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: It has been proposed that somatosensory stimulation in the form of electromyographically triggered neuromuscular electrical stimulation ( NMES ) to the peripheral nerve can influence functional measures of motor performance in subjects with stroke and can additionally produce changes in cortical excitability . Using a controlled , double-blind design , we studied the effects of intensive ( 60 h/3 weeks ) treatment at home with NMES compared with a sham treatment , applied to the extensor muscles of the hemiplegic forearm to facilitate h and opening in 16 chronic stroke subjects . We investigated improvement in functional use of the h and and change in cortical activation as measured by functional magnetic resonance imaging ( fMRI ) . Following treatment , subjects improved on measures of grasp and release of objects ( Box and Block Test and Jebsen Taylor H and Function Test [ JTHFT ] : small objects , stacking , heavy cans ) , isometric finger extension strength , and self-rated Motor Activity Log ( MAL ) : Amount of Use and How Well score . The sham subjects did not improve on any grasp and release measure or self-rated scale , but did improve on isometric finger extension strength . Importantly , however , following crossover , these subjects improved further in the measure of strength , grasp and release ( Box and Block [ JTHFT ] : page turning ) , and self-rated MAL : Amount of Use score and How Well score . Using fMRI and a finger-tracking task , an index of cortical intensity in the ipsilateral somatosensory cortex increased significantly from pre-test to post-test following treatment . Cortical activation , as measured by voxel count , did not change . These findings suggest that NMES may have an important role in stimulating cortical sensory areas allowing for improved motor function OBJECTIVE To examine rehabilitation interventions and result ing physical activity patterns of patients managed in acute stroke units to help inform development of a r and omized controlled trial of very early rehabilitation . DESIGN An open observational study of patient activity and therapist report of patient interventions . A survey of stroke unit re sources . METHODS Patients less than 14 days post-stroke from 5 metropolitan stroke units were observed over 2 consecutive weekdays at 10-minute intervals between 08.00 h and 17.00 h. Physical activity , location and person(s ) present were ascertained at each observation . Therapists completed treatment records . Senior staff completed stroke unit surveys . RESULTS Patients after stroke ( n=58 ) were with therapists 5.2 % of the observed day . Few patients ( 17.1 % ) received  daily therapy  by more than one therapist . When patients received therapy , average session times were 24 minutes of physiotherapy , 23 minutes of occupational therapy and 33 minutes of speech pathology .  The more time that family members were present , the longer the treatment time . Four to 11 min of upper-limb therapy was provided . Muscle weakness and left hemiparesis were associated with less upper-limb activity . CONCLUSION These acute stroke care units were re source d according to recommended staff-patient ratios . Patients received little therapy and had low levels of physical activity Background Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment . The current literature has a paucity of robotic devices that have been tested in a home environment . The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation ( hCAAR ) that can be used independently at home by stroke survivors with upper limb weakness . Methods hCAAR device comprises of a joystick h and le moved by the weak upper limb to perform tasks on the computer screen . The device provides assistance to the movements depending on users ability . Nineteen participants ( stroke survivors with upper limb weakness ) were recruited . Outcome measures performed at baseline ( A0 ) , at end of 8-weeks of hCAAR use ( A1 ) and 1 month after end of hCAAR use ( A2 ) were : Optotrak kinematic variables , Fugl Meyer Upper Extremity motor subscale ( FM-UE ) , Action Research Arm Test ( ARAT ) , Medical Research Council ( MRC ) and Modified Ashworth Scale ( MAS ) , Chedoke Arm and H and Activity Inventory ( CAHAI ) and ABILH AND . Results Two participants were unable to use hCAAR : one due to severe paresis and the other due to personal problems . The remaining 17 participants were able to use the device independently in their home setting . No serious adverse events were reported . The median usage time was 433 minutes ( IQR 250 – 791 min ) . A statistically significant improvement was observed in the kinematic and clinical outcomes at A1 . The median gain in the scores at A1 were by : movement time 19 % , path length 15 % and jerk 19 % , FM-UE 1 point , total MAS 1.5 point , total MRC 2 points , ARAT 3 points , CAHAI 5.5 points and ABILH AND 3 points . Three participants showed clinical ly significant improvement in all the clinical outcomes . Conclusions The hCAAR