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: Clinical studies had shown that EEG-based motor imagery Brain-Computer Interface ( MI-BCI ) combined with robotic feedback is effective in upper limb stroke rehabilitation , and transcranial Direct Current Stimulation ( tDCS ) combined with other rehabilitation techniques further enhanced the facilitating effect of tDCS . This motivated the current clinical study to investigate the effects of combining tDCS with MI-BCI and robotic feedback compared to sham-tDCS for upper limb stroke rehabilitation . The stroke patients recruited were r and omized to receive 20 minutes of tDCS or sham-tDCS prior to 10 sessions of 1-hour MI-BCI with robotic feedback for 2 weeks . The online accuracies of detecting motor imagery from idle condition were assessed and offline accuracies of classifying motor imagery from background rest condition were assessed from the EEG of the evaluation and therapy parts of the 10 rehabilitation sessions respectively . The results showed no evident differences between the online accuracies on the evaluation part from both groups , but the offline analysis on the therapy part yielded higher averaged accuracies for subjects who received tDCS ( n=3 ) compared to  sham-tDCS ( n=2 ) . The results suggest towards tDCS effect in modulating motor imagery in stroke , but a more conclusive result can be drawn when more data are collected in the ongoing study Background . No rehabilitation intervention has effectively improved functional use of the arm and h and in patients with severe upper limb paresis after stroke . Pilot studies suggest the potential for transcranial direct current stimulation and bilateral robotic training to enhance gains . Objective . In a double-blind , r and omized trial the combination of these interventions was tested . Methods . This study r and omized 96 patients with an ischemic supratentorial lesion of 3 to 8 weeks ’ duration with severe impairment of motor control with a Fugl-Meyer score ( FMS ) for the upper limb < 18 into 3 groups . For 6 weeks , group A received anodal stimulation of the lesioned hemisphere , group B received cathodal stimulation of the nonlesioned side for 20 minutes at 2.0 mA , and group C received sham stimulation . The electrodes were placed over the h and area and above the contralateral orbit . Contemporaneously , the subjects practice d 400 repetitions each of 2 different bilateral movements on a robotic assistive device . Results . The groups were matched at onset . The FMS improved in all patients at 6 weeks ( P < .001 ) . No between-group differences were found ; initial versus finish FMS scores were 7.8 ± 3.8 versus 19.1 ± 14.4 in group A , 7.9 ± 3.4 versus 18.8 ± 10.5 in group B , and 8.2 ± 4.4 versus 19.2 ± 15.0 in group C. No significant changes between groups were present at 3 months . Conclusions . Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness . Unilateral h and training and upregulation of the nonlesioned hemisphere might also be tried in this population Background Previous studies showed that anodal transcranial DC stimulation ( tDCS ) applied to the primary motor cortex of the affected hemisphere ( M1affected hemisphere ) after subcortical stroke transiently improves performance of complex tasks that mimic activities of daily living ( ADL ) . It is not known if relatively simpler motor tasks are similarly affected . Here we tested the effects of tDCS on pinch force ( PF ) and simple reaction time ( RT ) tasks in patients with chronic stroke in a double-blind cross-over Sham-controlled experimental design . Results Anodal tDCS shortened reaction times and improved pinch force in the paretic h and relative to Sham stimulation , an effect present in patients with higher impairment . Conclusion tDCS of M1affected hemisphere can modulate performance of motor tasks simpler than those previously studied , a finding that could potentially benefit patients with relatively higher impairment levels Abstract : Balanced transcallosal inhibition sustains symmetrical corticomotor excitability and assists the performance of bimanual voluntary movements . After stroke , transcallosal inhibition becomes asymmetric . This finding raised the notion that reducing poststroke asymmetry in transcallosal inhibition might prime the motor system before training and lead to improvements in walking recovery . In this study , we examined three neuromodulatory protocol s applied during walking to determine if they could increase ipsilesional and decrease contralesional motor excitability in patients with chronic stroke .  