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: Abstract Background : Patients with stroke present an asymmetric posture , severe balance dysfunction with delayed and disrupted equilibrium reactions , exaggerated postural sway and abnormal gait with an increased risk of falling . The aim of this study is to evaluate the efficacy of hydrokinesytherapy on stance , balance and gait in individuals after stroke . Methods : In this single-blinded r and omized controlled trial , patients with stroke were divided into two groups : an experimental one ( G1 ) , performing hydrokinesytherapy ( 3 times/week ) in addition to a conventional physical therapy ( 3 times/week ) and a control one ( G2 ) , performing only a conventional physical therapy ( 6 times/week ) . All of the participants underwent a proper clinical and baropodometric evaluation before and after 8 weeks of treatment . Results : The two groups presented similar clinical and instrumental features at enrolment ( mean modified Rankin Scale of 3 , and a disease duration of 6.3 ± 1.4 months ) . After treatment , the patients undergoing hydrokinesytherapy showed a significantly greater improvement than those undergoing traditional training . Conclusions : Hydrokinesytherapy may be considered a promising treatment in improving gait and balance in individuals following stroke Objective The aim of this study was to assess whether the effects of a motorized aquatic treadmill exercise program improve the isometric strength of the knee muscles , cardiorespiratory fitness , arterial stiffness , motor function , balance , functional outcomes , and quality of life in subacute stroke patients . Design Thirty-two patients were r and omly assigned to 4-wk training sessions of either aquatic therapy ( n = 19 ) or l and -based aerobic exercise ( n = 18 ) . Isometric strength was measured using an isokinetic dynamometer . Cardiopulmonary fitness was evaluated using a symptom-limited exercise tolerance test and by measuring brachial ankle pulse wave velocity . Moreover , motor function ( Fugl-Meyer Assessment [ FMA ] and FMA-lower limb [ FMA-LL ] ) , balance ( Berg Balance Scale [ BBS ] ) , Activities of daily living ( Korean version of the Modified Barthel Index [ K-MBI ] ) , and quality of life ( EQ-5D index ) were examined . Results There were no intergroup differences between demographic and clinical characteristics at baseline ( P > 0.05 ) . The results shows significant improvements in peak oxygen consumption ( P = 0.02 ) , maximal isometric strength of the bilateral knee extensors ( P < 0.01 ) and paretic knee flexors ( P = 0.01 ) , FMA ( P = 0.03 ) , FMA-LL ( P = 0.01 ) , BBS ( P = 0.01 ) , K-MBI ( P < 0.01 ) , and EQ-5D index ( P = 0.04 ) after treatment in the aquatic therapy group . However , only significant improvements in maximal isometric strength in the knee extensors ( P = 0.03 ) and flexors ( P = 0.04 ) were found within the aquatic therapy group and control group . Conclusions Water-based aerobic exercise performed on a motorized aquatic treadmill had beneficial effect on isometric muscle strength in the lower limb . To Cl aim CME Credits Complete the self- assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article , the reader should be able to : ( 1 ) Articulate the rationale for including walking on an aquatic treadmill in the rehabilitation of subacute stroke patients ; ( 2 ) Describe the beneficial effects of a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients ; and ( 3 ) Determine the appropriate indications for incorporating a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients . Level : Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians . The Association of Academic Physiatrists design ates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™ . Physicians should only cl aim credit commensurate with the extent of their participation in the activity Background When people with stroke recover gait speed , they report improved function and reduced disability . However , the minimal amount of change in gait speed that is clinical ly meaningful and associated with an important difference in function for people poststroke has not been determined . Objective The purpose of this study was to determine the minimal clinical ly important difference ( MCID ) for comfortable gait speed ( CGS ) associated with an improvement in the modified Rankin Scale ( mRS ) score for people between 20 to 60 days poststroke . Design This was a prospect i ve , longitudinal , cohort study . Methods The participants in this study were 283 people with first-time stroke prospect ively enrolled in the ongoing Locomotor Experience Applied Post Stroke ( LEAPS ) multi-site r and omized clinical trial . Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke . Improvement of ≥1 on the mRS was used to detect meaningful change in disability level . Results Mean ( SD ) CGS was 0.18 ( 0.16 ) m/s at 20 days and 0.39 ( 0.22 ) m/s at 60 days poststroke . Among all participants , 47.3 % experienced an improvement in disability level ≥1 . The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS . Limitations Because the mRS is not a gait-specific measure of disability , the estimated MCID for CGS was only 73.9 % sensitive and 57.0 % specific for detecting improvement in mRS scores . Conclusions We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s . Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not . Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke QUESTION Does progressive resistance training improve strength and activity after stroke ? Does any increase in strength carry over to activity ? DESIGN Systematic review of r and omised trials with meta- analysis . PARTICIPANTS Adults who have had a stroke . INTERVENTION Progressive resistance training compared with no intervention or placebo . OUTCOME MEASURES The primary outcome was change in strength . This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention . The secondary outcome was change in activity . This measurement had to be a direct measure of performance that produced continuous or ordinal data , or with scales that produced ordinal data . RESULTS Eleven studies involving 370 participants were included in this systematic review . The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8 , representing medium quality . The effect size of  progressive resistance training on strength was 0.98 ( 95 % CI 0.67 to 1.29 , I2=0 % ) . The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies . The effect size of progressive resistance training on activity was 0.42 ( 95 % CI -0.08 to 0.91 , I2=54 % ) . CONCLUSION After stroke , progressive resistance training has a large effect on strength compared with no intervention or placebo . There is uncertainty about whether these large increases in strength carry over to improvements in activity . REVIEW REGISTRATION PROSPERO CRD42015025401 . [ Dorsch S , Ada L , Alloggia D ( 2018 ) Progressive resistance training increases strength after stroke but this may not carry over to activity : a systematic review . Journal of Physiotherapy 64 : 84 - 90 ] Background and Purpose — Gait velocity is a powerful indicator of function and prognosis after stroke . Gait velocity can be stratified into clinical ly meaningful functional ambulation classes , such as household ambulation ( < 0.4 m/s ) , limited community ambulation ( 0.4 to 0.8 m/s ) , and full community ambulation ( > 0.8 m/s ) . The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinical ly meaningful changes in stroke-related function and quality of life . Methods — In subacute stroke survivors with mild to moderate deficits who participated in a r and omized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less , we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale ( SIS ) . Results — Of 64 eligible participants , 19 were initially household ambulators , and 12 of them ( 68 % ) transitioned to limited community ambulation , whereas of 45 initially limited community ambulators , 17 ( 38 % ) became full community ambulators . Function and quality -of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not . Among household ambulators , those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility ( P=0.0299 ) and participation ( P=0.0277 ) . Among limited community ambulators , those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation ( P=0.0085 ) . Conclusions — A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life , especially for household ambulators . Household ambulators possibly had more severe stroke deficits , reducing the risk of “ ceiling ” effects in SIS-measured activities of daily living and instrumental activities of daily living . Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit . Outcomes should be selected that are clinical ly meaningful for all levels of severity OBJECTIVE To evaluate the effect of an 8-week , water-based exercise program ( experimental group ) with that of an upper-extremity function program ( control group ) to increase cardiovascular fitness within a community setting for people with stroke . DESIGN Single-blind r and omized controlled trial . SETTING Public community center . PARTICIPANTS A volunteer sample of 12 community-dwelling people with stroke with mild to moderate residual motor deficits . INTERVENTION Study subjects participated in group exercise programs for 1 hour , 3 times a week for 8 weeks . The experimental group exercised in chest-deep water at targeted heart rates . The control group performed arm and h and exercises while sitting . Main outcome measures The primary outcome measure was cardiovascular fitness ( V(O2)max ) . Secondary measures were maximal workload , muscle strength , gait speed , and the Berg Balance Scale score . RESULTS The experimental group attained significant improvements over the control group in cardiovascular fitness , maximal workload , gait speed , and paretic lower-extremity muscle strength . The relatively short program ( 8 wk ) of water-based exercise result ed in a 22 % improvement in cardiovascular fitness in a small group of people with stroke who had relatively high function . CONCLUSIONS A water-based exercise program undertaken as a group program may be an effective way to promote fitness in people with stroke Objective : To evaluate the effects of an aquatic physiotherapy method ( Halliwick-Therapy ) upon mobility in the post-acute phase of stroke rehabilitation . Design : R and omized controlled trial . Setting : Hospital for neurological rehabilitation . Participants : Adult patients after first-ever stroke in post-acute inpatient rehabilitation at least two weeks after the onset of stroke ( n = 30 ) . Interventions : In the Halliwick-Therapy group ( n = 14 ) the treatment over a period of two weeks included 45 minutes of aquatic therapy three times per week and a conventional physiotherapeutic treatment twice a week . Subjects in the control group ( n = 16 ) received conventional physiotherapeutic treatment over a period of two weeks five times per week . Outcome measures : The primary outcome variable was postural stability ( Berg Balance Scale ) . Secondary outcome variables were functional reach , functional gait ability and basic functional mobility . Results : Compared to the control group , significantly more subjects in the Halliwick-Therapy group ( 83.3 % versus 46.7 % ) attained significant improvement of the Berg Balance Scale ( P < 0.05 ) . Improvement of the functional gait ability was significantly higher in the Halliwick-Therapy group ( mean ( SD ) 1.25(0.86 ) ) than in the control group ( mean ( SD ) 0.73 ( 0.70 ) ) ( P < 0.1 ) . The mean differences of improvements in functional reach and basic functional mobility were not statistically significant between groups . Conclusions : This study indicates that Halliwick-Therapy is safe and well tolerated in stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility [ Purpose ] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients . [ Subjects and Methods ] Twenty stroke patients were r and omly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group ( n = 10 each ) . Both the groups underwent neurodevelopmental treatment , and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater . Balance was measured using the Berg Balance Scale and Functional Reach Test , and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test . To compare in-group data before and after the intervention , paired t-test was used . Independent t-test was used to compare differences 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: Abstract Background : Patients with stroke present an asymmetric posture , severe balance dysfunction with delayed and disrupted equilibrium reactions , exaggerated postural sway and abnormal gait with an increased risk of falling . The aim of this study is to evaluate the efficacy of hydrokinesytherapy on stance , balance and gait in individuals after stroke . Methods : In this single-blinded r and omized controlled trial , patients with stroke were divided into two groups : an experimental one ( G1 ) , performing hydrokinesytherapy ( 3 times/week ) in addition to a conventional physical therapy ( 3 times/week ) and a control one ( G2 ) , performing only a conventional physical therapy ( 6 times/week ) . All of the participants underwent a proper clinical and baropodometric evaluation before and after 8 weeks of treatment . Results : The two groups presented similar clinical and instrumental features at enrolment ( mean modified Rankin Scale of 3 , and a disease duration of 6.3 ± 1.4 months ) . After treatment , the patients undergoing hydrokinesytherapy showed a significantly greater improvement than those undergoing traditional training . Conclusions : Hydrokinesytherapy may be considered a promising treatment in improving gait and balance in individuals following stroke Objective The aim of this study was to assess whether the effects of a motorized aquatic treadmill exercise program improve the isometric strength of the knee muscles , cardiorespiratory fitness , arterial stiffness , motor function , balance , functional outcomes , and quality of life in subacute stroke patients . Design Thirty-two patients were r and omly assigned to 4-wk training sessions of either aquatic therapy ( n = 19 ) or l and -based aerobic exercise ( n = 18 ) . Isometric strength was measured using an isokinetic dynamometer . Cardiopulmonary fitness was evaluated using a symptom-limited exercise tolerance test and by measuring brachial ankle pulse wave velocity . Moreover , motor function ( Fugl-Meyer Assessment [ FMA ] and FMA-lower limb [ FMA-LL ] ) , balance ( Berg Balance Scale [ BBS ] ) , Activities of daily living ( Korean version of the Modified Barthel Index [ K-MBI ] ) , and quality of life ( EQ-5D index ) were examined . Results There were no intergroup differences between demographic and clinical characteristics at baseline ( P > 0.05 ) . The results shows significant improvements in peak oxygen consumption ( P = 0.02 ) , maximal isometric