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 compare the effect of visual and kinesthetic locomotor imagery training on walking performance and to determine the clinical feasibility of incorporating auditory step rhythm into the training . Design : R and omized crossover trial . Setting : Laboratory of a Department of Physical Therapy . Subjects : Fifteen subjects with post-stroke hemiparesis . Intervention : Four locomotor imagery trainings on walking performance : visual locomotor imagery training , kinesthetic locomotor imagery training , visual locomotor imagery training with auditory step rhythm and kinesthetic locomotor imagery training with auditory step rhythm . Main outcome measures : The timed up- and -go test and electromyographic and kinematic analyses of the affected lower limb during one gait cycle . Results : After the interventions , significant differences were found in the timed up- and -go test results between the visual locomotor imagery training ( 25.69 ± 16.16 to 23.97 ± 14.30 ) and the kinesthetic locomotor imagery training with auditory step rhythm ( 22.68 ± 12.35 to 15.77 ± 8.58 ) ( P<0.05 ) . During the swing and stance phases , the kinesthetic locomotor imagery training exhibited significantly increased activation in a greater number of muscles and increased angular displacement of the knee and ankle joints compared with the visual locomotor imagery training , and these effects were more prominent when auditory step rhythm was integrated into each form of locomotor imagery training . The activation of the hamstring during the swing phase and the gastrocnemius during the stance phase , as well as kinematic data of the knee joint , were significantly different for posttest values between the visual locomotor imagery training and the kinesthetic locomotor imagery training with auditory step rhythm ( P<0.05 ) . Conclusions : The therapeutic effect may be further enhanced in the kinesthetic locomotor imagery training than in the visual locomotor imagery training . The auditory step rhythm together with the locomotor imagery training produces a greater positive effect in improving the walking performance of patients with post-stroke hemiparesis This r and omized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness . There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements . Imagining h and movements could stimulate restitution and redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to method ological limitations . This r and omized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke ( on average <3 months post-stroke ) . R and omization was performed using an automated statistical minimizing procedure . The primary outcome measure was a blinded rating on the Action Research Arm test . The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week , compared to 31 patients who performed equally intensive non-motor mental rehearsal , and 32 patients receiving normal care without additional training . No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test ( ANCOVA statistical P = 0.77 , and effect size partial η2 = 0.005 ) or any of the secondary outcome measures . Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke . In light of the evidence , it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right Objective : The purpose of this study was to evaluate whether locomotor imagery training leads to clinical improvements in gait after stroke . Design : Pretest — posttest matched control design . Participants : A total of 24 people with chronic hemiparetic stroke ( 13 for experimental and 11 for control ) were recruited in this study . Interventions : The subjects in the experimental group participated in videotape-based locomotor imagery training five days a week for four weeks . They also conducted regular physical therapy . Outcome measures : Kinematic gait parameters were collected using a three-dimensional motion analysis system . Functional gait performance was assessed using clinical measures : Activities-specific Balance Confidence Scale , Berg Balance Test , Dynamic Gait Index and modified Emory Functional Ambulation Profile . Results : After training , walking velocity increased 0.07 ± 0.06 m/s in the experimental group and 0.01 ± 0.07 m/s in the control group . In the experimental group , the affected and less affected limb stride lengths increased by 0.09 ± 0.12 m and 0.10 ± 0.07 m respectively , whereas in the control group they decreased by 0.00 ± 0.04 m and increased by 0.02 ± 0.06 m , respectively . Kinematic parameters in the lower extremity joints during walking were more improved after the training in the experimental group . Confidence in balance , postural control , dynamic balance and performance time for different environmental walking situations were also improved more in the experimental group . Conclusion : Locomotor imagery training can be considered as a useful option for restoration of ambulation for individuals with chronic hemiparetic stroke who are unable to participate in physical gait training OBJECTIVE To determine retention of motor changes 3 months after participation in a regimen consisting of mental practice ( MP ) combined with repetitive task-specific ( RTP ) practice . DESIGN Prospect i ve , blinded , cohort , pre-post study . SETTING Outpatient rehabilitation hospital . PARTICIPANTS