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: Objective : To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke . Design : R and omized controlled trial . Setting : Outpatient neurorehabilitation unit . Participants : A total of 20 individuals with chronic stroke . Interventions : The intervention consisted of 20 one-hour sessions , five sessions per week . The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training . The control group underwent one hour conventional therapy . Main measures : Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale , the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment , the Brunel Balance Assessment , and the 10-m Walking Test . Subjective data of the virtual reality-based intervention were collected from the experimental group , with a feedback question naire at the end of the trial . Results : The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale ( p < 0.05 ) and in the 10-m Walking Test ( p < 0.05 ) . Post-hoc analyses showed greater improvement in the experimental group : 3.8 ±2.6 vs. 1.8 ±1.4 in the Berg Balance Scale , –1.9 ±1.6 seconds vs. 0.0 ±2.3 seconds in the 10-m Walking Test , and also in the number of participants who increased level in the Brunel Balance Assessment ( χ2 = 2.5 , p < 0.01 ) . Conclusions : Virtual reality interventions can be an effective re source to enhance the improvement of balance in individuals with chronic stroke BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Trunk instability is one of main problems in survivors following stroke . We investigated the effects of weight-shift training ( WST ) on an unstable surface in sitting position on trunk control , proprioception , and balance in individuals with chronic hemiparetic stroke . Eighteen participants with chronic hemiparetic stroke were recruited and were allocated to either WST or control group . The WST group received a weight-shift training program for 30 min and then received a conventional exercise program for 30 min , while the control group received conventional exercise program for 60 min , five times a week for four weeks for both groups . In this r and omized control study , we used three outcome measures : trunk reposition error ( TRE ) , Trunk Impairment Scale ( TIS ) , and Timed Up and Go ( TUG ) test . TRE was measured by each participant 's reposition error to the target angle during his/her active trunk movement . TIS and TUG were examined for trunk control abilities and dynamic balance abilities , respectively . After training , TRE showed significantly greater improvement in the WST group ( mean change , 1.67 ± 1.45˚ ) than the control group ( mean change , 0.08 ± 1.05˚ ) . The TIS score was significantly higher in the WST group ( mean change , 2.33 ± 1.50 ) than the control group ( mean change , 0.13 ± 0.83 ) . The TUG test also showed a significant improvement in the WST group ( mean change , 5.03 ± 1.88 sec ) than the control group ( mean change , 2.59 ± 1.86 sec ) . Our findings indicate that weight-shift training is beneficial for improving trunk control and proprioception in patients with chronic hemiparetic stroke Objective : To investigate the feasibility and potential efficacy of ‘ activeTENS ’ ( that is transcutaneous electrical nerve stimulation ( TENS ) during everyday activities ) by assessing the immediate effects on strength , proprioception , balance/falls risk and mobility after stroke . Design : A paired- sample r and omized cross-over trial . Subjects : Twenty-nine mobile chronic stroke survivors with no pre-existing conditions limiting balance or mobility or contra-indications to TENS . Setting : University clinical research facility . Intervention : A single session of ‘ activeTENS ’ delivered via a ‘ sock electrode ’ ( 70–130 Hz , five second cycle ) plus a session of control treatment ( wearing the sock electrode with no stimulation ) , lasting approximately two hours in total . Main Outcomes : Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dyanometer , balance and falls risk ( St and ing Forward Reach Test ) and gait speed ( 10-m walk test ) . Results : All participants tolerated ‘ active TENS ’  . Most parameters improved during stimulation with activeTENS ; balance ( p = 0.009 ) , gait speed ( p = 0.002 ) , plantarflexor strength ( p = 0.008 ) and proprioception of plantarflexion ( p = 0.029 ) , except dorsiflexor strength ( p = 0.194 ) and dorsiflexion proprioception ( p = 0.078 ) . Conclusions : The results provide initial evidence of the potential of ‘ active TENS ’ to benefit physical function after stroke which warrants further phase II trials to develop the intervention . Concerns that stimulation could have a detrimental impact on balance and increase risk of falls were not supported Objective . Gait performance is an indicator of mobility impairment after stroke . This study evaluated changes in balance , lower extremity motor function , and spatiotemporal gait parameters after receiving body weight supported treadmill training ( BWSTT ) and conventional overground walking training ( CT ) in patients with subacute stroke using 3D motion analysis . Setting . Inpatient department of rehabilitation medicine at a university-affiliated hospital . Participants . 24 subjects with unilateral hemiplegia in the subacute stage were r and omized to the BWSTT ( n = 12 ) and CT ( n = 12 ) groups . Parameters were compared between the two groups . Data from twelve age matched healthy subjects were recorded as reference . Interventions . Patients received gait training with BWSTT or CT for an average of 30 minutes/day , 5 days/week , for 3 weeks . Main Outcome Measures . Balance was measured by the Brunel balance assessment . Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale . Kinematic data were collected and analyzed using a gait capture system before and after the interventions . Results . Both groups improved on balance and lower extremity motor function measures ( P < 0.05 ) , with no significant difference between the two groups after intervention . However , kinematic data were significantly improved ( P < 0.05 ) after BWSTT but not after CT .  Maximum hip extension and flexion angles were significantly improved ( P < 0.05 ) for the BWSTT group during the stance and swing phases compared to baseline . Conclusion . In subacute patients with stroke , BWSTT can lead to improved gait quality when compared with conventional gait training . Both methods can improve balance and motor function The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results , whereas little information is available regarding the use of this therapy in subacute stroke patients . The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase . Fifty adult stroke patients participated to the study : 25 subjects were r and omly assigned to balance training with Wii Fit , and the other 25 subjects were assigned to usual balance therapy . Both groups were also treated with conventional physical therapy ( 40 min 2 times/day ) . The main outcome was functional balance ( Berg Balance Scale-BBS ) , and secondary outcomes were disability ( Barthel Index-BI ) , walking ability ( Functional Ambulation Category ) , and walking speed ( 10-meters walking test ) .  Wii Fit training was more effective than usual balance therapy in improving balance ( BBS : 53 versus 48 , P = 0.004 ) and independency in activity of daily living ( BI : 98 versus 93 , P = 0.021 ) . A balance training performed with a Wii Fit as an add on to the conventional therapy was found to be more effective than conventional therapy alone in improving balance and reducing disability in patients with subacute stroke Background and Purpose — Exercise using virtual reality ( VR ) has improved balance in adults with traumatic brain injury and community-dwelling older adults . Rigorous r and omized studies regarding its efficacy , safety , and applicability with individuals after stroke are lacking . The purpose of this study was to determine whether an adjunct VR therapy improves balance , mobility , and gait in stroke rehabilitation in patients . Methods — A blinded r and omized controlled trial study ing 59 stroke survivors on an inpatient stroke rehabilitation unit was performed . The treatment group ( n=30 ) received st and ard stroke rehabilitation therapy plus a program of VR exercises that challenged balance ( eg , soccer goal tending , snowboarding ) performed while st and ing . The control group ( n=29 ) received st and ard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance ( performed in sitting ) . VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period . Objective outcome measures of balance and mobility were assessed before , immediately after , and 1 month after training . Results — Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test , with both groups meeting minimal clinical important differences after training . More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain ( P=0.04 ) immediately after training . Conclusions — This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes . Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR . Clinical Trial Registration — URL : http://www.ANZCTR.org.au/. Unique identifier : ACTRN12613000710729 Objective : The aim of this study was to evaluate the effects of virtual reality ( VR ) treadmill training on the balance skills of patients who have had a stroke . Design : A total of 14 patients with strokes were recruited and r and omly assigned to receive VR treadmill or traditional treadmill training . The outcome measures that were included for the study were center of pressure ( COP ) sway excursion , COP maximum sway in anterior-posterior direction , COP maximum sway in medial-lateral direction , COP sway area , bilateral limb-loading symmetric index , the sway excursion values for the paretic foot ( sway excursion/P ) , paretic limb stance time ( stance time/P ) , number of steps of the paretic limb ( number of steps/P ) , and contact area of the paretic foot ( contact A/P ) during quiet stance , sit-to-st and transfer , and level walking . Results : There were no significant improvements in COP-related measures and symmetric index during the quiet stance , either in the VR treadmill or traditional treadmill training group ( P > 0.05 ) . However , the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant ( P = 0.038 ) . Traditional treadmill training failed to improve sit-to-st and performance , whereas VR treadmill training improved symmetric index ( P = 0.028 ) and sway excursion ( P = 0.046 ) significantly during sit-to-st and transfer . The changes of symmetric index between groups were markedly different ( P = 0.045 ) . Finally , both groups improved significantly in stance time/P , but only VR treadmill training increased contact A/P ( P = 0.034 ) after training during level walking . The difference between groups during level walking was not significant . Conclusions : Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance , but VR treadmill training improved balance skill in the 