strength of the bilateral knee extensors ( P < 0.01 ) and paretic knee flexors ( P = 0.01 ) , FMA ( P = 0.03 ) , FMA-LL ( P = 0.01 ) , BBS ( P = 0.01 ) , K-MBI ( P < 0.01 ) , and EQ-5D index ( P = 0.04 ) after treatment in the aquatic therapy group . However , only significant improvements in maximal isometric strength in the knee extensors ( P = 0.03 ) and flexors ( P = 0.04 ) were found within the aquatic therapy group and control group . Conclusions Water-based aerobic exercise performed on a motorized aquatic treadmill had beneficial effect on isometric muscle strength in the lower limb . To Cl aim CME Credits Complete the self- assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article , the reader should be able to : ( 1 ) Articulate the rationale for including walking on an aquatic treadmill in the rehabilitation of subacute stroke patients ; ( 2 ) Describe the beneficial effects of a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients ; and ( 3 ) Determine the appropriate indications for incorporating a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients . Level : Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians . The Association of Academic Physiatrists design ates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™ . Physicians should only cl aim credit commensurate with the extent of their participation in the activity Background When people with stroke recover gait speed , they report improved function and reduced disability . However , the minimal amount of change in gait speed that is clinical ly meaningful and associated with an important difference in function for people poststroke has not been determined . Objective The purpose of this study was to determine the minimal clinical ly important difference ( MCID ) for comfortable gait speed ( CGS ) associated with an improvement in the modified Rankin Scale ( mRS ) score for people between 20 to 60 days poststroke . Design This was a prospect i ve , longitudinal , cohort study . Methods The participants in this study were 283 people with first-time stroke prospect ively enrolled in the ongoing Locomotor Experience Applied Post Stroke ( LEAPS ) multi-site r and omized clinical trial . Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke . Improvement of ≥1 on the mRS was used to detect meaningful change in disability level . Results Mean ( SD ) CGS was 0.18 ( 0.16 ) m/s at 20 days and 0.39 ( 0.22 ) m/s at 60 days poststroke . Among all participants , 47.3 % experienced an improvement in disability level ≥1 . The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS . Limitations Because the mRS is not a gait-specific measure of disability , the estimated MCID for CGS was only 73.9 % sensitive and 57.0 % specific for detecting improvement in mRS scores . Conclusions We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s . Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not . Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke QUESTION Does progressive resistance training improve strength and activity after stroke ? Does any increase in strength carry over to activity ? DESIGN Systematic review of r and omised trials with meta- analysis . PARTICIPANTS Adults who have had a stroke . INTERVENTION Progressive resistance training compared with no intervention or placebo . OUTCOME MEASURES The primary outcome was change in strength . This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention . The secondary outcome was change in activity . This measurement had to be a direct measure of performance that produced continuous or ordinal data , or with scales that produced ordinal data . RESULTS Eleven studies involving 370 participants were included in this systematic review . The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8 , representing medium quality . The effect size of  progressive resistance training on strength was 0.98 ( 95 % CI 0.67 to 1.29 , I2=0 % ) . The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies . The effect size of progressive resistance training on activity was 0.42 ( 95 % CI -0.08 to 0.91 , I2=54 % ) . CONCLUSION After stroke , progressive resistance training has a large effect on strength compared with no intervention or placebo . There is uncertainty about whether these large increases in strength carry over to improvements in activity . REVIEW REGISTRATION PROSPERO CRD42015025401 . [ Dorsch S , Ada L , Alloggia D ( 2018 ) Progressive resistance training increases strength after stroke but this may not carry over to activity : a systematic review . Journal of Physiotherapy 64 : 84 - 90 ] Background and Purpose — Gait velocity is a powerful indicator of function and prognosis after stroke . Gait velocity can be stratified into clinical ly meaningful functional ambulation classes , such as household ambulation ( < 0.4 m/s ) , limited community ambulation ( 0.4 to 0.8 m/s ) , and full community ambulation ( > 0.8 m/s ) . The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinical ly meaningful changes in stroke-related