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: Objective : To compare the effect of early customized vestibular rehabilitation with general instructions in patients after acoustic neuroma surgery . Setting : Tertiary referral centre . Subjects : Fifty-three patients after surgery . Design : A prospect i ve assessor-blinded , r and omized controlled trial . Interventions : After stratification for age ( < 50 years ; ≥50 years ) , patients were r and omly allocated into groups receiving general instructions or customized vestibular rehabilitation protocol s for 12 weeks . Outcome measures : St and ing Balance Sum , Timed Up and Go test , T and em Gait and Dynamic Gait Index . Balance performance was assessed preoperatively , at discharge ( one week after surgery ) , three , six , nine , 12 , 26 and 52 weeks after surgery . Results and discussion : All subjects clearly improved within the first six weeks after surgery . However , older subjects receiving vestibular rehabilitation performed significantly ( P<0.05 ) better on st and ing balance , Timed Up and Go test and T and em Gait , when compared with the older group that received only general instructions . This effect persisted up to 12 weeks and also became apparent on the Dynamic Gait Index . In addition , the older vestibular rehabilitation group had better balance scores at 12 weeks when compared with their original preoperative scores ( P<0.05 ) . This pattern remained even up to one year after surgery ( P<0.05 ) . Conclusion : In patients over 50 , early vestibular rehabilitation facilitates recovery of postural control after acoustic neuroma surgery . Customized vestibular rehabilitation should be given in addition to general instructions that stress the need of exposure to movement . Retention of the early beneficial effects even one year after surgery stresses the importance of customized vestibular rehabilitation Purpose . Cognitive and behavioural therapy ( CBT ) is often used to treat behavioural and emotional disorders in children , and its efficacy has been described in several studies . As behavioural and emotional disorders are frequent sequelae in brain tumor survivors , the goal of this work is to describe the efficacy of a CBT intervention in the treatment of young brain tumor survivors . Methods . Forty young patients , aged 4–18 years , were included in the study . The treatment group , composed of 17 patients , received sessions of CBT . The Child Behaviour Checklist 4–18 ( CBCL/4–18 ) and the Vinel and Adaptive Behavioural Scales ( VABS ) were administered to parents at the beginning and at the end of the hospitalisation . The statistical significance of changes for clinical subjects during the CBT administration was estimated . Results . With regard to the CBCL/4–18 , the clinical group showed a significant advantage on the withdrawn , somatic complaints , social problems , attention problems , internalising and total problem scales . On the VABS , the treatment group improved to a significantly greater extent in the social skills domain . Conclusions . These results substantiate our assumption that CBT is an effective intervention for young patients surviving brain tumors and may be particularly helpful to younger individuals in managing cancer-related limitations R and omized clinical trials ( RCTs ) are widely considered to be the gold st and ard of evidence for treatment efficacy , but they have not been widely applied to rehabilitation or , more specifically , traumatic brain injury rehabilitation . Ethical , scientific , and re source factors may limit the application of RCTs . Thus , rigorous observational alternatives to the RCT would be of great value . In the article by Powell et al , an attempt to rigorously apply an observational design to assess the relative effectiveness of  inpatient rehabilitation  versus  home  discharge failed to control for important confounding factors . It appears nearly impossible to successfully apply observational design s when the factors leading to the applications of different treatments are strongly related to the patient 's perceived prognosis . However , observational design s may be successfully applied when regional or temporal variations in care are studied . Moreover , a number of developments in measurement , study design , and statistical analysis may exp and the role of observational studies in answering questions of rehabilitation efficacy and effectiveness OBJECTIVE To evaluate the effects of the intensive repetition of movements elicited by the facilitation technique to improve voluntary movement of a hemiplegic lower limb in patients with brain damage . DESIGN A multiple-baseline design ( A-B-A-B : A without specific therapy , B with specific therapy ) across individuals . PATIENTS The sample comprised 22 subjects with stroke and 2 brain tumour-operated subjects ( age : 50.7 + /- 9.6 years , time after onset : 7.1 + /- 2.6 weeks ) . They were selected from among 165 patients with stroke who were admitted to our rehabilitation centre from September 1 , 1995 to March 31 , 