Inhibitory repetitive transcranial magnetic stimulation and inhibitory paired associative stimulation were applied to the contralesional motor system , and facilitatory anodal transcranial direct current stimulation was applied to the ipsilesional motor system . We tested the bilateral modulatory effects of each stimulation protocol on the tibialis anterior , medial gastrocnemius , medial hamstrings , and vastus lateralis of nine patients with chronic stroke . All stimulation protocol s increased paretic limb and decreased nonparetic limb motor excitability . There was no statistical difference in the extent of modulation between these stimulation protocol s. This result suggests these three protocol s are promising c and i date priming mechanisms for testing the hypothesis in a future study that reducing the poststroke asymmetry of between-hemisphere motor excitability will enhance the effect of gait therapy Objective : Motor recovery after stroke depends on the integrity of ipsilesional motor circuits and interactions between the ipsilesional and contralesional hemispheres . In this sham-controlled r and omized trial , we investigated whether noninvasive modulation of regional excitability of bilateral motor cortices in combination with physical and occupational therapy improves motor outcome after stroke . Methods : Twenty chronic stroke patients were r and omly assigned to receive 5 consecutive sessions of either 1 ) bihemispheric transcranial direct current stimulation ( tDCS ) ( anodal tDCS to upregulate excitability of ipsilesional motor cortex and cathodal tDCS to downregulate excitability of contralesional motor cortex ) with simultaneous physical/occupational therapy or 2 ) sham stimulation with simultaneous physical/occupational therapy .  Changes in motor impairment ( Upper Extremity Fugl-Meyer ) and motor activity ( Wolf Motor Function Test ) assessment s were outcome measures while functional imaging parameters were used to identify neural correlates of motor improvement . Results : The improvement of motor function was significantly greater in the real stimulation group ( 20.7 % in Fugl-Meyer and 19.1 % in Wolf Motor Function Test scores ) when compared to the sham group ( 3.2 % in Fugl-Meyer and 6.0 % in Wolf Motor Function Test scores ) . The effects outlasted the stimulation by at least 1 week . In the real-stimulation group , stronger activation of intact ipsilesional motor regions during paced movements of the affected limb were found postintervention whereas no significant activation changes were seen in the control group . Conclusions : The combination of bihemispheric tDCS and peripheral sensorimotor activities improved motor functions in chronic stroke patients that outlasted the intervention period . This novel approach may potentiate cerebral adaptive processes that facilitate motor recovery after stroke . Classification of evidence : This study provides Class I evidence that for adult patients with ischemic stroke treated at least 5 months after their first and only stroke , bihemispheric tDCS and simultaneous physical/occupational therapy given over 5 consecutive sessions significantly improves motor function as measured by the Upper Extremity Fugl-Meyer assessment ( raw change treated 6.1 ± 3.4 , sham 1.2 ± 1.0 ) OBJECTIVE The purpose of this study was to examine the effects of combined therapy using transcranial direct current stimulation ( tDCS ) with robot-assisted arm training ( AT ) for impairment of the upper limb in chronic stroke patients , and to clarify whether differences exist in the effect of anodal tDCS on the affected hemisphere ( tDCS(a ) + AT ) and cathodal tDCS on the unaffected hemisphere ( tDCS(c ) + AT ) . METHODS Subjects in this r and omized , double-blinded , crossover study comprised 18 chronic stroke patients with moderate-to-severe arm paresis . Each patient underwent 2 different treatments : tDCS(a ) + AT ; and tDCS(c ) + AT . Each intervention was administered for 5 days , and comprised AT with 1 mA of tDCS during the first 10 min . Outcomes were identified as changes in Fugl-Meyer Assessment ( FMUL ) , modified Ashworth scale ( MAS ) and Motor Activity Log ( MAL ) for the upper limb . RESULTS Both interventions showed significant improvements in FMUL and MAS , but not in MAL . Distal spasticity was significantly improved with tDCS(c ) + AT compared with tDCS(a ) + AT for right hemispheric lesions ( median -1 vs 0 ) , but not for left hemispheric lesions . CONCLUSION Although this study demonstrated that combined therapy could achieve limited effects in the hemiplegic arm of chronic stroke patients , a different effect of polarity of tDCS was seen for patients with right hemispheric lesions Background and Purpose — Treatment options for stroke-related dysphagia are currently limited . In this study , we investigated whether noninvasive brain stimulation in combination with swallowing maneuvers facilitates swallowing recovery in dysphagic stroke patients during early stroke convalescence . Methods — Fourteen patients with subacute unilateral hemispheric infa rct ion were r and omized to anodal transcranial direct current stimulation ( tDCS ) versus sham stimulation to the sensorimotor cortical representation of swallowing in the unaffected hemisphere over the course of 5 consecutive days with concurrent st and ardized swallowing maneuvers . Severity of dysphagia was measured using a vali date d swallowing scale , Dysphagia Outcome and Severity scale , before the first and after the last session of tDCS or sham . The effect of tDCS was analyzed in a multivariate linear regression model using changes in Dysphagia Outcome and Severity Scale as the outcome variable after adjusting for the effects of other potential confounding variables such as the National Institutes of Health Stroke Scale and Dysphagia Outcome and Severity scale scores at baseline , acute ischemic lesion volumes , patient age , and time from stroke onset to stimulation . Results — Patients who received anodal tDCS gained 2.60 points of improvement in Dysphagia Outcome and Severity scale scores compared to patients in the sham stimulation group who showed an improvement of 1.25 points ( P=0.019 ) after controlling for the effects of other aforementioned variables . Six out 7 ( 86 % ) patients in tDCS stimulation group gained at least 2 points of improvement compared with 3 out 7 ( 43 % ) patients in the sham group ( P=0.107 ) . Conclusions — Because brain stem swallowing centers have bilateral cortical innervations , measures that enhance cortical input and sensorimotor control of brain stem swallowing may be beneficial for dysphagia recovery BACKGROUND AND PURPOSE To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm , the effects of change in motor function over time on the accuracy of prediction were evaluated , and a prediction model for the probability of regaining dexterity at 6 months was developed . METHODS In 102 stroke patients , dexterity and paresis were measured with the  Action Research Arm Test , Motricity Index , and Fugl-Meyer motor evaluation .  For model development , 23 c and i date determinants were selected . Logistic regression analysis was used for prognostic factors and model development . RESULTS At 6 months , some dexterity in the paretic arm was found in 38 % , and complete functional recovery was seen in 11.6 % of the patients . Total anterior circulation infa rcts , right hemisphere strokes , homonymous hemianopia , visual gaze deficit , visual inattention , and paresis were statistically significant related to a poor arm function . Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity ( Action Research Arm Test > or=10 points ) from 74 % ( positive predictive value [ PPV ] , 0.74 ; 95 % confidence interval [ CI ] , 0.63 to 0.86 ) to 94 % ( PPV , 0.83 ; 95 % CI , 0.76 to 0.91 ) at 6 months . No change in probabilities of prediction dexterity was found after 4 weeks . CONCLUSIONS Based on the Fugl-Meyer scores of the flaccid arm , optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset . Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months Transcranial direct current stimulation ( tDCS ) is a noninvasive technique that is emerging as a prospect i ve therapy for different neurologic disorders . Previous studies have demonstrated that anodal and cathodal stimulation can improve motor performance in terms of dexterity and manual force . The objective of this study was to determine whether different electrodes ' setups ( anodal , cathodal , and simultaneous bilateral tDCS ) provide different motor performance and which montage was more effective . As secondary outcome , we have asked to the patients about their satisfaction , and to determine if the bilateral tDCS was more uncomfortable than unilateral tDCS .  Nine patients with stroke in subacute phase were enrolled in this study and r and omly divided in three groups . Our results showed that tD 
