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: AIM To evaluate the effects of ' ' Playstation EyeToy Games ' ' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke . METHODS The authors design ed a r and omized , controlled , assessor-blinded , 4-week trial , with follow-up at 3 months . A total of 20 hemiparetic in patients ( mean age 61.1 years ) , all within 12 months post-stroke , received 30 minutes of treatment with ' ' Playstation EyeToy Games ' ' per day , consisting of flexion and extension of the paretic shoulder , elbow and wrist as well as abduction of the paretic shoulder or placebo therapy ( watching the games for the same duration without physical involvement into the games ) in addition to conventional program , 5 days a week , 2 - 5 hours/day for 4 weeks . Brunnstrom 's staging and self-care sub-items of the functional independence measure ( FIM ) were performed at 0 month ( baseline ) , 4 weeks ( post-treatment ) , and 3 months ( follow-up ) after the treatment . RESULTS The mean change score ( 95 % confidence interval ) of the FIM self-care score ( 5.5 [ 2.9 - 8.0 ] vs 1.8 [ 0.1 - 3.7 ] , P=0.018 ) showed significantly more improvement in the EyeToy group compared to the control group . No significant differences were found between the groups for the Brunnstrom stages for h and and upper extremity . CONCLUSION ' ' Playstation EyeToy Games ' ' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients Background and Purpose — Botulinum toxin is increasingly used to treat upper limb spasticity due to stroke , but its impact on arm function is unclear . We evaluated botulinum toxin for upper limb spasticity and function poststroke . Methods — Three hundred thirty-three patients with stroke with upper limb spasticity and reduced arm function participated in a multicenter r and omized controlled trial . The intervention group received botulinum toxin type A injection(s ) plus a 4-week therapy program . The control group received the therapy program alone . Repeat injection(s ) and therapy were available at 3 , 6 , and 9 months . The primary outcome was upper limb function at 1 month ( Action Research Arm Test ) . Secondary outcomes included measures of impairment , activity limitation , and pain at 1 , 3 , and 12 months . Outcome assessment s were blinded and analysis was by intention to treat . Results — There was no significant difference in achievement of improved arm function ( Action Research Arm Test ) at 1 month ( intervention group : 42 of 167 [ 25.1 % ] , control group 30 of 154 [ 19.5 % ] ; P=0.232 ) . Significant differences in favor of the intervention group were seen in muscle tone at 1 month ; upper limb strength at 3 months ; basic arm functional tasks ( h and hygiene , facilitation of dressing ) at 1 , 3 , and 12 months ; and pain at 12 months . Conclusions — Botulinum toxin type A is unlikely to be useful for improving active upper limb function ( eg , reaching and grasping ) in the majority of patients with spasticity after stroke , but it may improve basic upper limb tasks ( h and hygiene , facilitation of dressing ) and pain CONTEXT Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % ] ; P<.001 ) and in the MAL Amount of Use ( on a 0 - 5 scale , increase from 1.21 to 2.13 vs from 1.15 to 1.65 ; between-group difference , 0.43 [ 95 % CI , 0.05 - 0.80 ] ; P<.001 ) and MAL Quality of Movement ( on a 0 - 5 scale , increase from 1.26 to 2.23 vs 1.18 to 1.66 ; between-group difference , 0.48 [ 95 % CI , 0.13 - 0.84 ] ; P<.001 ) . The CIMT group achieved a decrease of 19.5 in self-perceived h and function difficulty ( Stroke Impact Scale h and domain ) vs a decrease of 10.1 for the control group ( between-group difference , 9.42 [ 95 % CI , 0.27 - 18.57 ] ; P=.05 ) . CONCLUSION Among patients who had a stroke within the previous 3 to 9 months , CIMT produced statistically significant and clinical ly relevant improvements in arm motor function that persisted for at least 1 year . Trial Registration clinical trials.gov Identifier : NCT00057018 Background and Purpose — The Wolf Motor Function Test ( WMFT ) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements . This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population . Methods — Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment . Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment ( FMA ) on 2 occasions ( 12 to 16 days apart ) , with scoring performed independently by 2 r and om raters . Results — The  WMFT and FMA demonstrated agreement ( P < 0.0001 ) between raters at each session .  