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: Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients The functional effects of three types of therapy for subjects with long-term incomplete cervical spinal cord injuries were investigated . Men and women , aged 18 to 45 years , were assigned to one of four groups using a restricted r and omization process . The training period was divided into two consecutive eight-week time blocks where subjects received either ( 1 ) supervised physical exercise therapy ( PET ) , ( 2 ) neuromuscular stimulation ( NMS ) , or ( 3 ) electromyographic ( EMG ) biofeedback . Group 1 received EMG biofeedback followed by PET ; Group 2 received EMG biofeedback followed by NMS ; Group 3 received NMS followed by PET ; and Group 4 received 16 weeks of PET . Dependent measures ( manual muscle tests , self-care scores , mobility measures , and voluntary EMG activity ) were assessed before training , at eight weeks , and after 16 weeks of training . A significant improvement ( p less than .05 ) across time was found on all dependent measures except voluntary EMG . No difference was found on comparisons between groups To explore the question of whether auditorally augmented feedback can improve the eye-h and coordination of individuals with cerebral palsy , 59 ( cerebral-palsied ) students ( mean chronological age 14 years , 3 months ) were pretested with the Southern California Motor Accuracy Test and then r and omly assigned to three groups . Group 1 performed training exercises-tracing line drawings-while simultaneously receiving auditorally augmented feedback about their efforts . Group 2 performed the same training exercises without the augmented feedback . Group 3 served as controls . All subjects were post-tested with the Southern California Motor Accuracy Test , followed by a second post-test after a 3-month interval . At the first post-test , the performance of the feedback group was significantly superior to that of the other groups . At the second post-test , the performance patterns among the groups were essentially the same as the time of the first post-test , but between-group differences were no longer significant . The results of this study are discussed in both empirical and theoretical terms In this study , the extent to which bradykinesia in patients with idiopathic Parkinson 's disease can be influenced by practice and by specific training strategies was investigated . Fifteen patients with Parkinson 's disease tested after withdrawal of anti-Parkinson medication , and 15 matched control subjects , practised a ballistic aim ing task . Performance was tested before , during and after training and again 1 h later . The Parkinson 's disease patients and control subjects were r and omly assigned to one of two training schedules , practising with or without rhythmic auditory cues . At baseline , the Parkinson 's disease patients showed longer movement times , with a marked decrease in maximum acceleration and deceleration in the initial open-loop phase compared with those of the control subjects . With training , they were able to make significant improvement in the speed of aim ed movements , particularly in the early movement phase , without any deterioration in accuracy . These effects transferred to an untrained limb and were at least partially maintained after a 1-h delay . While patients remained impaired relative to control subjects at all phases of training and follow-up , the patients ' performance at the end of training did not differ significantly from the control subjects ' baseline function . Contrary to expectation , rhythmic auditory cues did not enhance improvement in the speed of aim ed movements in either patients or control subjects . If anything , less improvement was shown in the cued groups , although there were suggestions that the aim ing skill was retained better over the delay period . The results demonstrate preserved abilities to improve speed of single ballistic aim ing movements in Parkinson 's disease patients and the possibility of reducing bradykinesia by training Positional feedback ( PF ) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients . Thirty adult hemiparetic patients lacking normal voluntary wrist extension were r and omly placed in control and study groups . The control group received conventional therapy while the study group received positional feedback stimulation training ( PFST ) in addition to conventional treatment . At the end of the 4-week program , study patients showed a 280 % increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70 % increase when positioned in 30 degrees of flexion . Control patients showed no significant changes in torque . Study patients made an average 200 % gain in selective range of motion over their starting levels while controls made only a 50 % increase . Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision Bourbonnais D , Bilodeau S , Lepage Y , Beaudoin N , Gravel D , Forget R : Effect of force-feedback treatments in patients with chronic motor deficits after a stroke . Am J Phys Med Rehabil 2002;81:890–897 . Objective To assess the effects a motor reeducation approach based on static dynamometers used to provide feedback on the force produced . Design The study design was a single-blind , r and omized , controlled trial . Chronic stroke subjects participated in a 6-wk , thrice-weekly , force-feedback program of either the upper paretic limb ( n = 13 ) or the  lower paretic limb ( n = 12 ) . Baseline and postintervention assessment s of the performance of both the upper and the lower limb were measured for each subject , the untreated paretic limb  of each group serving as a control for the other group . Results With the exception of the h and grip force , strength measurements of the treated limb increased after completion of the treatment . The outcome measurements of the upper limb of the subjects included in the upper paretic limb were not significantly different after treatment from those measured in the lower paretic limb . In contrast , gait velocity and the distance walked in 2 min increased after treatment in the lower paretic limb as compared with the upper paretic limb , whereas the scores in the Fugl-Meyer test for the lower limb and the timed up- and -go test did not increase for either group after treatment . Conclusion The results indicate that treatment of the lower limb based on force feedback produces an improvement of gait velocity A long-term , comparison-group outcome trial with a partial crossover design was carried out on the effects of  electromyographic biofeedback ( EMGBF ) plus physiotherapy ( PT ) versus PT alone in the treatment of the hemiplegic upper limb in stroke patients who were at least six months beyond the onset of their disability . Both the experimental and the control groups benefited from their treatment , but EMGBF was shown to have an additional effect , both in the experimental patients , and in the control patients when they switched over to the experimental treatment condition OBJECTIVE This study investigated the effects of qualitative and quantitative knowledge of results ( KR ) on the acquisition of a motor skill . It was hypothesized that there would be differences in performance during skill acquisition and retention , depending on the type of feedback given . Qualitative KR was in the form of verbal encouragement and quantitative KR was in the form of an algebraic number representing an error score . METHODS Seventy-seven adults were r and omly assigned to one of four feedback conditions , Quantitative , Qualitative , Quantitative and Qualitative , and no feedback ( Control ) .  Participants learned an isometric force production skill . Data were collected during skill acquisition and retention phases . Computer hardware and custom software were used to collect data and administer the feedback conditions of the independent variable . RESULTS There was a statistically significant difference in the Acquisition Phase for the main effect of Condition F(3,73 ) = 6.35 , p < .05 , and for Block F(9,657 ) = 2.07 , p < .05 , but there was no statistically significant Condition X Block interaction F(27,657 ) = 1.02 , p > .05 . Pair-wise comparisons revealed statistically significant differences between conditions containing qualitative feedback and conditions containing no qualitative feedback ( p < .05 ) . The main effect of condition was significant F(3,73 ) = 3.00 , p < .05 in the retention phase , however there were no significant pair-wise comparisons ( p > .05 ) . CONCLUSION The results of this study suggest that in a healthy adult population , qualitative feedback , by itself and when combined with quantitative feedback , result ed in superior skill acquisition , but not in the retention of that skill . The artificiality of the task along with differing modes of feedback ( audible versus visual ) are two potentially limiting factors to this study . Future research that controls for these factors may yield more definitive findings about the role that qualitative feedback has in improving motor performance and learning Ninety seven patients with stroke who had participated in a r and omised trial of conventional physical therapy nu an enhanced therapy for arm function were followed up at one year . Despite the emphasis of the enhanced therapy approach on continued use of the arm in everyday life , the advantage seen for some patients with enhanced therapy at six months after stroke had diminished to a non-significant trend by one year . This was due to some late improvement in the conventional therapy group whereas the enhanced therapy group remained static or fell back slightly . It is recommended that trials should be conducted comparing very intensive therapy for the arm with controls without treatment . This would provide a model of the effects of therapy on intrinsic neural recovery that would be relevant to all areas of neurological rehabilitation OBJECTIVE To compare the effects of robot-assisted movement training with conventional techniques for the rehabilitation of upper-limb motor function after stroke . DESIGN R and omized controlled trial , 6-month follow-up . SETTING A Department of Veterans Affairs rehabilitation research and development center . PARTICIPANTS Consecutive sample of 27 subjects with chronic hemiparesis ( > 6mo after cerebrovascular accident ) r and omly allocated to group . INTERVENTIONS All subjects received twenty-four 1-hour sessions over 2 months . Subjects in the robot group practice d shoulder and elbow movements while assisted by a robot manipulator . Subjects in the control group received neurodevelopmental therapy ( targeting proximal upper limb function ) and 5 minutes of exposure to the robot in each session . MAIN OUTCOME MEASURES Fugl-Meyer assessment of motor impairment , FIMtrade mark instrument , and biomechanic measures of strength and reaching kinematics . Clinical evaluations were performed by a therapist blinded to group assignments . RESULTS Compared with the control group , the robot group had larger improvements in the proximal movement portion of the Fugl-Meyer test after 1 month of treatment ( P<.05 ) and also after 2 months of treatment ( P<.05 ) . The robot group had larger gains in strength ( P<.02 ) and larger increases in reach extent ( P<.01 ) after 2 months of treatment . At the 6-month follow-up , the groups no longer differed in terms of the Fugl-Meyer test ( P>.30 ) ; however , the robot group had larger improvements in the FIM ( P<.04 ) . CONCLUSIONS Compared with conventional treatment , robot-assisted movements had advantages in terms of clinical and biomechanical measures . Further research into the use of robotic manipulation for motor rehabilitation is justified Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia . A detailed study was carried out of recovery of arm function after acute stroke , and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning . In a single-blind r and omised trial , 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups . At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength , range and speed of movement . This effect seemed concentrated amongst those who had a milder initial impairment . More work is needed to discover the reasons for this improved recovery , and whether further development of this therapeutic approach might offer clinical ly significant gains for some patients BACKGROUND AND PURPOSE A traditional perspective on rehabilitation of patients with abnormal muscular hyperactivity presumes that relaxation should be facilitated prior to recruitment of antagonists , if effective movement about a joint is to occur . The purpose of the study was to determine the effect of training weak triceps brachii muscles , with hyperactivity present in the opposing biceps brachii muscles , on elbow function in individuals at least 1 year poststroke . SUBJECTS Sixteen patients with chronic stroke were r and omly assigned to receive electromyographic biofeedback to retrain the triceps muscle ( n = 8) or to receive conventional movement training ( n = 8) . METHODS Both groups participated in 5 baseline and 10 training sessions involving tasks requiring elbow extension . Preintervention and postintervention measurements included elbow extension range of motion , triceps and biceps muscle electromyographic activity during performance of elbow extension , resisted elbow extension , and a reaching task . RESULTS Two- sample t-test results of between-group comparisons for each variable were not significant . One- sample t-test results of within-group comparisons showed significant increases in triceps muscle mean electromyographic activity during two of the three tasks for the feedback group , but not for the nonfeedback group . Passive and active range of motion in both groups increased significantly , although biceps muscle co-contraction persisted . CONCLUSION AND DISCUSSION These results suggest that functional improvements at the elbow may have been due to biomechanical ( peripheral ) rather than neuromuscular ( central ) changes about the joint . Furthermore , these preliminary data indicate that patients 
    Output:
    
agent
***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: Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients The functional effects of three types of therapy for subjects with long-term incomplete cervical spinal cord injuries were investigated . Men and women , aged 18 to 45 years , were assigned to one of four groups using a restricted r and omization process . The training period was divided into two consecutive eight-week time blocks where subjects received either ( 1 ) supervised physical exercise therapy ( PET ) , ( 2 ) neuromuscular stimulation ( NMS ) , or ( 3 ) electromyographic ( EMG ) biofeedback . Group 1 received EMG biofeedback followed by PET ; Group 2 received EMG biofeedback followed by NMS ; Group 3 received NMS followed by PET ; and Group 4 received 16 weeks of PET . Dependent measures ( manual muscle tests , self-care scores , mobility measures , and voluntary EMG activity ) were assessed before training , at eight weeks , and after 16 weeks of training . A significant improvement ( p less than .05 ) across time was found on all dependent measures except voluntary EMG . No difference was found on comparisons between groups To explore the question of whether auditorally augmented feedback can improve the eye-h and coordination of individuals with cerebral palsy , 59 ( cerebral-palsied ) students ( mean chronological age 14 years , 3 months ) were pretested with the Southern California Motor Accuracy Test and then r and omly assigned to three groups . Group 1 performed training exercises-tracing line drawings-while simultaneously receiving auditorally augmented feedback about their efforts . Group 2 performed the same training exercises without the augmented feedback . Group 3 served as controls . All subjects were post-tested with the Southern California Motor Accuracy Test , followed by a second post-test after a 3-month interval . At the first post-test , the performance of the feedback group was significantly superior to that of the other groups . At the second post-test , the performance patterns among the groups were essentially the same as the time of the first post-test , but between-group differences were no longer significant . The results of this study are discussed in both empirical and theoretical terms In this study , the extent to which bradykinesia in patients with idiopathic Parkinson 's disease can be influenced by practice and by specific training strategies was investigated . Fifteen patients with Parkinson 's disease tested after withdrawal of anti-Parkinson medication , and 15 matched control subjects , practised a ballistic aim ing task . Performance was tested before , during and after training and again 1 h later . The Parkinson 's disease patients and control subjects were r and omly assigned to one of two training schedules , practising with or without