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: 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 Experimental and control groups of 10 hemiparetic stroke patients each underwent a 6 week , twice daily gait training program . The control group participated in a conventional physical therapy gait program . The experimental group trained in the same basic program with the addition of rhythmic auditory stimulation ( RAS ) .  Patients entered the study as soon as they could complete 5 strides with h and -held assistance . The training program had to be completed within 3 months of the patients ' stroke . In the experimental group RAS was used as a timekeeper to synchronize step patterns and gradually entrain higher stride frequencies . Study groups were equated by gender , lesion site , and age . Motor function was assessed at pretest using Barthel , Fugl-Meyer , and Berg Scales . Walking patterns were assessed during pre- and post-test without RAS present . Pre- vs post-test measures revealed a statistically significant ( P<0.05 ) increase in velocity ( 164 % vs 107 % ) , stride length ( 88 % vs 34 % ) , and reduction in EMG amplitude variability of the gastrocnemius muscle ( 69 % vs 33 % ) for the RAS-training group compared to the control group . The difference in stride symmetry improvement ( 32 % in the RAS-group vs 16 % in the control group ) was statistically not significant . The data offer evidence that RAS is an efficient tool to enhance efforts in gait rehabilitation with acute stroke patients Background and Purpose — Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke . The aim of the present study was to study the effects of progress of time on observed improvements in motor strength , synergisms , and activities during the first 16 weeks poststroke . Methods — Based on data from a previous study , 101 patients with first-ever ischemic middle cerebral artery strokes were prospect ively investigated during the first 16 weeks after stroke . Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model . The biweekly time change ( progress of time ) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index , reduction in visuospatial inattention based on the letter cancellation task , and improvement in walking ability , dexterity , and activities of daily living measured with the Functional Ambulation Categories , Action Research Arm test , and Barthel Index . Results — Time explained a significant change of 8.4 ( 42 % ) measurement units on the Barthel Index for the first 10 weeks poststroke , 1.1 ( 22 % ) measurement units on Functional Ambulation Categories , and 19 % on the Action Research Arm test for the first 6 and 8 weeks poststroke . Approximately 25 % ( for Fugl-Meyer – arm ) to 26 % ( for Motricity Index – arm ) of the significant change in measurements units was explained by time alone for the upper limb compared with 33 % for Fugl-Meyer – leg and 39 % for Motricity Index – leg of the lower limb . Time accounted for a reduction of 16 % in the letter cancellation task . Observed associations did not change after controlling for covariates such as age , gender , hemisphere of stroke , type of stroke , or intervention . Conclusion — Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining ≈16 % to 42 % of the observed improvements in the first 6 to 10 weeks after stroke onset Background and Purpose — To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability . Methods — A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population . Prospect i ve cohort study based on 18 repeated measurements over time during the first poststroke year . Baseline characteristics as well as longitudinal information from functional ambulation categories ( FAC ) , Fugl – Meyer leg score ( FM-leg ) , Motricity index leg score ( MI-leg ) , letter cancellation task ( LCT ) , Fugl-Meyer balance ( FM-balance ) , and timed balance test ( TBT ) were obtained . Intervention consisted of a basic rehabilitation program with additional arm , leg , or air splint therapy . Main outcome measure constituted change scores on FAC over time . Results — In total , 1532 of the 1717 change scores were available for regression analysis . The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC ( & bgr;=0.094 ; P<0.001 ) followed by changes scores on FM-leg ( & bgr;=0.014 ; P<0.001 ) and reduction in LCT omissions ( & bgr;=−0.010 ; P<0.001 ) and MI leg test ( & bgr;=0.001 ; P<0.001 ) . In addition , time itself was significantly negatively associated with improvement ( & bgr;=−0.002 ; P<0.001 ) . Conclusion — Improvement in st and ing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability , whereas reduction in visuospatial inattention is independently related to improvement of gait . Finally , time itself is an independent covariate that is negatively associated with change on FAC , suggesting that most pronounced improvements occur earlier after stroke Background and Purpose — Perception of the subjective visual vertical ( SVV ) is affected by cerebral hemispheric lesions . Knowledge of this disturbance is of interest for the study of its possible relation to balance disturbances . There is still uncertainty about the possible effects of a visual field defect and of the side and site of the lesion . This study was conducted to assess SVV with the head upright or tilted and to explore its relation to a visual field defect , visuospatial neglect , and the site of lesion . Methods — Forty patients with hemiplegia after a recent hemispheric stroke ( 20 with left and 20 with right stroke ) were studied . The site of the lesion was determined on CT scan , with special attention focused on the vestibular cortex . A neurological examination with determination of the visual field and