WMFT  scores for the dominant and nondominant extremities of individuals without impairment were different ( P ≤0.05 ) from the more and less affected extremities of subjects after stroke . The FMA score for the more affected extremity of subjects after stroke was different ( P ≤0.05 ) from the dominant and nondominant extremities . However , the FMA score for the less affected upper extremity of individuals after stroke was not different ( P > 0.05 ) from the dominant and nondominant extremities of individuals without impairment . The WMFT and FMA scores were related ( P < 0.02 ) for the more affected extremity in individuals after stroke . Conclusions — The interrater reliability , construct validity , and criterion validity of the WMFT , as used in these subject sample s , are supported Objective : Spasticity after stroke may be associated with worse functional outcome . Our study aim is to establish whether a low dose of botulinum toxin , given early post stroke before clinical ly evident spasticity warrants treatment , will improve recovery of arm function . Design : A double-blind r and omized placebo-controlled trial . Setting : An acute stroke unit . Subjects : Individuals recruited within three weeks of stroke onset with severe arm function deficits . Interventions : Injections of quarter and half st and ard dose botulinum toxin A to the upper limb , with a control of normal saline injections . Main measures : Arm function , active and passive movement , and spasticity at elbow and wrist were recorded at baseline , and at 4 , 8 , 12 and 20 weeks post intervention . A pre-planned subgroup analysis included only subjects with no arm function at baseline ( Action Research Arm Test score = 0 ) . Results : Thirty subjects were recruited , and 21 completed all assessment s. Arm function scores improved in all three groups between baseline and week 20 . There was no benefit for active treatment over control in the whole group analysis . In the subgroup analysis the active groups improved when compared with the control group and effect sizes for improvement in this subgroup were 0.6 and 0.5 for the quarter dose and half dose groups respectively . Conclusions : Individuals with no arm function within three weeks of stroke may benefit functionally from botulinum toxin . Using the effect size of 0.5 , further studies would need a minimum of 101 participants in each group to confirm this finding The  Motor Status Scale ( MSS ) measures shoulder , elbow ( maximum score = 40 ) , wrist , h and , and finger movements ( maximum score = 42 ) , and exp and s the measurement of upper extremity impairment and disability provided by the Fugl-Meyer ( FM ) score . This work examines the interrater reliability and criterion validity of the MSS performed in patients admitted to a rehabilitation hospital 21 ± 4 days after stroke . Using the MSS and the FM , 7 occupational therapists masked to each other ’s judgments , evaluated 12 consecutive patients with stroke . Two therapists evaluated 6 additional patients on consecutive days . Intraclass correlation coefficients were significant for each group of raters for the shoulder/elbow and for the wrist/h and ( P < 0.0001 ) ; test-retest measures were also significant for the shoulder/elbow ( Pearson correlation coefficient r = 0.99 , P < 0.004 ) and for the wrist/h and ( Pearson correlation coefficient r = 0.99 , P < 0.003 ) . The internal item consistency for the overall MSS was significant ( Cronbach alpha = 0.98 , P < 0.0001 ) . Finally the correlation between the MSS and the FM ( R 2 = 0.964 ) was significant ( P < 0.0001 ) . The MSS affords a reliable and valid assessment of upper limb impairment and disability following stroke OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review Objective . To investigate the effectiveness of computerized virtual reality ( VR ) training of the hemiparetic h and of patients poststroke using a system that provides repetitive motor reeducation and skill reacquisition . Methods . Eight subjects in the chronic phase poststroke participated in a 3-week program using their hemiparetic h and in a series of interactive computer games for 13 days of training , weekend breaks , and pretests and posttests . Each subject trained for about 2 to 2.5 h per day . Outcome measures consisted of changes in the computerized measures of thumb and finger range of motion , thumb and finger velocity , fractionation ( the ability to move fingers independently ) , thumb and finger strength , the Jebsen Test of H and Function , and a Kinematic reach to grasp test . Results . Subjects as a group improved in fractionation of 