rhythmic auditory cues . At baseline , the Parkinson 's disease patients showed longer movement times , with a marked decrease in maximum acceleration and deceleration in the initial open-loop phase compared with those of the control subjects . With training , they were able to make significant improvement in the speed of aim ed movements , particularly in the early movement phase , without any deterioration in accuracy . These effects transferred to an untrained limb and were at least partially maintained after a 1-h delay . While patients remained impaired relative to control subjects at all phases of training and follow-up , the patients ' performance at the end of training did not differ significantly from the control subjects ' baseline function . Contrary to expectation , rhythmic auditory cues did not enhance improvement in the speed of aim ed movements in either patients or control subjects . If anything , less improvement was shown in the cued groups , although there were suggestions that the aim ing skill was retained better over the delay period . The results demonstrate preserved abilities to improve speed of single ballistic aim ing movements in Parkinson 's disease patients and the possibility of reducing bradykinesia by training Positional feedback ( PF ) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients . Thirty adult hemiparetic patients lacking normal voluntary wrist extension were r and omly placed in control and study groups . The control group received conventional therapy while the study group received positional feedback stimulation training ( PFST ) in addition to conventional treatment . At the end of the 4-week program , study patients showed a 280 % increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70 % increase when positioned in 30 degrees of flexion . Control patients showed no significant changes in torque . Study patients made an average 200 % gain in selective range of motion over their starting levels while controls made only a 50 % increase . Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision Bourbonnais D , Bilodeau S , Lepage Y , Beaudoin N , Gravel D , Forget R : Effect of force-feedback treatments in patients with chronic motor deficits after a stroke . Am J Phys Med Rehabil 2002;81:890–897 . Objective To assess the effects a motor reeducation approach based on static dynamometers used to provide feedback on the force produced . Design The study design was a single-blind , r and omized , controlled trial . Chronic stroke subjects participated in a 6-wk , thrice-weekly , force-feedback program of either the upper paretic limb ( n = 13 ) or the  lower paretic limb ( n = 12 ) . Baseline and postintervention assessment s of the performance of both the upper and the lower limb were measured for each subject , the untreated paretic limb  of each group serving as a control for the other group . Results With the exception of the h and grip force , strength measurements of the treated limb increased after completion of the treatment . The outcome measurements of the upper limb of the subjects included in the upper paretic limb were not significantly different after treatment from those measured in the lower paretic limb . In contrast , gait velocity and the distance walked in 2 min increased after treatment in the lower paretic limb as compared with the upper paretic limb , whereas the scores in the Fugl-Meyer test for the lower limb and the timed up- and -go test did not increase for either group after treatment . Conclusion The results indicate that treatment of the lower limb based on force feedback produces an improvement of gait velocity A long-term , comparison-group outcome trial with a partial crossover design was carried out on the effects of  electromyographic biofeedback ( EMGBF ) plus physiotherapy ( PT ) versus PT alone in the treatment of the hemiplegic upper limb in stroke patients who were at least six months beyond the onset of their disability . Both the experimental and the control groups benefited from their treatment , but EMGBF was shown to have an additional effect , both in the experimental patients , and in the control patients when they switched over to the experimental treatment condition OBJECTIVE This study investigated the effects of qualitative and quantitative knowledge of results ( KR ) on the acquisition of a motor skill . It was hypothesized that there would be differences in performance during skill acquisition and retention , depending on the type of feedback given . Qualitative KR was in the form of verbal encouragement and quantitative KR was in the form of an algebraic number representing an error score . METHODS Seventy-seven adults were r and omly assigned to one of four feedback conditions , Quantitative , Qualitative , Quantitative and Qualitative , and no feedback ( Control ) .  