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: [ Purpose ] The purpose of this study was to evaluate the functional effects of additional action observational training for functional electrical stimulation treatment on weight bearing , stability and gait velocity of hemiplegic patients . [ Subjects and Methods ] Twenty subjects were r and omized into two groups . Subjects more than six months post-stroke participated .  Balance and gait velocity were measured at the baseline , and after six weeks of treatment . Both groups received functional electrical stimulation treatment . The experimental group additionally received action observational training . The paired t-test was used to analyze differences in the outcome measures between before and after the intervention . The difference between the groups was compared using the independent t-test . [ Results ] The experimental group showed significant increases in weight bearing ( anterior·posterior , right·left ) on the affected side , stability index and gait velocity . The control group showed only a significant increase in anterior·posterior weight bearing on the affected side . Moreover , according to the comparison of training effects between in the two groups , the variables of anterior·posterior weight bearing , stability index and gait velocity revealed a statistically significant difference . [ Conclusion ] Additional action observational training for functional electrical stimulation treatment should be considered as a therapeutic method in physical therapy for the improvement of weight bearing , stability index and gait velocity of hemiplegic patients For consciously performed motor tasks executed in a defined and constant way , both motor imagery ( MI ) and action observation ( AO ) have been shown to promote motor learning . It is not known whether these forms of non-physical training also improve motor actions when these actions have to be variably applied in an unstable and unpredictable environment . The present study therefore investigated the influence of MI balance training ( MI_BT ) and a balance training combining AO and MI ( AO+MI_BT ) on postural control of undisturbed and disturbed upright stance on unstable ground . As spinal reflex excitability after classical ( i.e. , physical ) balance training ( BT ) is generally decreased , we tested whether non-physical BT also has an impact on spinal reflex circuits . Thirty-six participants were r and omly allocated into an MI_BT group  , in which participants imagined postural exercises , an AO+MI_BT group , in which participants observed videos of other people performing balance exercises and imagined being the person in the video , and a non-active control group ( CON ) . Before and after 4 weeks of non-physical training , balance performance was assessed on a free-moving platform during stance without perturbation and during perturbed stance . Soleus H-reflexes were recorded during stable and unstable stance . The post-measurement revealed significantly decreased postural sway during undisturbed and disturbed stance after both MI_BT and AO+MI_BT . Spinal reflex excitability remained unchanged . This is the first study showing that non-physical training ( MI_BT and AO+MI_BT ) not only promotes motor learning of “ rigid ” postural tasks but also improves performance of highly variable and unpredictable balance actions . These findings may be relevant to improve postural control and thus reduce the risk of falls in temporarily immobilized patients The clinical impact of action observation ( AO ) on upper limb functional recovery in subacute stroke patients is recent evidence . We sought to test the hypothesis that training everyday life activities through AO coupled with task execution might activate the left hemisphere different from the right one . Sixty-seven first-ever ischemic stroke subjects were r and omly assigned to receive upper limb training coupled with AO tasks or st and ard rehabilitation . The groups were matched by age and gender , Bamford category , and interval from stroke and lesion side . Fugl-Meyer ( FM ) and Box and Block Test ( BBT ) were used to measure h and function recovery at the end ( T1 ) and 4 - 5 months after the treatment ( T2 ) . At T1 , FM was increased by 31 % ( ±26 % ) , of maximum achievable recovery , whereas BBT was increased by 17 % ( ±18 % ) ; at T2 , FM had reached 43 % ( ±45 % ) of maximum recovery , while BBT had reached 25 % ( ±22 % ) . Combining the effects of treatment to those of lesion side revealed significantly higher gains , in both FM and BBT scores , in left hemiparetic subjects when exposed to AO as compared to st and ard rehabilitation alone ( P < .01 ) . The findings lead to recommend the use of AO in addition to motor training in left hemiparetic patients [ Purpose ] This study examined the effects of action observation and action practice on stroke patients ’ upper limb function .  [ Subjects and Methods ] The subjects were 33 chronic stroke patients who were r and omly assigned to four groups . The action observation group ( 5 males , 3 females ) watched a video of the task , the action practice group ( 5 males , 4 females ) performed the action , the combined action observation-action practice group ( 5 males , 4 females ) watched the video of the task and practice d the action , and the control group ( 4 males , 3 females ) did not perform either action observation or action practice . The video used in the action observational physical training comprised a scene of an adult male picking up a cup , bringing it to his mouth in order to touch his mouth , and then returning the cup to its initial position . [ Results ] Improvements in drinking behavior functions were observed immediately after the experiment and one week later . After the intervention , the number of drinking motions had increased the most in the combination group . One week after the experiment , there were increases in the action observation , action training , and combination groups . [ Conclusion ] A combination of action observation and action training is the most effective treatment method , and action training is a desirable second to combined therapy Background Evidence exist that motor observation activates the same cortical motor areas that are involved in the performance of the observed actions . The so called “ mirror neuron system ” has been proposed to be responsible for this phenomenon . We employ this neural system and its capability to re-enact stored motor representations as a tool for rehabilitating motor control . In our new neurorehabilitative schema ( videotherapy ) we combine observation of daily actions with concomitant physical training of the observed actions focusing on the upper limbs . Following a pilot study in chronic patients in an ambulatory setting , we currently design ed a new multicenter clinical study dedicated to patients in the sub-acute state after stroke using a home-based self-induced training .  Within our protocol we assess 1 ) the capability of action observation to elicit rehabilitational effects in the motor system , and 2 ) the capacity of this schema to be performed by patients without assistance from a physiotherapist . The results of this study would be of high health and economical relevance . Methods / design A controlled , r and omized , multicenter , paralleled , 6 month follow-up study will be conducted on three groups of patients : one group will be given the experimental treatment whereas the other two will participate in control treatments .  All patients will undergo their usual rehabilitative treatment beside participation in the study . The experimental condition consists in the observation and immediate imitation of common daily h and and arm actions . The two parallel control groups are a placebo group and a group receiving usual rehabilitation without any trial-related treatment . Trial r and omization is provided via external data management . The primary efficacy endpoint is the improvement of the experimental group in a st and ardized motor function test ( Wolf Motor Function Test ) relative to control groups . Further assessment s refer to subjective and qualitative rehabilitational scores . This study has been review ed and approved by the ethics committee of Aachen University . Discussion This therapy provides an extension of therapeutic procedures for recovery after stroke and emphasizes the importance of action perception in neurorehabilitation The results of the study could become implemented into the wide physiotherapeutic practice , for example as an ad on and individualized therapy Background Rehabilitation for children with hemiplegic cerebral palsy ( HCP ) aim ed to improve function of the impaired upper limb ( UL ) uses a wide range of intervention programs . A new rehabilitative approach , called Action-Observation Therapy , based on the recent discovery of mirror neurons , has been used in adult stroke but not in children . The purpose of the present study is to design a r and omised controlled trial ( RCT ) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP . Methods / Design The trial is design ed according to CONSORT Statement . It is a r and omised , evaluator-blinded , match-pair group trial . Children with HCP will be r and omised within pairs to either experimental or control group . The experimental group will perform an Action-Observation Therapy , called UP-CAT ( Upper Limb-Children Action-Observation Training ) in which they will watch video sequences showing goal -directed actions , chosen according to children UL functional level , combined with motor training with their hemiplegic UL . The control group will perform the same tailored actions after watching computer games . A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed . Assisting H and Assessment was chosen as primary measure and , based on its calculation power , a sample size of 12 matched pairs was established . Moreover , Melbourne and ABILH AND -Kids were included as secondary measures . The time line of assessment s will be T0 ( in the week preceding the onset of the treatment ) , T1 and T2 ( in the week after the end of the treatment and 8 weeks later , respectively ) . A further assessment will be performed at T3 ( 24 weeks after T1 ) , to evaluate the retention of effects . In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging , exploring the mirror system and sensory-motor function , will be performed at T0 , T1 and T2 . Discussion The paper aims to describe the methodology of a RCT for evaluating the efficacy of  Action-Observation Therapy  in improving UL activity in children with hemiplegia . This study will be the first to test this new type of