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: Transcranial direct current stimulation ( tDCS ) is used in a variety of disorders after stroke including upper limb motor dysfunctions , hemispatial neglect , aphasia , and apraxia , and its effectiveness has been demonstrated . Although gait ability is important for daily living , there were few reports of the use of tDCS to improve balance and gait ability . The supplementary motor area ( SMA ) was reported to play a potentially important role in balance recovery after stroke . We aim ed to investigate the effect of combined therapy body weight-supported treadmill training ( BWSTT ) and tDCS on gait function recovery of stroke patients . Thirty stroke in patients participated in this study . The two BWSTT periods of 1weeks each , with real tDCS ( anode : front of Cz , cathode : inion , 1mA , 20min ) on SMA and sham stimulation , were r and omized in a double-blind crossover design . We measured the time required for the 10 m Walk Test ( 10MWT ) and Timed Up and Go ( TUG ) test before and after each period . We found that the real tDCS with BWSTT significantly improved gait speed ( 10MWT ) and applicative walking ability ( TUG ) , compared with BWSTT+sham stimulation periods ( p<0.05 ) . Our findings demonstrated the feasibility and efficacy of tDCS in gait training after stroke . The facilitative effects of tDCS on SMA possibly improved postural control during BWSTT . The results indicated the implication s for the use of tDCS in balance and gait training rehabilitation after stroke Purpose Bone fragility contributes to increased fracture risk , but little is known about the emergence of post-stroke bone loss . We investigated skeletal changes and relationships with physical activity , stroke severity , motor control and lean mass within 6 months of stroke . Methods This is a prospect i ve observational study . Participants were non-diabetic but unable to walk within 2 weeks of first stroke .  Distal tibial volumetric bone mineral density ( vBMD , primary outcome ) , bone geometry and microstructure ( high-resolution peripheral quantitative computed tomography ) were assessed at baseline and 6 months , as were secondary outcomes total body bone mineral content and lean mass ( dual energy X-ray absorptiometry ) , bone metabolism ( serum osteocalcin , N-terminal propeptide of type 1 procollagen ( P1NP ) , C-terminal telopeptide of type 1 collagen ( CTX ) ) , physical activity ( PAL2 accelerometer ) and motor control ( Chedoke McMaster )  which were also measured at 1 and 3 months . Results Thirty-seven participants ( 69.7 years ( SD 11.6 ) , 37.8 % females , NIHSS 12.6 ( SD 4.7 ) ) were included . The magnitude of difference in vBMD between paretic and non-paretic legs increased within 6 months , with a greater reduction observed in paretic legs ( mean difference = 1.5 % ( 95 % CI 0.5 , 2.6 ) , p = 0.007 ) . At 6 months , better motor control was associated with less bone loss since stroke ( r = 0.46 , p = 0.02 ) . A trend towards less bone loss was observed in people who regained independent walking compared to those who did not ( p = 0.053 ) . Higher baseline daily count of st and ing up was associated with less change in bone turnover over 6 months : osteocalcin ( r = −0.51 , p = 0.01 ) , P1NP ( r = −0.47 , p = 0.01 ) , CTX ( r = −0.53 , p = 0.01 ) . Conclusion Better motor control and walking recovery were associated with reduced bone loss . Interventions targeting these impairments from early post-stroke are warranted . Clinical trial registration URL : http://www.anzctr.org.au . Unique identifier : ACTRN12612000123842 Ikai T , Uematsu M , Eun SS , Kimura C , Hasegawa C , Miyano S : Prevention of secondary osteoporosis postmenopause in hemiplegia . Am J Phys Med Rehabil 2001;80:169–174 . Objectives To study secondary osteoporosis postmenopause in women with hemiplegia and to show the therapeutic effects of etidronate and how osteoporotic conditions relate to the activities of daily living ( ADL ) . Design Eighty-one postmenopausal women with hemiplegia were admitted within 6 mo of their first cerebrovascular accident . The bone mineral density ( BMD ) and biochemical markers of bone turnover were measured at the time of admission . Forty women ( treatment group ) received a 2-wk administration of etidronate . Forty-one women ( control group ) were not administered etidronate . Results After completing a 3-mo rehabilitation program , BMD levels were remeasured . ADL was evaluated by FIMTM . The low ADL group had a larger decrease in BMD than the high ADL group . For the control group , the BMD rate of change on the paretic side of the femoral neck was −9.6%/3 mo for the low ADL group . BMD loss was reduced significantly by the administration of etidronate for the low ADL group . Conclusions Results indicate that