feasibility study is the first clinical study of its kind reported in the current literature ; in this study , 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals . Statistically significant improvements were observed in the kinematic and clinical outcomes in the study Objective : To determine feasibility of a r and omised controlled trial ( RCT ) of home-based Reach-to-Grasp training after stroke . Design : single-blind parallel group RCT . Participants : Residual arm deficit less than 12 months post-stroke . Interventions : Reach-to-Grasp training in 14 one-hour therapist ’s visits over 6 weeks , plus one hour self- practice per day ( total 56 hours ) . Control : Usual care . Main Measures : Action Research Arm Test ( ARAT ) , Wolf Motor Function Test ( WMFT ) , pre-r and omisation , 7 , 12 , 24 weeks post-r and omisation . Results : Forty-seven participants ( Reach-to-Grasp=24 , usual care=23 ) were r and omised over 17 months .  Reach-to-Grasp participants received a median ( IQR ) 14 ( 13,14 ) visits , and performed 157 ( 96,211 ) repetitions per visit ; plus 30 minutes ( 22,45 ) self- practice per day . Usual care participants received 10.5 ( 5,14 ) therapist visits , comprising 38.6 ( 30,45 ) minutes of arm therapy with 16 ( 6,24 ) repetitions of functional tasks per visit . Median ARAT scores in the reach-to-grasp group were 8.5 ( 3.0,24.0 ) at baseline and 14.5 ( 3.5,26.0 ) at 24 weeks compared to median of 4 at both time points ( IQR : baseline ( 3.0,14.0 ) , 24 weeks ( 3.0,30.0 ) ) in the usual-care group . Median WMFT tasks completed at baseline and 24 weeks were 6 ( 3.0,11.5 ) and 8.5 ( 4.5,13.5 ) respectively in the reach-to-grasp group and 4 ( 3.0,10.0 ) , 6 ( 3.0,14.0 ) in the usual care group . Incidence of arm pain was similar between groups . The study was stopped before 11 patients reached the 24 weeks assessment . Conclusions : An RCT of home-based Reach-to-Grasp training after stroke is feasible and safe . With ARAT being our preferred measure it is estimated that 240 participants will be needed for a future two armed trial Background . Geographical location , socioeconomic status , and logistics surrounding transportation impede access of poststroke individuals to comprehensive rehabilitative services . Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing remote monitoring and adjusting therapy for underserved population s.  The H and Mentor Pro ( HMP ) was incorporated within a home exercise program ( HEP ) to improve upper-extremity ( UE ) functional capabilities poststroke . Objective . To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months poststroke and characterized as underserved . Methods . In this prospect i ve , single-blinded , multisite , r and omized controlled trial , 99 hemiparetic participants with limited access to UE rehabilitation were r and omized to either ( 1 ) the experimental group , which received combined HEP and HMP for 3 h/d ×5 days ×8 weeks , or ( 2 ) the control group , which received HEP only at an identical dosage . Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription . The Action Research Arm Test and Wolf Motor Function Test along with the Fugl-Meyer Assessment ( UE ) were primary and secondary outcome measures , respectively , undertaken before and after the interventions . Results . Both groups demonstrated improvement across all UE outcomes . Conclusions . Robotic + HEP and HEP only were both effectively delivered remotely . There was no difference between groups in change in motor function over time . Additional research is necessary to determine the appropriate dosage of HMP and HEP Background . Constraint-induced movement therapy ( CIMT ) is a rehabilitation approach for arm paresis consisting of an intensive schedule of treatment ( 6 h/d ) . The high dem and of re sources for CIMT is a critical issue for its implementation in the Italian health system . Objective . To compare the effects of a reduced-intensity modified CIMT ( mCIMT ) program that included splinting the unaffected arm for 12 hours daily with the effects of a conventional rehabilitation program for arm paresis in patients with stroke . Methods . Sixty-six participants with hemiparesis ( 3 - 24 months poststroke ) who could extend the wrist and several fingers at least 10 ° were r and omly assigned to mCIMT or conventional rehabilitation .  