human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — The Motor Activity Log ( MAL ) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and h and ( amount of use [ AOU ] ) and quality of movement [ QOM ] ) during activities of daily living . Scores range from 0 to 5 . The following clinimetric properties of the MAL were quantified : internal consistency ( Cronbach α ) , test – retest agreement ( Bl and and Altman method ) , cross-sectional construct validity ( correlation between AOU and QOM and with the Action Research Arm [ ARA ] test ) , longitudinal construct validity ( correlation of change on the MAL during the intervention with a global change rating [ GCR ] and with change on the ARA ) , and responsiveness ( effect size ) . Methods — Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm ( forced use ) were performed in 56 chronic stroke patients . Results — Internal consistency was high ( AOU : α=0.88 ; QOM : α=0.91 ) . The limits of agreement were −0.70 to 0.85 and −0.61 to 0.71 for AOU and QOM , respectively . The correlation with the ARA score ( Spearman ρ ) was 0.63 ( AOU and QOM ) . However , the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA , Spearman ρ was between 0.16 and 0.22 . The responsiveness ratio was 1.9 ( AOU ) and 2.0 ( QOM ) . Conclusion — The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention . The cross-sectional construct validity of the MAL is reasonable , but the results raise doubt about its longitudinal construct validity Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients This study presents results from a r and omized controlled clinical trial of the Mirror Image Movement Enabler ( MIME ) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients , including data on the use of its bilateral training mode . MIME incorporates a PUMA 560 robot ( Staubli Unimation Inc , Duncan , South Carolina ) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions . Robot-assisted treatment ( bilateral , unilateral , and combined bilateral and unilateral ) was compared with conventional therapy . Similar to a previous study in chronic stroke , combined unilateral and bilateral robotic training had advantages compared with conventional therapy , producing larger improvements on a motor impairment scale and a measure of abnormal synergies . However , gains in all treatment groups were equivalent at the 6-month follow-up . Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training , although the combined group had more hypertonia and less movement out of synergy at baseline . Robot-assisted treatment gains exceeded those expected from spontaneous recovery . These results are discussed in light of the need for further device development and continued clinical trials Background and Purpose — Severe upper limb paresis is a major contributor to disability after stroke . This study investigated the efficacy of a new nonrobotic training device , the Sensorimotor Active Rehabilitation Training ( SMART ) Arm , that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension , permitting stroke survivors with severe paresis to practice a constrained reaching task . Methods — A single-blind , r and omized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis . Thirty-three participants completed the study , of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation , 13 received training using the SMART Arm alone , and 10 received no intervention ( control ) . Training consisted of 12 1-hour sessions over 4 weeks . The primary outcome measure was “ upper arm function , ” item 6 of the Motor Assessment Scale . Secondary outcome measures included impairment measures ; triceps muscle strength , reaching force , modified Ashworth scale ; and activity measures : reaching distance and Motor Assessment Scale . Assessment s were administered before ( 0 weeks ) and after training ( 4 weeks ) and at 2 months follow-up ( 12 weeks ) . Results — Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up . There was no significant difference between these 2 groups . There was no change in the control group . Conclusions — Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis , highlighting the benefits of intensive task-oriented practice , even in the context of severe paresis Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach Objective : To investigate progress toward motor recovery in patients with chronic hemiparesis ( mean time since stroke 3.2 years ) , comparing different types of practice schedules . Design : To increase voluntary control of the upper extremity , active neuromuscular stimulation was administered during blocked and r and om practice schedules as patients performed three specific movements : wrist/finger extension , elbow joint extension , and shoulder joint abduction . Methods : 34 stroke subjects volunteered to participate and were r and omly assigned to one of three treatment groups : blocked practice ( the same movement was repetitively performed on successive trials ) combined with active neuromuscular stimulation ; r and om practice ( different movements on successive trials ) along with active stimulation ; or no active stimulation assistance control group . Subjects completed two days of 90 minute training for each of two weeks with at least 24 hours of rest between sessions . A session was three sets of 30 successful active neuromuscular stimulation trials with the three movements executed 10 times/set . Results : Mixed design analyses on three categories of behavioural measures indicated motor improvements for the blocked and r and om practice /stimulation groups in comparison with the control group during the post-test period , with a larger number of blocks moved , faster premotor and motor reaction times , and less variability in the sustained muscular contraction task . Conclusions : Upper extremity rehabilitation intervention of active stimulation and blocked practice performed as well as stimulation/r and om practice . Moreover , these purpose ful voluntary movement findings support and extend sensorimotor integration theory to both practice schedules Positional feedback ( PF ) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients . Thirty adult hemiparetic patients lacking normal voluntary wrist extension were r and omly placed in control and study groups . The control group received conventional therapy while the study group received positional feedback stimulation training ( PFST ) in addition to conventional treatment . At the end of the 4-week program , study patients showed a 280 % increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70 % increase when positioned in 30 degrees of flexion . Control patients showed no significant changes in torque . Study patients made an average 200 % gain in selective range of motion over their starting levels while controls made only a 50 % increase . Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision 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 Objective : To determine the efficacy of activity-based therapies using arm ergometer or robotic or group occupational therapy for motor recovery of the paretic arm in patients with an acute stroke ( ≤4 weeks ) admitted to an inpatient rehabilitation facility , and to obtain information to plan a large r and omized controlled trial . Design : Prospect i ve , r and omized controlled study . Setting : Stroke unit in a rehabilitation hospital . Subjects : Thirty patients with an acute stroke ( ≤4 weeks ) who had arm weakness ( Medical Research Council grade 2 or less at the shoulder joint ) . Intervention : Occupational therapy ( OT ) group ( control ) ( n = 10 ) , arm ergometer ( n = 10 ) or robotic ( n = 10 ) therapy group . All patients received st and ard , inpatient , post-stroke rehabilitation training for 3 hours a day , plus 12 additional 40-minute sessions of the activity-based therapy . Main measures : The primary outcome measures were discharge scores in the Fugl-Meyer Assessment Scale for upper limb impairment , Motor Status Scale , total Functional Independence Measure ( FIM ) and FIM-motor and FIM-cognition subscores . Results : The three groups ( OT group versus arm ergometer versus robotic ) were comparable on clinical demographic measures except the robotic group was significantly older and there were more  haemorrhagic  stroke patients in the arm ergometer group . After adjusting for age , stroke type and outcome measures at baseline , a similar degree of improvement in the discharge scores was found in all of the primary outcome measures . Conclusion : This study suggests that activity-based therapies using an arm ergometer or robot when used over shortened training periods have the same effect as OT group therapy in decreasing impairment and improving disability in the paretic arm of severely affected stroke patients in the subacute phase Background and Purpose — Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke , with follow-ups at a maximum of 12 months . The aim of this study was to examine the effect of repetitive sensorimot 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — The Motor Activity Log ( MAL ) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and h and ( amount of use [ AOU ] ) and quality of movement [ QOM ] ) during activities of daily living . Scores range from 0 to 5 . The following clinimetric properties of the MAL were quantified : internal consistency ( Cronbach α ) , test – retest agreement ( Bl and and Altman method ) , cross-sectional construct validity ( correlation between AOU and QOM and with the Action Research Arm [ ARA ] test ) , longitudinal construct validity ( correlation of change on the MAL during the intervention with a global change rating [ GCR ] and with change on the ARA ) , and responsiveness ( effect size ) . Methods — Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm ( forced use ) were performed in 56 chronic stroke patients . Results — Internal consistency was high ( AOU : α=0.88 ; QOM : α=0.91 ) . The limits of agreement were −0.70 to 0.85 and −0.61 to 0.71 for AOU and QOM , respectively . The correlation with the ARA score ( Spearman ρ ) was 0.63 ( AOU and QOM ) . However , the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA , Spearman ρ was between 0.16 and 0.22 . The responsiveness ratio was 1.9 ( AOU ) and 2.0 ( QOM ) . Conclusion — The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention . The cross-sectional construct validity of the MAL is reasonable , but the results raise doubt about its longitudinal construct validity Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients This study presents results from a r and omized controlled clinical trial of the Mirror Image Movement Enabler ( MIME ) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients , including data on the use of its bilateral training mode . MIME incorporates a PUMA 560 robot ( Staubli Unimation Inc , Duncan , South Carolina ) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions . Robot-assisted treatment ( bilateral , unilateral , and combined bilateral and unilateral ) was compared with conventional therapy . Similar to a previous study in chronic stroke , combined unilateral and bilateral robotic training had advantages compared with conventional therapy , producing larger improvements on a motor impairment scale and a measure of abnormal synergies . However , gains in all treatment groups were equivalent at the 6-month follow-up . Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training , although the combined group had more hypertonia and less movement out of synergy at baseline . Robot-assisted treatment gains exceeded those expected from spontaneous recovery . These results are discussed in light of the need for further device development and continued clinical trials Background and Purpose — Severe upper limb paresis is a major contributor to disability after stroke . This study investigated the efficacy of a new nonrobotic training device , the Sensorimotor Active Rehabilitation Training ( SMART ) Arm , that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension , permitting stroke survivors with severe paresis to practice a constrained reaching task . Methods — A single-blind , r and omized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis . Thirty-three participants completed the study , of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation , 13 received training using the SMART Arm alone , and 10 received no intervention ( control ) . Training consisted of 12 1-hour sessions over 4 weeks . The primary outcome measure was “ upper arm function , ” item 6 of the Motor Assessment Scale . Secondary outcome measures included impairment measures ; triceps muscle strength , reaching force , modified Ashworth scale ; and activity measures : reaching distance and Motor Assessment Scale . Assessment s were administered before ( 0 weeks ) and after training ( 4 weeks ) and at 2 months follow-up ( 12 weeks ) . Results — Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up . There was no significant difference between these 2 groups . There was no change in the control group . Conclusions — Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis , highlighting the benefits of intensive task-oriented practice , even in the context of severe paresis Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach Objective : To investigate progress toward motor recovery in patients with chronic hemiparesis ( mean time since stroke 3.2 years ) , comparing different types of practice schedules . Design : To increase voluntary control of the upper extremity , active neuromuscular stimulation was administered during blocked and r and om practice schedules as patients performed three specific movements : wrist/finger extension , elbow joint extension , and shoulder joint abduction . Methods : 34 stroke subjects volunteered to participate and were r and omly assigned to one of three treatment groups : blocked practice ( the same movement was repetitively performed on successive trials ) combined with active neuromuscular stimulation ; r and om practice ( different movements on successive trials ) along with active stimulation ; or no active stimulation assistance control group . Subjects completed two days of 90 minute training for each of two weeks with at least 24 hours of rest between sessions . A session was three sets of 30 successful active neuromuscular stimulation trials with the three movements executed 10 times/set . Results : Mixed design analyses on three categories of behavioural measures indicated motor improvements for the blocked and r and om practice /stimulation groups in comparison with the control group during the post-test period , with a larger number of blocks moved , faster premotor and motor reaction times , and less variability in the sustained muscular contraction task . Conclusions : Upper extremity rehabilitation intervention of active stimulation and blocked practice performed as well as stimulation/r and om practice . Moreover , these purpose ful voluntary movement findings support and extend sensorimotor integration theory to both practice schedules Positional feedback ( PF ) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients . Thirty adult hemiparetic patients lacking normal voluntary wrist extension were r and omly placed in control and study groups . The control group received conventional therapy while the study group received positional feedback stimulation training ( PFST ) in addition to conventional treatment . At the end of the 4-week program , study patients showed a 280 % increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70 % increase when positioned in 30 degrees of flexion . Control patients showed no significant changes in torque . Study patients made an average 200 % gain in selective range of motion over their starting levels while controls made only a 50 % increase . Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision 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 Objective : To determine the efficacy of activity-based therapies using arm ergometer or robotic or group occupational therapy for motor recovery of the paretic arm in patients with an acute stroke ( ≤4 weeks ) admitted to an inpatient rehabilitation facility , and to obtain information to plan a large r and omized controlled trial . Design : Prospect i ve , r and omized controlled study . Setting : Stroke unit in a rehabilitation hospital . Subjects : Thirty patients with an acute stroke ( ≤4 weeks ) who had arm weakness ( Medical Research Council grade 2 or less at the shoulder joint ) . Intervention : Occupational therapy ( OT ) group ( control ) ( n = 10 ) , arm ergometer ( n = 10 ) or robotic ( n = 10 ) therapy group . All patients received st and ard , inpatient , post-stroke rehabilitation training for 3 hours a day , plus 12 additional 40-minute sessions of the activity-based therapy . Main measures : The primary outcome measures were discharge scores in the Fugl-Meyer Assessment Scale for upper limb impairment , Motor Status Scale , total Functional Independence Measure ( FIM ) and FIM-motor and FIM-cognition subscores . Results : The three groups ( OT group versus arm ergometer versus robotic ) were comparable on clinical demographic measures except the robotic group was significantly older and there were more  haemorrhagic  stroke patients in the arm ergometer group . After adjusting for age , stroke type and outcome measures at baseline , a similar degree of improvement in the discharge scores was found in all of the primary outcome measures . Conclusion : This study suggests that activity-based therapies using an arm ergometer or robot when used over shortened training periods have the same effect as OT group therapy in decreasing impairment and improving disability in the paretic arm of severely affected stroke patients in the subacute phase Background and Purpose — Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke , with follow-ups at a maximum of 12 months . The aim of this study was to examine the effect of repetitive sensorimot 
    Output:
    