects were r and omized to either a VR group ( n=9 ) or non-VR group ( NVR , n=9 ) . Training was performed three times a week for 4 weeks for approximately 1h each visit . MAIN OUTCOME MEASURES Kinematic and kinetic gait parameters . RESULTS Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training ( p=0.036 ) . The VR group had greater change in ankle ROM post-training ( 19.5 % ) as compared to the NVR group ( 3.3 % ) . Significant differences were found in knee ROM on the affected side during stance and swing , with greater change in the VR group . No significant changes were observed in kinematics or kinetics of the hip post-training . CONCLUSIONS These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis . It is likely that the effects of training included improved motor control at the ankle , which enabled the cascade of changes that produced the functional improvements seen after training Background and Purpose — Gait velocity is a powerful indicator of function and prognosis after stroke . Gait velocity can be stratified into clinical ly meaningful functional ambulation classes , such as household ambulation ( < 0.4 m/s ) , limited community ambulation ( 0.4 to 0.8 m/s ) , and full community ambulation ( > 0.8 m/s ) . The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinical ly meaningful changes in stroke-related function and quality of life . Methods — In subacute stroke survivors with mild to moderate deficits who participated in a r and omized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less , we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale ( SIS ) . Results — Of 64 eligible participants , 19 were initially household ambulators , and 12 of them ( 68 % ) transitioned to limited community ambulation , whereas of 45 initially limited community ambulators , 17 ( 38 % ) became full community ambulators . Function and quality -of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not . Among household ambulators , those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility ( P=0.0299 ) and participation ( P=0.0277 ) . Among limited community ambulators , those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation ( P=0.0085 ) . Conclusions — A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life , especially for household ambulators . Household ambulators possibly had more severe stroke deficits , reducing the risk of “ ceiling ” effects in SIS-measured activities of daily living and instrumental activities of daily living . Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit . Outcomes should be selected that are clinical ly meaningful for all levels of severity Background and Purpose — Training of the lower extremity ( LE ) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion . The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone . Methods — A single , blind , r and omized clinical trial was conducted . Eighteen individuals poststroke participated in a 4-week training protocol . One group trained with the robot virtual reality ( VR ) system and the other group trained with the robot alone . Outcome measures were temporal features of gait measured in a laboratory setting and the community . Results — Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone . Similarly , significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR . These differences were maintained at 3 months ’ follow-up . Conclusions — The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone Background and Purpose — Hemiparesis result ing in functional limitation of an upper extremity is common among stroke survivors . Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery , limited evidence is available on the efficacy of virtual reality for stroke rehabilitation . Methods — In this pilot , r and omized , single-blinded clinical trial with 2 parallel groups involving stroke patients within 2 months , we compared the feasibility , safety , and efficacy of virtual reality using the Nintendo Wii gaming system ( VRWii ) versus recreational therapy ( playing cards , bingo , or “ Jenga ” ) among those receiving st and ard rehabilitation to evaluate arm motor improvement . The primary feasibility outcome was the total time receiving the intervention . The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period . Efficacy , a secondary outcome measure , was evaluated with the Wolf Motor Function Test , Box and Block Test , and Stroke Impact Scale at 4 weeks after intervention . Results — Overall , 22 of 110 ( 20 % ) of screened patients were r and omized . The mean age ( range ) was 61.3 ( 41 to 83 ) years . Two participants dropped out after a training session . The interventions were successfully delivered in 9 of 10 participants in the VRWii and 8 of 10 in the recreational therapy arm . The mean total session time was 388 minutes in the recreational therapy group compared with 364 minutes in the VRWii group ( P=0.75 ) . There were no serious adverse events in any group . Relative to the recreational therapy group , participants in the VRWii arm had a significant improvement in mean motor function of 7 seconds ( Wolf Motor Function Test , 7.4 seconds ; 95 % CI , −14.5 , −0.2 ) after adjustment for age , baseline