Each group underwent 10 ( 2 h/d ) treatment sessions ( 5 d/wk for 2 weeks ) . Patients were assessed with the Wolf Motor Function Test ( WMFT-FA and WMFT-T ) , the Motor Activity Log ( MAL-AOU and MAL-QOM ) , and the Ashworth Scale before and after treatment and 3 months later . Results . Between-groups analysis showed that the mCIMT group overall had greater improvement than the control group in terms of the WMFT-FA ( P = .010 ) , MAL-AOU ( P < .001 ) , and MAL-QOM ( P < .001 ) . Differences between groups were significant both after treatment ( P < .01 ) and at the 3-month follow-up ( P < .01 ) , although 40 % of participants did not complete the 3-month assessment . Furthermore , the mCIMT group showed a greater decrease of Ashworth Scale score than the control group at 3 months ( P = .021 ) . Conclusion . Two hours of CIMT may be more effective than conventional rehabilitation in improving motor function and use of the paretic arm in patients with chronic stroke Objective : To investigate the effects of different intensities of arm rehabilitation training on the functional recovery of  hemiplegic upper extremity . Design : A r and omized controlled trial . Interventions : Thirty-two stroke patients meeting the enrolment criteria were r and omly divided into three groups : group A ( n = 11 ) , group B ( n = 10 ) and group C ( n = 11 ) . Each group received arm training for 1 hour , 2 hours and 3 hours a day respectively , 5 days per week , for a period of six weeks . Main measures : Motor function was assessed by Fugl-Meyer Assessment , Action Research Arm Test and Barthel Index , carried out before treatment , two weeks , four weeks and six weeks after treatment . Results : When comparing the three groups , the Fugl-Meyer Assessment improvement was more significant in group C ( 20.50 ± 7.84 ) than that in group A ( 11.90 ± 6.52 ) and group B ( 13.80 ± 6.41 ) after four weeks of treatment ( P < 0.05 ) . The Action Research Arm Test score improvement was more significant in group C ( 7.30 ± 2.95 ) than in group A ( 3.30 ± 2.91 ) ( P < 0.05 ) . After six weeks of treatment , the Fugl-Meyer Assessment and Action Research Arm Test score improvements were more significant in group C ( 24.50 ± 7.96 , 10.90 ± 3.60 ) and group B ( 19.70 ± 7.09 , 8.70 ± 4.62 ) than in group A ( 13.00 ± 6.38 , 5.30 ± 3.40 ) ( P < 0.05 ) . There were no significant differences of Barthel Index among the three groups ( P > 0.05 ) . In each group , Fugl-Meyer Assessment , Action Research Arm Test and Barthel Index scores increased significantly after six weeks of treatment ( P < 0.05 ) . Conclusions : An increase in the intensity of arm training might improve the motor function of the arm after stroke Background . Somatosensory stimulation in the form of repetitive peripheral nerve stimulation ( RPSS ) is a promising strategy to improve motor function of the upper limb in chronic stroke . Home-based RPSS may be an alternative to hospital-based RPSS . Objectives . To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance h and motor function in patients in the chronic phase after stroke . Methods . Twenty patients were r and omized to either active or sham RPSS associated with daily motor training performed 
    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: It has been proposed that somatosensory stimulation in the form of electromyographically triggered neuromuscular electrical stimulation ( NMES ) to the peripheral nerve can influence functional measures of motor performance in subjects with stroke and can additionally produce changes in cortical excitability . Using a controlled , double-blind design , we studied the effects of intensive ( 60 h/3 weeks ) treatment at home with NMES compared with a sham treatment , applied to the extensor muscles of the hemiplegic forearm to facilitate h and opening in 16 chronic stroke subjects . We investigated improvement in functional use of the h and and change in cortical activation as measured by functional magnetic resonance imaging ( fMRI ) . Following treatment , subjects improved on measures of grasp and release of objects ( Box and Block Test and Jebsen Taylor H and Function Test [ JTHFT ] : small objects , stacking , heavy cans ) , isometric finger extension strength , and self-rated Motor Activity Log ( MAL ) : Amount of Use and How Well score . The sham subjects did not improve on any grasp and release measure or self-rated scale , but did improve on isometric finger extension strength . Importantly , however , following crossover , these subjects improved further in the measure of strength , grasp and release ( Box and Block [ JTHFT ] : page turning ) , and self-rated MAL : Amount of Use score and How Well score . Using fMRI and a finger-tracking task , an index of cortical intensity in the ipsilateral somatosensory cortex increased significantly from pre-test to post-test following treatment . Cortical activation , as measured by voxel count , did not change . These findings suggest that NMES may have an important role in stimulating cortical sensory areas allowing for improved motor function OBJECTIVE To examine rehabilitation interventions and result ing physical activity patterns of patients managed in acute stroke units to help inform development of a r and omized controlled trial of very early rehabilitation . DESIGN An open observational study of patient activity and therapist report of patient interventions . A survey of stroke unit re sources . METHODS Patients less than 14 days post-stroke from 5 metropolitan stroke units were observed over 2 consecutive weekdays at 10-minute intervals between 08.00 h and 17.00 h. Physical activity , location and person(s ) present were ascertained at each observation . Therapists completed treatment records . Senior staff completed stroke unit surveys . RESULTS Patients after stroke ( n=58 ) were with therapists 5.2 % of the observed day . Few patients ( 17.1 % ) received  daily therapy  by more than one therapist . When patients received therapy , average session times were 24 minutes of physiotherapy , 23 minutes of occupational therapy and 33 minutes of speech pathology .  