ADL corresponds to the progression of osteoporosis in postmenopausal women with hemiplegia and that increasing the level of ADL will reduce the progression of osteoporosis . Use of etidronate has also been proven to have a suppressive effect on the BMD decrease in women Muscle strength , usually measured as the peak torque during maximal contraction , is impaired in persons with stroke . Time-dependent properties of muscle contraction may also be altered but have not been quantified . We quantified both magnitude ( peak torque ) and time-dependent parameters ( times to develop and reduce torque ) in eight different isometric joint actions . Parameters were compared among the more and less affected arms of 20 persons with chronic stroke and the nondominant arms of 10 similarly aged healthy persons .  Torque-generation parameters were independent from one another ( i.e. , low correlations ) and highly reliable between trials and days . All parameters were impaired in the more affected arm , whereas peak torque and time to develop torque were impaired in the less affected arm . Following stroke , torque-generation impairments include both magnitude and time-dependent properties and exist not only in the more affected but also in the less affected arm . Clinicians attempting to improve upper-extremity function should employ therapeutic exercises that challenge patients to improve both their strength and speed of muscle contraction Background and Purpose — Stroke is a major risk factor for hip fracture . Patients with intermediate rather than severe or mild stroke deficits at the time of hospital discharge have the most fractures . This proof-of-concept study evaluated the efficacy of a single infusion of zoledronate , an intravenous bisphosphonate , in preserving hip bone density after stroke . Methods — In a 1-year r and omized , double-blind , placebo-controlled , clinical trial , 27 newly hemiplegic patients ( 6 females , 21 males ) with acute stroke were assigned to receive 4 mg of the intravenous zoledronate ( n=14 ) or placebo ( n=13 ) within 35 days . Strict inclusion criteria were followed-up to ensure recruited patients were likely to have residual functional impairment . Both groups received calcium and vitamin D supplementation . The primary outcome measure was the change in bone mineral density ( BMD ; Lunar Prodigy ) at the hemiplegic hip during the year of investigation . Results — The treatment was generally well tolerated . Mean total hip BMD was unchanged in the hemiplegic hip of the zoledronate group ( mean 0.0 % change ) , whereas in the placebo group the total hip BMD changed by −5.5 % , with the greatest bone loss observed in the trochanteric subregion ( mean , −8.1 % ) . On the unaffected side the mean change in total hip BMD was + 1.0 % with zoledronate versus a mean change of −2.7 % without . Repeated measures ANOVA confirmed the significance of the differences between groups at both hips ( hemiplegic , P<0.001 ; unaffected , P=0.002 ) . Conclusions — Stroke patients were protected from the deleterious effects of hemiplegia on hip bone density for at least 1 year after a single infusion of zoledronate Şahin L , Özoran K , Gündüz OH , Uçan H , Yücel M : Bone mineral density in patients with stroke . Am J Phys Med Rehabil 2001;80:592–596 . ObjectiveS troke is an acute neurologic dysfunction of vascular origin , characterized by loss of voluntary movement , sensory disturbances , and neurologic findings in the contralateral half of the body . Acute and long-term complications because of immobilization are seen in all organ systems . The aim of this study was to determine any differences between the affected and unaffected sides ’ bone mineral densities of acute and chronic stroke patients . Design In this study , we determined the bone mineral densities ( BMD ) of 30 male patients with acute ( 0 - 20 days ) and 30 male patients with chronic ( 6 months or longer ) stroke and compared the densities with the normal side . Upper and lower limb BMDs were measured by dual-energy x-ray absorptiometry . Additionally , patients were evaluated for the degree of spasticity , the phases of motor improvement , and the activities of daily living . Results In acute-phase stroke patients , BMD of the affected side was not significantly different from BMD of the normal side . BMD of both upper limbs of acute stroke patients was not different from normal side upper limb BMD of chronic stroke patients . In both acute and chronic stroke patients , affected and unaffected side lower limb BMDs ( femur total BMD scores ) were not significantly different . However , in chronic stroke patients , affected side BMD of Ward ’s region was significantly higher compared with the normal side . There is no correlation between BMD and Brunnstrom phases , Ashworth scales , and the degree