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 — The Motor Activity Log ( MAL ) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and h and ( amount of use [ AOU ] ) and quality of movement [ QOM ] ) during activities of daily living . Scores range from 0 to 5 . The following clinimetric properties of the MAL were quantified : internal consistency ( Cronbach α ) , test – retest agreement ( Bl and and Altman method ) , cross-sectional construct validity ( correlation between AOU and QOM and with the Action Research Arm [ ARA ] test ) , longitudinal construct validity ( correlation of change on the MAL during the intervention with a global change rating [ GCR ] and with change on the ARA ) , and responsiveness ( effect size ) . Methods — Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm ( forced use ) were performed in 56 chronic stroke patients . Results — Internal consistency was high ( AOU : α=0.88 ; QOM : α=0.91 ) . The limits of agreement were −0.70 to 0.85 and −0.61 to 0.71 for AOU and QOM , respectively . The correlation with the ARA score ( Spearman ρ ) was 0.63 ( AOU and QOM ) . However , the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA , Spearman ρ was between 0.16 and 0.22 . The responsiveness ratio was 1.9 ( AOU ) and 2.0 ( QOM ) . Conclusion — The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention . The cross-sectional construct validity of the MAL is reasonable , but the results raise doubt about its longitudinal construct validity 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 OBJECTIVE To evaluate the efficacy of a combined treatment for spastic foot using selective injections of botulinum toxin ( BTA ) into the tibialis posterior muscle followed by ankle taping , and to compare it with current BTA treatment procedure . DESIGN Single-blind r and omized control trial . Three-month follow-up after treatment . SETTING Neurorehabilitation clinic . SUBJECTS Eighteen out patients with equinovarus foot due to severe spasticity after stroke . INTERVENTIONS ( 1 ) Injection of 190 to 320 BTA U into several calf muscles ( group A ) ; ( 2 ) injection of 100 BTA U into the tibialis posterior muscle , followed by ankle-foot taping ( group B ) . MAIN OUTCOME MEASURES Ankle range of motion ( ROM ) , Ashworth scale , gait velocity , and step length . RESULTS Average Ashworth scores decreased 1 point in both groups , but the benefit appeared of shorter duration in group B. Changes in both foot position at rest and passive ankle ROM were observed in all patients , without treatment-related differences , except for gain in passive dorsiflexion that appeared higher in group A. Gait velocity and step length showed similar increases in both groups . CONCLUSION The combination of selective injections of low BTA doses with ankle-foot taping is as effective as the injection of the current doses for the reduction of foot inversion with positive effects on gait parameters Objective : To assess and to compare the reliability of the Modified Tardieu Scale with the Modified Ashworth Scale in patients with severe brain injury and impaired consciousness . Design : Cross-sectional observational comparison study . Setting : An early rehabilitation centre for adults with neurological disorders . Subjects : Thirty patients with impaired consciousness due to severe cerebral damage of various aetiologies . Measurement protocol : Four experienced physical therapists rated each patient in a r and omized order once daily for two consecutive days . Shoulder , elbow , wrist , hip , knee and ankle spasticity were assessed by the use of Modified Tardieu Scale and Modified Ashworth Scale data collection procedures . Main outcome measures : Test - retest and inter-rater reliability ( k = kappa value ) of the Modified Tardieu Scale and the Modified Ashworth Scale .  Results : The test-retest reliability of the Modified Ashworth Scale was moderate to good ( k = 0.47 - 0.62 ) and of the Modified Tardieu Scale moderate to very good ( k = 0.52 - 0.87 ) . Test - retest reliability was significantly higher within the Modified Tardieu Scale in comparison with the Modified Ashworth Scale ( Z<1.96 ; p<0.05 ) except for shoulder extensor and internal rotator muscles ( Z<1.96 ; p<0.05 ) . Although inter-rater reliability of both scales was poor to moderate ( Modified Ashworth Scale : k = 0.16 - 0.42 ; Modified Tardieu Scale : k = 0.29 - 0.53 ) , significantly higher k-values were revealed with the Modified Tardieu Scale for all tested muscle groups ( Z<1.96 ; p<0.05 ) except for wrist extensors ( Z<1.96 ; p<0.05 ) . Conclusion : In patients with severe brain injury and impaired consciousness the Modified Tardieu Scale provides higher test-retest and inter-rater reliability compared with the Modified Ashworth  Scale and may therefore be a more valid spasticity scale in adults OBJECTIVE To explore the effect of treatment after botulinum toxin type A combined with treatments for the spastic foot . DESIGN Single-blind , r and omized trial , with 3-month follow-up . SUBJECTS Twenty-three chronic hemiplegic adult patients with spastic equinus foot . METHODS Following botulinum toxin type A injection at the medial and lateral gastrocnemius , patients were assigned r and omly to 3 groups , and treated with taping , electrical stimulation or stretching . They were evaluated before treatment ( t0 ) , and at 10 ( t1 ) , 20 ( t2 ) and 90 ( t3 ) days after treatment . Outcome measures were : Modified Ashworth Scale ; passive range of motion at the ankle ; measurement of muscle action potential