human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To 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 QUESTION Do people with stroke spend more time in active task practice during circuit class therapy sessions versus individual physiotherapy sessions ? Do people with stroke practise different tasks during circuit class therapy sessions versus individual physiotherapy sessions ? DESIGN Prospect i ve , observational study . PARTICIPANTS Twenty-nine people with stroke in inpatient rehabilitation setting s. INTERVENTIONS Individual therapy sessions and circuit class therapy sessions provided within a larger r and omised controlled trial . OUTCOME MEASURES Seventy-nine therapy sessions were video-recorded and the footage was analysed for time spent engaged in various categories of activity . In a sub sample of 28 videos , the number of steps taken by people with stroke per therapy session was counted . RESULTS Circuit class therapy sessions were of a longer duration ( mean difference 38.0minutes , 95 % CI 29.9 to 46.1 ) , and participants spent more time engaged in active task practice ( mean difference 23.8minutes , 95 % CI 16.1 to 31.4 ) compared with individual sessions . A greater percentage of time in circuit class therapy sessions was spent practising tasks in sitting ( mean difference 5.3 % , 95 % CI 2.4 to 8.2 ) and in sit-to-st and practice ( mean difference 2.7 % , 95 % CI 1.4 to 4.1 ) , and a lower percentage of time in walking practice ( mean difference 19.1 % , 95 % CI 10.0 to 28.1 ) compared with individual sessions . PARTICIPANTS took an average of 371 steps ( SD 418 ) during therapy sessions and this did not differ significantly between group and individual sessions . CONCLUSION People with stroke spent more time in active task practice , but a similar amount of time in walking practice when physiotherapy was offered in circuit class therapy sessions versus individual therapy sessions . There is a need for effective strategies to increase the amount of walking practice during physiotherapy sessions for people after stroke Background and Purpose — Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke . The aim of the present study was to study the effects of progress of time on observed improvements in motor strength , synergisms , and activities during the first 16 weeks poststroke . Methods — Based on data from a previous study , 101 patients with first-ever ischemic middle cerebral artery strokes were prospect ively investigated during the first 16 weeks after stroke . Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model . The biweekly time change ( progress of time ) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index , reduction in visuospatial inattention based on the letter cancellation task , and improvement in walking ability , dexterity , and activities of daily living measured with the Functional Ambulation Categories , Action Research Arm test , and Barthel Index . Results — Time explained a significant change of 8.4 ( 42 % ) measurement units on the Barthel Index for the first 10 weeks poststroke , 1.1 ( 22 % ) measurement units on Functional Ambulation Categories , and 19 % on the Action Research Arm test for the first 6 and 8 weeks poststroke . Approximately 25 % ( for Fugl-Meyer – arm ) to 26 % ( for Motricity Index – arm ) of the significant change in measurements units was explained by time alone for the upper limb compared with 33 % for Fugl-Meyer – leg and 39 % for Motricity Index – leg of the lower limb . Time accounted for a reduction of 16 % in the letter cancellation task . Observed associations did not change after controlling for covariates such as age , gender , hemisphere of stroke , type of stroke , or intervention . Conclusion — Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining ≈16 % to 42 % of the observed improvements in the first 6 to 10 weeks after stroke onset OBJECTIVE To prospect ively monitor occupational therapy activities and intervention techniques used during inpatient stroke rehabilitation in order to provide a description of current clinical practice . METHODS Data were collected prospect ively from 954 clients with stroke receiving occupational therapy from six U.S. rehabilitation hospitals . Descriptive statistics summarized frequency , intensity , and duration of occupational therapy sessions ; proportion of time spent in 16 therapeutic activities ; and proportion of those activities that included any of 31 interventions . RESULTS Clients received on average 11.8 days ( SD = 7.2 ) of occupational therapy , with each session lasting on average 39.4 min ( SD = 16.9 ) . Upper-extremity control ( 22.9 % of treatment time ) and dressing ( 14.2 % of treatment time ) were the most frequently provided activities . Interventions provided most frequently during upper-extremity control activities were strengthening , motor learning , and postural awareness . CONCLUSION Occupational therapy provided reflected an integration of treatment approaches . Upper-extremity control and basic activities of daily living were the most frequent activities . A small proportion of sessions addressed community integration Background and Purpose — We aim to compare demographics and functional outcomes of patients with stroke in a variety of vascular territories who underwent inpatient rehabilitation .  Such comparative data are important in functional prognostication , rehabilitation , and healthcare planning , but literature is scarce and isolated . Methods — Using data collected prospect ively over a 9-year period , we studied 2213 individuals who sustained first-ever ischemic strokes and were admitted to an inpatient stroke rehabilitation program .  