of activities of daily living . Conclusions Higher BMD of the affected side Ward ’s region in chronic cerebrovascular accident patients may be related to spasticity and changes in walking pattern , which increase the mechanical stress loading of the Ward ’s region 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 OBJECTIVES To determine fracture risk in U.S. stroke patients and identify patient characteristics that predict highest fracture risk in two complementary cohorts . DESIGN Secondary analyses of two prospect i ve cohorts . SETTING Veterans Affairs ( VA ) Medical Centers . PARTICIPANTS The VA Acute Stroke ( VASt ) cohort includes 1,073 veterans admitted to nine VA hospitals for stroke between April 1995 and March 1997 . The Integrated Stroke Outcomes Data base ( ISOD ) includes 6,578 veterans who received inpatient rehabilitation for stroke at 121 VA facilities during fiscal years 2001 and 2002 . MEASUREMENTS Fractures detected using International Classification of Diseases , 9th Revision , codes in the VA computerized patient record system ; baseline patient characteristics and stroke features ; Functional Independence Measures scores in ISOD . RESULTS Estimated 2-year fracture rates after stroke in the VASt and ISOD cohorts were 6.1 % and 4.7 % , respectively . Longer hospitalizations for stroke ( P=.06 ) and new motor or sensory impairment ( P=.09 ) showed trends toward greater risk in the VASt cohort . Female sex ( P < .001 ) , cognitive impairment ( P=.01 ) , and nonblack race ( P=.04 ) were associated with higher fracture risk in the ISOD . Intermediate functional impairment conferred higher fracture risk than mild or severe functional impairment . CONCLUSION Veterans who suffer a stroke are at high risk of subsequent fracture , which can lead to further disability . Women , nonblacks , and those with intermediate functional impairment were at particularly high risk of 
    Output:
    
agent
In subacute and chronic stroke studies , the skeletal sites in the paretic limbs sustained a more pronounced decline in bone quality than did their counterparts in the non-paretic limbs .
The rate of changes showed a decelerating trend as post-stroke duration increased , but the timing of achieving the steady rate differed across skeletal sites .
The magnitude of bone changes in the paretic upper limb was more pronounced than the paretic lower limb .
There was a strong relationship between muscle strength/mass and bone density/strength index .
Muscle spasticity seemed to have a negative impact on bone integrity in the paretic upper limb , but its influence on bone properties in the paretic lower limb was uncertain .
Substantial bone changes in the paretic limbs occurred particularly in the first few months after stroke onset .
Early intervention , muscle strength training , and long-term management strategies may be important to enhance bone health post-stroke .
***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: Transcranial direct current stimulation ( tDCS ) is used in a variety of disorders after stroke including upper limb motor dysfunctions , hemispatial neglect , aphasia , and apraxia , and its effectiveness has been demonstrated . Although gait ability is important for daily living , there were few reports of the use of tDCS to improve balance and gait ability . The supplementary motor area ( SMA ) was reported to play a potentially important role in balance recovery after stroke . We aim ed to investigate the effect of combined therapy body weight-supported treadmill training ( BWSTT ) and tDCS on gait function recovery of stroke patients . Thirty stroke in patients participated in this study . The two BWSTT periods of 1weeks each , with real tDCS ( anode : front of Cz , cathode : inion , 1mA , 20min ) on SMA and sham stimulation , were r and omized in a double-blind crossover design . We measured the time required for the 10 m Walk Test ( 10MWT ) and Timed Up and Go ( TUG ) test before and after each period . We found that the real tDCS with BWSTT significantly improved gait speed ( 10MWT ) and applicative walking ability ( TUG ) , compared with BWSTT+sham stimulation periods ( p<0.05 ) . Our findings demonstrated the feasibility and efficacy of tDCS in gait training after stroke . The facilitative effects of tDCS on SMA possibly improved postural control during BWSTT . The results indicated the implication s for the use of tDCS in balance and gait training rehabilitation after stroke Purpose Bone fragility contributes to increased fracture risk , but little is known about the emergence of post-stroke bone loss . We investigated skeletal changes and relationships with physical activity , stroke severity , motor control and lean mass within 6 months of stroke . Methods This is a prospect i ve observational study . Participants were non-diabetic but unable to walk within 2 weeks of first stroke .  