1997 . METHODS Two 2-week facilitation technique sessions ( more than 100 repetitions a day for each of 5 kinds of movement ) were applied at 2-week intervals in patients with hemiplegia , who were being treated with continuous conventional rehabilitation exercise without the facilitation technique for hemiplegia . Motor function of the affected lower limb ( Brunnstrom Recovery Stage of hemiplegia , the foot-tap test and the strength of knee extension/flexion ) and walking velocity were evaluated at 2-week intervals . RESULTS Significant improvements in Brunnstrom Stage , foot-tapping and the strength of knee extension/flexion of the affected lower limb were seen after the first conventional rehabilitation exercise session and after the first and second facilitation technique and conventional rehabilitation exercise sessions . The improvements after facilitation technique and conventional rehabilitation exercise sessions were significantly greater than those after the preceding conventional rehabilitation exercise sessions . CONCLUSION Intensive repetition of movement elicited by the facilitation technique ( chiefly proprioceptive neuromuscural facilitation pattern , stretch reflex and skin-muscle reflex ) improved voluntary movement of a hemiplegic lower limb in patients with brain damage PURPOSE Patients with gliomas often experience cognitive deficits , including problems with attention and memory . This r and omized , controlled trial evaluated the effects of a multifaceted cognitive rehabilitation program ( CRP ) on cognitive functioning and selected quality -of-life domains in patients with gliomas . PATIENTS AND METHODS One hundred forty adult patients with low- grade and anaplastic gliomas , favorable prognostic factors , and both subjective cognitive symptoms and objective cognitive deficits were recruited from 11 hospitals in the Netherl and s. Patients were r and omly assigned to an intervention group or to a waiting-list control group . The intervention incorporated both computer-based attention retraining and compensatory skills training of attention , memory , and executive functioning . Participants completed a battery of  neuropsychological  ( NP ) tests and self-report question naires on cognitive functioning , fatigue , mental health-related quality of life , and community integration at baseline , after completion of the CRP , and at 6-month follow-up . RESULTS At the immediate post-treatment evaluation , statistically significant intervention effects were observed for measures of subjective cognitive functioning and its perceived burden but not for the objective NP outcomes or for any of the other self-report measures . At the 6-month follow-up , the CRP group performed significantly better than the control group on NP tests of attention and verbal memory and reported less mental fatigue . Group differences in other subjective outcomes were not significant at 6 months . CONCLUSION The CRP has a salutary effect on short-term cognitive complaints and on longer-term cognitive performance and mental fatigue . Additional research is needed to identify which elements of the intervention are most effective Cognitive impairment is one of the most common neurological disorders in neuro-oncological patients and exerts a deep negative impact on quality of life interfering with familiar , social and career-related activities . To test the effectiveness of early cognitive rehabilitation treatment for in patients affected by primary brain tumors . Out of 109 consecutive patients enrolled in the study , 58 patients were r and omly assigned to a rehabilitation group or to a control group . The rehabilitation consisted of 16 one-hour individual sessions of therapist-guided cognitive training , spread over 4 weeks , combining computer exercises and metacognitive training . Patients in the control group received usual care without cognitive training . All patients were evaluated by means of a comprehensive neuropsychological battery at the admission ( T0 ) and after 4 weeks ( T1 ) . Patients in the rehabilitation group showed a significant improvement of cognitive functions . In particular , the domains that benefited most from the training were visual attention and verbal memory . The control group exhibited only a slightly , not statistically relevant , enhancement of cognitive performances .  