human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND PURPOSE Arm function recovery is notoriously poor in stroke patients . The effect of treatment modalities , particularly those directed at improving upper limb function , has been studied primarily in chronic stroke patients . The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke . METHODS In a single-blind , r and omized , controlled multicenter trial , 100 consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group . The intervention was applied for 6 weeks . Patients were evaluated for level of impairment ( Brunnström-Fugl-Meyer test ) and disability ( Action Research Arm test , Barthel Index ) before , midway , and after the intervention period and at follow-up 6 and 12 months after stroke . RESULTS Patients in the experimental group performed better on the Brunnström-Fugl-Meyer test than those in the control group throughout the study period , but differences were significant only at follow-up . Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability . The effect of the therapy was attributed to the repetitive stimulation of muscle activity . The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention . No adverse effects due to the intervention were found . CONCLUSIONS Adding a specific intervention during the acute phase after stroke improved motor recovery , which was apparent 1 year later . These results emphasize the potential beneficial effect of therapeutic interventions for the arm Objective : To investigate whether additional early physiotherapy after stroke improved functional recovery in stroke patients . Design : A prospect i ve , r and omized , controlled study . Setting : One stroke ward and an acute stroke unit in a large teaching hospital , southern China . Subjects : Patients with first-onset stroke consecutively admitted to the stroke centre . Interventions : One group ( n = 78 ) received additional early physiotherapy ( AEP ) for 45 minutes , five days a week for four weeks starting within the first week since stroke onset ; the routine therapy ( RT ) group ( n = 78 ) received no professional rehabilitation therapy . Main outcome measures : Glasgow Coma Scale , Mini-Mental State Examination , Fugl-Meyer Assessment of Motor Recovery , Clinical Neurological Deficit Scale and Modified Barthel Index ( MBI ) . Results : Patients from the AEP group had a high drop-out rate ( n = 28 ) , but those remaining made relatively better functional recovery at 30 days than those from the RT group if measured by MBI . Multiple linear regression analysis revealed that cognitive disturbance , aphasia , double incontinence , site of lesion and sensory impairment might affect functional recovery after stroke . Conclusions : Additional early physiotherapy might improve independence of patients after stroke but failed to show benefit in other aspects in our study . Cognitive disturbance , aphasia , double incontinence , site of lesion as well as sensory impairment might affect functional outcome after stroke BACKGROUND Community physiotherapy is often prescribed for stroke patients with long-term mobility problems . We aim ed to assess the effectiveness of this treatment in patients who had mobility problems 1 year after stroke . METHODS We screened 359 patients older than 50 years for a single-masked , r and omised controlled trial to assess the effects of community physiotherapy . Assessment s were made at baseline , 3 , 6 , and 9 months in 170 eligible patients assigned treatment or no intervention . The primary outcome measure was mobility measured by the Rivermead mobility index . Secondary outcome measures were gait speed , number of falls , daily activity ( Barthel index scores ) , social activity ( Frenchay activities index ) , hospital anxiety and depression scale , and emotional stress of carers ( general health question naire 28 ) . Analyses were by intention to treat . FINDINGS Follow-up was available for 146 patients ( 86 % ) . Changes in scores on the Rivermead mobility index ( score range 0 - 15 ) differed significantly between treatment and control groups at 3 months ( p=0.018 ) , but only by a median of 1 point ( 95 % CI 0 - 1 ) , with an interpolated value of 0.55 ( 0.08 - 1.04 ) . Gait speed was 2.6 m/min ( 0.30 - 4.95 ) higher in the treatment group at 3 months . Neither treatment effect persisted at 6-months ' and 9-months ' follow-up . Treatment had no effect on patients ' daily activity , social activity , anxiety , depression , and number of falls , or on emotional stress of carers . INTERPRETATION Community physiotherapy treatment for patients with mobility problems 1 year after stroke leads to significant , but clinical ly small , improvements in mobility and gait speed that are not sustained after treatment ends BACKGROUND AND PURPOSE The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams . Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this results . Physiotherapy is one component of most rehabilitation teams and recent systematic review s have shown that patients with stroke receiving more physiotherapy  achieve more recovery from disability . However , information about the actual amounts of physiotherapy needed to achieve this result is not known . METHOD A pragmatic , r and omized , single-blind , controlled trial comparing recovery from disability in subjects receiving the current st and ard amount of 30 minutes ' physiotherapy with those receiving double that amount ( 60 minutes ) . The study included measures of physical performance and function , psychological aspects of anxiety and depression , and perceived control over recovery . RESULTS Some 114 subjects were recruited to the study ; full six-week data are available for 104 subjects and six-month data for 93 subjects . Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference . Scrutiny of the recovery curves of the whole sample showed that , in half the sample , three distinct patterns of recovery were demonstrated . CONCLUSION These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients . The subgroup analysis of patterns of recovery must be regarded as speculative , but provides the basis for hypotheses about those likely to respond well to more intensive therapy Objective : To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome . Design : A r and omized controlled trial . Setting : A stroke unit which provides acute care and rehabilitation for all stroke admissions . Subjects : One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days . Intervention : The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist , commencing within 10 days of stroke , and available up to 30 minutes/day , five days/week for six weeks . The control group received stroke unit care . Main outcome measures : The primary outcome measure was the Action Research Arm Test ( ARAT ) three months after stroke . Secondary outcome measures : Motricity Index ; Frenchay Arm Test ; upper limb pain ; Barthel ADL Index ; Nottingham E-ADL Scale ; and costs to health and social services at three and six months after stroke . Results : There were no differences in outcomes between the intervention and control groups three and six months after stroke . During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as in patients . The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group ( p = 0.001 ) . There were no differences in service costs . Conclusions : An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke . The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias The effectiveness of ongoing rehabilitation services for postacute stroke survivors is poorly documented . We design ed a r and omized control , single-blinded study to demonstrate the effectiveness of intensive outpatient therapy . The treatment intervention consisted of 1 hr each of physical and occupational therapy , four times per week , for 12 wk ; therapy focused on neuromuscular facilitation and functional tasks . All subjects were screened before the therapies and after 3 mo and 9 mo . Forty-nine stroke survivors , who were at least l yr ( mean , 2.9 yr ) poststroke , were r and omized with two treated patients to each control ( no treatment supplied ) . All patients had received inpatient rehabilitation at the time of their acute stroke , but no patient had any ongoing therapy  within the last 6 mo . The outcome measures included the Functional Independence Measure ( FIM ) , Brunnstrom stages of motor recovery , timed mobility tasks , and the Jebson h and evaluation . We also evaluated the level of depression , self-esteem , and socialization . The treated patients demonstrated an improvement of 6.6 points over the 3 mo of therapy compared with only 1.5 points in the control group in the FIM motor score transformed using Rasch analysis . The change from time 0 to 3 mo was significant in the treated group but not in the controls . Treated patients maintained their gains at the 9-mo follow-up , and controls lost ground . The treated group improved in terms of socialization and self-esteem as evidence d by a lower Sickness Impact Profile , whereas the controls tended to get worse . There was a trend toward less depression , but this did not reach a P = 0.05 level of significance . This study demonstrates that significant functional gains can still be attained in the postacute stroke survivor , despite prior inpatient rehabilitation services Of the 373 stroke patients 95 were admitted to the feasibility study of stroke rehabilitation . The patients were divided into two groups , an intensive and a normal treatment group . In this study , the functional recovery of stroke , measured by ADL and motor function was significantly better in the intensive treatment group . There was no difference in institutionalization or incidence of death between the groups . The gain of ADL and motor function was greatest during the first three months after stroke in the intensive treatment group . The conclusion is that intensified physiotherapy seems to improve the functional recovery of stroke patients Background and Purpose — Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke , with follow-ups at a maximum of 12 months . The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke . Subjects and Methods — One hundred consecutive stroke patients were r and omly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group . The intervention period was 6 weeks . Assessment s of the patients were made before , midway , and after intervention , and at 6 and 12 months after stroke . In this study , 62 patients were reassessed at 5 years after stroke . The Brunnström-Fugl-Meyer ( BFM ) test , Action Research Arm ( ARA ) test , and Barthel index ( BI ) were used as the primary outcome measures . Results — At the 5-year follow-up , there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group . The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA . No effect was found for the BI . The treatment was most effective in patients with a severe initial motor deficit . Conclusions — Adding a specific intervention for the arm during the acute phase after a stroke result ed in a clinical ly meaningful and long-lasting effect on motor function . The effect can be attributed to early , repetitive , and targeted stimulation Ninety seven patients with stroke who had participated in a r and omised trial of conventional physical therapy nu an enhanced therapy for arm function were followed up at one year . Despite the emphasis of the enhanced therapy approach on continued use of the arm in everyday life , the advantage seen for some patients with enhanced therapy at six months after stroke had diminished to a non-significant trend by one year . This was due to some late improvement in the conventional therapy group whereas the enhanced therapy group remained static or fell back slightly . It is recommended that trials should be conducted comparing very intensive therapy for the arm with controls without treatment . This would provide a model of the effects of therapy on intrinsic neural recovery that would be relevant to all areas of neurological rehabilitation Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia . A detailed study was carried out of recovery of arm function after acute stroke , and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning . In a single-blind r and omised trial , 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups . At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength , range and speed of movement . This effect seemed concentrated amongst those who had a milder initial impairment . More work is needed to discover the reasons for this improved recovery , and whether further development of this therapeutic approach might offer clinical ly significant gains for some patients BACKGROUND AND PURPOSE Many patients have impaired arm function after stroke , for which they receive physiotherapy . The aim of the study was to determine whether increasing the amount of physiotherapy early after stroke improved the recovery of arm function and to compare the effects of this therapy when administered by a qualified therapist or a trained , supervised assistant . The physiotherapy followed a typical British approach , which is Bobath derived . Ten hours of additional therapy were given over a 5-week period . METHODS The study design was a single-blind , r and omized , controlled trial . Stroke patients were recruited from those admitted to the hospital in the 5 weeks after stroke . They 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND PURPOSE Arm function recovery is notoriously poor in stroke patients . The effect of treatment modalities , particularly those directed at improving upper limb function , has been studied primarily in chronic stroke patients . The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke . METHODS In a single-blind , r and omized , controlled multicenter trial , 100 consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group . The intervention was applied for 6 weeks . Patients were evaluated for level of impairment ( Brunnström-Fugl-Meyer test ) and disability ( Action Research Arm test , Barthel Index ) before , midway , and after the intervention period and at follow-up 6 and 12 months after stroke . RESULTS Patients in the experimental group performed better on the Brunnström-Fugl-Meyer test than those in the control group throughout the study period , but differences were significant only at follow-up . Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability . The effect of the therapy was attributed to the repetitive stimulation of muscle activity . The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention . No adverse effects due to the intervention were found . CONCLUSIONS Adding a specific intervention during the acute phase after stroke improved motor recovery , which was apparent 1 year later . These results emphasize the potential beneficial effect of therapeutic interventions for the arm Objective : To investigate whether additional early physiotherapy after stroke improved functional recovery in stroke patients . Design : A prospect i ve , r and omized , controlled study . Setting : One stroke ward and an acute stroke unit in a large teaching hospital , southern China . Subjects : Patients with first-onset stroke consecutively admitted to the stroke centre . Interventions : One group ( n = 78 ) received additional early physiotherapy ( AEP ) for 45 minutes , five days a week for four weeks starting within the first week since stroke onset ; the routine therapy ( RT ) group ( n = 78 ) received no professional rehabilitation therapy . Main outcome measures : Glasgow Coma Scale , Mini-Mental State Examination , Fugl-Meyer Assessment of Motor Recovery , Clinical Neurological Deficit Scale and Modified Barthel Index ( MBI ) . Results : Patients from the AEP group had a high drop-out rate ( n = 28 ) , but those remaining made relatively better functional recovery at 30 days than those from the RT group if measured by MBI . Multiple linear regression analysis revealed that cognitive disturbance , aphasia , double incontinence , site of lesion and sensory impairment might affect functional recovery after