functional status ( Wolf Motor Function Test ) , and stroke severity . Conclusions — VRWii gaming technology represents a safe , feasible , and potentially effective alternative to facilitate rehabilitation therapy and promote motor recovery after stroke OBJECTIVES To investigate the effect of Nintendo Wii ™ -based motor cognitive training versus balance exercise therapy on activities of daily living in patients with Parkinson 's disease . DESIGN Parallel , prospect i ve , single-blind , r and omised clinical trial . SETTING Brazilian Parkinson Association . PARTICIPANTS Thirty-two patients with Parkinson 's disease ( Hoehn and Yahr stages 1 and 2 ) . INTERVENTIONS Fourteen training sessions consisting of 30 minutes of stretching , strengthening and axial mobility exercises , plus 30 minutes of balance training . The control group performed balance exercises without feedback or cognitive stimulation , and the experimental group performed 10 Wii Fit ™ games . MAIN OUTCOME MEASURE Section II of the Unified Parkinson 's Disease Rating Scale ( UPDRS-II ) . R AND OMISATION Participants were r and omised into a control group ( n=16 ) and an experimental group ( n=16 ) through blinded drawing of names . STATISTICAL ANALYSIS Repeated- measures analysis of variance ( RM-ANOVA ) . RESULTS Both groups showed improvement in the UPDRS-II with assessment effect ( RM-ANOVA P<0.001 , observed power=0.999 ) . There was no difference between the control group and the experimental group before training { 8.9 [ st and ard deviation ( SD ) 2.9 ] vs 10.1 ( SD 3.8 ) } , after training [ 7.6 ( SD 2.9 ) vs 8.1 ( SD 3.5 ) ] or 60 days after training [ 8.1 ( SD 3.2 ) vs 8.3 ( SD 3.6 ) ] . The mean difference of the whole group between before training and after training was -0.9 ( SD 2.3 , 95 % confidence interval -1.7 to -0.6 ) . CONCLUSION Patients with Parkinson 's disease showed improved performance in activities of daily living after 14 sessions of balance training , with no additional advantages associated with the Wii-based motor and cognitive training . Registered on http://www . clinical trials.gov ( identifier : NCT01580787 ) Purpose . This study examined the association between impaired physical function and participation in  community ambulation  following stroke . We hypothesised that participation would be significantly less following stroke , and that physical impairments would be associated with participation . Method . Using a case – control design 30 survivors of stroke aged 45 and older and 30 controls provided health status information and a self-report of participation in community ambulation  ( number of trips and walking-related activities ( WRA ) reported prospect ively over a 12-day period ) . The association of physical impairments ( strength , range of motion , sensation , muscle tone , vision , and activity limitations ( gait speed and performance on complex walking tasks ) ) with level of participation was analysed using negative binomial regression and goodness of fit . Results . Participants included 30 individuals with and 30 without stroke , average age 68 years , majority were Caucasian women . Average time  since stroke was 40 months . Participation in survivors of stroke was characterised by fewer trips and WRA and lower satisfaction ( p < 0.001 ) . Usual gait speed , balance , muscle strength and muscle length were impaired ( p < 0.001 ) in stroke vs. controls , and associated with number of trips and WRA ( p < 0.05 ) . However , these factors explained less than very little of the variance in participation . Conclusions . While individual factors were associated with level of participation , results failed to accurately predict participation in community ambulation following stroke . Other factors , such as depression , cognition and self-efficacy may be stronger determinants of participation Objective : This study examined the effects of treadmill training with optic flow on the functional recovery of balance and gait in stroke patients . Design : R and omized controlled experimental study . Participants : Thirty patients following stroke were divided r and omly into the treadmill with optic flow group ( n = 10 ) , treadmill group ( n = 10 ) and control group ( n = 10 ) . Interventions : The subjects in the experimental group wore a head-mounted display to receive speed-modulated optic flow during treadmill training for 30 minutes , while those in the treadmill group and control group received treadmill training and regular therapy for the same time , three times a week for four weeks . Main measures : The data were collected using timed up- and -go test , functional reach test , 10-m walk test , and six-minute walk test before and after treatment . Results : The timed up- and -go test in the treadmill with optic flow group ( 5.55 ± 2.04 ) improved significantly greater than the treadmill ( 1.50 ± 0.93 ) and control ( 0.40 ± 0.84 ) groups . The functional reach test in the treadmill with optic flow group ( 2.78 ± 1.44 ) was significantly higher than the control group ( 0.20 ± 0.16 ) only . The gait velocity in the treadmill with optic flow group ( 0.21 ± 0.06 ) showed a significant decrease compared to the treadmill ( 0 
    Output:
    