Distal tibial volumetric bone mineral density ( vBMD , primary outcome ) , bone geometry and microstructure ( high-resolution peripheral quantitative computed tomography ) were assessed at baseline and 6 months , as were secondary outcomes total body bone mineral content and lean mass ( dual energy X-ray absorptiometry ) , bone metabolism ( serum osteocalcin , N-terminal propeptide of type 1 procollagen ( P1NP ) , C-terminal telopeptide of type 1 collagen ( CTX ) ) , physical activity ( PAL2 accelerometer ) and motor control ( Chedoke McMaster )  which were also measured at 1 and 3 months . Results Thirty-seven participants ( 69.7 years ( SD 11.6 ) , 37.8 % females , NIHSS 12.6 ( SD 4.7 ) ) were included . The magnitude of difference in vBMD between paretic and non-paretic legs increased within 6 months , with a greater reduction observed in paretic legs ( mean difference = 1.5 % ( 95 % CI 0.5 , 2.6 ) , p = 0.007 ) . At 6 months , better motor control was associated with less bone loss since stroke ( r = 0.46 , p = 0.02 ) . A trend towards less bone loss was observed in people who regained independent walking compared to those who did not ( p = 0.053 ) . Higher baseline daily count of st and ing up was associated with less change in bone turnover over 6 months : osteocalcin ( r = −0.51 , p = 0.01 ) , P1NP ( r = −0.47 , p = 0.01 ) , CTX ( r = −0.53 , p = 0.01 ) . Conclusion Better motor control and walking recovery were associated with reduced bone loss . Interventions targeting these impairments from early post-stroke are warranted . Clinical trial registration URL : http://www.anzctr.org.au . Unique identifier : ACTRN12612000123842 Ikai T , Uematsu M , Eun SS , Kimura C , Hasegawa C , Miyano S : Prevention of secondary osteoporosis postmenopause in hemiplegia . Am J Phys Med Rehabil 2001;80:169–174 . Objectives To study secondary osteoporosis postmenopause in women with hemiplegia and to show the therapeutic effects of etidronate and how osteoporotic conditions relate to the activities of daily living ( ADL ) . Design Eighty-one postmenopausal women with hemiplegia were admitted within 6 mo of their first cerebrovascular accident . The bone mineral density ( BMD ) and biochemical markers of bone turnover were measured at the time of admission . Forty women ( treatment group ) received a 2-wk administration of etidronate . Forty-one women ( control group ) were not administered etidronate . Results After completing a 3-mo rehabilitation program , BMD levels were remeasured . ADL was evaluated by FIMTM . The low ADL group had a larger decrease in BMD than the high ADL group . For the control group , the BMD rate of change on the paretic side of the femoral neck was −9.6%/3 mo for the low ADL group . BMD loss was reduced significantly by the administration of etidronate for the low ADL group . Conclusions Results indicate that ADL corresponds to the progression of osteoporosis in postmenopausal women with hemiplegia and that increasing the level of ADL will reduce the progression of osteoporosis . Use of etidronate has also been proven to have a suppressive effect on the BMD decrease in women Muscle strength , usually measured as the peak torque during maximal contraction , is impaired in persons with stroke . Time-dependent properties of muscle contraction may also be altered but have not been quantified . We quantified both magnitude ( peak torque ) and time-dependent parameters ( times to develop and reduce torque ) in eight different isometric joint actions . Parameters were compared among the more and less affected arms of 20 persons with chronic stroke and the nondominant arms of 10 similarly aged healthy persons .  Torque-generation parameters were independent from one another ( i.e. , low correlations ) and highly reliable between trials and days . All parameters were impaired in the more affected arm , whereas peak torque and time to develop torque were impaired in the less affected arm . Following stroke , torque-generation impairments include both magnitude and time-dependent properties and exist not only in the more affected but also in the less affected arm . Clinicians attempting to improve upper-extremity function should employ therapeutic exercises that challenge patients to improve both their strength and speed of muscle contraction Background and Purpose — Stroke is a major risk factor for hip fracture . Patients with intermediate rather than severe or mild stroke deficits at the time of hospital discharge have the most fractures . This proof-of-concept study evaluated the efficacy of a single infusion of zoledronate , an intravenous bisphosphonate , in preserving hip bone density after stroke . Methods — In a 1-year r and omized , double-blind , placebo-controlled , clinical trial , 27 newly hemiplegic