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 It is thought that therapy should be functional , be highly repetitive , and promote afferent input to best stimulate h and motor recovery after stroke , yet patients struggle to access such therapy . We developed the MusicGlove , an instrumented glove that requires the user to practice gripping-like movements and thumb-finger opposition to play a highly engaging , music-based , video game . The purpose of this study was to 1 ) compare the effect of training with MusicGlove to conventional h and therapy 2 ) determine if MusicGlove training was more effective than a matched form of isometric h and movement training ; and 3 ) determine if MusicGlove game scores predict clinical outcomes . Methods 12 chronic stroke survivors with moderate hemiparesis were r and omly assigned to receive MusicGlove , isometric , and conventional h and therapy in a within-subjects design . Each subject participated in six one-hour treatment sessions three times per week for two weeks , for each training type , for a total of 18 treatment sessions . A blinded rater assessed h and impairment before and after each training type and at one-month follow-up including the Box and Blocks ( B & B ) test as the primary outcome measure . Subjects also completed the Intrinsic Motivation Inventory ( IMI ) . Results Subjects improved h and function related to grasping small objects more after MusicGlove compared to conventional training , as measured by the B & B score ( improvement of 3.21±3.82 vs. -0.29±2.27 blocks ; P=0.010 ) and the 9 Hole Peg test ( improvement of 2.14±2.98 vs. -0.85±1.29 pegs/minute ; P=0.005 ) . There was no significant difference between training types in the broader assessment batteries of h and function . Subjects benefited less from isometric therapy than MusicGlove training , but the difference was not significant ( P>0.09 ) . Subjects sustained improvements in h and function at a one month follow-up , and found the MusicGlove more motivating than the other two therapies , as measured by the IMI . MusicGlove games scores correlated strongly with the B & B score . Conclusions These results support the hypothesis that h and therapy that is engaging , incorporates high numbers of repetitions of gripping and thumb-finger opposition movements , and promotes afferent input is a promising approach to improving an individual ’s ability to manipulate small objects . The MusicGlove provides a simple way to access such therapy 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 Acquired brain injury ( ABI ) is the main cause of death and disability among young adults . In most cases , survivors can experience balance instability , result ing in functional impairments that are associated with diminished health-related quality of life . Traditional rehabilitation therapy may be tedious . This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders . We present eBaViR ( easy Balance Virtual Rehabilitation ) , a system based on the Nintendo ® Wii Balance Board ® ( WBB ) , which has been design ed by clinical therapists to improve st and ing balance in patients with ABI through motivational and adaptative exercises . We hypothesize that eBaViR , is feasible , safe and potentially effective in enhancing st and ing balance . Methods In this contribution , we present a r and omized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients . This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation ( n = 9 ) versus st and ard rehabilitation ( n = 8) . Effectiveness was evaluated by means of traditional static and dynamic balance scales . Results The final sample consisted of 11 men and 6 women . Mean ± SD age was 47.3 ± 17.8 and mean ± SD chronicity was 570.9 ± 313.2 days . Patients using eBaViR had a significant improvement in static balance ( p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test ) compared to patients who underwent traditional therapy . Regarding dynamic balance , the results showed significant improvement over time in all these measures , but no significant group effect or group-by-time interaction was detected for any of them , which suggests that both groups improved in the same way . There were no serious adverse events during treatment in either group . Conclusions The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population . These results have encouraged us to reinforce the virtual treatment with new exercises , so an evolution of the system is currently being developed OBJECTIVE To investigate the feasibility of virtual reality driving simulation rehabilitation training ( VRDSRT ) with military personnel recovering from traumatic brain injury ( TBI ) . METHODS Eleven men with TBI were r and omly assigned as controls ( n = 5 ) receiving residential rehabilitation only or the VRDSRT group ( n = 6 ) receiving residential rehabilitation and VRDSRT . All subjects underwent pre- and post- assessment s including simulator driving , and completing road rage and risky driving question naires . Between assessment s , VRDSRT subjects received 4 - 6 , 60- to 90-min rehabilitation training sessions involving practicing progressively more complex driving skills ( lane position , speed control , etc . ) through progressively more dem and ing traffic . RESULTS VRDSRT was well received , considered realistic and effective , with no reported simulation sickness . Driving performance improved significantly in the VRDSRT group only ( p < 0.01 ) . They also demonstrated a reduction in road rage ( p = 0.01 ) and risky driving ( p = 0.04 ) at post- assessment . CONCLUSION VRDSRT showed promising results with respect to retraining driving performance and behavior among military personnel recovering from TBI Background and Purpose — Virtual reality ( VR ) is a new promising computer-assisted technology to promote motor recovery in stroke patients .  VR-induced neuroplasticity supporting locomotor recovery is not known . We investigated the effects of VR intervention on cortical reorganization and associated locomotor recovery in stroke patients . Methods — Ten chronic stroke patients were assigned r and omly to either the control group or the  VR  group . VR was design ed to provide interactive real-life practice environments in which practice parameters can be individualized to optimize motor relearning . Laterality index ( LI ) in the regions of interests ( ROIs ) and locomotor recovery were measured before and after VR using functional MRI ( fMRI ) and st and ardized locomotor tests , respectively . The t test and nonparametric test were performed to compare the mean differences at P<0.05 . Results — There was a significant difference in the interval change in the LI score for the primary sensorimotor cortex ( SMC ) between the groups ( P<0.05 ) , indicating that VR practice produced a greater increase in LI for the control group . However , the interval changes in the other ROIs were not significantly different ( P>0.05 ) . Motor function was significantly improved after VR ( P<0.05 ) . Conclusions — Our novel findings suggest that VR could induce cortical reorganization from aberrant ipsilateral to contralateral SMC activation . This enhanced cortical reorganization might play an important role in recovery of locomotor function in patients with chronic stroke . This is the first fMRI study in the literature that provides evidence for neuroplasticity and associated locomotor recovery after VR Purpose . This proof-of-concept study investigated whether feedback-mediated exercise ( FME ) of the affected arm of hemiplegic patients increases patient motivation and promotes greater improvement of motor function , compared to no-feedback exercise ( NFE ) . Method . We developed a feedback-mediated treatment that uses gaming scenarios and allows online and offline monitoring of both temporal and spatial characteristics of planar movements . Twenty poststroke hemiplegic in patients , r and omly assigned to the FME and NFE group , received therapy five days a week for three weeks . The outcome measures were evaluated from the following : ( 1 ) the modified drawing test ( mDT ) , ( 2 ) received therapy time — RTT , and ( 3 ) intrinsic motivation inventory — IMI . Results . The FME group patients showed significantly higher improvement in the speed metric ( P < 0.01 ) , and smoothness metric ( P < 0.01 ) , as well as higher RTT ( P < 0.01 ) . Significantly higher patient motivation is observed in the FME group ( interest/enjoyment subscale ( P < 0.01 ) and perceived competence subscale ( P < 0.01 ) ) . Conclusion . Prolonged endurance in training and greater improvement in certain areas of motor function , as well as very high patient motivation and strong positive impressions about the treatment , suggest the positive effects of feedback-mediated treatment and its high level of acceptance by patients Background and Purpose — Training of the lower extremity ( LE ) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion . The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone . Methods — A single , blind , r and omized clinical trial was conducted . Eighteen individuals poststroke participated in a 4-week training protocol . One group trained with the robot virtual reality ( VR ) system and the other group trained with the robot alone . Outcome measures were temporal features of gait measured in a laboratory setting and the community . Results — Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone . Similarly , significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR . These differences were maintained at 3 months ’ follow-up . Conclusions — The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone This r and omised controlled and double-blinded pilot study evaluated if interactive virtual reality balance related games integrated within conventional rehabilitation sessions result ed in more superior retraining of dynamic balance compared to CR after stroke . 