treatment in childhood . The paper presents the theoretical background , study hypotheses , outcome measures and trial methodology .Trial Registration Objective . A r and omized controlled observer-blind trial was design ed to evaluate the effectiveness of action observation as an add-on treatment to the st and ard rehabilitation of upper-limb function , early after stroke . Methods . Stroke survivors ( N = 102 ) were consecutively recruited from 13 centers 30 days ( ±7 ) after a first-ever stroke and r and omly assigned to the  experimental ( EG )  or  control group (  CG ) . EG participants watched video footage of daily routine tasks ( actions ) carried out with the upper limb in order to prepare to imitate the presented action . At the end of each sequence , a therapist prompted the patient to perform the same movement for 2 minutes , providing help when needed . Static images without animals or human beings were shown to the CG . At the end of each sequence , the CG executed movements that simulated the shoulder and elbow joint mobilization activities performed by the EG . Results for the Fugl-Meyer test , Frenchay Arm test , Box and Block test ( BBT ) , Modified Ashworth Scale , and Functional Independence Measure Motor items were recorded before treatment ( T0 ) , after 4 weeks of treatment ( T1 ) , and at the follow-up visit 4 to 5 months after the conclusion of treatment ( T2 ) . Results . An improvement over time was appreciated on all measures of impairment and functional ability with both treatment programs . A Time × Treatment interaction emerged from the generalized estimating equations analysis of BBT , showing significant T0–T1 and T0–T2 differences in favor of EG . Conclusion . This multicenter trial endorses the use of action observation in upper-extremity rehabilitation , along with a role for the mirror neuron system in poststroke recovery OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change Background . Mirror therapy is a priming technique to improve motor function of the affected arm after stroke . Objective . To investigate whether a mirror therapy – based action observation ( AO ) protocol contributes to motor learning of the affected arm after stroke . Methods . A total of 37 participants in the chronic stage after stroke were r and omly allocated to the AO or control observation ( CO ) group . Participants were instructed to perform an upper-arm reaching task as fast and as fluently as possible . All participants trained the upper-arm reaching task with their affected arm alternated with either AO or CO . Participants in the AO group observed mirrored video tapes of reaching movements performed by their 
    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: [ Purpose ] The purpose of this study was to evaluate the functional effects of additional action observational training for functional electrical stimulation treatment on weight bearing , stability and gait velocity of hemiplegic patients . [ Subjects and Methods ] Twenty subjects were r and omized into two groups . Subjects more than six months post-stroke participated .  Balance and gait velocity were measured at the baseline , and after six weeks of treatment . Both groups received functional electrical stimulation treatment . The experimental group additionally received action observational training . The paired t-test was used to analyze differences in the outcome measures between before and after the intervention . The difference between the groups was compared using the independent t-test . [ Results ] The experimental group showed significant increases in weight bearing ( anterior·posterior , right·left ) on the affected side , stability index and gait velocity . The control group showed only a significant increase in anterior·posterior weight bearing on the affected side . Moreover , according to the comparison of training effects between in the two groups , the variables of anterior·posterior weight bearing , stability index and gait velocity revealed a statistically significant difference . [ Conclusion ] Additional action observational training for functional electrical stimulation treatment should be considered as a therapeutic method in physical therapy for the improvement of weight bearing , stability index and gait velocity of hemiplegic patients For consciously performed motor tasks executed in a defined and constant way , both motor imagery ( MI ) and action observation ( AO ) have been shown to promote motor learning . It is not known whether these forms of non-physical training also improve motor actions when these actions have to be variably applied in an unstable and unpredictable environment . The present study therefore investigated the influence of MI balance training ( MI_BT ) and a balance training combining AO and MI ( AO+MI_BT ) on postural control of undisturbed and disturbed upright stance on unstable ground . As spinal reflex excitability after classical ( i.e. , physical ) balance training ( BT ) is generally decreased , we tested whether non-physical BT also has an impact on spinal reflex circuits . Thirty-six participants were r and omly allocated into an MI_BT group  , in which participants imagined postural exercises , an AO+MI_BT group , in which participants observed videos of other people performing balance exercises and imagined being the person in the video , and a non-active control group ( CON ) . Before and after 4 weeks of non-physical training , balance performance was assessed on a free-moving platform during stance without perturbation and during perturbed stance . Soleus H-reflexes were recorded during stable and unstable stance . The post-measurement revealed significantly decreased postural sway during undisturbed and disturbed stance after both MI_BT and AO+MI_BT . Spinal reflex excitability remained unchanged . This is the first study showing that non-physical training ( MI_BT and AO+MI_BT ) not only promotes motor learning of “ rigid ” postural tasks but also improves performance of highly variable and unpredictable balance actions . These findings may be relevant to improve postural control and thus reduce the risk of falls in temporarily immobilized patients The clinical impact of action observation ( AO ) on upper limb functional recovery in subacute stroke patients is recent evidence . We sought to test the hypothesis that training everyday life activities through AO coupled with task execution might activate the left hemisphere different from the right one . Sixty-seven first-ever ischemic stroke subjects were r and omly assigned to receive upper limb training coupled with AO tasks or st and ard rehabilitation . The groups were matched by age and gender , Bamford category , and interval from stroke and lesion side . Fugl-Meyer ( FM ) and Box and Block Test ( BBT ) were used to measure h and function recovery at the end ( T1 ) and 4 - 5 months after the treatment ( T2 ) . At T1 , FM was increased by 31 % ( ±26 % ) , of maximum achievable recovery , whereas BBT was increased by 17 % ( ±18 % ) ; at T2 , FM had reached 43 % ( ±45 % ) of maximum recovery , while BBT had reached 25 % ( ±22 % ) . Combining the effects of treatment to those of lesion side revealed significantly higher gains , in both FM and BBT scores , in left hemiparetic subjects when exposed to AO as compared to st and ard rehabilitation alone ( P < .01 ) . The findings lead to recommend the use of AO in addition to motor training in left hemiparetic patients [ Purpose ] This study examined the effects of action observation and action practice on stroke patients ’ upper limb function .  [ Subjects and Methods ] The subjects were 33 chronic stroke patients who were r and omly assigned to four groups . The action observation group ( 5 males , 3 females ) watched a video of the task , the action practice group ( 5 males , 4 females ) performed the action , the combined action observation-action practice group ( 5 males , 4 females ) watched the video of the task and practice d the action , and the control group ( 4 males , 3 females ) did not perform either action observation or action practice . The video used in the action observational physical training comprised a scene of an adult male picking up a cup , bringing it to his mouth in order to touch his mouth , and then returning the cup to its initial position . [ Results ] Improvements in drinking behavior functions were observed immediately after the experiment and one week later . After the intervention , the number of drinking motions had increased the most in the combination group . One week after the experiment , there were increases in the action observation , action training , and combination groups . [ Conclusion ] A combination of action observation and action training is the most effective treatment method , and action training is a desirable second to combined therapy Background Evidence exist that motor observation activates the same cortical motor areas that are involved in the performance of the observed actions . The so called “ mirror neuron system ” has been proposed to be responsible for this phenomenon . We employ this neural system and its capability to re-enact stored motor representations as a tool for rehabilitating motor control . In our new neurorehabilitative schema ( videotherapy ) we combine observation of daily actions with concomitant physical training of the observed actions focusing on the upper limbs . Following a pilot study in chronic patients in an ambulatory setting , we currently design ed a new multicenter clinical study dedicated to patients in the sub-acute state after stroke using a home-based self-induced training .  Within our protocol we assess 1 ) the capability of action observation to elicit rehabilitational effects in the motor system , and 2 ) the capacity of this schema to be performed by patients without assistance from a physiotherapist . The results of this study would be of high health and economical relevance . Methods / design A controlled , r and omized , multicenter , paralleled , 6 month follow-up study will be conducted on three groups of patients : one group will be given the experimental treatment whereas the other two will participate in control treatments .  