at the gastrocnemius medialis ; and measurement of maximum ankle dorsiflexion angle in stance using gait analysis . RESULTS The group treated with electrical stimulation performed better at t1 on the Modified Ashworth Scale . The taping and electrical stimulation groups performed better in all outcome measures at t3 . The taping group performed better mainly for maximum ankle dorsiflexion angle in stance . The stretching group showed a less durable result , with some worsening at the t3 evaluation compared with the assessment performed before treatment . CONCLUSIONS This pilot study indicates that combining botulinum toxin type A administration for the ankle plantar flexors with taping and electrical stimulation might be beneficial Current antispastic medications are unsatisfactory for spasticity treatment , but botulinum toxin type A ( BTX-A ) shows promise as a new therapeutic option . This open-label , prospect i ve study aim ed to assess the effectiveness of BTX-A in improving functional mobility in the early post-stroke population using an individualised , flexible range of doses and targeted muscle groups . Twenty-one stroke patients ( 13 male , 8 female ) were enrolled and injected with BTX-A ( Botox , Allergan , mean dose : 255 U ; range : 185–300 ) according to individual spasticity patterns . Assessment s were made at baseline and weeks 2 , 4 , 6 , 10 and 16 post-treatment . Outcome measures comprised : Modified Ashworth Scale ( MAS ) , finger flexion scale ( Bhakta ) , MRC scale , Physician ’s Rating Scale ( PRS ) , Nine Hole Peg Test ( 9HPT ) , Motor Assessment Scale , Clinical Global Impression ( CGI ) , Global Assessment of Spasticity ( GASS ) and Visual Analogue Scale ( VAS ) for pain assessment . Statistically significant improvements in muscle tone as determined by the MAS were found in all areas ( except arm ) till week 16 ( p<0.05 ) . Finger positioning improved for the study duration , whilst muscle power increased only slightly in specific muscles . PRS revealed significant improvements to week 10 and slight improvement in 9HPT performance in selected patients was observed . Motor Assessment Scale results were statistically significant for arm , h and and advanced h and functions , although the overall functional benefit was mild . GASS and CGI results also showed improvement . Pain was present only in 11 patients and did not significantly improve following treatment . Individualised BTX-A injection regimens may be an effective , reversible and safe new treatment option for patients with spasticity . Nevertheless , functional improvement may be reached only in selected patients OBJECTIVE This report describes the design of a study aim ing to provide evidence for the extended use of botulinum toxin A in focal 
    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 — The Motor Activity Log ( MAL ) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and h and ( amount of use [ AOU ] ) and quality of movement [ QOM ] ) during activities of daily living . Scores range from 0 to 5 . The following clinimetric properties of the MAL were quantified : internal consistency ( Cronbach α ) , test – retest agreement ( Bl and and Altman method ) , cross-sectional construct validity ( correlation between AOU and QOM and with the Action Research Arm [ ARA ] test ) , longitudinal construct validity ( correlation of change on the MAL during the intervention with a global change rating [ GCR ] and with change on the ARA ) , and responsiveness ( effect size ) . Methods — Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm ( forced use ) were performed in 56 chronic stroke patients . Results — Internal consistency was high ( AOU : α=0.88 ; QOM : α=0.91 ) . The limits of agreement were −0.70 to 0.85 and −0.61 to 0.71 for AOU and QOM , respectively . The correlation with the ARA score ( Spearman ρ ) was 0.63 ( AOU and QOM ) . However , the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA , Spearman ρ was between 0.16 and 0.22 . The responsiveness ratio was 1.9 ( AOU ) and 2.0 ( QOM ) . Conclusion — The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention . The cross-sectional construct validity of the MAL is reasonable , but the results raise doubt about its longitudinal construct validity 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 OBJECTIVE To evaluate the efficacy of a combined treatment for spastic foot using selective injections of botulinum toxin ( BTA ) into the tibialis posterior muscle followed by ankle taping , and to compare it with current BTA treatment procedure . DESIGN Single-blind r and omized control trial . Three-month follow-up after treatment . SETTING Neurorehabilitation clinic . SUBJECTS Eighteen out patients with equinovarus foot due to severe spasticity after stroke . INTERVENTIONS ( 1 ) Injection of 190 to 320 BTA U into several calf muscles ( group A ) ; ( 2 ) injection of 100 BTA U into the tibialis posterior muscle , followed by ankle-foot taping ( group B ) . MAIN OUTCOME MEASURES Ankle range of motion ( ROM ) , Ashworth scale , gait velocity , and step length . RESULTS Average Ashworth scores decreased 1 point in both groups , but the benefit appeared of shorter duration in group B. Changes in both foot position at rest and passive ankle ROM were observed in all patients , without treatment-related differences , except for gain in passive dorsiflexion that appeared higher in group A. Gait velocity and step length showed similar increases in both groups . CONCLUSION The combination of selective injections of low BTA doses