The more time that family members were present , the longer the treatment time . Four to 11 min of upper-limb therapy was provided . Muscle weakness and left hemiparesis were associated with less upper-limb activity . CONCLUSION These acute stroke care units were re source d according to recommended staff-patient ratios . Patients received little therapy and had low levels of physical activity Background Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment . The current literature has a paucity of robotic devices that have been tested in a home environment . The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation ( hCAAR ) that can be used independently at home by stroke survivors with upper limb weakness . Methods hCAAR device comprises of a joystick h and le moved by the weak upper limb to perform tasks on the computer screen . The device provides assistance to the movements depending on users ability . Nineteen participants ( stroke survivors with upper limb weakness ) were recruited . Outcome measures performed at baseline ( A0 ) , at end of 8-weeks of hCAAR use ( A1 ) and 1 month after end of hCAAR use ( A2 ) were : Optotrak kinematic variables , Fugl Meyer Upper Extremity motor subscale ( FM-UE ) , Action Research Arm Test ( ARAT ) , Medical Research Council ( MRC ) and Modified Ashworth Scale ( MAS ) , Chedoke Arm and H and Activity Inventory ( CAHAI ) and ABILH AND . Results Two participants were unable to use hCAAR : one due to severe paresis and the other due to personal problems . The remaining 17 participants were able to use the device independently in their home setting . No serious adverse events were reported . The median usage time was 433 minutes ( IQR 250 – 791 min ) . A statistically significant improvement was observed in the kinematic and clinical outcomes at A1 . The median gain in the scores at A1 were by : movement time 19 % , path length 15 % and jerk 19 % , FM-UE 1 point , total MAS 1.5 point , total MRC 2 points , ARAT 3 points , CAHAI 5.5 points and ABILH AND 3 points . Three participants showed clinical ly significant improvement in all the clinical outcomes . Conclusions The hCAAR feasibility study is the first clinical study of its kind reported in the current literature ; in this study , 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals . Statistically significant improvements were observed in the kinematic and clinical outcomes in the study Objective : To determine feasibility of a r and omised controlled trial ( RCT ) of home-based Reach-to-Grasp training after stroke . Design : single-blind parallel group RCT . Participants : Residual arm deficit less than 12 months post-stroke . Interventions : Reach-to-Grasp training in 14 one-hour therapist ’s visits over 6 weeks , plus one hour self- practice per day ( total 56 hours ) . Control : Usual care . Main Measures : Action Research Arm Test ( ARAT ) , Wolf Motor Function Test ( WMFT ) , pre-r and omisation , 7 , 12 , 24 weeks post-r and omisation . Results : Forty-seven participants ( Reach-to-Grasp=24 , usual care=23 ) were r and omised over 17 months .  Reach-to-Grasp participants received a median ( IQR ) 14 ( 13,14 ) visits , and performed 157 ( 96,211 ) repetitions per visit ; plus 30 minutes ( 22,45 ) self- practice per day . Usual care participants received 10.5 ( 5,14 ) therapist visits , comprising 38.6 ( 30,45 ) minutes of arm therapy with 16 ( 6,24 ) repetitions of functional tasks per visit . Median ARAT scores in the reach-to-grasp group were 8.5 ( 3.0,24.0 ) at baseline and 14.5 ( 3.5,26.0 ) at 24 weeks compared to median of 4 at both time points ( IQR : baseline ( 3.0,14.0 ) , 24 weeks ( 3.0,30.0 ) ) in the usual-care group . Median WMFT tasks completed at baseline and 24 weeks were 6 ( 3.0,11.5 ) and 8.5 ( 4.5,13.5 ) respectively in the reach-to-grasp group and 4 ( 3.0,10.0 ) , 6 ( 3.0,14.0 ) in the usual care group . Incidence of arm pain was similar between groups . The study was stopped before 11 patients reached the 24 weeks assessment . Conclusions : An RCT of home-based Reach-to-Grasp training after stroke is feasible and safe . With ARAT being our preferred measure it is estimated that 240 participants will be needed for a future two armed trial Background . Geographical location , socioeconomic status , and logistics surrounding transportation impede access of poststroke individuals to comprehensive rehabilitative services . Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing remote monitoring and adjusting therapy for underserved population s.  