    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: Clinical studies had shown that EEG-based motor imagery Brain-Computer Interface ( MI-BCI ) combined with robotic feedback is effective in upper limb stroke rehabilitation , and transcranial Direct Current Stimulation ( tDCS ) combined with other rehabilitation techniques further enhanced the facilitating effect of tDCS . This motivated the current clinical study to investigate the effects of combining tDCS with MI-BCI and robotic feedback compared to sham-tDCS for upper limb stroke rehabilitation . The stroke patients recruited were r and omized to receive 20 minutes of tDCS or sham-tDCS prior to 10 sessions of 1-hour MI-BCI with robotic feedback for 2 weeks . The online accuracies of detecting motor imagery from idle condition were assessed and offline accuracies of classifying motor imagery from background rest condition were assessed from the EEG of the evaluation and therapy parts of the 10 rehabilitation sessions respectively . The results showed no evident differences between the online accuracies on the evaluation part from both groups , but the offline analysis on the therapy part yielded higher averaged accuracies for subjects who received tDCS ( n=3 ) compared to  sham-tDCS ( n=2 ) . The results suggest towards tDCS effect in modulating motor imagery in stroke , but a more conclusive result can be drawn when more data are collected in the ongoing study Background . No rehabilitation intervention has effectively improved functional use of the arm and h and in patients with severe upper limb paresis after stroke . Pilot studies suggest the potential for transcranial direct current stimulation and bilateral robotic training to enhance gains . Objective . In a double-blind , r and omized trial the combination of these interventions was tested . Methods . This study r and omized 96 patients with an ischemic supratentorial lesion of 3 to 8 weeks ’ duration with severe impairment of motor control with a Fugl-Meyer score ( FMS ) for the upper limb < 18 into 3 groups . For 6 weeks , group A received anodal stimulation of the lesioned hemisphere , group B received cathodal stimulation of the nonlesioned side for 20 minutes at 2.0 mA , and group C received sham stimulation . The electrodes were placed over the h and area and above the contralateral orbit . Contemporaneously , the subjects practice d 400 repetitions each of 2 different bilateral movements on a robotic assistive device . Results . The groups were matched at onset . The FMS improved in all patients at 6 weeks ( P < .001 ) . No between-group differences were found ; initial versus finish FMS scores were 7.8 ± 3.8 versus 19.1 ± 14.4 in group A , 7.9 ± 3.4 versus 18.8 ± 10.5 in group B , and 8.2 ± 4.4 versus 19.2 ± 15.0 in group C. No significant changes between groups were present at 3 months . Conclusions . Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness . Unilateral h and training and upregulation of the nonlesioned hemisphere might also be tried in this population Background Previous studies showed that anodal transcranial DC stimulation ( tDCS ) applied to the primary motor cortex of the affected hemisphere ( M1affected hemisphere ) after subcortical stroke transiently improves performance of complex tasks that mimic activities of daily living ( ADL ) . It is not known if relatively simpler motor tasks are similarly affected . Here we tested the effects of tDCS on pinch force ( PF ) and simple reaction time ( RT ) tasks in patients with chronic stroke in a double-blind cross-over Sham-controlled experimental design . Results Anodal tDCS shortened reaction times and improved pinch force in the paretic h and relative to Sham stimulation , an effect present in patients with higher impairment . Conclusion tDCS of M1affected hemisphere can modulate performance of motor tasks simpler than those previously studied , a finding that could potentially benefit patients with relatively higher impairment levels Abstract : Balanced transcallosal inhibition sustains symmetrical corticomotor excitability and assists the performance of bimanual voluntary movements . After stroke , transcallosal inhibition becomes asymmetric . This finding raised the notion that reducing poststroke asymmetry in transcallosal inhibition might prime the motor system before training and lead to improvements in walking recovery . In this study , we examined three neuromodulatory protocol s applied during walking to determine if they could increase ipsilesional and decrease contralesional motor excitability in patients with chronic stroke .  