stroke . Conclusions : Additional early physiotherapy might improve independence of patients after stroke but failed to show benefit in other aspects in our study . Cognitive disturbance , aphasia , double incontinence , site of lesion as well as sensory impairment might affect functional outcome after stroke BACKGROUND Community physiotherapy is often prescribed for stroke patients with long-term mobility problems . We aim ed to assess the effectiveness of this treatment in patients who had mobility problems 1 year after stroke . METHODS We screened 359 patients older than 50 years for a single-masked , r and omised controlled trial to assess the effects of community physiotherapy . Assessment s were made at baseline , 3 , 6 , and 9 months in 170 eligible patients assigned treatment or no intervention . The primary outcome measure was mobility measured by the Rivermead mobility index . Secondary outcome measures were gait speed , number of falls , daily activity ( Barthel index scores ) , social activity ( Frenchay activities index ) , hospital anxiety and depression scale , and emotional stress of carers ( general health question naire 28 ) . Analyses were by intention to treat . FINDINGS Follow-up was available for 146 patients ( 86 % ) . Changes in scores on the Rivermead mobility index ( score range 0 - 15 ) differed significantly between treatment and control groups at 3 months ( p=0.018 ) , but only by a median of 1 point ( 95 % CI 0 - 1 ) , with an interpolated value of 0.55 ( 0.08 - 1.04 ) . Gait speed was 2.6 m/min ( 0.30 - 4.95 ) higher in the treatment group at 3 months . Neither treatment effect persisted at 6-months ' and 9-months ' follow-up . Treatment had no effect on patients ' daily activity , social activity , anxiety , depression , and number of falls , or on emotional stress of carers . INTERPRETATION Community physiotherapy treatment for patients with mobility problems 1 year after stroke leads to significant , but clinical ly small , improvements in mobility and gait speed that are not sustained after treatment ends BACKGROUND AND PURPOSE The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams . Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this results . Physiotherapy is one component of most rehabilitation teams and recent systematic review s have shown that patients with stroke receiving more physiotherapy  achieve more recovery from disability . However , information about the actual amounts of physiotherapy needed to achieve this result is not known . METHOD A pragmatic , r and omized , single-blind , controlled trial comparing recovery from disability in subjects receiving the current st and ard amount of 30 minutes ' physiotherapy with those receiving double that amount ( 60 minutes ) . The study included measures of physical performance and function , psychological aspects of anxiety and depression , and perceived control over recovery . RESULTS Some 114 subjects were recruited to the study ; full six-week data are available for 104 subjects and six-month data for 93 subjects . Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference . Scrutiny of the recovery curves of the whole sample showed that , in half the sample , three distinct patterns of recovery were demonstrated . CONCLUSION These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients . The subgroup analysis of patterns of recovery must be regarded as speculative , but provides the basis for hypotheses about those likely to respond well to more intensive therapy Objective : To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome . Design : A r and omized controlled trial . Setting : A stroke unit which provides acute care and rehabilitation for all stroke admissions . Subjects : One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days . Intervention : The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist , commencing within 10 days of stroke , and available up to 30 minutes/day , five days/week for six weeks . The control group received stroke unit care . Main outcome measures : The primary outcome measure was the Action Research Arm Test ( ARAT ) three months after stroke . Secondary outcome measures : Motricity Index ; Frenchay Arm Test ; upper limb pain ; Barthel ADL Index ; Nottingham E-ADL Scale ; and costs to health and social services at three and six months after stroke . Results : There were no differences in outcomes between the intervention and control groups three and six months after stroke . During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as in patients . The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group ( p = 0.001 ) . There were no differences in service costs . Conclusions : An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke . The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias The effectiveness of ongoing rehabilitation services for postacute stroke survivors is poorly documented . We design ed a r and omized control , single-blinded study to demonstrate the effectiveness of intensive outpatient therapy . The treatment intervention consisted of 1 hr each of physical and occupational therapy , four times per week , for 12 wk ; therapy focused on neuromuscular facilitation and functional tasks . All subjects were screened before the therapies and after 3 mo and 9 mo . Forty-nine stroke survivors , who were at least l yr ( mean , 2.9 yr ) poststroke , were