19 subjects diagnosed with a recent episode of stroke were recruited from a local rehabilitation hospital and r and omly assigned to either a control or an experimental group . Subjects in the control groups underwent 60 minutes of conventional rehabilitation while those in the experimental groups underwent 40 minutes of convention rehabilitation and 20 minutes of self-directed virtual reality balanced rehabilitation .  Functional Reach Test , Timed Up and Go , Modified Barthel Index , Berg Balance Scale , and Centre of Pressure of subjects in both groups were evaluated before and on completion of the rehabilitation sessions . Results indicate that the inclusion of interactive virtual reality balance related games within conventional rehabilitation can lead to improved functional mobility and balance after a recent episode of stroke without increasing treatment time that requires more health professional manpower OBJECTIVES Occupationally embedded exercise is a central idea in the profession of occupational therapy . This experiment compared the effect of an occupationally embedded exercise involving a simple dice game with a rote exercise in persons with stroke with pronator spasticity . Both exercise conditions involved bilaterally assisted supination , consistent with the neurodevelopmental model of practice . METHODS The sample consisted of 14 men and 12 women post-cerebrovascular accident with a mean age of 68.4 years ( SD = 11.2 ) at six clinical sites in California , Texas , and Michigan . Subjects had pronator spasticity , full passive range for supination after a brief warm-up , and no functional supination . After r and om assignment for experimental condition , the subjects engaged in two sets of 10 repetitions of bilaterally assisted supination in either the occupationally embedded condition ( dice game ) or the rote condition ( no game ) . A pen recorder electronically documented degrees of rotation of the h and le that was grasped during the exercise . RESULTS The occupationally embedded exercise result ed in significantly more h and le rotation ( requiring more supination ) than the rote exercise , t ( 24 ) = 2.28 , p ( one tailed ) < .05 . The effect size was large . CONCLUSION This study advances the experimental analysis of therapeutic occupation in the area of occupationally embedded exercise . Clinicians are urged to consider the multidimensional nature of occupationally embedded exercise [ Purpose ] The purpose of this study was to investigate the effects of training using video games played on the Xbox Kinect on the muscle strength , muscle 
    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 It is thought that therapy should be functional , be highly repetitive , and promote afferent input to best stimulate h and motor recovery after stroke , yet patients struggle to access such therapy . We developed the MusicGlove , an instrumented glove that requires the user to practice gripping-like movements and thumb-finger opposition to play a highly engaging , music-based , video game . The purpose of this study was to 1 ) compare the effect of training with MusicGlove to conventional h and therapy 2 ) determine if MusicGlove training was more effective than a matched form of isometric h and movement training ; and 3 ) determine if MusicGlove game scores predict clinical outcomes . Methods 12 chronic stroke survivors with moderate hemiparesis were r and omly assigned to receive MusicGlove , isometric , and conventional h and therapy in a within-subjects design . Each subject participated in six one-hour treatment sessions three times per week for two weeks , for each training type , for a total of 18 treatment sessions . A blinded rater assessed h and impairment before and after each training type and at one-month follow-up including the Box and Blocks ( B & B ) test as the primary outcome measure . Subjects also completed the Intrinsic Motivation Inventory ( IMI ) . Results Subjects improved h and function related to grasping small objects more after MusicGlove compared to conventional training , as measured by the B & B score ( improvement of 3.21±3.82 vs. -0.29±2.27 blocks ; P=0.010 ) and the 9 Hole Peg test ( improvement of 2.14±2.98 vs. -0.85±1.29 pegs/minute ; P=0.005 ) . There was no significant difference between training types in the broader assessment batteries of h and function . Subjects benefited less from isometric therapy than MusicGlove training , but the difference was not significant ( P>0.09 ) . Subjects sustained improvements in h and function at a one month follow-up , and found the MusicGlove more motivating than the other two therapies , as measured by the IMI . MusicGlove games scores correlated strongly with the B & B score . Conclusions These results support the hypothesis that h and therapy that is engaging , incorporates high numbers of repetitions of gripping and thumb-finger opposition movements , and promotes afferent input is a promising approach to improving an individual ’s ability to manipulate small objects . The MusicGlove provides a simple way to access such therapy 