Inhibitory repetitive transcranial magnetic stimulation and inhibitory paired associative stimulation were applied to the contralesional motor system , and facilitatory anodal transcranial direct current stimulation was applied to the ipsilesional motor system . We tested the bilateral modulatory effects of each stimulation protocol on the tibialis anterior , medial gastrocnemius , medial hamstrings , and vastus lateralis of nine patients with chronic stroke . All stimulation protocol s increased paretic limb and decreased nonparetic limb motor excitability . There was no statistical difference in the extent of modulation between these stimulation protocol s. This result suggests these three protocol s are promising c and i date priming mechanisms for testing the hypothesis in a future study that reducing the poststroke asymmetry of between-hemisphere motor excitability will enhance the effect of gait therapy Objective : Motor recovery after stroke depends on the integrity of ipsilesional motor circuits and interactions between the ipsilesional and contralesional hemispheres . In this sham-controlled r and omized trial , we investigated whether noninvasive modulation of regional excitability of bilateral motor cortices in combination with physical and occupational therapy improves motor outcome after stroke . Methods : Twenty chronic stroke patients were r and omly assigned to receive 5 consecutive sessions of either 1 ) bihemispheric transcranial direct current stimulation ( tDCS ) ( anodal tDCS to upregulate excitability of ipsilesional motor cortex and cathodal tDCS to downregulate excitability of contralesional motor cortex ) with simultaneous physical/occupational therapy or 2 ) sham stimulation with simultaneous physical/occupational therapy .  Changes in motor impairment ( Upper Extremity Fugl-Meyer ) and motor activity ( Wolf Motor Function Test ) assessment s were outcome measures while functional imaging parameters were used to identify neural correlates of motor improvement . Results : The improvement of motor function was significantly greater in the real stimulation group ( 20.7 % in Fugl-Meyer and 19.1 % in Wolf Motor Function Test scores ) when compared to the sham group ( 3.2 % in Fugl-Meyer and 6.0 % in Wolf Motor Function Test scores ) . The effects outlasted the stimulation by at least 1 week . In the real-stimulation group , stronger activation of intact ipsilesional motor regions during paced movements of the affected limb were found postintervention whereas no significant activation changes were seen in the control group . Conclusions : The combination of bihemispheric tDCS and peripheral sensorimotor activities improved motor functions in chronic stroke patients that outlasted the intervention period . This novel approach may potentiate cerebral adaptive processes that facilitate motor recovery after stroke . Classification of evidence : This study provides Class I evidence that for adult patients with ischemic stroke treated at least 5 months after their first and only stroke , bihemispheric tDCS and simultaneous physical/occupational therapy given over 5 consecutive sessions significantly improves motor function as measured by the Upper Extremity Fugl-Meyer assessment ( raw change treated 6.1 ± 3.4 , sham 1.2 ± 1.0 ) OBJECTIVE The purpose of this study was to examine the effects of combined therapy using transcranial direct current stimulation ( tDCS ) with robot-assisted arm training ( AT ) for impairment of the upper limb in chronic stroke patients , and to clarify whether differences exist in the effect of anodal tDCS on the affected hemisphere ( tDCS(a ) + AT ) and cathodal tDCS on the unaffected hemisphere ( tDCS(c ) + AT ) . METHODS Subjects in this r and omized , double-blinded , crossover study comprised 18 chronic stroke patients with moderate-to-severe arm paresis . Each patient underwent 2 different treatments : tDCS(a ) + AT ; and tDCS(c ) + AT . Each intervention was administered for 5 days , and comprised AT with 1 mA of tDCS during the first 10 min . Outcomes were identified as changes in Fugl-Meyer Assessment ( FMUL ) , modified Ashworth scale ( MAS ) and Motor Activity Log ( MAL ) for the upper limb . RESULTS Both interventions showed significant improvements in FMUL and MAS , but not in MAL . Distal spasticity was significantly improved with tDCS(c ) + AT compared with tDCS(a ) + AT for right hemispheric lesions ( median -1 vs 0 ) , but