visual neglect was conducted before SVV was tested . Subjects sat in a dark room and adjusted a luminous rod to the vertical position . Measures were repeated with binocular and monocular vision and with the head upright or tilted to the right or left . Results — SVV was abnormally deviated in 23 of 40 patients ( 57 % ) . The deviation was significantly greater among patients with a right or left hemispheric lesion than among healthy controls ( −2.2 ° and 1.5 ° versus 0.2 ° ) ; the same applied to the range of uncertainty ( 7.6 ° and 4.7 ° versus 1.9 ° ) . SVV deviation was not significantly related to the location of the lesion but was closely related to visuospatial neglect . The “ E ” effect observed in controls with the head tilted , ie , an SVV shift in the direction opposite to the head tilt , was not observed in hemiplegic patients with the head tilted toward the nonparetic side . Conclusions — Recent hemispheric stroke affects SVV perception , which is closely correlated to visuospatial neglect . It is suggested that the E effect might be mediated by the stretching of the somatosensory structure of the neck BACKGROUND AND PURPOSE Of all stroke survivors , 30 % to 66 % are unable to use their affected arm in performing activities of daily living . Although forced use therapy appears to improve arm function in chronic stroke patients , there is no conclusive evidence . This study evaluates the effectiveness of forced use therapy . METHODS In an observer-blinded r and omized clinical trial , 66 chronic stroke patients were allocated to either forced use therapy ( immobilization of the unaffected arm combined with intensive training ) or a reference therapy of equally intensive bimanual training , based on Neuro-Developmental Treatment , for a period of 2 weeks . Outcomes were evaluated on the basis of the Rehabilitation Activities Profile ( activities ) , the Action Research Arm ( ARA ) test ( dexterity ) , the upper extremity section of the Fugl-Meyer Assessment scale , the Motor Activity Log ( MAL ) , and a Problem Score . The minimal clinical ly important difference ( MCID ) was determined at the onset of the study . RESULTS One week after the last treatment session , a significant difference in effectiveness in favor of the forced use group compared with the bimanual group ( corrected for baseline differences ) was found for the ARA score ( 3.0 points ; 95 % CI , 1.3 to 4.8 ; MCID , 5.7 points ) and the MAL amount of use score ( 0.52 points ; 95 % CI , 0.11 to 0.93 ; MCID , 0.50 ) . The other parameters revealed no significant differential effects . One-year follow-up effects were observed only for the ARA . The differences in treatment effect for the ARA and the MAL amount of use scores were clinical ly relevant for patients with sensory disorders and hemineglect , respectively . CONCLUSIONS The present study showed a small but lasting effect of forced use therapy on the dexterity of the affected arm ( ARA ) and a temporary clinical ly relevant effect on the amount of use of the affected arm during activities of daily living ( MAL amount of use ) . The effect of forced use therapy was clinical ly relevant in the subgroups of patients with sensory disorders and hemineglect , respectively Objectives : Bobath based ( BB ) and movement science based ( MSB ) physiotherapy interventions are widely used for patients after stroke . There is little evidence to suggest which is most effective . This single-blind r and omised controlled trial evaluated the effect of these treatments on movement abilities and functional independence . Methods : A total of 120 patients admitted to a stroke rehabilitation ward were r and omised into two treatment groups to receive either BB or MSB treatment . Primary outcome measures were the Rivermead Motor Assessment and the Motor Assessment Scale . Secondary measures assessed functional independence , walking speed , arm function , muscle tone , and sensation . Measures were performed by a blinded assessor at baseline , and then at 1 , 3 , and 6 months after baseline . Analysis of serial measurements was performed to compare outcomes between the groups by calculating the area under the curve ( AUC ) and inserting AUC values into Mann-Whitney U tests . Results : Comparison between groups showed no significant difference for any outcome measures . Significance values for the Rivermead Motor Assessment ranged from p = 0.23 to p = 0.97 and for the Motor Assessment Scale from p = 0.29 to p = 0.87 . Conclusions : There were no significant differences in movement abilities or functional independence between patients receiving a BB or an MSB intervention . Therefore the study did not show that one approach was more effective than the other in the treatment of stroke patients In a recent study , De Haart et al. ( Arch Phys Med Rehabil 85:886–895 , 2004 ) investigated the recovery of balance in stroke patients using traditional analyses of center-of-pressure ( COP ) trajectories to assess the effects of health status , rehabilitation , and task conditions like  st and ing with eyes open or closed and st and ing while performing a cognitive dual task .  To unravel the underlying control processes , we reanalyzed these data in terms of stochastic dynamics using more advanced analyses . Dimensionality , local stability , regularity , and scaling behavior of COP trajectories were determined and compared with shuffled and phase-r and omized surrogate data . The presence of long-range correlations discarded the possibility that the COP trajectories were purely r and om . Compared to the healthy controls , the COP trajectories of the stroke patients were characterized by increased dimensionality and instability , but greater regularity in the frontal plane . 
