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: Objectives : To determine whether 12-week home-based exergame step training can improve stepping performance , gait and complementary physical and neuropsychological measures associated with falls in Parkinson ’s disease . Design : A single-blinded r and omised controlled trial . Setting : Community ( experimental intervention ) , university laboratory ( outcome measures ) . Subjects : Sixty community-dwelling people with Parkinson ’s disease . Interventions : Home-based step training using videogame technology . Main measures : The primary outcomes were the choice stepping reaction time test and Functional Gait Assessment . Secondary outcomes included physical and neuropsychological measures associated with falls in Parkinson ’s disease , number of falls over six months and self-reported mobility and balance . Results : Post intervention , there were no differences between the intervention ( n = 28 ) and control ( n = 25 ) groups in the primary or secondary outcomes except for the Timed Up and Go test , where there was a significant difference in favour of the control group ( P = 0.02 ) . Intervention participants reported mobility improvement , whereas control participants reported mobility deterioration — between-group difference on an 11-point scale = 0.9 ( 95 % confidence interval : −1.8 to −0.1 , P = 0.03 ) . Interaction effects between intervention and disease severity on physical function measures were observed ( P = 0.01 to P = 0.08 ) with seemingly positive effects for the low-severity group and potentially negative effects for the high-severity group . Conclusion : Overall , home-based exergame step training was not effective in improving the outcomes assessed . However , the improved physical function in the lower disease severity intervention participants as well as the self-reported improved mobility in the intervention group suggest home-based exergame step training may have benefits for some people with Parkinson ’s disease OBJECTIVES To compare the effects of functional training , bicycle exercise , and exergaming on walking capacity of elderly with Parkinson disease ( PD ) . DESIGN A pilot r and omized , controlled , single-blinded trial . SETTING A state reference health care center for elderly , a public reference outpatient clinic for the elderly . PARTICIPANTS Elderly individuals ( ≥60 years of age ; N=62 ) with idiopathic PD ( stage 2 to 3 of modified Hoehn and Yahr staging scale ) according to the London Brain Bank . INTERVENTION The participants were r and omly assigned to three groups . Group 1 ( G1 ) participated in functional training ( n=22 ) ; group 2 ( G2 ) performed bicycle exercise ( n=20 ) , and group 3 ( G3 ) trained with Kinect Adventures ( Microsoft , Redmond , WA ) exergames ( n=20 ) . MAIN OUTCOME MEASURES The primary outcome measure was the 6-minute walk test ( 6MWT ) ; secondary outcome measures were the 10-m walk test ( 10MWT ) , sitting-rising test ( SRT ) , body mass index , Parkinson Disease Question naire-39 , World Health Organization Disability Assessment Schedule 2.0 ( WHODAS 2.0 ) , and 15-item Geriatric Depression Scale . RESULTS All groups showed significant improvements in 6MWT ( G1 P=.008 ; G2 P=.001 ; G3 P=.005 ) , SRT ( G1 P<.001 ; G2 P=.001 ; G3 P=.003 ) , and WHODAS 2.0 ( G1 P=.018 ; G2 P=.019 ; G3 P=.041 ) . Only G3 improved gait speed in 10MWT ( P=.11 ) . G1 ( P=.014 ) and G3 ( P=.004 ) improved quality of life . No difference was found between groups . CONCLUSIONS Eight weeks of exergaming can improve the walking capacity of elderly patients with PD . Exergame training had similar outcomes compared with functional training and bicycle exercise . The three physical exercise modalities presented significant improvements on walking capacity , ability to st and up and sit , and functionality of the participants This study investigated changes in motor and cognitive skills , anxiety levels , and quality of life perception among patients with Parkinson 's Disease ( PD ) following training with different commercial gaming devices — Nintendo Wii ™ and Xbox Kinect ™ . We used a quasi-experimental , simple blinded clinical trial , dividing 27 patients with PD into three equal groups of nine members : ( a ) Nintendo Wii ™ , ( b ) Xbox Kinect ™ , and ( c ) control group .  