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 Acquired brain injury ( ABI ) is the main cause of death and disability among young adults . In most cases , survivors can experience balance instability , result ing in functional impairments that are associated with diminished health-related quality of life . Traditional rehabilitation therapy may be tedious . This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders . We present eBaViR ( easy Balance Virtual Rehabilitation ) , a system based on the Nintendo ® Wii Balance Board ® ( WBB ) , which has been design ed by clinical therapists to improve st and ing balance in patients with ABI through motivational and adaptative exercises . We hypothesize that eBaViR , is feasible , safe and potentially effective in enhancing st and ing balance . Methods In this contribution , we present a r and omized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients . This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation ( n = 9 ) versus st and ard rehabilitation ( n = 8) . Effectiveness was evaluated by means of traditional static and dynamic balance scales . Results The final sample consisted of 11 men and 6 women . Mean ± SD age was 47.3 ± 17.8 and mean ± SD chronicity was 570.9 ± 313.2 days . Patients using eBaViR had a significant improvement in static balance ( p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test ) compared to patients who underwent traditional therapy . Regarding dynamic balance , the results showed significant improvement over time in all these measures , but no significant group effect or group-by-time interaction was detected for any of them , which suggests that both groups improved in the same way . There were no serious adverse events during treatment in either group . Conclusions The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population . These results have encouraged us to reinforce the virtual treatment with new exercises , so an evolution of the system is currently being developed OBJECTIVE To investigate the feasibility of virtual reality driving simulation rehabilitation training ( VRDSRT ) with military personnel recovering from traumatic brain injury ( TBI ) . METHODS Eleven men with TBI were r and omly assigned as controls ( n = 5 ) receiving residential rehabilitation only or the VRDSRT group ( n = 6 ) receiving residential rehabilitation and VRDSRT . All subjects underwent pre- and post- assessment s including simulator driving , and completing road rage and risky driving question naires . Between assessment s , VRDSRT subjects received 4 - 6 , 60- to 90-min rehabilitation training sessions involving practicing progressively more complex driving skills ( lane position , speed control , etc . ) through progressively more dem and ing traffic . RESULTS VRDSRT was well received , considered realistic and effective , with no reported simulation sickness . Driving performance improved significantly in the VRDSRT group only ( p < 0.01 ) . They also demonstrated a reduction in road rage ( p = 0.01 ) and risky driving ( p = 0.04 ) at post- assessment . CONCLUSION VRDSRT showed promising results with respect to retraining driving performance and behavior among military personnel recovering from TBI Background and Purpose — Virtual reality ( VR ) is a new promising computer-assisted technology to promote motor recovery in stroke patients .  VR-induced neuroplasticity supporting locomotor recovery is not known . We investigated the effects of VR intervention on cortical reorganization and associated locomotor recovery in stroke patients . Methods — Ten chronic stroke patients were assigned r and omly to either the control group or the  VR  group . VR was design ed to provide interactive real-life practice environments in which practice parameters can be individualized to optimize motor relearning . Laterality index ( LI ) in the regions of interests ( ROIs ) and locomotor recovery were measured before and after VR using functional MRI ( fMRI ) and st and ardized locomotor tests , respectively . The t test and nonparametric test were performed to compare the mean differences at P<0.05 . Results — There was a significant difference in the interval change in the LI score for the primary sensorimotor cortex ( SMC ) between the groups ( P<0.05 ) , indicating that VR practice produced a greater increase in LI for the control group . However , the interval changes in the other ROIs were not significantly different ( P>0.05 ) . Motor function was significantly improved after VR ( P<0.05 ) . Conclusions — Our novel findings suggest that VR could induce cortical reorganization from aberrant ipsilateral to contralateral SMC activation . This enhanced cortical reorganization might play an important role in recovery of locomotor function in patients with chronic stroke . This is the first fMRI study in the literature that provides evidence for neuroplasticity and associated locomotor recovery after VR Purpose . This proof-of-concept study investigated whether feedback-mediated exercise ( FME ) of