not for left hemispheric lesions . CONCLUSION Although this study demonstrated that combined therapy could achieve limited effects in the hemiplegic arm of chronic stroke patients , a different effect of polarity of tDCS was seen for patients with right hemispheric lesions Background and Purpose — Treatment options for stroke-related dysphagia are currently limited . In this study , we investigated whether noninvasive brain stimulation in combination with swallowing maneuvers facilitates swallowing recovery in dysphagic stroke patients during early stroke convalescence . Methods — Fourteen patients with subacute unilateral hemispheric infa rct ion were r and omized to anodal transcranial direct current stimulation ( tDCS ) versus sham stimulation to the sensorimotor cortical representation of swallowing in the unaffected hemisphere over the course of 5 consecutive days with concurrent st and ardized swallowing maneuvers . Severity of dysphagia was measured using a vali date d swallowing scale , Dysphagia Outcome and Severity scale , before the first and after the last session of tDCS or sham . The effect of tDCS was analyzed in a multivariate linear regression model using changes in Dysphagia Outcome and Severity Scale as the outcome variable after adjusting for the effects of other potential confounding variables such as the National Institutes of Health Stroke Scale and Dysphagia Outcome and Severity scale scores at baseline , acute ischemic lesion volumes , patient age , and time from stroke onset to stimulation . Results — Patients who received anodal tDCS gained 2.60 points of improvement in Dysphagia Outcome and Severity scale scores compared to patients in the sham stimulation group who showed an improvement of 1.25 points ( P=0.019 ) after controlling for the effects of other aforementioned variables . Six out 7 ( 86 % ) patients in tDCS stimulation group gained at least 2 points of improvement compared with 3 out 7 ( 43 % ) patients in the sham group ( P=0.107 ) . Conclusions — Because brain stem swallowing centers have bilateral cortical innervations , measures that enhance cortical input and sensorimotor control of brain stem swallowing may be beneficial for dysphagia recovery BACKGROUND AND PURPOSE To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm , the effects of change in motor function over time on the accuracy of prediction were evaluated , and a prediction model for the probability of regaining dexterity at 6 months was developed . METHODS In 102 stroke patients , dexterity and paresis were measured with the  Action Research Arm Test , Motricity Index , and Fugl-Meyer motor evaluation .  For model development , 23 c and i date determinants were selected . Logistic regression analysis was used for prognostic factors and model development . RESULTS At 6 months , some dexterity in the paretic arm was found in 38 % , and complete functional recovery was seen in 11.6 % of the patients . Total anterior circulation infa rcts , right hemisphere strokes , homonymous hemianopia , visual gaze deficit , visual inattention , and paresis were statistically significant related to a poor arm function . Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity ( Action Research Arm Test > or=10 points ) from 74 % ( positive predictive value [ PPV ] , 0.74 ; 95 % confidence interval [ CI ] , 0.63 to 0.86 ) to 94 % ( PPV , 0.83 ; 95 % CI , 0.76 to 0.91 ) at 6 months . No change in probabilities of prediction dexterity was found after 4 weeks . CONCLUSIONS Based on the Fugl-Meyer scores of the flaccid arm , optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset . Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months Transcranial direct current stimulation ( tDCS ) is a noninvasive technique that is emerging as a prospect i ve therapy for different neurologic disorders . Previous studies have demonstrated that anodal and cathodal stimulation can improve motor performance in terms of dexterity and manual force . The objective of this study was to determine whether different electrodes ' setups ( anodal , cathodal , and simultaneous bilateral tDCS ) provide different motor performance and which montage was more effective . As secondary outcome , we have asked to the patients about their satisfaction , and to determine if the bilateral tDCS was more uncomfortable than unilateral tDCS .  Nine patients with stroke in subacute phase were enrolled in this study and r and omly divided in three groups . Our results showed that tD 
    Output:
    