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: Background and purpose Providing active assistance to complete desired arm movements is a common technique in upper extremity rehabilitation after stroke . Such active assistance may improve recovery by affecting somatosensory input , motor planning , spasticity or soft tissue properties , but it is labor intensive and has not been vali date d in controlled trials . The purpose of this study was to investigate the effects of robotically administered active-assistive exercise and compare those with free reaching voluntary exercise in improving arm movement ability after chronic stroke . Methods Nineteen individuals at least one year post-stroke were r and omized into one of two groups . One group performed 24 sessions of active-assistive reaching exercise with a simple robotic device , while a second group performed a task-matched amount of unassisted reaching . The main outcome measures were range and speed of supported arm movement , range , straightness and smoothness of unsupported reaching , and the Rancho Los Amigos Functional Test of Upper Extremity Function . Results and discussion There were significant improvements with training for range of motion and velocity of supported reaching , straightness of unsupported reaching , and functional movement ability . These improvements were not significantly different between the two training groups . The group that performed unassisted reaching exercise improved the smoothness of their reaching movements more than the robot-assisted group . Conclusion Improvements with both forms of exercise confirmed that repeated , task-related voluntary activation of the damaged motor system is a key stimulus to motor recovery following chronic stroke . Robotically assisting in reaching successfully improved arm movement ability , although it did not provide any detectable , additional value beyond the movement practice that occurred concurrently with it . The inability to detect any additional value of robot-assisted reaching may have been due to this pilot study 's limited sample size , the specific diagnoses of the participants , or the inclusion of only individuals with chronic stroke This study presents results from a r and omized controlled clinical trial of the Mirror Image Movement Enabler ( MIME ) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients , including data on the use of its bilateral training mode . MIME incorporates a PUMA 560 robot ( Staubli Unimation Inc , Duncan , South Carolina ) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions . Robot-assisted treatment ( bilateral , unilateral , and combined bilateral and unilateral ) was compared with conventional therapy . Similar to a previous study in chronic stroke , combined unilateral and bilateral robotic training had advantages compared with conventional therapy , producing larger improvements on a motor impairment scale and a measure of abnormal synergies . However , gains in all treatment groups were equivalent at the 6-month follow-up . Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training , although the combined group had more hypertonia and less movement out of synergy at baseline . Robot-assisted treatment gains exceeded those expected from spontaneous recovery . These results are discussed in light of the need for further device development and continued clinical trials CONTEXT Reorganization in central motor networks occurs during early recovery from hemiparetic stroke . In chronic stroke survivors , specific rehabilitation therapy can improve upper extremity function . OBJECTIVE To test the hypothesis that in patients who have chronic motor impairment following stroke , specific rehabilitation therapy that improves arm function is associated with reorganization of cortical networks . DESIGN , SETTING , AND PATIENTS A r and omized controlled clinical trial conducted in a US ambulatory rehabilitation program with 21 patients ( median [ IQR ] , 50.3 [ 34.8 - 77.3 ] months after unilateral stroke ) . Data were collected between 2001 and 2004 . INTERVENTIONS Patients were r and omly assigned to bilateral arm training with rhythmic auditory cueing ( BATRAC ) ( n = 9 ) or st and ardized dose-matched therapeutic exercises ( DMTE ) ( n = 12 ) . Both were conducted for 1 hour , 3 times a week , for 6 weeks . MAIN OUTCOME MEASURES Within 2 weeks before and after the intervention , brain activation during elbow movement assessed by functional magnetic resonance imaging ( fMRI ) and functional outcome assessed using arm function scores . RESULTS Patients in the BATRAC group but not in the DMTE group increased hemispheric activation during paretic arm movement ( P = .03 ) . Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum ( P = .009 ) . BATRAC was associated with significant increases in activation in pre central ( P<.001 ) and post central gyri ( P = .03 ) and the cerebellum ( P<.001 ) , although 3 BATRAC patients showed no fMRI changes . Considering all patients , there were no differences in functional outcome between groups . When only BATRAC patients with fMRI response were included ( n = 6 ) , BATRAC improved arm function more than DMTE did ( P = .02 ) . CONCLUSIONS These preliminary findings suggest that BATRAC induces reorganization in contralesional motor networks and provide biological plausibility for repetitive bilateral training as a potential therapy for upper extremity rehabilitation in hemiparetic stroke Background and Purpose Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke . We investigated the hypothesis that bilateral arm training with rhythmic auditory cueing ( BATRAC ) will improve motor function in the hemiparetic arm of stroke patients . Methods In this single group pilot study we determined the effects of 6 weeks of BATRAC on 14 patients with chronic hemiparetic stroke ( median time after stroke , 30 months ) immediately after training and at 2 months after training . Four 5-minute periods per session ( 3 times per week ) of BATRAC were performed with the use of a custom- design ed arm training machine . Results The patients showed significant and potentially durable increases in the following : Fugl-Meyer Upper Extremity Motor Performance Test of impairment ( P < 0.0004 ) , Wolf Motor Function Test ( performance time measure , P < 0.02 ) , and University of Maryl and Arm Question naire for Stroke measuring daily use of the hemiparetic arm ( P < 0.002 ) . Isometric strength improved in elbow flexion ( P < 0.05 ) and wrist flexion ( P < 0.02 ) for the paretic arm and in elbow flexion ( P < 0.02 ) and wrist extension ( P < 0.02 ) for the nonparetic arm . Active range of motion improved for paretic-side shoulder extension ( P < 0.01 ) , wrist flexion ( P < 0.004 ) , and thumb opposition ( P < 0.002 ) , and passive range of motion improved for paretic wrist flexion ( P < 0.03 ) . Conclusions Six weeks of BATRAC improves functional motor performance of the paretic upper extremity as well as a few changes in isometric strength and range of motion . These benefits are largely sustained at 8 weeks after training cessation Background and Purpose The etiology of ischemic stroke affects prognosis , outcome , and management . Trials of therapies for patients with acute stroke should include measurements of responses as influenced by subtype of ischemic stroke . A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment ( TOAST ) . Methods A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies . “ Possible ” and “ probable ” diagnoses can be made based on the physician 's certainty of diagnosis . The usefulness and interrater agreement of the classification were tested by two neurologists who had not participated in the writing of the criteria . The neurologists independently used the TOAST classification system in their bedside evaluation of 20 patients , first based only on clinical features and then after review ing the results of diagnostic tests . Results The TOAST classification denotes five subtypes of ischemic stroke : 1 ) large-artery atherosclerosis , 2 ) cardioembolism , 3 ) small-vessel occlusion , 4 ) stroke of other determined etiology , and 5 ) stroke of undetermined etiology . Using this rating system , interphysician agreement was very high . The two physicians disagreed in only one patient . They were both able to reach a specific etiologic diagnosis in 11 patients , whereas the cause of stroke was not determined in nine . Conclusions The TOAST stroke subtype classification system is easy to use and has good interobserver agreement . This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke . Clinical trials testing treatments for acute ischemic stroke should include similar methods to diagnose subtypes of stroke Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach Stein J , Krebs HI , Frontera WR , Fasoli SE , Hughes R , Hogan N : Comparison of two techniques of robot-aided upper limb exercise training after stroke . Am J Phys Med Rehabil 2004;83:720–728 . Objective : This study examined whether incorporating progressive resistive training into robot-aided exercise training provides incremental benefits over active-assisted robot-aided exercise for the upper limb after stroke . Design : A total of 47 individuals at least 1 yr poststroke were enrolled in this 6-wk training protocol . Paretic upper limb motor abilities were evaluated using clinical measures and a robot-based assessment to determine eligibility for robot-aided progressive resistive training at study entry . Subjects capable of participating in resistance training were r and omized to receive either active-assisted robot-aided exercises or robot-aided progressive resistance training . Subjects who were incapable of participating in resistance training underwent active-assisted robotic therapy and were again screened for eligibility after 3 wks of robotic therapy . Those subjects capable of participating in resistance training