After pretests , experimental group participants spent 10 sessions playing four games of the selected gaming device , while control group participants received no intervention . Only those engaged with the Nintendo Wii ™ significantly improved their performance on single and dual task gait tests , decreased anxiety levels , and improved memory , attention , and reversibility . The control group showed no changes on any measures OBJECTIVE To evaluate the effects of gait training with virtual reality ( VR ) on walking distance and physical fitness in individuals with Parkinson 's Disease ( PD ) . METHODS Thirty-seven individuals with PD participated in this prospect i ve , r and omized , controlled clinical trial . They were r and omly allocated to a control group su bmi tted to conventional training ( n = 12 ) , a treadmill group su bmi tted to gait training on a treadmill ( n = 13 ) and a VR group su bmi tted to gait training using the XboxTM ( n = 12 ) . Clinical measures , gait variables and the Six-Minute Walk Test ( 6MWT ) were evaluated : pre-intervention , after one intervention session , post-intervention and follow up ( 30 days after intervention ) . RESULTS The VR and treadmill groups travelled longer distances on the 6MWT and had faster gait speed in comparison to the control group . The VR and treadmill groups demonstrated an increase in pre-6MWT HR . The VR group had more intense HR after the first session and throughout training , but these gains were not maintained at the follow-up . CONCLUSION The present findings demonstrate that gait training with a VR program is as effective as treadmill training with regard to gains in walking distance and improvements in temporal gait variables in individuals with PD BACKGROUND / PURPOSE Virtual reality has the advantage to provide rich sensory feedbacks for training balance function . This study tested if the home-based virtual reality balance training is more effective than the conventional home balance training in improving balance , walking , and quality of life in patients with Parkinson 's disease ( PD ) . METHODS Twenty-three patients with idiopathic PD were recruited and underwent twelve 50-minute training sessions during the 6-week training period . The experimental group ( n = 11 ) was trained with a custom-made virtual reality balance training system , and the control group ( n = 12 ) was trained by a licensed physical therapist . Outcomes were measured at Week 0 ( pretest ) , Week 6 ( posttest ) , and Week 8 ( follow-up ) . The primary outcome was the Berg Balance Scale . The secondary outcomes included the Dynamic Gait Index , timed Up- and -Go test , Parkinson 's Disease Question naire , and the motor score of the Unified Parkinson 's Disease Rating Scale . RESULTS The experimental and control groups were comparable at pretest . After training , both groups performed better in the Berg Balance Scale , Dynamic Gait Index , timed Up- and -Go test , and Parkinson 's Disease Question naire at posttest and follow-up than at pretest . However , no significant differences were found between these two groups at posttest and follow-up . CONCLUSION This study did not find any difference between the effects of the home-based virtual reality balance training and conventional home balance training . The two training options were equally effective in improving balance , walking , and quality of life among community-dwelling patients with PD BACKGROUND Gait and cognitive disturbances are common in Parkinson 's disease ( PD ) . These deficits exacerbate fall risk and difficulties with mobility , especially during complex or dual-task walking . Traditional gait training generally fails to fully address these complex gait activities . Virtual reality ( VR ) incorporates principles of motor learning while delivering engaging and challenging training in complex environments . We hypothesized that VR may be applied to address the multifaceted deficits associated with fall risk in PD . METHODS Twenty patients received 18 sessions ( 3 per week ) of progressive intensive treadmill training with virtual obstacles ( TT + VR ) . Outcome measures included gait under usual-walking and dual-task conditions and while negotiating physical obstacles . Cognitive function and functional performance were also assessed . RESULTS Patients were 67.1 ± 6.5 years and had a mean disease duration of 9.8 ± 5.6 years . Posttraining , gait speed significantly improved during usual walking , during dual task , and while negotiating overground obstacles . Dual-task gait variability decreased ( ie , improved ) and Trail Making Test times ( parts A and B ) improved . Gains in functional performance measures and retention effects , 1 month later , were also observed . CONCLUSIONS To our knowledge , this is the first time that TT + VR has been used for gait training in PD . The results indicate that TT + VR is viable in PD and may significantly improve physical performance , gait during complex challenging conditions , and even certain aspects of cognitive function . These findings have important implication s for underst and ing