Cognitive rehabilitation for neuro-oncological in patients result ed in a significant enhancement of cognitive performances after the training , also providing a foundation for early administration . Future research should be aim ed to clarify the patients ’ characteristics that predict neuropsychological improvement , to identify the most effective elements in rehabilitative programs and to study the effects of treatment extension to everyday life OBJECTIVE To describe  patient-reported disability in primary brain tumours using the International Classification of Functioning , Disability and Health ( ICF ) ; and comparison with categories within the core sets for stroke and traumatic brain injury . METHOD A prospect i ve community cross-sectional survey ( n = 106 ) following definitive treatment for primary brain tumours . Problems reported by participants were linked with ICF categories using ' linkage ' rules . Participants rated  ' activities and participation '  and  ' environmental factor '  components of ICF checklist ( using qualifiers ) ; and responses compared with categories within core sets for stroke and traumatic brain injury . RESULTS Participant mean age 51 years , median time since diagnosis 2 years ; over a third had high grade tumours . Participants considered 44 categories in ' activities and participation ' and 16 categories ( barriers ) in ' environmental factors ' as relevant ( ≥ 10 % response ) using checklist . Reported problems included : Mobility , Domestic life , General tasks/ dem and s ; and Human made changes to environment . Although the linked categories for brain tumour survivors were similar to those in the core sets for stroke and traumatic brain injury , there was more commonality with the traumatic brain injury core set . CONCLUSION The existing comprehensive stroke and traumatic brain injury core sets incorporate issues relevant to brain tumour survivors in post-acute setting s. Findings from this report will assist in defining a future core set for brain tumour ; the possibility however , of using a single core set relevant to most long-term neurological conditions needs to be explored Clinical experience suggests that application of the fundamental principles of rehabilitation medicine can improve the care of patients with cancer . Despite the high incidence of neurological and functional deficits in patients affected by brain tumours ( BTs ) , rehabilitation treatment of this population is not as well established as it is for patients with other neurological conditions . To assess functional outcome in brain tumour in patients who underwent early rehabilitation after surgery . 75 patients who had undergone neurosurgery for primary BTs and 75 patients affected by stroke were enrolled in a case-control study . All patients were evaluated by means of a core set of clinical scales ( Functional Independence Measure , Sitting Balance score , St and ing Balance score , Hauser Index , Massachusetts General Hospital Functional Ambulation Classification ) . Patients were evaluated before the beginning ( T0 ) and at the end ( T1 ) of rehabilitation treatment . The neurorehabilitation programme consisted of individual 60-min sessions of treatment , administered once a day , six days a week , for four consecutive weeks . Speech therapy was included when aphasia was diagnosed . All the measures of outcome were indicative of substantial improvements for neuro-oncological and for stroke patients ( P = 0.000 ) . Analysis of subgroups showed that patients affected by meningioma achieved better results ( in efficiency terms ) as regards independence in activities of daily living ( P = 0.02 ) and mobility ( P = 0.04 ) compared with patients affected by glioblastoma or stroke . Rehabilitation after surgery can improve functional outcome , justifying the delivery of rehabilitation services , even during the acute phase , to BTs in patients , irrespective of tumour type Purpose Physical exercise ( PE ) and /or therapy ( PT ) shows beneficial effects in advanced cancer patients and is increasingly implemented in hospice and palliative care , although systematic data are rare . This retrospective study systematic ally evaluated the feasibility of PE/PT in terminally ill cancer patients and of different modalities in correspondence to socio-demographic and disease- and care-related aspects . Methods All consecutive terminally ill cancer patients treated in a palliative care inpatient ward during a 3.5-year period were included . The modalities were chosen according to the therapists ' and patients ' appraisal of current performance status and symptoms . Results PE/PT were offered to 572 terminally ill cancer patients , whereof 528 patients ( 92 % ) were able to perform at least one PE/PT unit ( average 4.2 units/patient ) . The most frequently feasible modalities were physical exercises in 50 % , relaxation therapy in 22 % , breathing training in 10 % , and positioning and lymph edema treatment in 6 % each .  Physical exercise  and  positioning treatment were performed significantly more often in older patients ( p = 0.009 and p = 0.022 , respectively ) , while relaxation ( p = 0.05 ) and lymph edema treatment ( p = 0.001 ) were used more frequently in younger . Breathing training was most frequently performed in head and neck cancer ( p = 0.002 ) and lung cancer ( p = 0.026 ) , positioning treatment in brain tumor patients ( p = 0.021 ) , and lymph edema treatment in sarcoma patients ( p = 0.012 ) . Conclusions PE/PT were feasible in > 90 % of terminally ill cancer patients to whom PE/PT had been offered . Physical exercises , relaxation therapy , and breathing training were the most frequently applicable methods . Prospect i ve trials are needed to evaluate the efficacy of specific PE/PT programs in 