The H and Mentor Pro ( HMP ) was incorporated within a home exercise program ( HEP ) to improve upper-extremity ( UE ) functional capabilities poststroke . Objective . To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months poststroke and characterized as underserved . Methods . In this prospect i ve , single-blinded , multisite , r and omized controlled trial , 99 hemiparetic participants with limited access to UE rehabilitation were r and omized to either ( 1 ) the experimental group , which received combined HEP and HMP for 3 h/d ×5 days ×8 weeks , or ( 2 ) the control group , which received HEP only at an identical dosage . Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription . The Action Research Arm Test and Wolf Motor Function Test along with the Fugl-Meyer Assessment ( UE ) were primary and secondary outcome measures , respectively , undertaken before and after the interventions . Results . Both groups demonstrated improvement across all UE outcomes . Conclusions . Robotic + HEP and HEP only were both effectively delivered remotely . There was no difference between groups in change in motor function over time . Additional research is necessary to determine the appropriate dosage of HMP and HEP Background . Constraint-induced movement therapy ( CIMT ) is a rehabilitation approach for arm paresis consisting of an intensive schedule of treatment ( 6 h/d ) . The high dem and of re sources for CIMT is a critical issue for its implementation in the Italian health system . Objective . To compare the effects of a reduced-intensity modified CIMT ( mCIMT ) program that included splinting the unaffected arm for 12 hours daily with the effects of a conventional rehabilitation program for arm paresis in patients with stroke . Methods . Sixty-six participants with hemiparesis ( 3 - 24 months poststroke ) who could extend the wrist and several fingers at least 10 ° were r and omly assigned to mCIMT or conventional rehabilitation .  Each group underwent 10 ( 2 h/d ) treatment sessions ( 5 d/wk for 2 weeks ) . Patients were assessed with the Wolf Motor Function Test ( WMFT-FA and WMFT-T ) , the Motor Activity Log ( MAL-AOU and MAL-QOM ) , and the Ashworth Scale before and after treatment and 3 months later . Results . Between-groups analysis showed that the mCIMT group overall had greater improvement than the control group in terms of the WMFT-FA ( P = .010 ) , MAL-AOU ( P < .001 ) , and MAL-QOM ( P < .001 ) . Differences between groups were significant both after treatment ( P < .01 ) and at the 3-month follow-up ( P < .01 ) , although 40 % of participants did not complete the 3-month assessment . Furthermore , the mCIMT group showed a greater decrease of Ashworth Scale score than the control group at 3 months ( P = .021 ) . Conclusion . Two hours of CIMT may be more effective than conventional rehabilitation in improving motor function and use of the paretic arm in patients with chronic stroke Objective : To investigate the effects of different intensities of arm rehabilitation training on the functional recovery of  hemiplegic upper extremity . Design : A r and omized controlled trial . Interventions : Thirty-two stroke patients meeting the enrolment criteria were r and omly divided into three groups : group A ( n = 11 ) , group B ( n = 10 ) and group C ( n = 11 ) . Each group received arm training for 1 hour , 2 hours and 3 hours a day respectively , 5 days per week , for a period of six weeks . Main measures : Motor function was assessed by Fugl-Meyer Assessment , Action Research Arm Test and Barthel Index , carried out before treatment , two weeks , four weeks and six weeks after treatment . Results : When comparing the three groups , the Fugl-Meyer Assessment improvement was more significant in group C ( 20.50 ± 7.84 ) than that in group A ( 11.90 ± 6.52 ) and group B ( 13.80 ± 6.41 ) after four weeks of treatment ( P < 0.05 ) . The Action Research Arm Test score improvement was more significant in group C ( 7.30 ± 2.95 ) than in group A ( 3.30 ± 2.91 ) ( P < 0.05 ) . After six weeks of treatment , the Fugl-Meyer Assessment and Action Research Arm Test score improvements were more significant in group C ( 24.50 ± 7.96 , 10.90 ± 3.60 ) and group B ( 19.70 ± 7.09 , 8.70 ± 4.62 ) than in group A ( 13.00 ± 6.38 , 5.30 ± 3.40 ) ( P < 0.05 ) . There were no significant differences of Barthel Index among the three groups ( P > 0.05 ) . In each group , Fugl-Meyer Assessment , Action Research Arm Test and Barthel Index scores increased significantly after six weeks of treatment ( P < 0.05 ) . Conclusions : An increase in the intensity of arm training might improve the motor function of the arm after stroke Background . Somatosensory stimulation in the form of repetitive peripheral nerve stimulation ( RPSS ) is a promising strategy to improve motor function of the upper limb in chronic stroke . Home-based RPSS may be an alternative to hospital-based RPSS . Objectives . To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance h and motor function in patients in the chronic phase after stroke . Methods . Twenty patients were r and omized to either active or sham RPSS associated with daily motor training performed 
    Output:
    