at 3 wks were then r and omized to receive either robot-aided resistance training or to continue with robot-aided active-assisted training . Results : One subject withdrew due to unrelated medical issues , and data for the remaining 46 subjects were analyzed . Subjects in all groups showed improvement in measures of motor control ( mean increase in Fugl-Meyer of 3.3 ; 95 % confidence interval , 2.2–4.4 ) and maximal force ( mean increase in maximal force of 3.5 N , P = 0.027 ) over the course of robot-aided exercise training . No differences in outcome measures were observed between the resistance training groups and the matched active-assisted training groups . Subjects ’ ability to perform the robotic task at the time of group assignment predicted the magnitude of the gain in motor control . Conclusion : The incorporation of robot-aided progressive resistance exercises into a program of robot-aided exercise did not favorably or negatively affect the gains in motor control or strength associated with this training , though interpretation of these results is limited by sample size . Individuals with better motor control at baseline experienced greater increases in motor control with robotic training We report progress in the development of AutoCITE , a workstation that delivers the task practice component of upper-limb Constraint-Induced Movement therapy and that can potentially be used in the clinic or the home without the need for one-on-one supervision from a therapist . AutoCITE incorporates a computer and eight task devices arranged on a modified cabinet . Task performance is automatically recorded , and several types of feedback are provided . In preliminary testing , nine chronic stroke subjects with mild to moderate motor deficits practice d with AutoCITE for 3 h each weekday for 2 weeks . Subjects wore a padded mitt on the less-affected h and for a target of 90 % of their waking hours . In terms of effect sizes , gains were large and significant on the Motor Activity Log , and moderate to large on the Wolf Motor Function Test . These gains were comparable to the gains of a matched group of 12 subjects who received st and ard Constraint-Induced Movement therapy Twelve moderately to severely involved chronic stroke survivors ( > 12 mo ) were r and omized to one of two treatments : robotics and motor learning ( ROB-ML ) or functional neuromuscular stimulation and motor learning ( FNS-ML ) . Treatment was 5 h/d , 5 d/wk for 12 wk . ROB-ML 
    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: Background and purpose Providing active assistance to complete desired arm movements is a common technique in upper extremity rehabilitation after stroke . Such active assistance may improve recovery by affecting somatosensory input , motor planning , spasticity or soft tissue properties , but it is labor intensive and has not been vali date d in controlled trials . The purpose of this study was to investigate the effects of robotically administered active-assistive exercise and compare those with free reaching voluntary exercise in improving arm movement ability after chronic stroke . Methods Nineteen individuals at least one year post-stroke were r and omized into one of two groups . One group performed 24 sessions of active-assistive reaching exercise with a simple robotic device , while a second group performed a task-matched amount of unassisted reaching . The main outcome measures were range and speed of supported arm movement , range , straightness and smoothness of unsupported reaching , and the Rancho Los Amigos Functional Test of Upper Extremity Function . Results and discussion There were significant improvements with training for range of motion and velocity of supported reaching , straightness of unsupported reaching , and functional movement ability . These improvements were not significantly different between the two training groups . The group that performed unassisted reaching exercise improved the smoothness of their reaching movements more than the robot-assisted group . Conclusion Improvements with both forms of exercise confirmed that repeated , task-related voluntary activation of the damaged motor system is a key stimulus to motor recovery following chronic stroke . Robotically assisting in reaching successfully improved arm movement ability , although it did not provide any detectable , additional value beyond the movement practice that occurred concurrently with it . The inability to detect any additional value of robot-assisted reaching may have been due to this pilot study 's limited sample size , the specific diagnoses of the participants , or the inclusion of only individuals with chronic stroke This study presents results from a r and omized controlled clinical trial of the Mirror Image Movement Enabler ( MIME ) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients , including data on the use of its bilateral training mode . MIME incorporates a PUMA 560 robot ( Staubli Unimation Inc , Duncan , South Carolina ) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions . Robot-assisted treatment ( bilateral , unilateral , and combined bilateral and unilateral ) was compared with conventional therapy . Similar to a previous study in chronic stroke , combined unilateral and bilateral robotic training had advantages compared with conventional therapy , producing larger improvements on a motor impairment scale and a measure of abnormal synergies . However , gains in all treatment groups were equivalent at the 6-month follow-up . Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training , although the combined group had more hypertonia and less movement out of synergy at baseline . Robot-assisted treatment gains exceeded those expected from spontaneous recovery . These results are discussed in light of the need for further device development and continued clinical trials CONTEXT Reorganization in central motor networks occurs during early recovery from hemiparetic stroke . In chronic stroke survivors , specific rehabilitation therapy can improve upper extremity function . OBJECTIVE To test the hypothesis that in patients who have chronic motor impairment following stroke , specific rehabilitation therapy that improves arm function is associated with reorganization of cortical networks . DESIGN , SETTING , AND PATIENTS A r and omized controlled clinical trial conducted in a US ambulatory rehabilitation program with 21 patients ( median [ IQR ] , 50.3 [ 34.8 - 77.3 ] months after unilateral stroke ) . Data were collected between 2001 and 2004 . INTERVENTIONS Patients were r and omly assigned to bilateral arm training with rhythmic auditory cueing ( BATRAC ) ( n = 9 ) or st and ardized dose-matched therapeutic exercises ( DMTE ) ( n = 12 ) . Both were conducted for 1 hour , 3 times a week , for 6 weeks . MAIN OUTCOME MEASURES Within 2 weeks before and after the intervention , brain activation during elbow movement assessed by functional magnetic resonance imaging ( fMRI ) and functional outcome assessed using arm function scores . RESULTS Patients in the BATRAC group but not in the DMTE group increased hemispheric activation during paretic arm movement ( P = .03 ) . Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum ( P = .009 ) . BATRAC was associated with significant increases in activation in pre central ( P<.001 ) and post central gyri ( P = .03 ) and the cerebellum ( P<.001 ) , although 3 BATRAC patients showed no fMRI changes . Considering all patients , there were no differences in functional outcome between groups . When only BATRAC patients with fMRI response were included ( n = 6 ) , BATRAC improved arm function more than DMTE did ( P = .02 ) . CONCLUSIONS These preliminary findings suggest that BATRAC induces reorganization in contralesional motor networks and provide biological plausibility for repetitive bilateral training as a potential therapy for upper extremity rehabilitation in hemiparetic stroke Background and Purpose Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke . We investigated the hypothesis that bilateral arm training with rhythmic auditory cueing ( BATRAC ) will improve motor function in the hemiparetic arm of stroke patients . Methods In this single group pilot study we determined the effects of 6 weeks of BATRAC on 14 patients with chronic hemiparetic stroke ( median time after stroke , 30 months ) immediately after training and at 2 months after training . Four 5-minute periods per session ( 3 times per week ) of BATRAC were performed with the use of a custom- design ed arm training machine . Results The patients showed significant and potentially durable increases in the following : Fugl-Meyer Upper Extremity Motor Performance Test of impairment ( P < 0.0004 ) , Wolf Motor Function Test ( performance time measure , P < 0.02 ) , and University of Maryl and Arm Question naire for Stroke measuring daily use of the hemiparetic arm ( P < 0.002 ) . Isometric strength improved in elbow flexion ( P < 0.05 ) and wrist flexion ( P < 0.02 ) for the paretic arm and in elbow flexion ( P < 0.02 ) and wrist extension ( P < 0.02 ) for the nonparetic arm . Active range of motion improved for paretic-side shoulder extension ( P < 0.01 ) , wrist flexion ( P < 0.004 ) , and thumb opposition ( P < 0.002 ) , and passive range of motion improved for paretic wrist flexion ( P < 0.03 ) . Conclusions Six weeks of BATRAC improves functional motor performance of the paretic upper extremity as well as a few changes in isometric strength and range of motion . These benefits are largely sustained at 8 weeks after training cessation Background and Purpose The etiology of ischemic stroke affects prognosis , outcome , and management . Trials of therapies for patients with acute stroke should include measurements of responses as influenced by subtype of ischemic stroke . A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment ( TOAST ) . Methods A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies . “ Possible ” and “ probable ” diagnoses can be made based on the physician 's certainty of diagnosis . The usefulness and interrater agreement of the classification were tested by two neurologists who had not participated in the writing of the criteria . The neurologists independently used the TOAST classification system in their bedside evaluation of 20 patients , first based only on clinical features and then after review ing the results of diagnostic tests . Results The TOAST classification denotes five subtypes of ischemic stroke : 1 ) large-artery atherosclerosis , 2 ) cardioembolism , 3 ) small-vessel occlusion , 4 ) stroke of other determined etiology , and 5 ) stroke of undetermined etiology . Using this rating system , interphysician agreement was very high . The two physicians disagreed in only one patient . They were both able to reach a specific etiologic diagnosis in 11 patients , whereas the cause of stroke was not determined in nine . Conclusions The TOAST stroke subtype classification system is easy to use and has good interobserver agreement . This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke . Clinical trials testing treatments for acute ischemic stroke should include similar methods to diagnose subtypes of stroke Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach Stein J , Krebs HI , Frontera WR , Fasoli SE , Hughes R , Hogan N : Comparison of two techniques of robot-aided upper limb exercise training after stroke . Am J Phys Med Rehabil 2004;83:720–728 . Objective : This study examined whether incorporating progressive resistive training into robot-aided exercise training provides incremental benefits over active-assisted robot-aided exercise for the upper limb after stroke . Design : A total of 47 individuals at least 1 yr poststroke were enrolled in this 6-wk training protocol . Paretic upper limb motor abilities were evaluated using clinical measures and a robot-based assessment to determine eligibility for robot-aided progressive resistive training at study entry . Subjects capable of participating in resistance training were r and omized to receive either active-assisted robot-aided exercises or robot-aided progressive resistance training . Subjects who were incapable of participating in resistance training underwent active-assisted robotic therapy and were again screened for eligibility after 3 wks of robotic therapy . Those subjects capable of participating in resistance training at 3 wks were then r and omized to receive either robot-aided resistance training or to continue with robot-aided active-assisted training . Results : One subject withdrew due to unrelated medical issues , and data for the remaining 46 subjects were analyzed . Subjects in all groups showed improvement in measures of motor control ( mean increase in Fugl-Meyer of 3.3 ; 95 % confidence interval , 2.2–4.4 ) and maximal force ( mean increase in maximal force of 3.5 N , P = 0.027 ) over the course of robot-aided exercise training . No differences in outcome measures were observed between the resistance training groups and the matched active-assisted training groups . Subjects ’ ability to perform the robotic task at the time of group assignment predicted the magnitude of the gain in motor control . Conclusion : The incorporation of robot-aided progressive resistance exercises into a program of robot-aided exercise did not favorably or negatively affect the gains in motor control or strength associated with this training , though interpretation of these results is limited by sample size . Individuals with better motor control at baseline experienced greater increases in motor control with robotic training We report progress in the development of AutoCITE , a workstation that delivers the task practice component of upper-limb Constraint-Induced Movement therapy and that can potentially be used in the clinic or the home without the need for one-on-one supervision from a therapist . AutoCITE incorporates a computer and eight task devices arranged on a modified cabinet . Task performance is automatically recorded , and several types of feedback are provided . In preliminary testing , nine chronic stroke subjects with mild to moderate motor deficits practice d with AutoCITE for 3 h each weekday for 2 weeks . Subjects wore a padded mitt on the less-affected h and for a target of 90 % of their waking hours . In terms of effect sizes , gains were large and significant on the Motor Activity Log , and moderate to large on the Wolf Motor Function Test . These gains were comparable to the gains of a matched group of 12 subjects who received st and ard Constraint-Induced Movement therapy Twelve moderately to severely involved chronic stroke survivors ( > 12 mo ) were r and omized to one of two treatments : robotics and motor learning ( ROB-ML ) or functional neuromuscular stimulation and motor learning ( FNS-ML ) . Treatment was 5 h/d , 5 d/wk for 12 wk . ROB-ML 
    Output:
    