Individuals ( N=21 ) in the chronic stage of stroke ( mean age ± SD , 66.1 ± 8.1y ; age range , 56 - 76y ; mean time since stroke at study enrollment , 58.7mo ; range , 13 - 129mo ) exhibiting mild to moderate impairments of h and function . INTERVENTIONS All individuals had been r and omly assigned to receive a 10-week regimen consisting of MP emphasizing paretic upper extremity ( UE ) use during valued activities . Directly after each of these sessions , subjects were administered audiotaped MP . We assessed this group 's paretic UE motor levels before , after , and 3 months after intervention . MAIN OUTCOME MEASURES The UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment ( FM ) , the Action Research Arm Test ( ARAT ) , the Arm Motor Ability Test ( AMAT ) , and the Box and Block Test ( BB ) . RESULTS None of the scores significantly changed from the period directly after intervention to the 3-month posttesting period ( FM : t=.817 ; ARAT : t=.923 ; AMAT : t=.898 , t=.818 , and t=.967 for the Functional Ability , Quality of Movement , and Time scales , respectively ; BB : t=.892 ) . CONCLUSIONS Changes in paretic UE movement realized through MP combined with RTP ( MP + RTP ) participation are retained 3 months after the intervention has concluded . This is the first study examining retention of motor changes after MP + RTP participation , and one of only a few studies examining long retention of motor changes after any intervention targeting stroke-induced hemiparesis Background and Purpose — Although there is strong evidence on the beneficial effects of virtual reality (VR)-based rehabilitation , it is not yet well understood how the different aspects of these systems affect recovery . Consequently , we do not exactly know what features of VR neurorehabilitation systems are decisive in conveying their beneficial effects . Methods — To specifically address this issue , we developed 3 different configurations of the same VR-based rehabilitation system , the Rehabilitation Gaming System , using 3 different interface technologies : vision-based tracking , haptics , and a passive exoskeleton .  Forty-four patients with chronic stroke were r and omly allocated to one of the configurations and used the system for 35 minutes a day for 5 days a week during 4 weeks . Results — Our results revealed significant within-subject improvements at most of the st and ard clinical evaluation scales for all groups . Specifically we observe that the beneficial effects of VR-based training are modulated by the use/nonuse of compensatory movement strategies and the specific sensorimotor contingencies presented to the user , that is , visual feedback versus combined visual haptic feedback . Conclusions — Our findings suggest that the beneficial effects of VR-based neurorehabilitation systems such as the Rehabilitation Gaming System for the treatment of chronic stroke depend on the specific interface systems used . These results have strong implication s for the design of future VR rehabilitation strategies that aim at maximizing functional outcomes and their retention . Clinical Trial Registration — This trial was not registered because it is a small clinical study that evaluates the feasibility of prototype devices Background and Purpose — The epidemiology of stroke in Belarus is unclear . Therefore , a population -based register of stroke was set up in western Belarus to determine incidence and case-fatality in a defined urban population . Methods — The Grodno Stroke Study is a prospect i ve community-based research among 311 134 residents of the city of Grodno , Belarus . St and ard definitions and multiple overlapping sources of ascertainment were used to identify all cases of first-ever-in-a-lifetime strokes in all age groups occurring between January 1 , 2001 , and December 31 , 2003 . Results — During 3 years , 2069 cases of first-ever-in-a-lifetime strokes were registered . Mean age at stroke onset was 65.8±11.6 years ; rate of hospitalization was 89.7 % . The crude annual incidence rate of first-ever-in-a-lifetime strokes for the study period was 222 per 100 000 ( 95 % CI , 212 to 233 ) . Incidence adjusted to the European st and ard population and to the World Health Organization world st and ard population was 287 per 100 000 ( 95 % CI , 274 to 301 ) and 220 per 100 000 ( 95 % CI , 210 to 231 ) , respectively . The 28-day case-fatality rate was 26.1 % . The prevalence of hypertension among all first-ever-in-a-lifetime stroke patients was 87.5 % ; 529 ( 25.6 % ) were current smokers . A total 23.1 % of patients had atrial fibrillation , 19.1 % had past myocardial infa rct ion , 14.7 % had diabetes mellitus , and 22.1 % had hypercholesterolemia . Conclusions — High incidence and case-fatality rates determine the considerable burden of stroke in Belarus and might at least partly be related to the high prevalence of risk factors among the population OBJECTIVE To study the efficacy of mental imagery at promoting relearning for people after a stroke . DESIGN Prospect i ve , r and omized controlled trial . SETTING An inpatient rehabilitation stroke unit in Hong Kong . PARTICIPANTS Forty-six in patients , 60 years of age or older , after a cerebral infa rct ion . INTERVENTIONS Patients were r and omized to receive 15 sessions ( 1 h/d for 3 wk ) of either the mental imagery