the affected arm of hemiplegic patients increases patient motivation and promotes greater improvement of motor function , compared to no-feedback exercise ( NFE ) . Method . We developed a feedback-mediated treatment that uses gaming scenarios and allows online and offline monitoring of both temporal and spatial characteristics of planar movements . Twenty poststroke hemiplegic in patients , r and omly assigned to the FME and NFE group , received therapy five days a week for three weeks . The outcome measures were evaluated from the following : ( 1 ) the modified drawing test ( mDT ) , ( 2 ) received therapy time — RTT , and ( 3 ) intrinsic motivation inventory — IMI . Results . The FME group patients showed significantly higher improvement in the speed metric ( P < 0.01 ) , and smoothness metric ( P < 0.01 ) , as well as higher RTT ( P < 0.01 ) . Significantly higher patient motivation is observed in the FME group ( interest/enjoyment subscale ( P < 0.01 ) and perceived competence subscale ( P < 0.01 ) ) . Conclusion . Prolonged endurance in training and greater improvement in certain areas of motor function , as well as very high patient motivation and strong positive impressions about the treatment , suggest the positive effects of feedback-mediated treatment and its high level of acceptance by patients Background and Purpose — Training of the lower extremity ( LE ) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion . The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone . Methods — A single , blind , r and omized clinical trial was conducted . Eighteen individuals poststroke participated in a 4-week training protocol . One group trained with the robot virtual reality ( VR ) system and the other group trained with the robot alone . Outcome measures were temporal features of gait measured in a laboratory setting and the community . Results — Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone . Similarly , significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR . These differences were maintained at 3 months ’ follow-up . Conclusions — The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone This r and omised controlled and double-blinded pilot study evaluated if interactive virtual reality balance related games integrated within conventional rehabilitation sessions result ed in more superior retraining of dynamic balance compared to CR after stroke . 19 subjects diagnosed with a recent episode of stroke were recruited from a local rehabilitation hospital and r and omly assigned to either a control or an experimental group . Subjects in the control groups underwent 60 minutes of conventional rehabilitation while those in the experimental groups underwent 40 minutes of convention rehabilitation and 20 minutes of self-directed virtual reality balanced rehabilitation .  Functional Reach Test , Timed Up and Go , Modified Barthel Index , Berg Balance Scale , and Centre of Pressure of subjects in both groups were evaluated before and on completion of the rehabilitation sessions . Results indicate that the inclusion of interactive virtual reality balance related games within conventional rehabilitation can lead to improved functional mobility and balance after a recent episode of stroke without increasing treatment time that requires more health professional manpower OBJECTIVES Occupationally embedded exercise is a central idea in the profession of occupational therapy . This experiment compared the effect of an occupationally embedded exercise involving a simple dice game with a rote exercise in persons with stroke with pronator spasticity . Both exercise conditions involved bilaterally assisted supination , consistent with the neurodevelopmental model of practice . METHODS The sample consisted of 14 men and 12 women post-cerebrovascular accident with a mean age of 68.4 years ( SD = 11.2 ) at six clinical sites in California , Texas , and Michigan . Subjects had pronator spasticity , full passive range for supination after a brief warm-up , and no functional supination . After r and om assignment for experimental condition , the subjects engaged in two sets of 10 repetitions of bilaterally assisted supination in either the occupationally embedded condition ( dice game ) or the rote condition ( no game ) . A pen recorder electronically documented degrees of rotation of the h and le that was grasped during the exercise . RESULTS The occupationally embedded exercise result ed in significantly more h and le rotation ( requiring more supination ) than the rote exercise , t ( 24 ) = 2.28 , p ( one tailed ) < .05 . The effect size was large . CONCLUSION This study advances the experimental analysis of therapeutic occupation in the area of occupationally embedded exercise . Clinicians are urged to consider the multidimensional nature of occupationally embedded exercise [ Purpose ] The purpose of this study was to investigate the effects of training using video games played on the Xbox Kinect on the muscle strength , muscle 
    Output:
    