All patients will undergo their usual rehabilitative treatment beside participation in the study . The experimental condition consists in the observation and immediate imitation of common daily h and and arm actions . The two parallel control groups are a placebo group and a group receiving usual rehabilitation without any trial-related treatment . Trial r and omization is provided via external data management . The primary efficacy endpoint is the improvement of the experimental group in a st and ardized motor function test ( Wolf Motor Function Test ) relative to control groups . Further assessment s refer to subjective and qualitative rehabilitational scores . This study has been review ed and approved by the ethics committee of Aachen University . Discussion This therapy provides an extension of therapeutic procedures for recovery after stroke and emphasizes the importance of action perception in neurorehabilitation The results of the study could become implemented into the wide physiotherapeutic practice , for example as an ad on and individualized therapy Background Rehabilitation for children with hemiplegic cerebral palsy ( HCP ) aim ed to improve function of the impaired upper limb ( UL ) uses a wide range of intervention programs . A new rehabilitative approach , called Action-Observation Therapy , based on the recent discovery of mirror neurons , has been used in adult stroke but not in children . The purpose of the present study is to design a r and omised controlled trial ( RCT ) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP . Methods / Design The trial is design ed according to CONSORT Statement . It is a r and omised , evaluator-blinded , match-pair group trial . Children with HCP will be r and omised within pairs to either experimental or control group . The experimental group will perform an Action-Observation Therapy , called UP-CAT ( Upper Limb-Children Action-Observation Training ) in which they will watch video sequences showing goal -directed actions , chosen according to children UL functional level , combined with motor training with their hemiplegic UL . The control group will perform the same tailored actions after watching computer games . A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed . Assisting H and Assessment was chosen as primary measure and , based on its calculation power , a sample size of 12 matched pairs was established . Moreover , Melbourne and ABILH AND -Kids were included as secondary measures . The time line of assessment s will be T0 ( in the week preceding the onset of the treatment ) , T1 and T2 ( in the week after the end of the treatment and 8 weeks later , respectively ) . A further assessment will be performed at T3 ( 24 weeks after T1 ) , to evaluate the retention of effects . In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging , exploring the mirror system and sensory-motor function , will be performed at T0 , T1 and T2 . Discussion The paper aims to describe the methodology of a RCT for evaluating the efficacy of  Action-Observation Therapy  in improving UL activity in children with hemiplegia . This study will be the first to test this new type of treatment in childhood . The paper presents the theoretical background , study hypotheses , outcome measures and trial methodology .Trial Registration Objective . A r and omized controlled observer-blind trial was design ed to evaluate the effectiveness of action observation as an add-on treatment to the st and ard rehabilitation of upper-limb function , early after stroke . Methods . Stroke survivors ( N = 102 ) were consecutively recruited from 13 centers 30 days ( ±7 ) after a first-ever stroke and r and omly assigned to the  experimental ( EG )  or  control group (  CG ) . EG participants watched video footage of daily routine tasks ( actions ) carried out with the upper limb in order to prepare to imitate the presented action . At the end of each sequence , a therapist prompted the patient to perform the same movement for 2 minutes , providing help when needed . Static images without animals or human beings were shown to the CG . At the end of each sequence , the CG executed movements that simulated the shoulder and elbow joint mobilization activities performed by the EG . Results for the Fugl-Meyer test , Frenchay Arm test , Box and Block test ( BBT ) , Modified Ashworth Scale , and Functional Independence Measure Motor items were recorded before treatment ( T0 ) , after 4 weeks of treatment ( T1 ) , and at the follow-up visit 4 to 5 months after the conclusion of treatment ( T2 ) . Results . An improvement over time was appreciated on all measures of impairment and functional ability with both treatment programs . A Time × Treatment interaction emerged from the generalized estimating equations analysis of BBT , showing significant T0–T1 and T0–T2 differences in favor of EG . Conclusion . This multicenter trial endorses the use of action observation in upper-extremity rehabilitation , along with a role for the mirror neuron system in poststroke recovery OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change Background . Mirror therapy is a priming technique to improve motor function of the affected arm after stroke . Objective . To investigate whether a mirror therapy – based action observation ( AO ) protocol contributes to motor learning of the affected arm after stroke . Methods . A total of 37 participants in the chronic stage after stroke were r and omly allocated to the AO or control observation ( CO ) group . Participants were instructed to perform an upper-arm reaching task as fast and as fluently as possible . All participants trained the upper-arm reaching task with their affected arm alternated with either AO or CO . Participants in the AO group observed mirrored video tapes of reaching movements performed by their 
    Output:
    