Strokes were divided into anterior cerebral artery , middle cerebral artery ( MCA ) , posterior cerebral artery , brain stem , cerebellar , small-vessel strokes , and strokes occurring in more than one vascular territory . The main functional outcome measure was the Functional Independence Measure ( FIM ) . Repeated- measures analysis of covariance with post hoc analyses was used to compare functional outcomes of the stroke groups . Results — The most common stroke groups were MCA stroke ( 50.8 % ) and small-vessel stroke ( 12.8 % ) . After adjustments for age , gender , risk factors , and admission year , the stroke groups can be arranged from most to least severe disability on admission : strokes in more than one vascular territory , MCA , anterior cerebral artery , posterior cerebral artery , brain stem , cerebellar , and small-vessel strokes . The sequence was similar on discharge , except cerebellar strokes had the least disability rather than small-vessel strokes . Hemispheric ( more than one vascular territory , MCA , anterior cerebral artery , posterior cerebral artery ) strokes collectively have significantly lower admission and discharge total and cognitive FIM scores compared with the other stroke groups . MCA stroke had the lowest FIM efficiency and cerebellar stroke the highest . Regardless , patients with stroke made significant ( P<0.001 ) and approximately equal ( P=0.535 ) functional gains in all groups . Higher admission motor and cognitive FIM scores , longer rehabilitation stay , younger patients , lower number of medical complications , and a year of admission after 2000 were associated with higher discharge total FIM scores on multiple regression analysis . Conclusions — Patients with stroke made significant functional gains and should be offered rehabilitation regardless of stroke vascular territory . The initial functional status at admission , rather than the stroke subgroup , better predicts discharge functional outcomes postrehabilitation 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 Stroke is a leading cause of adult disability and the recovery of motor function is important for independence in activities of daily living . Predicting motor recovery after stroke in individual patients is difficult . Accurate prognosis would enable realistic rehabilitation goal - setting and more efficient allocation of re sources . The aim of this study was to test and refine an algorithm for predicting the potential for recovery of upper limb function after stroke . Forty participants were prospect ively enrolled within 3 days of ischaemic stroke . First ,  shoulder abduction and finger extension strength  were grade d 72 h after stroke onset to compute a shoulder abduction and finger extension score . Secondly , transcranial magnetic stimulation was used to assess the functional integrity of descending motor pathways to the affected upper limb . Third , diffusion-weighted magnetic resonance imaging was used to assess the structural integrity of the posterior limbs of the internal capsules . Finally , these measures were combined in the PREP algorithm for predicting an individual 's potential for upper limb recovery at 12 weeks , measured with the Action Research Arm Test . A cluster analysis was used to independently group patients according to Action Research Arm Test score at 12 weeks , for comparison with predictions from the PREP algorithm . There was excellent correspondence between the cluster analysis of Action Research Arm Test score at 12 weeks and predictions made with the PREP algorithm . The algorithm had positive predictive power of 88 % , negative predictive power of 83 % , specificity of 88 % and sensitivity of 73 % . This study provides preliminary data in support of the PREP algorithm for the prognosis of upper limb recovery in individual patients .  PREP may enable tailored planning of rehabilitation and more accurate stratification of patients in clinical trials UNLABELLED Horn SD , DeJong G , Smout RJ , Gassaway J , James R , Conroy B. Stroke rehabilitation patients , practice , and outcomes : is earlier and more aggressive therapy better ? OBJECTIVE To examine associations of patient characteristics , rehabilitation therapies , neurotropic medications , nutritional support , and timing of initiation of rehabilitation with functional outcomes and discharge destination for inpatient stroke rehabilitation patients . DESIGN Prospect i ve observational cohort study . SETTING Five U.S. inpatient rehabilitation facilities . PARTICIPANTS Post-stroke rehabilitation patients ( N=830 ; age , > 18 y ) with moderate or severe strokes , from the Post-Stroke Rehabilitation Outcomes Project data base . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Discharge total , motor , and cognitive FIM scores and discharge destination . RESULTS Controlling for patient differences , various activities and interventions were associated with better outcomes including earlier initiation of rehabilitation , more time spent per day in higher-level rehabilitation activities such as gait , upper-extremity control , and problem solving , use of newer psychiatric medications , and enteral feeding . Several findings part with conventional practice , such as starting gait training in the first 3 hours of physical therapy , even for low-level patients , was associated with better outcomes . CONCLUSIONS Specific therapy activities and interventions are associated with better outcomes . Earlier re 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To 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 QUESTION Do people with stroke spend more time in active task practice during circuit class therapy sessions versus individual physiotherapy sessions ? Do people with stroke practise different tasks during circuit class therapy sessions versus individual physiotherapy sessions ? DESIGN Prospect i ve , observational study . PARTICIPANTS Twenty-nine people with stroke in inpatient rehabilitation setting s. INTERVENTIONS Individual therapy sessions and circuit class therapy sessions provided within a larger r and omised controlled trial . OUTCOME MEASURES Seventy-nine therapy sessions were video-recorded and the footage was analysed for time spent engaged in various categories of activity . In a sub sample of 28 videos , the number of steps taken by people with stroke per therapy session was counted . RESULTS Circuit class therapy sessions were of a longer duration ( mean difference 38.0minutes , 95 % CI 29.9 to 46.1 ) , and participants spent more time engaged in active task practice ( mean difference 23.8minutes , 95 % CI 16.1 to 31.4 ) compared with individual sessions . A greater percentage of time in circuit class therapy sessions was spent practising tasks in sitting ( mean difference 5.3 % , 95 % CI 2.4 to 8.2 ) and in sit-to-st and practice ( mean difference 2.7 % , 95 % CI 1.4 to 4.1 ) , and a lower percentage of time in walking practice ( mean difference 19.1 % , 95 % CI 10.0 to 28.1 ) compared with individual sessions . PARTICIPANTS took an average of 371 steps ( SD 418 ) during therapy sessions and this did not differ significantly between group and individual sessions . CONCLUSION People with stroke spent more time in active task practice , but a similar amount of time in walking practice when physiotherapy was offered in circuit class therapy sessions versus individual therapy sessions . There is a need for effective strategies to increase the amount of walking practice during physiotherapy sessions for people after stroke Background and Purpose — Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke . The aim of the present study was to study the effects of progress of time on observed improvements in motor strength , synergisms , and activities during the first 16 weeks poststroke . Methods — Based on data from a previous study , 101 patients with first-ever ischemic middle cerebral artery strokes were prospect ively investigated during the first 16 weeks after stroke . Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model . The biweekly time change ( progress of time ) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index , reduction in visuospatial inattention based on the letter cancellation task , and improvement in walking ability , dexterity , and activities of daily living measured with the Functional Ambulation Categories , Action Research Arm test , and Barthel Index . Results — Time explained a significant change of 8.4 ( 42 % ) measurement units on the Barthel Index for the first 10 weeks poststroke , 1.1 ( 22 % ) measurement units on Functional Ambulation Categories , and 19 % on the Action Research Arm test for the first 6 and 8 weeks poststroke . Approximately 25 % ( for Fugl-Meyer – arm ) to 26 % ( for Motricity Index – arm ) of the significant change in measurements units was explained by time alone for the upper limb compared with 33 % for Fugl-Meyer – leg and 39 % for Motricity Index – leg of the lower limb . Time accounted for a reduction of 16 % in the letter cancellation task . Observed associations did not change after controlling for covariates such as age , gender , hemisphere of stroke , type of stroke , or intervention . Conclusion — Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining ≈16 % to 42 % of the observed improvements in the first 6 to 10 weeks after stroke onset OBJECTIVE To prospect ively monitor occupational therapy activities and intervention techniques used during inpatient stroke rehabilitation in order to provide a description of current clinical practice . METHODS Data were collected prospect ively from 954 clients with stroke receiving occupational therapy from six U.S. rehabilitation hospitals . Descriptive statistics summarized frequency , intensity , and duration of occupational therapy sessions ; proportion of time spent in 16 therapeutic activities ; and proportion of those activities that included any of 31 interventions . RESULTS Clients received on average 11.8 days ( SD = 7.2 ) of occupational therapy , with each session lasting on average 39.4 min ( SD = 16.9 ) . Upper-extremity control ( 22.9 % of treatment time ) and dressing ( 14.2 % of treatment time ) were the most frequently provided activities . Interventions provided most frequently during upper-extremity control activities were strengthening , motor learning , and postural awareness . CONCLUSION Occupational therapy provided reflected an integration of treatment approaches . Upper-extremity control and basic activities of daily living were the most frequent activities . A small proportion of sessions addressed community integration Background and Purpose — We aim to compare demographics and functional outcomes of patients with stroke in a variety of vascular territories who underwent inpatient rehabilitation .  Such comparative data are important in functional prognostication , rehabilitation , and healthcare planning , but literature is scarce and isolated . Methods — Using data collected prospect ively over a 9-year period , we studied 2213 individuals who sustained first-ever ischemic strokes and were admitted to an inpatient stroke rehabilitation program .  