program or the conventional functional training intervention on the relearning of daily living tasks . MAIN OUTCOME MEASURES Performance of 15 trained and 5 untrained tasks , including household , cooking , and shopping tasks ; and the Fugl-Meyer Assessment and Color Trails Test ( CTT ) . RESULTS Patients engaged in mental imagery-based intervention showed better relearning of both trained and untrained tasks compared with the control group ( trained tasks : P<.005 ; untrained tasks : P<.001 ) . They also demonstrated a greater ability to retain the trained tasks after 1 month and transfer the skills relearned to other untrained tasks ( P<.001 ) . However , among the various ability measures , the mental imagery group showed a significant increase in the CTT scores only after the intervention ( P<.005 ) . CONCLUSIONS Mental imagery can be used as a training strategy to promote the relearning of daily tasks for people after an acute stroke . The imagery process is likely to improve the planning and execution of both the trained and the untrained ( novel ) tasks . The effect of its relearning appears to help patients to retain and generalize the skills and tasks learned in the rehabilitation program Background and Purpose — Modified constraint-induced therapy ( mCIT ) is an outpatient therapy encouraging repetitive , task-specific practice with the affected arm . mCIT has shown efficacy in all stages poststroke . Given its efficacy when combined with other therapy regimens , the current study examined the efficacy of mental practice when combined with mCIT versus mCIT only using r and omized , controlled methods . Method — Ten patients with chronic stroke ( 7 males ; mean age , 61.4±3.02 years ; age range , 48 to 79 years ; mean time since stroke , 28.5 months ; range , 13 to 42 months ) exhibiting stable , affected arm motor deficits were administered mCIT , consisting of : ( 1 ) structured therapy emphasizing affected arm use in functional activities 3 days/week for 10 weeks ; and ( 2 ) less affected arm restraint 5 days/week for 5 hours . Both of these components were administered during a 10-week period . Subjects r and omly assigned to the mCIT+mental practice experimental condition also received 30-minute mental practice sessions provided directly after therapy sessions . These mental practice sessions required daily cognitive rehearsal of the activities of daily living practice d during mCIT clinical sessions . Results — No pre-existing differences were found between groups on any demographic variable or movement scale . All subjects exhibited marked reductions in affected arm impairment and functional limitation . However 
    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 compare the effect of visual and kinesthetic locomotor imagery training on walking performance and to determine the clinical feasibility of incorporating auditory step rhythm into the training . Design : R and omized crossover trial . Setting : Laboratory of a Department of Physical Therapy . Subjects : Fifteen subjects with post-stroke hemiparesis . Intervention : Four locomotor imagery trainings on walking performance : visual locomotor imagery training , kinesthetic locomotor imagery training , visual locomotor imagery training with auditory step rhythm and kinesthetic locomotor imagery training with auditory step rhythm . Main outcome measures : The timed up- and -go test and electromyographic and kinematic analyses of the affected lower limb during one gait cycle . Results : After the interventions , significant differences were found in the timed up- and -go test results between the visual locomotor imagery training ( 25.69 ± 16.16 to 23.97 ± 14.30 ) and the kinesthetic locomotor imagery training with auditory step rhythm ( 22.68 ± 12.35 to 15.77 ± 8.58 ) ( P<0.05 ) . During the swing and stance phases , the kinesthetic locomotor imagery training exhibited significantly increased activation in a greater number of muscles and increased angular displacement of the knee and ankle joints compared with the visual locomotor imagery training , and these effects were more prominent when auditory step rhythm was integrated into each form of locomotor imagery training . The activation of the hamstring during the swing phase and the gastrocnemius during the stance phase , as well as kinematic data of the knee joint , were significantly different for posttest values between the visual locomotor imagery training and the kinesthetic locomotor imagery training with auditory step rhythm ( P<0.05 ) . Conclusions : The therapeutic effect may be further enhanced in the kinesthetic locomotor imagery training than in the visual locomotor imagery training . The auditory step rhythm together with the locomotor imagery training produces a greater positive effect in improving the walking performance of patients with post-stroke hemiparesis This r and omized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness . There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements . Imagining h and movements could stimulate restitution and redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to method ological limitations . This r and omized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke ( on average <3 months post-stroke ) . R and omization was performed using an automated statistical minimizing procedure . The primary outcome measure was a blinded rating on the Action Research Arm test . The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week , compared to 31 patients who performed equally intensive non-motor mental rehearsal , and 32 patients receiving normal care without additional training . No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test ( ANCOVA statistical P = 0.77 , and effect size partial η2 = 0.005 ) or any of the secondary outcome measures . Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke . In light of the evidence , it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right Objective : The purpose of this study was to evaluate whether locomotor imagery training leads to clinical improvements in gait after stroke . Design : Pretest — posttest matched control design . Participants : A total of 24 people with chronic hemiparetic stroke ( 13 for experimental and 11 for control ) were recruited in this study . Interventions : The subjects in the experimental group participated in videotape-based locomotor imagery training five days a week for four weeks . They also conducted regular physical therapy . Outcome measures : Kinematic gait parameters were collected using a three-dimensional motion analysis system . Functional gait performance was assessed using clinical measures : Activities-specific Balance Confidence Scale , Berg Balance Test , Dynamic Gait Index and modified Emory Functional Ambulation Profile . Results : After training , walking velocity increased 0.07 ± 0.06 m/s in the experimental group and 0.01 ± 0.07 m/s in the control group . In the experimental group , the affected and less affected limb stride lengths increased by 0.09 ± 0.12 m and 0.10 ± 0.07 m respectively , whereas in the control group they decreased by 0.00 ± 0.04 m and increased by 0.02 ± 0.06 m , respectively . Kinematic parameters in the lower extremity joints during walking were more improved after the training in the experimental group . Confidence in balance , postural control , dynamic balance and performance time for different environmental walking situations were also improved more in the experimental group . Conclusion : Locomotor imagery training can be considered as a useful option for restoration of ambulation for individuals with chronic hemiparetic stroke who are unable to participate in physical gait training OBJECTIVE To determine retention of motor changes 3 months after participation in a regimen consisting of mental practice ( MP ) combined with repetitive task-specific ( RTP ) practice . DESIGN Prospect i ve , blinded , cohort , pre-post study . SETTING Outpatient rehabilitation hospital . PARTICIPANTS Individuals ( N=21 ) in the chronic stage of stroke ( mean age ± SD , 66.1 ± 8.1y ; age range , 56 - 76y ; mean time since stroke at study enrollment , 58.7mo ; range , 13 - 129mo ) exhibiting mild to moderate impairments of h and function . INTERVENTIONS All individuals had been r and omly assigned to receive a 10-week regimen consisting of MP emphasizing paretic upper extremity ( UE ) use during valued activities . Directly after each of these sessions , subjects were administered audiotaped MP . We assessed this group 's paretic UE motor levels before , after , and 3 months after intervention . MAIN OUTCOME MEASURES The UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment ( FM ) , the Action Research Arm Test ( ARAT ) , the Arm Motor Ability Test ( AMAT ) , and the Box and Block Test ( BB ) . RESULTS None of the scores significantly changed from the period directly after intervention to the 3-month posttesting period ( FM : t=.817 ; ARAT : t=.923 ; AMAT : t=.898 , t=.818 , and t=.967 for the Functional Ability , Quality of Movement , and Time scales , respectively ; BB : t=.892 ) . CONCLUSIONS Changes in paretic UE movement realized through MP combined with RTP ( MP + RTP ) participation are retained 3 months after the intervention has concluded . This is the first study examining retention of motor changes after MP + RTP participation , and one of only a few studies examining long retention of motor changes after any intervention targeting stroke-induced hemiparesis Background and Purpose — Although there is strong evidence on the beneficial effects of virtual reality (VR)-based rehabilitation , it is not yet well understood how the different aspects of these systems affect recovery . Consequently , we do not exactly know what features of VR neurorehabilitation systems are decisive in conveying their beneficial effects . Methods — To specifically address this issue , we developed 3 different configurations of the same VR-based rehabilitation system , the Rehabilitation Gaming System , using 3 different interface technologies : vision-based tracking , haptics , and a passive exoskeleton .  