    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: 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 Experimental and control groups of 10 hemiparetic stroke patients each underwent a 6 week , twice daily gait training program . The control group participated in a conventional physical therapy gait program . The experimental group trained in the same basic program with the addition of rhythmic auditory stimulation ( RAS ) .  Patients entered the study as soon as they could complete 5 strides with h and -held assistance . The training program had to be completed within 3 months of the patients ' stroke . In the experimental group RAS was used as a timekeeper to synchronize step patterns and gradually entrain higher stride frequencies . Study groups were equated by gender , lesion site , and age . Motor function was assessed at pretest using Barthel , Fugl-Meyer , and Berg Scales . Walking patterns were assessed during pre- and post-test without RAS present . Pre- vs post-test measures revealed a statistically significant ( P<0.05 ) increase in velocity ( 164 % vs 107 % ) , stride length ( 88 % vs 34 % ) , and reduction in EMG amplitude variability of the gastrocnemius muscle ( 69 % vs 33 % ) for the RAS-training group compared to the control group . The difference in stride symmetry improvement ( 32 % in the RAS-group vs 16 % in the control group ) was statistically not significant . The data offer evidence that RAS is an efficient tool to enhance efforts in gait rehabilitation with acute stroke patients Background and Purpose — Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke . The aim of the present study was to study the effects of progress of time on observed improvements in motor strength , synergisms , and activities during the first 16 weeks poststroke . Methods — Based on data from a previous study , 101 patients with first-ever ischemic middle cerebral artery strokes were prospect ively investigated during the first 16 weeks after stroke . Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model . The biweekly time change ( progress of time ) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index , reduction in visuospatial inattention based on the letter cancellation task , and improvement in walking ability , dexterity , and activities of daily living measured with the Functional Ambulation Categories , Action Research Arm test , and Barthel Index . Results — Time explained a significant change of 8.4 ( 42 % ) measurement units on the Barthel Index for the first 10 weeks poststroke , 1.1 ( 22 % ) measurement units on Functional Ambulation Categories , and 19 % on the Action Research Arm test for the first 6 and 8 weeks poststroke . Approximately 25 % ( for Fugl-Meyer – arm ) to 26 % ( for Motricity Index – arm ) of the significant change in measurements units was explained by time alone for the upper limb compared with 33 % for Fugl-Meyer – leg and 39 % for Motricity Index – leg of the lower limb . Time accounted for a reduction of 16 % in the letter cancellation task . Observed associations did not change after controlling for covariates such as age , gender , hemisphere of stroke , type of stroke , or intervention . Conclusion — Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining ≈16 % to 42 % of the observed improvements in the first 6 to 10 weeks after stroke onset Background and Purpose — To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability . Methods — A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population . Prospect i ve cohort study based on 18 repeated measurements over time during the first poststroke year . Baseline characteristics as well as longitudinal information from functional ambulation categories ( FAC ) , Fugl – Meyer leg score ( FM-leg ) , Motricity index leg score ( MI-leg ) , letter cancellation task ( LCT ) , Fugl-Meyer balance ( FM-balance ) , and timed balance test ( TBT ) were obtained . Intervention consisted of a basic rehabilitation program with additional arm , leg , or air splint therapy . Main outcome measure constituted change scores on FAC over time . Results — In total , 1532 of the 1717 change scores were available for regression analysis . The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC ( & bgr;=0.094 ; P<0.001 ) followed by changes scores on FM-leg ( & bgr;=0.014 ; P<0.001 ) and reduction in LCT omissions ( & bgr;=−0.010 ; P<0.001 ) and MI leg test ( & bgr;=0.001 ; P<0.001 ) . In addition , time itself was significantly negatively associated with improvement ( & bgr;=−0.002 ; P<0.001 ) . Conclusion — Improvement in st and ing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability , whereas reduction in visuospatial inattention is independently related to improvement of gait . Finally , time itself is an independent covariate that is negatively associated with change on FAC , suggesting that most pronounced improvements occur earlier after stroke Background and Purpose — Perception of the subjective visual vertical ( SVV ) is affected by cerebral hemispheric lesions . Knowledge of this disturbance is of interest for the study of its possible relation to balance disturbances . There is still uncertainty about the possible effects of a visual field defect and of the side and site of the lesion . This study was conducted to assess SVV with the head upright or tilted and to explore its relation to a visual field defect , visuospatial neglect , and the site of lesion . Methods — Forty patients with hemiplegia after a recent hemispheric stroke ( 20 with left and 20 with right stroke ) were studied . The site of the lesion was determined on CT scan , with special attention focused on the vestibular cortex . A neurological examination with determination of the visual field and visual