motor learning in the presence of PD and for treating fall risk in PD , aging , and others who share a heightened risk of falls Introduction Telerehabilitation enables patients to access remote rehabilitation services for patient-physiotherapist videoconferencing in their own homes . Home-based virtual reality ( VR ) balance training has been shown to reduce postural instability in patients with Parkinson 's disease ( PD ) . The primary aim was to compare improvements in postural stability after remotely supervised in-home VR balance training and in-clinic sensory integration balance training ( SIBT ) . Methods In this multicenter study , 76 PD patients ( modified Hoehn and Yahr stages 2.5–3 ) were r and omly assigned to receive either in-home VR telerehabilitation ( n = 38 ) or in-clinic SIBT ( n = 38 ) in 21 sessions of 50 minutes each , 3 days/week for 7 consecutive weeks . VR telerehabilitation consisted of grade d exergames using the Nintendo Wii Fit system ; SIBT included exercises to improve postural stability . Patients were evaluated before treatment , after treatment , and at 1-month follow-up . Results Analysis revealed significant between-group differences in improvement on the Berg Balance Scale for the VR telerehabilitation group ( p = 0.04 ) and significant Time × Group interactions in the Dynamic Gait Index ( p = 0.04 ) for the in-clinic group . Both groups showed differences in all outcome measures over time , except for fall frequency . Cost comparison yielded between-group differences in treatment and equipment costs . Conclusions VR is a feasible alternative to in-clinic SIBT for reducing postural instability in PD patients having a caregiver OBJECTIVES To assess the feasibility , safety and outcomes of playing Microsoft Kinect Adventures ™ for people with Parkinson 's disease in order to guide the design of a r and omised clinical trial . DESIGN Single-group , blinded trial . SETTING Rehabilitation Center of São Camilo University , Brazil . PARTICIPANTS Seven patients ( six males , one female ) with Parkinson 's disease ( Hoehn and Yahr Stages 2 and 3 ) . INTERVENTIONS Fourteen 60-minute sessions , three times per week , playing four games of Kinect Adventures ! MAIN OUTCOME MEASURES The feasibility and safety outcomes were patients ' game performance and adverse events , respectively . The clinical outcomes were the 6-minute walk test , Balance Evaluation System Test , Dynamic Gait Index and Parkinson 's Disease Question naire ( PDQ-39 ) . RESULTS Patients ' scores for the four games showed improvement . The mean [ st and ard deviation ( SD ) ] scores in the first and last sessions of the Space Pop game were 151 ( 36 ) and 198 ( 29 ) , respectively [ mean ( SD ) difference 47 ( 7 ) , 95 % confidence interval 15 to 79 ] . There were no adverse events . Improvements were also seen in the 6-minute walk test , Balance Evaluation System Test , Dynamic Gait Index and PDQ-39 following training . CONCLUSION Kinect-based training  was safe and feasible for people with Parkinson 's disease ( Hoehn and Yahr Stages 2 and 3 ) . Patients improved their scores for all four games . No serious adverse events occurred during training with Kinect Adventures ! , which promoted improvement in activities ( balance and gait ) , body functions ( cardiopulmonary aptitude ) and participation ( quality of life ) Background Difficulty performing more than one task at a time ( dual tasking ) is a common and disabling problem experienced by people with Parkinson disease ( PD ) . If asked to perform another task when walking , people with PD often take shorter steps or walk more slowly . Currently there is uncertainty about whether clinicians should teach people with PD to avoid dual tasking or whether they should encourage them to practice dual tasking with the hope that practice will lead to enhanced performance . This study will address this issue by comparing single to dual task gait training . Methods and design A prospect i ve r and omised clinical trial is being conducted . Sixty participants with idiopathic PD will be recruited , provided they score I-IV on the modified Hoehn and Yahr ( 1967 ) scale , and fulfil other inclusion criteria . Participants will be r and omly allocated to either a single or dual task gait training group . Both groups will receive 12 hours of walking training over 4 weeks . The single task group will undertake gait training with cueing strategies to increase step length . The dual task group will train to improve step length when walking and performing a variety of added tasks . Both groups will receive a tailored home program for 6 months . Blinded assessors will conduct four assessment s : two baseline assessment s , one 