Forty-four patients with chronic stroke were r and omly allocated to one of the configurations and used the system for 35 minutes a day for 5 days a week during 4 weeks . Results — Our results revealed significant within-subject improvements at most of the st and ard clinical evaluation scales for all groups . Specifically we observe that the beneficial effects of VR-based training are modulated by the use/nonuse of compensatory movement strategies and the specific sensorimotor contingencies presented to the user , that is , visual feedback versus combined visual haptic feedback . Conclusions — Our findings suggest that the beneficial effects of VR-based neurorehabilitation systems such as the Rehabilitation Gaming System for the treatment of chronic stroke depend on the specific interface systems used . These results have strong implication s for the design of future VR rehabilitation strategies that aim at maximizing functional outcomes and their retention . Clinical Trial Registration — This trial was not registered because it is a small clinical study that evaluates the feasibility of prototype devices Background and Purpose — The epidemiology of stroke in Belarus is unclear . Therefore , a population -based register of stroke was set up in western Belarus to determine incidence and case-fatality in a defined urban population . Methods — The Grodno Stroke Study is a prospect i ve community-based research among 311 134 residents of the city of Grodno , Belarus . St and ard definitions and multiple overlapping sources of ascertainment were used to identify all cases of first-ever-in-a-lifetime strokes in all age groups occurring between January 1 , 2001 , and December 31 , 2003 . Results — During 3 years , 2069 cases of first-ever-in-a-lifetime strokes were registered . Mean age at stroke onset was 65.8±11.6 years ; rate of hospitalization was 89.7 % . The crude annual incidence rate of first-ever-in-a-lifetime strokes for the study period was 222 per 100 000 ( 95 % CI , 212 to 233 ) . Incidence adjusted to the European st and ard population and to the World Health Organization world st and ard population was 287 per 100 000 ( 95 % CI , 274 to 301 ) and 220 per 100 000 ( 95 % CI , 210 to 231 ) , respectively . The 28-day case-fatality rate was 26.1 % . The prevalence of hypertension among all first-ever-in-a-lifetime stroke patients was 87.5 % ; 529 ( 25.6 % ) were current smokers . A total 23.1 % of patients had atrial fibrillation , 19.1 % had past myocardial infa rct ion , 14.7 % had diabetes mellitus , and 22.1 % had hypercholesterolemia . Conclusions — High incidence and case-fatality rates determine the considerable burden of stroke in Belarus and might at least partly be related to the high prevalence of risk factors among the population OBJECTIVE To study the efficacy of mental imagery at promoting relearning for people after a stroke . DESIGN Prospect i ve , r and omized controlled trial . SETTING An inpatient rehabilitation stroke unit in Hong Kong . PARTICIPANTS Forty-six in patients , 60 years of age or older , after a cerebral infa rct ion . INTERVENTIONS Patients were r and omized to receive 15 sessions ( 1 h/d for 3 wk ) of either the mental imagery program or the conventional functional training intervention on the relearning of daily living tasks . MAIN OUTCOME MEASURES Performance of 15 trained and 5 untrained tasks , including household , cooking , and shopping tasks ; and the Fugl-Meyer Assessment and Color Trails Test ( CTT ) . RESULTS Patients engaged in mental imagery-based intervention showed better relearning of both trained and untrained tasks compared with the control group ( trained tasks : P<.005 ; untrained tasks : P<.001 ) . They also demonstrated a greater ability to retain the trained tasks after 1 month and transfer the skills relearned to other untrained tasks ( P<.001 ) . However , among the various ability measures , the mental imagery group showed a significant increase in the CTT scores only after the intervention ( P<.005 ) . CONCLUSIONS Mental imagery can be used as a training strategy to promote the relearning of daily tasks for people after an acute stroke . The imagery process is likely to improve the planning and execution of both the trained and the untrained ( novel ) tasks . The effect of its relearning appears to help patients to retain and generalize the skills and tasks learned in the rehabilitation program Background and Purpose — Modified constraint-induced therapy ( mCIT ) is an outpatient therapy encouraging repetitive , task-specific practice with the affected arm . mCIT has shown efficacy in all stages poststroke . Given its efficacy when combined with other therapy regimens , the current study examined the efficacy of mental practice when combined with mCIT versus mCIT only using r and omized , controlled methods . Method — Ten patients with chronic stroke ( 7 males ; mean age , 61.4±3.02 years ; age range , 48 to 79 years ; mean time since stroke , 28.5 months ; range , 13 to 42 months ) exhibiting stable , affected arm motor deficits were administered mCIT , consisting of : ( 1 ) structured therapy emphasizing affected arm use in functional activities 3 days/week for 10 weeks ; and ( 2 ) less affected arm restraint 5 days/week for 5 hours . Both of these components were administered during a 10-week period . Subjects r and omly assigned to the mCIT+mental practice experimental condition also received 30-minute mental practice sessions provided directly after therapy sessions . These mental practice sessions required daily cognitive rehearsal of the activities of daily living practice d during mCIT clinical sessions . Results — No pre-existing differences were found between groups on any demographic variable or movement scale . All subjects exhibited marked reductions in affected arm impairment and functional limitation . However 
    Output:
    