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: AIM To evaluate the effects of ' ' Playstation EyeToy Games ' ' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke . METHODS The authors design ed a r and omized , controlled , assessor-blinded , 4-week trial , with follow-up at 3 months . A total of 20 hemiparetic in patients ( mean age 61.1 years ) , all within 12 months post-stroke , received 30 minutes of treatment with ' ' Playstation EyeToy Games ' ' per day , consisting of flexion and extension of the paretic shoulder , elbow and wrist as well as abduction of the paretic shoulder or placebo therapy ( watching the games for the same duration without physical involvement into the games ) in addition to conventional program , 5 days a week , 2 - 5 hours/day for 4 weeks . Brunnstrom 's staging and self-care sub-items of the functional independence measure ( FIM ) were performed at 0 month ( baseline ) , 4 weeks ( post-treatment ) , and 3 months ( follow-up ) after the treatment . RESULTS The mean change score ( 95 % confidence interval ) of the FIM self-care score ( 5.5 [ 2.9 - 8.0 ] vs 1.8 [ 0.1 - 3.7 ] , P=0.018 ) showed significantly more improvement in the EyeToy group compared to the control group . No significant differences were found between the groups for the Brunnstrom stages for h and and upper extremity . CONCLUSION ' ' Playstation EyeToy Games ' ' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients Background and Purpose — Botulinum toxin is increasingly used to treat upper limb spasticity due to stroke , but its impact on arm function is unclear . We evaluated botulinum toxin for upper limb spasticity and function poststroke . Methods — Three hundred thirty-three patients with stroke with upper limb spasticity and reduced arm function participated in a multicenter r and omized controlled trial . The intervention group received botulinum toxin type A injection(s ) plus a 4-week therapy program . The control group received the therapy program alone . Repeat injection(s ) and therapy were available at 3 , 6 , and 9 months . The primary outcome was upper limb function at 1 month ( Action Research Arm Test ) . Secondary outcomes included measures of impairment , activity limitation , and pain at 1 , 3 , and 12 months . Outcome assessment s were blinded and analysis was by intention to treat . Results — There was no significant difference in achievement of improved arm function ( Action Research Arm Test ) at 1 month ( intervention group : 42 of 167 [ 25.1 % ] , control group 30 of 154 [ 19.5 % ] ; P=0.232 ) . Significant differences in favor of the intervention group were seen in muscle tone at 1 month ; upper limb strength at 3 months ; basic arm functional tasks ( h and hygiene , facilitation of dressing ) at 1 , 3 , and 12 months ; and pain at 12 months . Conclusions — Botulinum toxin type A is unlikely to be useful for improving active upper limb function ( eg , reaching and grasping ) in the majority of patients with spasticity after stroke , but it may improve basic upper limb tasks ( h and hygiene , facilitation of dressing ) and pain CONTEXT Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % ] ; P<.001 ) and in the MAL Amount of Use ( on a 0 - 5 scale , increase from 1.21 to 2.13 vs from 1.15 to 1.65 ; between-group difference , 0.43 [ 95 % CI , 0.05 - 0.80 ] ; P<.001 ) and MAL Quality of Movement ( on a 0 - 5 scale , increase from 1.26 to 2.23 vs 1.18 to 1.66 ; between-group difference , 0.48 [ 95 % CI , 0.13 - 0.84 ] ; P<.001 ) . The CIMT group achieved a decrease of 19.5 in self-perceived h and function difficulty ( Stroke Impact Scale h and domain ) vs a decrease of 10.1 for the control group ( between-group difference , 9.42 [ 95 % CI , 0.27 - 18.57 ] ; P=.05 ) . CONCLUSION Among patients who had a stroke within the previous 3 to 9 months , CIMT produced statistically significant and clinical ly relevant improvements in arm motor function that persisted for at least 1 year . Trial Registration clinical trials.gov Identifier : NCT00057018 Background and Purpose — The Wolf Motor Function Test ( WMFT ) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements . This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population . Methods — Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment . Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment ( FMA ) on 2 occasions ( 12 to 16 days apart ) , with scoring performed independently by 2 r and om raters . Results — The  WMFT and FMA demonstrated agreement ( P < 0.0001 ) between raters at each session .  