    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: Objectives : To determine whether 12-week home-based exergame step training can improve stepping performance , gait and complementary physical and neuropsychological measures associated with falls in Parkinson ’s disease . Design : A single-blinded r and omised controlled trial . Setting : Community ( experimental intervention ) , university laboratory ( outcome measures ) . Subjects : Sixty community-dwelling people with Parkinson ’s disease . Interventions : Home-based step training using videogame technology . Main measures : The primary outcomes were the choice stepping reaction time test and Functional Gait Assessment . Secondary outcomes included physical and neuropsychological measures associated with falls in Parkinson ’s disease , number of falls over six months and self-reported mobility and balance . Results : Post intervention , there were no differences between the intervention ( n = 28 ) and control ( n = 25 ) groups in the primary or secondary outcomes except for the Timed Up and Go test , where there was a significant difference in favour of the control group ( P = 0.02 ) . Intervention participants reported mobility improvement , whereas control participants reported mobility deterioration — between-group difference on an 11-point scale = 0.9 ( 95 % confidence interval : −1.8 to −0.1 , P = 0.03 ) . Interaction effects between intervention and disease severity on physical function measures were observed ( P = 0.01 to P = 0.08 ) with seemingly positive effects for the low-severity group and potentially negative effects for the high-severity group . Conclusion : Overall , home-based exergame step training was not effective in improving the outcomes assessed . However , the improved physical function in the lower disease severity intervention participants as well as the self-reported improved mobility in the intervention group suggest home-based exergame step training may have benefits for some people with Parkinson ’s disease OBJECTIVES To compare the effects of functional training , bicycle exercise , and exergaming on walking capacity of elderly with Parkinson disease ( PD ) . DESIGN A pilot r and omized , controlled , single-blinded trial . SETTING A state reference health care center for elderly , a public reference outpatient clinic for the elderly . PARTICIPANTS Elderly individuals ( ≥60 years of age ; N=62 ) with idiopathic PD ( stage 2 to 3 of modified Hoehn and Yahr staging scale ) according to the London Brain Bank . INTERVENTION The participants were r and omly assigned to three groups . Group 1 ( G1 ) participated in functional training ( n=22 ) ; group 2 ( G2 ) performed bicycle exercise ( n=20 ) , and group 3 ( G3 ) trained with Kinect Adventures ( Microsoft , Redmond , WA ) exergames ( n=20 ) . MAIN OUTCOME MEASURES The primary outcome measure was the 6-minute walk test ( 6MWT ) ; secondary outcome measures were the 10-m walk test ( 10MWT ) , sitting-rising test ( SRT ) , body mass index , Parkinson Disease Question naire-39 , World Health Organization Disability Assessment Schedule 2.0 ( WHODAS 2.0 ) , and 15-item Geriatric Depression Scale . RESULTS All groups showed significant improvements in 6MWT ( G1 P=.008 ; G2 P=.001 ; G3 P=.005 ) , SRT ( G1 P<.001 ; G2 P=.001 ; G3 P=.003 ) , and WHODAS 2.0 ( G1 P=.018 ; G2 P=.019 ; G3 P=.041 ) . Only G3 improved gait speed in 10MWT ( P=.11 ) . G1 ( P=.014 ) and G3 ( P=.004 ) improved quality of life . No difference was found between groups . CONCLUSIONS Eight weeks of exergaming can improve the walking capacity of elderly patients with PD . Exergame training had similar outcomes compared with functional training and bicycle exercise . The three physical exercise modalities presented significant improvements on walking capacity , ability to st and up and sit , and functionality of the participants This study investigated changes in motor and cognitive skills , anxiety levels , and quality of life perception among patients with Parkinson 's Disease ( PD ) following training with different commercial gaming devices — Nintendo Wii ™ and Xbox Kinect ™ . We used a quasi-experimental , simple blinded clinical trial , dividing 27 patients with PD into three equal groups of nine members : ( a ) Nintendo Wii ™ , ( b ) Xbox Kinect ™ , and ( c ) control group .  