function and quality of life . Methods — In subacute stroke survivors with mild to moderate deficits who participated in a r and omized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less , we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale ( SIS ) . Results — Of 64 eligible participants , 19 were initially household ambulators , and 12 of them ( 68 % ) transitioned to limited community ambulation , whereas of 45 initially limited community ambulators , 17 ( 38 % ) became full community ambulators . Function and quality -of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not . Among household ambulators , those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility ( P=0.0299 ) and participation ( P=0.0277 ) . Among limited community ambulators , those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation ( P=0.0085 ) . Conclusions — A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life , especially for household ambulators . Household ambulators possibly had more severe stroke deficits , reducing the risk of “ ceiling ” effects in SIS-measured activities of daily living and instrumental activities of daily living . Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit . Outcomes should be selected that are clinical ly meaningful for all levels of severity OBJECTIVE To evaluate the effect of an 8-week , water-based exercise program ( experimental group ) with that of an upper-extremity function program ( control group ) to increase cardiovascular fitness within a community setting for people with stroke . DESIGN Single-blind r and omized controlled trial . SETTING Public community center . PARTICIPANTS A volunteer sample of 12 community-dwelling people with stroke with mild to moderate residual motor deficits . INTERVENTION Study subjects participated in group exercise programs for 1 hour , 3 times a week for 8 weeks . The experimental group exercised in chest-deep water at targeted heart rates . The control group performed arm and h and exercises while sitting . Main outcome measures The primary outcome measure was cardiovascular fitness ( V(O2)max ) . Secondary measures were maximal workload , muscle strength , gait speed , and the Berg Balance Scale score . RESULTS The experimental group attained significant improvements over the control group in cardiovascular fitness , maximal workload , gait speed , and paretic lower-extremity muscle strength . The relatively short program ( 8 wk ) of water-based exercise result ed in a 22 % improvement in cardiovascular fitness in a small group of people with stroke who had relatively high function . CONCLUSIONS A water-based exercise program undertaken as a group program may be an effective way to promote fitness in people with stroke Objective : To evaluate the effects of an aquatic physiotherapy method ( Halliwick-Therapy ) upon mobility in the post-acute phase of stroke rehabilitation . Design : R and omized controlled trial . Setting : Hospital for neurological rehabilitation . Participants : Adult patients after first-ever stroke in post-acute inpatient rehabilitation at least two weeks after the onset of stroke ( n = 30 ) . Interventions : In the Halliwick-Therapy group ( n = 14 ) the treatment over a period of two weeks included 45 minutes of aquatic therapy three times per week and a conventional physiotherapeutic treatment twice a week . Subjects in the control group ( n = 16 ) received conventional physiotherapeutic treatment over a period of two weeks five times per week . Outcome measures : The primary outcome variable was postural stability ( Berg Balance Scale ) . Secondary outcome variables were functional reach , functional gait ability and basic functional mobility . Results : Compared to the control group , significantly more subjects in the Halliwick-Therapy group ( 83.3 % versus 46.7 % ) attained significant improvement of the Berg Balance Scale ( P < 0.05 ) . Improvement of the functional gait ability was significantly higher in the Halliwick-Therapy group ( mean ( SD ) 1.25(0.86 ) ) than in the control group ( mean ( SD ) 0.73 ( 0.70 ) ) ( P < 0.1 ) . The mean differences of improvements in functional reach and basic functional mobility were not statistically significant between groups . Conclusions : This study indicates that Halliwick-Therapy is safe and well tolerated in stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility [ Purpose ] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients . [ Subjects and Methods ] Twenty stroke patients were r and omly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group ( n = 10 each ) . Both the groups underwent neurodevelopmental treatment , and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater . Balance was measured using the Berg Balance Scale and Functional Reach Test , and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test . To compare in-group data before and after the intervention , paired t-test was used . Independent t-test was used to compare differences in 
    Output:
    