Strokes were divided into anterior cerebral artery , middle cerebral artery ( MCA ) , posterior cerebral artery , brain stem , cerebellar , small-vessel strokes , and strokes occurring in more than one vascular territory . The main functional outcome measure was the Functional Independence Measure ( FIM ) . Repeated- measures analysis of covariance with post hoc analyses was used to compare functional outcomes of the stroke groups . Results — The most common stroke groups were MCA stroke ( 50.8 % ) and small-vessel stroke ( 12.8 % ) . After adjustments for age , gender , risk factors , and admission year , the stroke groups can be arranged from most to least severe disability on admission : strokes in more than one vascular territory , MCA , anterior cerebral artery , posterior cerebral artery , brain stem , cerebellar , and small-vessel strokes . The sequence was similar on discharge , except cerebellar strokes had the least disability rather than small-vessel strokes . Hemispheric ( more than one vascular territory , MCA , anterior cerebral artery , posterior cerebral artery ) strokes collectively have significantly lower admission and discharge total and cognitive FIM scores compared with the other stroke groups . MCA stroke had the lowest FIM efficiency and cerebellar stroke the highest . Regardless , patients with stroke made significant ( P<0.001 ) and approximately equal ( P=0.535 ) functional gains in all groups . Higher admission motor and cognitive FIM scores , longer rehabilitation stay , younger patients , lower number of medical complications , and a year of admission after 2000 were associated with higher discharge total FIM scores on multiple regression analysis . Conclusions — Patients with stroke made significant functional gains and should be offered rehabilitation regardless of stroke vascular territory . The initial functional status at admission , rather than the stroke subgroup , better predicts discharge functional outcomes postrehabilitation 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 Stroke is a leading cause of adult disability and the recovery of motor function is important for independence in activities of daily living . Predicting motor recovery after stroke in individual patients is difficult . Accurate prognosis would enable realistic rehabilitation goal - setting and more efficient allocation of re sources . The aim of this study was to test and refine an algorithm for predicting the potential for recovery of upper limb function after stroke . Forty participants were prospect ively enrolled within 3 days of ischaemic stroke . First ,  shoulder abduction and finger extension strength  were grade d 72 h after stroke onset to compute a shoulder abduction and finger extension score . Secondly , transcranial magnetic stimulation was used to assess the functional integrity of descending motor pathways to the affected upper limb . Third , diffusion-weighted magnetic resonance imaging was used to assess the structural integrity of the posterior limbs of the internal capsules . Finally , these measures were combined in the PREP algorithm for predicting an individual 's potential for upper limb recovery at 12 weeks , measured with the Action Research Arm Test . A cluster analysis was used to independently group patients according to Action Research Arm Test score at 12 weeks , for comparison with predictions from the PREP algorithm . There was excellent correspondence between the cluster analysis of Action Research Arm Test score at 12 weeks and predictions made with the PREP algorithm . The algorithm had positive predictive power of 88 % , negative predictive power of 83 % , specificity of 88 % and sensitivity of 73 % . This study provides preliminary data in support of the PREP algorithm for the prognosis of upper limb recovery in individual patients .  PREP may enable tailored planning of rehabilitation and more accurate stratification of patients in clinical trials UNLABELLED Horn SD , DeJong G , Smout RJ , Gassaway J , James R , Conroy B. Stroke rehabilitation patients , practice , and outcomes : is earlier and more aggressive therapy better ? OBJECTIVE To examine associations of patient characteristics , rehabilitation therapies , neurotropic medications , nutritional support , and timing of initiation of rehabilitation with functional outcomes and discharge destination for inpatient stroke rehabilitation patients . DESIGN Prospect i ve observational cohort study . SETTING Five U.S. inpatient rehabilitation facilities . PARTICIPANTS Post-stroke rehabilitation patients ( N=830 ; age , > 18 y ) with moderate or severe strokes , from the Post-Stroke Rehabilitation Outcomes Project data base . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Discharge total , motor , and cognitive FIM scores and discharge destination . RESULTS Controlling for patient differences , various activities and interventions were associated with better outcomes including earlier initiation of rehabilitation , more time spent per day in higher-level rehabilitation activities such as gait , upper-extremity control , and problem solving , use of newer psychiatric medications , and enteral feeding . Several findings part with conventional practice , such as starting gait training in the first 3 hours of physical therapy , even for low-level patients , was associated with better outcomes . CONCLUSIONS Specific therapy activities and interventions are associated with better outcomes . Earlier re 
    Output:
    