Participants learned an isometric force production skill . Data were collected during skill acquisition and retention phases . Computer hardware and custom software were used to collect data and administer the feedback conditions of the independent variable . RESULTS There was a statistically significant difference in the Acquisition Phase for the main effect of Condition F(3,73 ) = 6.35 , p < .05 , and for Block F(9,657 ) = 2.07 , p < .05 , but there was no statistically significant Condition X Block interaction F(27,657 ) = 1.02 , p > .05 . Pair-wise comparisons revealed statistically significant differences between conditions containing qualitative feedback and conditions containing no qualitative feedback ( p < .05 ) . The main effect of condition was significant F(3,73 ) = 3.00 , p < .05 in the retention phase , however there were no significant pair-wise comparisons ( p > .05 ) . CONCLUSION The results of this study suggest that in a healthy adult population , qualitative feedback , by itself and when combined with quantitative feedback , result ed in superior skill acquisition , but not in the retention of that skill . The artificiality of the task along with differing modes of feedback ( audible versus visual ) are two potentially limiting factors to this study . Future research that controls for these factors may yield more definitive findings about the role that qualitative feedback has in improving motor performance and learning Ninety seven patients with stroke who had participated in a r and omised trial of conventional physical therapy nu an enhanced therapy for arm function were followed up at one year . Despite the emphasis of the enhanced therapy approach on continued use of the arm in everyday life , the advantage seen for some patients with enhanced therapy at six months after stroke had diminished to a non-significant trend by one year . This was due to some late improvement in the conventional therapy group whereas the enhanced therapy group remained static or fell back slightly . It is recommended that trials should be conducted comparing very intensive therapy for the arm with controls without treatment . This would provide a model of the effects of therapy on intrinsic neural recovery that would be relevant to all areas of neurological rehabilitation OBJECTIVE To compare the effects of robot-assisted movement training with conventional techniques for the rehabilitation of upper-limb motor function after stroke . DESIGN R and omized controlled trial , 6-month follow-up . SETTING A Department of Veterans Affairs rehabilitation research and development center . PARTICIPANTS Consecutive sample of 27 subjects with chronic hemiparesis ( > 6mo after cerebrovascular accident ) r and omly allocated to group . INTERVENTIONS All subjects received twenty-four 1-hour sessions over 2 months . Subjects in the robot group practice d shoulder and elbow movements while assisted by a robot manipulator . Subjects in the control group received neurodevelopmental therapy ( targeting proximal upper limb function ) and 5 minutes of exposure to the robot in each session . MAIN OUTCOME MEASURES Fugl-Meyer assessment of motor impairment , FIMtrade mark instrument , and biomechanic measures of strength and reaching kinematics . Clinical evaluations were performed by a therapist blinded to group assignments . RESULTS Compared with the control group , the robot group had larger improvements in the proximal movement portion of the Fugl-Meyer test after 1 month of treatment ( P<.05 ) and also after 2 months of treatment ( P<.05 ) . The robot group had larger gains in strength ( P<.02 ) and larger increases in reach extent ( P<.01 ) after 2 months of treatment . At the 6-month follow-up , the groups no longer differed in terms of the Fugl-Meyer test ( P>.30 ) ; however , the robot group had larger improvements in the FIM ( P<.04 ) . CONCLUSIONS Compared with conventional treatment , robot-assisted movements had advantages in terms of clinical and biomechanical measures . Further research into the use of robotic manipulation for motor rehabilitation is justified Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia . A detailed study was carried out of recovery of arm function after acute stroke , and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning . In a single-blind r and omised trial , 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups . At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength , range and speed of movement . This effect seemed concentrated amongst those who had a milder initial impairment . More work is needed to discover the reasons for this improved recovery , and whether further development of this therapeutic approach might offer clinical ly significant gains for some patients BACKGROUND AND PURPOSE A traditional perspective on rehabilitation of patients with abnormal muscular hyperactivity presumes that relaxation should be facilitated prior to recruitment of antagonists , if effective movement about a joint is to occur . The purpose of the study was to determine the effect of training weak triceps brachii muscles , with hyperactivity present in the opposing biceps brachii muscles , on elbow function in individuals at least 1 year poststroke . SUBJECTS Sixteen patients with chronic stroke were r and omly assigned to receive electromyographic biofeedback to retrain the triceps muscle ( n = 8) or to receive conventional movement training ( n = 8) . METHODS Both groups participated in 5 baseline and 10 training sessions involving tasks requiring elbow extension . Preintervention and postintervention measurements included elbow extension range of motion , triceps and biceps muscle electromyographic activity during performance of elbow extension , resisted elbow extension , and a reaching task . RESULTS Two- sample t-test results of between-group comparisons for each variable were not significant . One- sample t-test results of within-group comparisons showed significant increases in triceps muscle mean electromyographic activity during two of the three tasks for the feedback group , but not for the nonfeedback group . Passive and active range of motion in both groups increased significantly , although biceps muscle co-contraction persisted . CONCLUSION AND DISCUSSION These results suggest that functional improvements at the elbow may have been due to biomechanical ( peripheral ) rather than neuromuscular ( central ) changes about the joint . Furthermore , these preliminary data indicate that patients 
    Output:
    