    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: Objective : To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke . Design : R and omized controlled trial . Setting : Outpatient neurorehabilitation unit . Participants : A total of 20 individuals with chronic stroke . Interventions : The intervention consisted of 20 one-hour sessions , five sessions per week . The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training . The control group underwent one hour conventional therapy . Main measures : Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale , the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment , the Brunel Balance Assessment , and the 10-m Walking Test . Subjective data of the virtual reality-based intervention were collected from the experimental group , with a feedback question naire at the end of the trial . Results : The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale ( p < 0.05 ) and in the 10-m Walking Test ( p < 0.05 ) . Post-hoc analyses showed greater improvement in the experimental group : 3.8 ±2.6 vs. 1.8 ±1.4 in the Berg Balance Scale , –1.9 ±1.6 seconds vs. 0.0 ±2.3 seconds in the 10-m Walking Test , and also in the number of participants who increased level in the Brunel Balance Assessment ( χ2 = 2.5 , p < 0.01 ) . Conclusions : Virtual reality interventions can be an effective re source to enhance the improvement of balance in individuals with chronic stroke BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Trunk instability is one of main problems in survivors following stroke . We investigated the effects of weight-shift training ( WST ) on an unstable surface in sitting position on trunk control , proprioception , and balance in individuals with chronic hemiparetic stroke . Eighteen participants with chronic hemiparetic stroke were recruited and were allocated to either WST or control group . The WST group received a weight-shift training program for 30 min and then received a conventional exercise program for 30 min , while the control group received conventional exercise program for 60 min , five times a week for four weeks for both groups . In this r and omized control study , we used three outcome measures : trunk reposition error ( TRE ) , Trunk Impairment Scale ( TIS ) , and Timed Up and Go ( TUG ) test . TRE was measured by each participant 's reposition error to the target angle during his/her active trunk movement . TIS and TUG were examined for trunk control abilities and dynamic balance abilities , respectively . After training , TRE showed significantly greater improvement in the WST group ( mean change , 1.67 ± 1.45˚ ) than the control group ( mean change , 0.08 ± 1.05˚ ) . The TIS score was significantly higher in the WST group ( mean change , 2.33 ± 1.50 ) than the control group ( mean change , 0.13 ± 0.83 ) . The TUG test also showed a significant improvement in the WST group ( mean change , 5.03 ± 1.88 sec ) than the control group ( mean change , 2.59 ± 1.86 sec ) . Our findings indicate that weight-shift training is beneficial for improving trunk control and proprioception in patients with chronic hemiparetic stroke Objective : To investigate the feasibility and potential efficacy of ‘ activeTENS ’ ( that is transcutaneous electrical nerve stimulation ( TENS ) during everyday activities ) by assessing the immediate effects on strength , proprioception , balance/falls risk and mobility after stroke . Design : A paired- sample r and omized cross-over trial . Subjects : Twenty-nine mobile chronic stroke survivors with no pre-existing conditions limiting balance or mobility or contra-indications to TENS . Setting : University clinical research facility . Intervention : A single session of ‘ activeTENS ’ delivered via a ‘ sock electrode ’ ( 70–130 Hz , five second cycle ) plus a session of control treatment ( wearing the sock electrode with no stimulation ) , lasting approximately two hours in total . Main Outcomes : Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dyanometer , balance and falls risk ( St and ing Forward Reach Test ) and gait speed ( 10-m walk test ) . Results : All participants tolerated ‘ active TENS ’  . Most parameters improved during stimulation with activeTENS ; balance ( p = 0.009 ) , gait speed ( p = 0.002 ) , plantarflexor strength ( p = 0.008 ) and proprioception of plantarflexion ( p = 0.029 ) , except dorsiflexor strength ( p = 0.194 ) and dorsiflexion proprioception ( p = 0.078 ) . Conclusions : The results provide initial evidence of the potential of ‘ active TENS ’ to benefit physical function after stroke which warrants further phase II trials to develop the intervention . Concerns that stimulation could have a detrimental impact on balance and increase risk of falls were not supported Objective . Gait performance is an indicator of mobility impairment after stroke . This study evaluated changes in balance , lower extremity motor function , and spatiotemporal gait parameters after receiving body weight supported treadmill training ( BWSTT ) and conventional overground walking training ( CT ) in patients with subacute stroke using 3D motion analysis . Setting . Inpatient department of rehabilitation medicine at a university-affiliated hospital . Participants . 24 subjects with unilateral hemiplegia in the subacute stage were r and omized to the BWSTT ( n = 12 ) and CT ( n = 12 ) groups . Parameters were compared between the two groups . Data from twelve age matched healthy subjects were recorded as reference . Interventions . Patients received gait training with BWSTT or CT for an average of 30 minutes/day , 5 days/week , for 3 weeks . Main Outcome Measures . Balance was measured by the Brunel balance assessment . Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale . Kinematic data were collected and analyzed using a gait capture system before and after the interventions . Results . Both groups improved on balance and lower extremity motor function measures ( P < 0.05 ) , with no significant difference between the two groups after intervention . However , kinematic data were significantly improved ( P < 0.05 ) after BWSTT but not after CT .  Maximum hip extension and flexion angles were significantly improved ( P < 0.05 ) for the BWSTT group during the stance and swing phases compared to baseline . Conclusion . In subacute patients with stroke , BWSTT can lead to improved gait quality when compared with conventional gait training . Both methods can improve balance and motor function The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results , whereas little information is available regarding the use of this therapy in subacute stroke patients . The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase . Fifty adult stroke patients participated to the study : 25 subjects were r and omly assigned to balance training with Wii Fit , and the other 25 subjects were assigned to usual balance therapy . Both groups were also treated with conventional physical therapy ( 40 min 2 times/day ) . The main outcome was functional balance ( Berg Balance Scale-BBS ) , and secondary outcomes were disability ( Barthel Index-BI ) , walking ability ( Functional Ambulation Category ) , and walking speed ( 10-meters walking test ) .  Wii Fit training was more effective than usual balance therapy in improving balance ( BBS : 53 versus 48 , P = 0.004 ) and independency in activity of daily living ( BI : 98 versus 93 , P = 0.021 ) . A balance training performed with a Wii Fit as an add on to the conventional therapy was found to be more effective than conventional therapy alone in improving balance and reducing disability in patients with subacute stroke Background and Purpose — Exercise using virtual reality ( VR ) has improved balance in adults with traumatic brain injury and community-dwelling older adults . Rigorous r and omized studies regarding its efficacy , safety , and applicability with individuals after stroke are lacking . The purpose of this study was to determine whether an adjunct VR therapy improves balance , mobility , and gait in stroke rehabilitation in patients . Methods — A blinded r and omized controlled trial study ing 59 stroke survivors on an inpatient stroke rehabilitation unit was performed . The treatment group ( n=30 ) received st and ard stroke rehabilitation therapy plus a program of VR exercises that challenged balance ( eg , soccer goal tending , snowboarding ) performed while st and ing . The control group ( n=29 ) received st and ard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance ( performed in sitting ) . VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period . Objective outcome measures of balance and mobility were assessed before , immediately after , and 1 month after training . Results — Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test , with both groups meeting minimal clinical important differences after training . More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain ( P=0.04 ) immediately after training . Conclusions — This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes . Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR . Clinical Trial Registration — URL : http://www.ANZCTR.org.au/. Unique identifier : ACTRN12613000710729 Objective : The aim of this study was to evaluate the effects of virtual reality ( VR ) treadmill training on the balance skills of patients who have had a stroke . Design : A total of 14 patients with strokes were recruited and r and omly assigned to receive VR treadmill or traditional treadmill training . The outcome measures that were included for the study were center of pressure ( COP ) sway excursion , COP maximum sway in anterior-posterior direction , COP maximum sway in medial-lateral direction , COP sway area , bilateral limb-loading symmetric index , the sway excursion values for the paretic foot ( sway excursion/P ) , paretic limb stance time ( stance time/P ) , number of steps of the paretic limb ( number of steps/P ) , and contact area of the paretic foot ( contact A/P ) during quiet stance , sit-to-st and transfer , and level walking . Results : There were no significant improvements in COP-related measures and symmetric index during the quiet stance , either in the VR treadmill or traditional treadmill training group ( P > 0.05 ) . However , the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant ( P = 0.038 ) . Traditional treadmill training failed to improve sit-to-st and performance , whereas VR treadmill training improved symmetric index ( P = 0.028 ) and sway excursion ( P = 0.046 ) significantly during sit-to-st and transfer . The changes of symmetric index between groups were markedly different ( P = 0.045 ) . Finally , both groups improved significantly in stance time/P , but only VR treadmill training increased contact A/P ( P = 0.034 ) after training during level walking . The difference between groups during level walking was not significant . Conclusions : Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance , but VR treadmill training improved balance skill in the 
    Output:
    