r and omized with two treated patients to each control ( no treatment supplied ) . All patients had received inpatient rehabilitation at the time of their acute stroke , but no patient had any ongoing therapy  within the last 6 mo . The outcome measures included the Functional Independence Measure ( FIM ) , Brunnstrom stages of motor recovery , timed mobility tasks , and the Jebson h and evaluation . We also evaluated the level of depression , self-esteem , and socialization . The treated patients demonstrated an improvement of 6.6 points over the 3 mo of therapy compared with only 1.5 points in the control group in the FIM motor score transformed using Rasch analysis . The change from time 0 to 3 mo was significant in the treated group but not in the controls . Treated patients maintained their gains at the 9-mo follow-up , and controls lost ground . The treated group improved in terms of socialization and self-esteem as evidence d by a lower Sickness Impact Profile , whereas the controls tended to get worse . There was a trend toward less depression , but this did not reach a P = 0.05 level of significance . This study demonstrates that significant functional gains can still be attained in the postacute stroke survivor , despite prior inpatient rehabilitation services Of the 373 stroke patients 95 were admitted to the feasibility study of stroke rehabilitation . The patients were divided into two groups , an intensive and a normal treatment group . In this study , the functional recovery of stroke , measured by ADL and motor function was significantly better in the intensive treatment group . There was no difference in institutionalization or incidence of death between the groups . The gain of ADL and motor function was greatest during the first three months after stroke in the intensive treatment group . The conclusion is that intensified physiotherapy seems to improve the functional recovery of stroke patients Background and Purpose — Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke , with follow-ups at a maximum of 12 months . The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke . Subjects and Methods — One hundred consecutive stroke patients were r and omly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group . The intervention period was 6 weeks . Assessment s of the patients were made before , midway , and after intervention , and at 6 and 12 months after stroke . In this study , 62 patients were reassessed at 5 years after stroke . The Brunnström-Fugl-Meyer ( BFM ) test , Action Research Arm ( ARA ) test , and Barthel index ( BI ) were used as the primary outcome measures . Results — At the 5-year follow-up , there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group . The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA . No effect was found for the BI . The treatment was most effective in patients with a severe initial motor deficit . Conclusions — Adding a specific intervention for the arm during the acute phase after a stroke result ed in a clinical ly meaningful and long-lasting effect on motor function . The effect can be attributed to early , repetitive , and targeted stimulation Ninety seven patients with stroke who had participated in a r and omised trial of conventional physical therapy nu an enhanced therapy for arm function were followed up at one year . Despite the emphasis of the enhanced therapy approach on continued use of the arm in everyday life , the advantage seen for some patients with enhanced therapy at six months after stroke had diminished to a non-significant trend by one year . This was due to some late improvement in the conventional therapy group whereas the enhanced therapy group remained static or fell back slightly . It is recommended that trials should be conducted comparing very intensive therapy for the arm with controls without treatment . This would provide a model of the effects of therapy on intrinsic neural recovery that would be relevant to all areas of neurological rehabilitation Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia . A detailed study was carried out of recovery of arm function after acute stroke , and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning . In a single-blind r and omised trial , 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups . At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength , range and speed of movement . This effect seemed concentrated amongst those who had a milder initial impairment . More work is needed to discover the reasons for this improved recovery , and whether further development of this therapeutic approach might offer clinical ly significant gains for some patients BACKGROUND AND PURPOSE Many patients have impaired arm function after stroke , for which they receive physiotherapy . The aim of the study was to determine whether increasing the amount of physiotherapy early after stroke improved the recovery of arm function and to compare the effects of this therapy when administered by a qualified therapist or a trained , supervised assistant . The physiotherapy followed a typical British approach , which is Bobath derived . Ten hours of additional therapy were given over a 5-week period . METHODS The study design was a single-blind , r and omized , controlled trial . Stroke patients were recruited from those admitted to the hospital in the 5 weeks after stroke . They 
    Output:
    