After pretests , experimental group participants spent 10 sessions playing four games of the selected gaming device , while control group participants received no intervention . Only those engaged with the Nintendo Wii ™ significantly improved their performance on single and dual task gait tests , decreased anxiety levels , and improved memory , attention , and reversibility . The control group showed no changes on any measures OBJECTIVE To evaluate the effects of gait training with virtual reality ( VR ) on walking distance and physical fitness in individuals with Parkinson 's Disease ( PD ) . METHODS Thirty-seven individuals with PD participated in this prospect i ve , r and omized , controlled clinical trial . They were r and omly allocated to a control group su bmi tted to conventional training ( n = 12 ) , a treadmill group su bmi tted to gait training on a treadmill ( n = 13 ) and a VR group su bmi tted to gait training using the XboxTM ( n = 12 ) . Clinical measures , gait variables and the Six-Minute Walk Test ( 6MWT ) were evaluated : pre-intervention , after one intervention session , post-intervention and follow up ( 30 days after intervention ) . RESULTS The VR and treadmill groups travelled longer distances on the 6MWT and had faster gait speed in comparison to the control group . The VR and treadmill groups demonstrated an increase in pre-6MWT HR . The VR group had more intense HR after the first session and throughout training , but these gains were not maintained at the follow-up . CONCLUSION The present findings demonstrate that gait training with a VR program is as effective as treadmill training with regard to gains in walking distance and improvements in temporal gait variables in individuals with PD BACKGROUND / PURPOSE Virtual reality has the advantage to provide rich sensory feedbacks for training balance function . This study tested if the home-based virtual reality balance training is more effective than the conventional home balance training in improving balance , walking , and quality of life in patients with Parkinson 's disease ( PD ) . METHODS Twenty-three patients with idiopathic PD were recruited and underwent twelve 50-minute training sessions during the 6-week training period . The experimental group ( n = 11 ) was trained with a custom-made virtual reality balance training system , and the control group ( n = 12 ) was trained by a licensed physical therapist . Outcomes were measured at Week 0 ( pretest ) , Week 6 ( posttest ) , and Week 8 ( follow-up ) . The primary outcome was the Berg Balance Scale . The secondary outcomes included the Dynamic Gait Index , timed Up- and -Go test , Parkinson 's Disease Question naire , and the motor score of the Unified Parkinson 's Disease Rating Scale . RESULTS The experimental and control groups were comparable at pretest . After training , both groups performed better in the Berg Balance Scale , Dynamic Gait Index , timed Up- and -Go test , and Parkinson 's Disease Question naire at posttest and follow-up than at pretest . However , no significant differences were found between these two groups at posttest and follow-up . CONCLUSION This study did not find any difference between the effects of the home-based virtual reality balance training and conventional home balance training . The two training options were equally effective in improving balance , walking , and quality of life among community-dwelling patients with PD BACKGROUND Gait and cognitive disturbances are common in Parkinson 's disease ( PD ) . These deficits exacerbate fall risk and difficulties with mobility , especially during complex or dual-task walking . Traditional gait training generally fails to fully address these complex gait activities . Virtual reality ( VR ) incorporates principles of motor learning while delivering engaging and challenging training in complex environments . We hypothesized that VR may be applied to address the multifaceted deficits associated with fall risk in PD . METHODS Twenty patients received 18 sessions ( 3 per week ) of progressive intensive treadmill training with virtual obstacles ( TT + VR ) . Outcome measures included gait under usual-walking and dual-task conditions and while negotiating physical obstacles . Cognitive function and functional performance were also assessed . RESULTS Patients were 67.1 ± 6.5 years and had a mean disease duration of 9.8 ± 5.6 years . Posttraining , gait speed significantly improved during usual walking , during dual task , and while negotiating overground obstacles . Dual-task gait variability decreased ( ie , improved ) and Trail Making Test times ( parts A and B ) improved . Gains in functional performance measures and retention effects , 1 month later , were also observed . CONCLUSIONS To our knowledge , this is the first time that TT + VR has been used for gait training in PD . The results indicate that TT + VR is viable in PD and may significantly improve physical performance , gait during complex challenging conditions , and even certain aspects of cognitive function . These findings have important implication s for underst and ing motor