patients ( 6 females , 21 males ) with acute stroke were assigned to receive 4 mg of the intravenous zoledronate ( n=14 ) or placebo ( n=13 ) within 35 days . Strict inclusion criteria were followed-up to ensure recruited patients were likely to have residual functional impairment . Both groups received calcium and vitamin D supplementation . The primary outcome measure was the change in bone mineral density ( BMD ; Lunar Prodigy ) at the hemiplegic hip during the year of investigation . Results — The treatment was generally well tolerated . Mean total hip BMD was unchanged in the hemiplegic hip of the zoledronate group ( mean 0.0 % change ) , whereas in the placebo group the total hip BMD changed by −5.5 % , with the greatest bone loss observed in the trochanteric subregion ( mean , −8.1 % ) . On the unaffected side the mean change in total hip BMD was + 1.0 % with zoledronate versus a mean change of −2.7 % without . Repeated measures ANOVA confirmed the significance of the differences between groups at both hips ( hemiplegic , P<0.001 ; unaffected , P=0.002 ) . Conclusions — Stroke patients were protected from the deleterious effects of hemiplegia on hip bone density for at least 1 year after a single infusion of zoledronate Şahin L , Özoran K , Gündüz OH , Uçan H , Yücel M : Bone mineral density in patients with stroke . Am J Phys Med Rehabil 2001;80:592–596 . ObjectiveS troke is an acute neurologic dysfunction of vascular origin , characterized by loss of voluntary movement , sensory disturbances , and neurologic findings in the contralateral half of the body . Acute and long-term complications because of immobilization are seen in all organ systems . The aim of this study was to determine any differences between the affected and unaffected sides ’ bone mineral densities of acute and chronic stroke patients . Design In this study , we determined the bone mineral densities ( BMD ) of 30 male patients with acute ( 0 - 20 days ) and 30 male patients with chronic ( 6 months or longer ) stroke and compared the densities with the normal side . Upper and lower limb BMDs were measured by dual-energy x-ray absorptiometry . Additionally , patients were evaluated for the degree of spasticity , the phases of motor improvement , and the activities of daily living . Results In acute-phase stroke patients , BMD of the affected side was not significantly different from BMD of the normal side . BMD of both upper limbs of acute stroke patients was not different from normal side upper limb BMD of chronic stroke patients . In both acute and chronic stroke patients , affected and unaffected side lower limb BMDs ( femur total BMD scores ) were not significantly different . However , in chronic stroke patients , affected side BMD of Ward ’s region was significantly higher compared with the normal side . There is no correlation between BMD and Brunnstrom phases , Ashworth scales , and the degree of activities of daily living . Conclusions Higher BMD of the affected side Ward ’s region in chronic cerebrovascular accident patients may be related to spasticity and changes in walking pattern , which increase the mechanical stress loading of the Ward ’s region 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 OBJECTIVES To determine fracture risk in U.S. stroke patients and identify patient characteristics that predict highest fracture risk in two complementary cohorts . DESIGN Secondary analyses of two prospect i ve cohorts . SETTING Veterans Affairs ( VA ) Medical Centers . PARTICIPANTS The VA Acute Stroke ( VASt ) cohort includes 1,073 veterans admitted to nine VA hospitals for stroke between April 1995 and March 1997 . The Integrated Stroke Outcomes Data base ( ISOD ) includes 6,578 veterans who received inpatient rehabilitation for stroke at 121 VA facilities during fiscal years 2001 and 2002 . MEASUREMENTS Fractures detected using International Classification of Diseases , 9th Revision , codes in the VA computerized patient record system ; baseline patient characteristics and stroke features ; Functional Independence Measures scores in ISOD . RESULTS Estimated 2-year fracture rates after stroke in the VASt and ISOD cohorts were 6.1 % and 4.7 % , respectively . Longer hospitalizations for stroke ( P=.06 ) and new motor or sensory impairment ( P=.09 ) showed trends toward greater risk in the VASt cohort . Female sex ( P < .001 ) , cognitive impairment ( P=.01 ) , and nonblack race ( P=.04 ) were associated with higher fracture risk in the ISOD . Intermediate functional impairment conferred higher fracture risk than mild or severe functional impairment . CONCLUSION Veterans who suffer a stroke are at high risk of subsequent fracture , which can lead to further disability . Women , nonblacks , and those with intermediate functional impairment were at particularly high risk of 
    Output:
    