neglect was conducted before SVV was tested . Subjects sat in a dark room and adjusted a luminous rod to the vertical position . Measures were repeated with binocular and monocular vision and with the head upright or tilted to the right or left . Results — SVV was abnormally deviated in 23 of 40 patients ( 57 % ) . The deviation was significantly greater among patients with a right or left hemispheric lesion than among healthy controls ( −2.2 ° and 1.5 ° versus 0.2 ° ) ; the same applied to the range of uncertainty ( 7.6 ° and 4.7 ° versus 1.9 ° ) . SVV deviation was not significantly related to the location of the lesion but was closely related to visuospatial neglect . The “ E ” effect observed in controls with the head tilted , ie , an SVV shift in the direction opposite to the head tilt , was not observed in hemiplegic patients with the head tilted toward the nonparetic side . Conclusions — Recent hemispheric stroke affects SVV perception , which is closely correlated to visuospatial neglect . It is suggested that the E effect might be mediated by the stretching of the somatosensory structure of the neck BACKGROUND AND PURPOSE Of all stroke survivors , 30 % to 66 % are unable to use their affected arm in performing activities of daily living . Although forced use therapy appears to improve arm function in chronic stroke patients , there is no conclusive evidence . This study evaluates the effectiveness of forced use therapy . METHODS In an observer-blinded r and omized clinical trial , 66 chronic stroke patients were allocated to either forced use therapy ( immobilization of the unaffected arm combined with intensive training ) or a reference therapy of equally intensive bimanual training , based on Neuro-Developmental Treatment , for a period of 2 weeks . Outcomes were evaluated on the basis of the Rehabilitation Activities Profile ( activities ) , the Action Research Arm ( ARA ) test ( dexterity ) , the upper extremity section of the Fugl-Meyer Assessment scale , the Motor Activity Log ( MAL ) , and a Problem Score . The minimal clinical ly important difference ( MCID ) was determined at the onset of the study . RESULTS One week after the last treatment session , a significant difference in effectiveness in favor of the forced use group compared with the bimanual group ( corrected for baseline differences ) was found for the ARA score ( 3.0 points ; 95 % CI , 1.3 to 4.8 ; MCID , 5.7 points ) and the MAL amount of use score ( 0.52 points ; 95 % CI , 0.11 to 0.93 ; MCID , 0.50 ) . The other parameters revealed no significant differential effects . One-year follow-up effects were observed only for the ARA . The differences in treatment effect for the ARA and the MAL amount of use scores were clinical ly relevant for patients with sensory disorders and hemineglect , respectively . CONCLUSIONS The present study showed a small but lasting effect of forced use therapy on the dexterity of the affected arm ( ARA ) and a temporary clinical ly relevant effect on the amount of use of the affected arm during activities of daily living ( MAL amount of use ) . The effect of forced use therapy was clinical ly relevant in the subgroups of patients with sensory disorders and hemineglect , respectively Objectives : Bobath based ( BB ) and movement science based ( MSB ) physiotherapy interventions are widely used for patients after stroke . There is little evidence to suggest which is most effective . This single-blind r and omised controlled trial evaluated the effect of these treatments on movement abilities and functional independence . Methods : A total of 120 patients admitted to a stroke rehabilitation ward were r and omised into two treatment groups to receive either BB or MSB treatment . Primary outcome measures were the Rivermead Motor Assessment and the Motor Assessment Scale . Secondary measures assessed functional independence , walking speed , arm function , muscle tone , and sensation . Measures were performed by a blinded assessor at baseline , and then at 1 , 3 , and 6 months after baseline . Analysis of serial measurements was performed to compare outcomes between the groups by calculating the area under the curve ( AUC ) and inserting AUC values into Mann-Whitney U tests . Results : Comparison between groups showed no significant difference for any outcome measures . Significance values for the Rivermead Motor Assessment ranged from p = 0.23 to p = 0.97 and for the Motor Assessment Scale from p = 0.29 to p = 0.87 . Conclusions : There were no significant differences in movement abilities or functional independence between patients receiving a BB or an MSB intervention . Therefore the study did not show that one approach was more effective than the other in the treatment of stroke patients In a recent study , De Haart et al. ( Arch Phys Med Rehabil 85:886–895 , 2004 ) investigated the recovery of balance in stroke patients using traditional analyses of center-of-pressure ( COP ) trajectories to assess the effects of health status , rehabilitation , and task conditions like  st and ing with eyes open or closed and st and ing while performing a cognitive dual task .  To unravel the underlying control processes , we reanalyzed these data in terms of stochastic dynamics using more advanced analyses . Dimensionality , local stability , regularity , and scaling behavior of COP trajectories were determined and compared with shuffled and phase-r and omized surrogate data . The presence of long-range correlations discarded the possibility that the COP trajectories were purely r and om . Compared to the healthy controls , the COP trajectories of the stroke patients were characterized by increased dimensionality and instability , but greater regularity in the frontal plane . 
    Output:
    