WMFT  scores for the dominant and nondominant extremities of individuals without impairment were different ( P ≤0.05 ) from the more and less affected extremities of subjects after stroke . The FMA score for the more affected extremity of subjects after stroke was different ( P ≤0.05 ) from the dominant and nondominant extremities . However , the FMA score for the less affected upper extremity of individuals after stroke was not different ( P > 0.05 ) from the dominant and nondominant extremities of individuals without impairment . The WMFT and FMA scores were related ( P < 0.02 ) for the more affected extremity in individuals after stroke . Conclusions — The interrater reliability , construct validity , and criterion validity of the WMFT , as used in these subject sample s , are supported Objective : Spasticity after stroke may be associated with worse functional outcome . Our study aim is to establish whether a low dose of botulinum toxin , given early post stroke before clinical ly evident spasticity warrants treatment , will improve recovery of arm function . Design : A double-blind r and omized placebo-controlled trial . Setting : An acute stroke unit . Subjects : Individuals recruited within three weeks of stroke onset with severe arm function deficits . Interventions : Injections of quarter and half st and ard dose botulinum toxin A to the upper limb , with a control of normal saline injections . Main measures : Arm function , active and passive movement , and spasticity at elbow and wrist were recorded at baseline , and at 4 , 8 , 12 and 20 weeks post intervention . A pre-planned subgroup analysis included only subjects with no arm function at baseline ( Action Research Arm Test score = 0 ) . Results : Thirty subjects were recruited , and 21 completed all assessment s. Arm function scores improved in all three groups between baseline and week 20 . There was no benefit for active treatment over control in the whole group analysis . In the subgroup analysis the active groups improved when compared with the control group and effect sizes for improvement in this subgroup were 0.6 and 0.5 for the quarter dose and half dose groups respectively . Conclusions : Individuals with no arm function within three weeks of stroke may benefit functionally from botulinum toxin . Using the effect size of 0.5 , further studies would need a minimum of 101 participants in each group to confirm this finding The  Motor Status Scale ( MSS ) measures shoulder , elbow ( maximum score = 40 ) , wrist , h and , and finger movements ( maximum score = 42 ) , and exp and s the measurement of upper extremity impairment and disability provided by the Fugl-Meyer ( FM ) score . This work examines the interrater reliability and criterion validity of the MSS performed in patients admitted to a rehabilitation hospital 21 ± 4 days after stroke . Using the MSS and the FM , 7 occupational therapists masked to each other ’s judgments , evaluated 12 consecutive patients with stroke . Two therapists evaluated 6 additional patients on consecutive days . Intraclass correlation coefficients were significant for each group of raters for the shoulder/elbow and for the wrist/h and ( P < 0.0001 ) ; test-retest measures were also significant for the shoulder/elbow ( Pearson correlation coefficient r = 0.99 , P < 0.004 ) and for the wrist/h and ( Pearson correlation coefficient r = 0.99 , P < 0.003 ) . The internal item consistency for the overall MSS was significant ( Cronbach alpha = 0.98 , P < 0.0001 ) . Finally the correlation between the MSS and the FM ( R 2 = 0.964 ) was significant ( P < 0.0001 ) . The MSS affords a reliable and valid assessment of upper limb impairment and disability following stroke OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review Objective . To investigate the effectiveness of computerized virtual reality ( VR ) training of the hemiparetic h and of patients poststroke using a system that provides repetitive motor reeducation and skill reacquisition . Methods . Eight subjects in the chronic phase poststroke participated in a 3-week program using their hemiparetic h and in a series of interactive computer games for 13 days of training , weekend breaks , and pretests and posttests . Each subject trained for about 2 to 2.5 h per day . Outcome measures consisted of changes in the computerized measures of thumb and finger range of motion , thumb and finger velocity , fractionation ( the ability to move fingers independently ) , thumb and finger strength , the Jebsen Test of H and Function , and a Kinematic reach to grasp test . Results . Subjects as a group improved in fractionation of the 
    Output:
    