with ankle-foot taping is as effective as the injection of the current doses for the reduction of foot inversion with positive effects on gait parameters Objective : To assess and to compare the reliability of the Modified Tardieu Scale with the Modified Ashworth Scale in patients with severe brain injury and impaired consciousness . Design : Cross-sectional observational comparison study . Setting : An early rehabilitation centre for adults with neurological disorders . Subjects : Thirty patients with impaired consciousness due to severe cerebral damage of various aetiologies . Measurement protocol : Four experienced physical therapists rated each patient in a r and omized order once daily for two consecutive days . Shoulder , elbow , wrist , hip , knee and ankle spasticity were assessed by the use of Modified Tardieu Scale and Modified Ashworth Scale data collection procedures . Main outcome measures : Test - retest and inter-rater reliability ( k = kappa value ) of the Modified Tardieu Scale and the Modified Ashworth Scale .  Results : The test-retest reliability of the Modified Ashworth Scale was moderate to good ( k = 0.47 - 0.62 ) and of the Modified Tardieu Scale moderate to very good ( k = 0.52 - 0.87 ) . Test - retest reliability was significantly higher within the Modified Tardieu Scale in comparison with the Modified Ashworth Scale ( Z<1.96 ; p<0.05 ) except for shoulder extensor and internal rotator muscles ( Z<1.96 ; p<0.05 ) . Although inter-rater reliability of both scales was poor to moderate ( Modified Ashworth Scale : k = 0.16 - 0.42 ; Modified Tardieu Scale : k = 0.29 - 0.53 ) , significantly higher k-values were revealed with the Modified Tardieu Scale for all tested muscle groups ( Z<1.96 ; p<0.05 ) except for wrist extensors ( Z<1.96 ; p<0.05 ) . Conclusion : In patients with severe brain injury and impaired consciousness the Modified Tardieu Scale provides higher test-retest and inter-rater reliability compared with the Modified Ashworth  Scale and may therefore be a more valid spasticity scale in adults OBJECTIVE To explore the effect of treatment after botulinum toxin type A combined with treatments for the spastic foot . DESIGN Single-blind , r and omized trial , with 3-month follow-up . SUBJECTS Twenty-three chronic hemiplegic adult patients with spastic equinus foot . METHODS Following botulinum toxin type A injection at the medial and lateral gastrocnemius , patients were assigned r and omly to 3 groups , and treated with taping , electrical stimulation or stretching . They were evaluated before treatment ( t0 ) , and at 10 ( t1 ) , 20 ( t2 ) and 90 ( t3 ) days after treatment . Outcome measures were : Modified Ashworth Scale ; passive range of motion at the ankle ; measurement of muscle action potential at the gastrocnemius medialis ; and measurement of maximum ankle dorsiflexion angle in stance using gait analysis . RESULTS The group treated with electrical stimulation performed better at t1 on the Modified Ashworth Scale . The taping and electrical stimulation groups performed better in all outcome measures at t3 . The taping group performed better mainly for maximum ankle dorsiflexion angle in stance . The stretching group showed a less durable result , with some worsening at the t3 evaluation compared with the assessment performed before treatment . CONCLUSIONS This pilot study indicates that combining botulinum toxin type A administration for the ankle plantar flexors with taping and electrical stimulation might be beneficial Current antispastic medications are unsatisfactory for spasticity treatment , but botulinum toxin type A ( BTX-A ) shows promise as a new therapeutic option . This open-label , prospect i ve study aim ed to assess the effectiveness of BTX-A in improving functional mobility in the early post-stroke population using an individualised , flexible range of doses and targeted muscle groups . Twenty-one stroke patients ( 13 male , 8 female ) were enrolled and injected with BTX-A ( Botox , Allergan , mean dose : 255 U ; range : 185–300 ) according to individual spasticity patterns . Assessment s were made at baseline and weeks 2 , 4 , 6 , 10 and 16 post-treatment . Outcome measures comprised : Modified Ashworth Scale ( MAS ) , finger flexion scale ( Bhakta ) , MRC scale , Physician ’s Rating Scale ( PRS ) , Nine Hole Peg Test ( 9HPT ) , Motor Assessment Scale , Clinical Global Impression ( CGI ) , Global Assessment of Spasticity ( GASS ) and Visual Analogue Scale ( VAS ) for pain assessment . Statistically significant improvements in muscle tone as determined by the MAS were found in all areas ( except arm ) till week 16 ( p<0.05 ) . Finger positioning improved for the study duration , whilst muscle power increased only slightly in specific muscles . PRS revealed significant improvements to week 10 and slight improvement in 9HPT performance in selected patients was observed . Motor Assessment Scale results were statistically significant for arm , h and and advanced h and functions , although the overall functional benefit was mild . GASS and CGI results also showed improvement . Pain was present only in 11 patients and did not significantly improve following treatment . Individualised BTX-A injection regimens may be an effective , reversible and safe new treatment option for patients with spasticity . Nevertheless , functional improvement may be reached only in selected patients OBJECTIVE This report describes the design of a study aim ing to provide evidence for the extended use of botulinum toxin A in focal 
    Output:
    