    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: Objective : To compare the effect of early customized vestibular rehabilitation with general instructions in patients after acoustic neuroma surgery . Setting : Tertiary referral centre . Subjects : Fifty-three patients after surgery . Design : A prospect i ve assessor-blinded , r and omized controlled trial . Interventions : After stratification for age ( < 50 years ; ≥50 years ) , patients were r and omly allocated into groups receiving general instructions or customized vestibular rehabilitation protocol s for 12 weeks . Outcome measures : St and ing Balance Sum , Timed Up and Go test , T and em Gait and Dynamic Gait Index . Balance performance was assessed preoperatively , at discharge ( one week after surgery ) , three , six , nine , 12 , 26 and 52 weeks after surgery . Results and discussion : All subjects clearly improved within the first six weeks after surgery . However , older subjects receiving vestibular rehabilitation performed significantly ( P<0.05 ) better on st and ing balance , Timed Up and Go test and T and em Gait , when compared with the older group that received only general instructions . This effect persisted up to 12 weeks and also became apparent on the Dynamic Gait Index . In addition , the older vestibular rehabilitation group had better balance scores at 12 weeks when compared with their original preoperative scores ( P<0.05 ) . This pattern remained even up to one year after surgery ( P<0.05 ) . Conclusion : In patients over 50 , early vestibular rehabilitation facilitates recovery of postural control after acoustic neuroma surgery . Customized vestibular rehabilitation should be given in addition to general instructions that stress the need of exposure to movement . Retention of the early beneficial effects even one year after surgery stresses the importance of customized vestibular rehabilitation Purpose . Cognitive and behavioural therapy ( CBT ) is often used to treat behavioural and emotional disorders in children , and its efficacy has been described in several studies . As behavioural and emotional disorders are frequent sequelae in brain tumor survivors , the goal of this work is to describe the efficacy of a CBT intervention in the treatment of young brain tumor survivors . Methods . Forty young patients , aged 4–18 years , were included in the study . The treatment group , composed of 17 patients , received sessions of CBT . The Child Behaviour Checklist 4–18 ( CBCL/4–18 ) and the Vinel and Adaptive Behavioural Scales ( VABS ) were administered to parents at the beginning and at the end of the hospitalisation . The statistical significance of changes for clinical subjects during the CBT administration was estimated . Results . With regard to the CBCL/4–18 , the clinical group showed a significant advantage on the withdrawn , somatic complaints , social problems , attention problems , internalising and total problem scales . On the VABS , the treatment group improved to a significantly greater extent in the social skills domain . Conclusions . These results substantiate our assumption that CBT is an effective intervention for young patients surviving brain tumors and may be particularly helpful to younger individuals in managing cancer-related limitations R and omized clinical trials ( RCTs ) are widely considered to be the gold st and ard of evidence for treatment efficacy , but they have not been widely applied to rehabilitation or , more specifically , traumatic brain injury rehabilitation . Ethical , scientific , and re source factors may limit the application of RCTs . Thus , rigorous observational alternatives to the RCT would be of great value . In the article by Powell et al , an attempt to rigorously apply an observational design to assess the relative effectiveness of  inpatient rehabilitation  versus  home  discharge failed to control for important confounding factors . It appears nearly impossible to successfully apply observational design s when the factors leading to the applications of different treatments are strongly related to the patient 's perceived prognosis . However , observational design s may be successfully applied when regional or temporal variations in care are studied . Moreover , a number of developments in measurement , study design , and statistical analysis may exp and the role of observational studies in answering questions of rehabilitation efficacy and effectiveness OBJECTIVE To evaluate the effects of the intensive repetition of movements elicited by the facilitation technique to improve voluntary movement of a hemiplegic lower limb in patients with brain damage . DESIGN A multiple-baseline design ( A-B-A-B : A without specific therapy , B with specific therapy ) across individuals . PATIENTS The sample comprised 22 subjects with stroke and 2 brain tumour-operated subjects ( age : 50.7 + /- 9.6 years , time after onset : 7.1 + /- 2.6 weeks ) . They were selected from among 165 patients with stroke who were admitted to our rehabilitation centre from September 1 , 1995 to March 31 , 1997 . METHODS Two 2-week facilitation technique sessions ( more than 100 repetitions a day for each of 5 kinds of movement ) were applied at 2-week intervals in patients with hemiplegia , who were being treated with continuous conventional rehabilitation exercise without the facilitation technique for hemiplegia . Motor function of the affected lower limb ( Brunnstrom Recovery Stage of hemiplegia , the foot-tap test and the strength of knee extension/flexion ) and walking velocity were evaluated at 2-week intervals . RESULTS Significant improvements in Brunnstrom Stage , foot-tapping and the strength of knee extension/flexion of the affected lower limb were seen after the first conventional rehabilitation exercise session and after the first and second facilitation technique and conventional rehabilitation exercise sessions . The improvements after facilitation technique and conventional rehabilitation exercise sessions were significantly greater than those after the preceding conventional rehabilitation exercise sessions . CONCLUSION Intensive repetition of movement elicited by the facilitation technique ( chiefly proprioceptive neuromuscural facilitation pattern , stretch reflex and skin-muscle reflex ) improved voluntary movement of a hemiplegic lower limb in patients with brain damage PURPOSE Patients with gliomas often experience cognitive deficits , including problems with attention and memory . This r and omized , controlled trial evaluated the effects of a multifaceted cognitive rehabilitation program ( CRP ) on cognitive functioning and selected quality -of-life domains in patients with gliomas . PATIENTS AND METHODS One hundred forty adult patients with low- grade and anaplastic gliomas , favorable prognostic factors , and both subjective cognitive symptoms and objective cognitive deficits were recruited from 11 hospitals in the Netherl and s. Patients were r and omly assigned to an intervention group or to a waiting-list control group . The intervention incorporated both computer-based attention retraining and compensatory skills training of attention , memory , and executive functioning . Participants completed a battery of  neuropsychological  ( NP ) tests and self-report question naires on cognitive functioning , fatigue , mental health-related quality of life , and community integration at baseline , after completion of the CRP , and at 6-month follow-up . RESULTS At the immediate post-treatment evaluation , statistically significant intervention effects were observed for measures of subjective cognitive functioning and its perceived burden but not for the objective NP outcomes or for any of the other self-report measures . At the 6-month follow-up , the CRP group performed significantly better than the control group on NP tests of attention and verbal memory and reported less mental fatigue . Group differences in other subjective outcomes were not significant at 6 months . CONCLUSION The CRP has a salutary effect on short-term cognitive complaints and on longer-term cognitive performance and mental fatigue . Additional research is needed to identify which elements of the intervention are most effective Cognitive impairment is one of the most common neurological disorders in neuro-oncological patients and exerts a deep negative impact on quality of life interfering with familiar , social and career-related activities . To test the effectiveness of early cognitive rehabilitation treatment for in patients affected by primary brain tumors . Out of 109 consecutive patients enrolled in the study , 58 patients were r and omly assigned to a rehabilitation group or to a control group . The rehabilitation consisted of 16 one-hour individual sessions of therapist-guided cognitive training , spread over 4 weeks , combining computer exercises and metacognitive training . Patients in the control group received usual care without cognitive training . All patients were evaluated by means of a comprehensive neuropsychological battery at the admission ( T0 ) and after 4 weeks ( T1 ) . Patients in the rehabilitation group showed a significant improvement of cognitive functions . In particular , the domains that benefited most from the training were visual attention and verbal memory . The control group exhibited only a slightly , not statistically relevant , enhancement of cognitive performances .  