learning in the presence of PD and for treating fall risk in PD , aging , and others who share a heightened risk of falls Introduction Telerehabilitation enables patients to access remote rehabilitation services for patient-physiotherapist videoconferencing in their own homes . Home-based virtual reality ( VR ) balance training has been shown to reduce postural instability in patients with Parkinson 's disease ( PD ) . The primary aim was to compare improvements in postural stability after remotely supervised in-home VR balance training and in-clinic sensory integration balance training ( SIBT ) . Methods In this multicenter study , 76 PD patients ( modified Hoehn and Yahr stages 2.5–3 ) were r and omly assigned to receive either in-home VR telerehabilitation ( n = 38 ) or in-clinic SIBT ( n = 38 ) in 21 sessions of 50 minutes each , 3 days/week for 7 consecutive weeks . VR telerehabilitation consisted of grade d exergames using the Nintendo Wii Fit system ; SIBT included exercises to improve postural stability . Patients were evaluated before treatment , after treatment , and at 1-month follow-up . Results Analysis revealed significant between-group differences in improvement on the Berg Balance Scale for the VR telerehabilitation group ( p = 0.04 ) and significant Time × Group interactions in the Dynamic Gait Index ( p = 0.04 ) for the in-clinic group . Both groups showed differences in all outcome measures over time , except for fall frequency . Cost comparison yielded between-group differences in treatment and equipment costs . Conclusions VR is a feasible alternative to in-clinic SIBT for reducing postural instability in PD patients having a caregiver OBJECTIVES To assess the feasibility , safety and outcomes of playing Microsoft Kinect Adventures ™ for people with Parkinson 's disease in order to guide the design of a r and omised clinical trial . DESIGN Single-group , blinded trial . SETTING Rehabilitation Center of São Camilo University , Brazil . PARTICIPANTS Seven patients ( six males , one female ) with Parkinson 's disease ( Hoehn and Yahr Stages 2 and 3 ) . INTERVENTIONS Fourteen 60-minute sessions , three times per week , playing four games of Kinect Adventures ! MAIN OUTCOME MEASURES The feasibility and safety outcomes were patients ' game performance and adverse events , respectively . The clinical outcomes were the 6-minute walk test , Balance Evaluation System Test , Dynamic Gait Index and Parkinson 's Disease Question naire ( PDQ-39 ) . RESULTS Patients ' scores for the four games showed improvement . The mean [ st and ard deviation ( SD ) ] scores in the first and last sessions of the Space Pop game were 151 ( 36 ) and 198 ( 29 ) , respectively [ mean ( SD ) difference 47 ( 7 ) , 95 % confidence interval 15 to 79 ] . There were no adverse events . Improvements were also seen in the 6-minute walk test , Balance Evaluation System Test , Dynamic Gait Index and PDQ-39 following training . CONCLUSION Kinect-based training  was safe and feasible for people with Parkinson 's disease ( Hoehn and Yahr Stages 2 and 3 ) . Patients improved their scores for all four games . No serious adverse events occurred during training with Kinect Adventures ! , which promoted improvement in activities ( balance and gait ) , body functions ( cardiopulmonary aptitude ) and participation ( quality of life ) Background Difficulty performing more than one task at a time ( dual tasking ) is a common and disabling problem experienced by people with Parkinson disease ( PD ) . If asked to perform another task when walking , people with PD often take shorter steps or walk more slowly . Currently there is uncertainty about whether clinicians should teach people with PD to avoid dual tasking or whether they should encourage them to practice dual tasking with the hope that practice will lead to enhanced performance . This study will address this issue by comparing single to dual task gait training . Methods and design A prospect i ve r and omised clinical trial is being conducted . Sixty participants with idiopathic PD will be recruited , provided they score I-IV on the modified Hoehn and Yahr ( 1967 ) scale , and fulfil other inclusion criteria . Participants will be r and omly allocated to either a single or dual task gait training group . Both groups will receive 12 hours of walking training over 4 weeks . The single task group will undertake gait training with cueing strategies to increase step length . The dual task group will train to improve step length when walking and performing a variety of added tasks . Both groups will receive a tailored home program for 6 months . Blinded assessors will conduct four assessment s : two baseline assessment s , one 
    Output:
    