Cognitive rehabilitation for neuro-oncological in patients result ed in a significant enhancement of cognitive performances after the training , also providing a foundation for early administration . Future research should be aim ed to clarify the patients ’ characteristics that predict neuropsychological improvement , to identify the most effective elements in rehabilitative programs and to study the effects of treatment extension to everyday life OBJECTIVE To describe  patient-reported disability in primary brain tumours using the International Classification of Functioning , Disability and Health ( ICF ) ; and comparison with categories within the core sets for stroke and traumatic brain injury . METHOD A prospect i ve community cross-sectional survey ( n = 106 ) following definitive treatment for primary brain tumours . Problems reported by participants were linked with ICF categories using ' linkage ' rules . Participants rated  ' activities and participation '  and  ' environmental factor '  components of ICF checklist ( using qualifiers ) ; and responses compared with categories within core sets for stroke and traumatic brain injury . RESULTS Participant mean age 51 years , median time since diagnosis 2 years ; over a third had high grade tumours . Participants considered 44 categories in ' activities and participation ' and 16 categories ( barriers ) in ' environmental factors ' as relevant ( ≥ 10 % response ) using checklist . Reported problems included : Mobility , Domestic life , General tasks/ dem and s ; and Human made changes to environment . Although the linked categories for brain tumour survivors were similar to those in the core sets for stroke and traumatic brain injury , there was more commonality with the traumatic brain injury core set . CONCLUSION The existing comprehensive stroke and traumatic brain injury core sets incorporate issues relevant to brain tumour survivors in post-acute setting s. Findings from this report will assist in defining a future core set for brain tumour ; the possibility however , of using a single core set relevant to most long-term neurological conditions needs to be explored Clinical experience suggests that application of the fundamental principles of rehabilitation medicine can improve the care of patients with cancer . Despite the high incidence of neurological and functional deficits in patients affected by brain tumours ( BTs ) , rehabilitation treatment of this population is not as well established as it is for patients with other neurological conditions . To assess functional outcome in brain tumour in patients who underwent early rehabilitation after surgery . 75 patients who had undergone neurosurgery for primary BTs and 75 patients affected by stroke were enrolled in a case-control study . All patients were evaluated by means of a core set of clinical scales ( Functional Independence Measure , Sitting Balance score , St and ing Balance score , Hauser Index , Massachusetts General Hospital Functional Ambulation Classification ) . Patients were evaluated before the beginning ( T0 ) and at the end ( T1 ) of rehabilitation treatment . The neurorehabilitation programme consisted of individual 60-min sessions of treatment , administered once a day , six days a week , for four consecutive weeks . Speech therapy was included when aphasia was diagnosed . All the measures of outcome were indicative of substantial improvements for neuro-oncological and for stroke patients ( P = 0.000 ) . Analysis of subgroups showed that patients affected by meningioma achieved better results ( in efficiency terms ) as regards independence in activities of daily living ( P = 0.02 ) and mobility ( P = 0.04 ) compared with patients affected by glioblastoma or stroke . Rehabilitation after surgery can improve functional outcome , justifying the delivery of rehabilitation services , even during the acute phase , to BTs in patients , irrespective of tumour type Purpose Physical exercise ( PE ) and /or therapy ( PT ) shows beneficial effects in advanced cancer patients and is increasingly implemented in hospice and palliative care , although systematic data are rare . This retrospective study systematic ally evaluated the feasibility of PE/PT in terminally ill cancer patients and of different modalities in correspondence to socio-demographic and disease- and care-related aspects . Methods All consecutive terminally ill cancer patients treated in a palliative care inpatient ward during a 3.5-year period were included . The modalities were chosen according to the therapists ' and patients ' appraisal of current performance status and symptoms . Results PE/PT were offered to 572 terminally ill cancer patients , whereof 528 patients ( 92 % ) were able to perform at least one PE/PT unit ( average 4.2 units/patient ) . The most frequently feasible modalities were physical exercises in 50 % , relaxation therapy in 22 % , breathing training in 10 % , and positioning and lymph edema treatment in 6 % each .  Physical exercise  and  positioning treatment were performed significantly more often in older patients ( p = 0.009 and p = 0.022 , respectively ) , while relaxation ( p = 0.05 ) and lymph edema treatment ( p = 0.001 ) were used more frequently in younger . Breathing training was most frequently performed in head and neck cancer ( p = 0.002 ) and lung cancer ( p = 0.026 ) , positioning treatment in brain tumor patients ( p = 0.021 ) , and lymph edema treatment in sarcoma patients ( p = 0.012 ) . Conclusions PE/PT were feasible in > 90 % of terminally ill cancer patients to whom PE/PT had been offered . Physical exercises , relaxation therapy , and breathing training were the most frequently applicable methods . Prospect i ve trials are needed to evaluate the efficacy of specific PE/PT programs in 
    Output:
    