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 — The Motor Activity Log ( MAL ) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and h and ( amount of use [ AOU ] ) and quality of movement [ QOM ] ) during activities of daily living . Scores range from 0 to 5 . The following clinimetric properties of the MAL were quantified : internal consistency ( Cronbach α ) , test – retest agreement ( Bl and and Altman method ) , cross-sectional construct validity ( correlation between AOU and QOM and with the Action Research Arm [ ARA ] test ) , longitudinal construct validity ( correlation of change on the MAL during the intervention with a global change rating [ GCR ] and with change on the ARA ) , and responsiveness ( effect size ) . Methods — Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm ( forced use ) were performed in 56 chronic stroke patients . Results — Internal consistency was high ( AOU : α=0.88 ; QOM : α=0.91 ) . The limits of agreement were −0.70 to 0.85 and −0.61 to 0.71 for AOU and QOM , respectively . The correlation with the ARA score ( Spearman ρ ) was 0.63 ( AOU and QOM ) . However , the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA , Spearman ρ was between 0.16 and 0.22 . The responsiveness ratio was 1.9 ( AOU ) and 2.0 ( QOM ) . Conclusion — The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention . The cross-sectional construct validity of the MAL is reasonable , but the results raise doubt about its longitudinal construct validity BACKGROUND Effective rehabilitative therapies are needed for patients with long-term deficits after stroke . METHODS In this multicenter , r and omized , controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke , we r and omly assigned 49 patients to receive intensive robot-assisted therapy  , 50 to receive intensive comparison therapy , and 28 to receive usual care . Therapy consisted of 36 1-hour sessions over a period of 12 weeks . The primary outcome was a change in motor function , as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke , at 12 weeks . Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale . Secondary analyses assessed the treatment effect at 36 weeks . RESULTS At 12 weeks , the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care ( difference , 2.17 points ; 95 % confidence interval [ CI ] , -0.23 to 4.58 ) and worse than that for patients receiving intensive comparison therapy ( difference , -0.14 points ; 95 % CI , -2.94 to 2.65 ) , but the differences were not significant . The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care ( difference , 7.64 points ; 95 % CI , 2.03 to 13.24 ) . No other treatment comparisons were significant at 12 weeks . Secondary analyses showed that at 36 weeks , robot-assisted therapy significantly improved the Fugl-Meyer score ( difference , 2.88 points ; 95 % CI , 0.57 to 5.18 ) and the time on the Wolf Motor Function Test ( difference , -8.10 seconds ; 95 % CI , -13.61 to -2.60 ) as compared with usual care but not with intensive therapy . No serious adverse events were reported . CONCLUSIONS In patients with long-term upper-limb deficits after stroke , robot-assisted therapy did not significantly improve motor function at 12 weeks , as compared with usual care or intensive therapy . In secondary analyses , robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy . ( Clinical Trials.gov number , NCT00372411 . Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach 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 This r and omized , controlled , multisite Department of Veterans Affairs clinical trial assessed robot-assisted ( RA ) upper-limb therapy with the Mirror Image Movement Enabler ( MIME ) in the acute stroke rehabilitation setting . Hemiparetic subjects ( n = 54 ) received RA therapy using MIME for either up to 15 hours ( low-dose ) or 30 hours ( high-dose ) or received up to 15 hours of additional conventional therapy in addition to usual care ( control ) . The primary outcome measure was the Fugl-Meyer Assessment ( FMA ) . The secondary outcome measures were the Functional Independence Measure ( FIM ) , Wolf Motor Function Test , Motor Power , and Ashworth scores at intake , discharge , and 6-month follow-up . Mean duration of study treatment was 8.6 , 15.8 , and 9.4 hours for the low-dose , high-dose , and control groups , respectively . Gains in the primary outcome measure were not significantly different between groups at follow-up . Significant correlations were found at discharge between FMA gains and the dose and intensity of RA . Intensity also correlated with FMA gain at 6 months . The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months . As used during acute rehabilitation , motor-control changes at follow-up were no less with MIME than with additional conventional therapy . Intensity of training with MIME was positively correlated with motor-control gains Background and purpose There is little evidence available on the use of robot-assisted therapy in subacute stroke patients . A r and omized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset . Methods Fifty-three subacute stroke patients at their first-ever stroke were enrolled 30 ± 7 days after the acute event and r and omized into two groups , both exposed to st and ard therapy . Additional 30 sessions of robot-assisted therapy were provided to the Experimental Group . Additional 30 sessions of usual therapy were provided to the Control Group . The following impairment evaluations were performed at the beginning ( T0 ) , after 15 sessions ( T1 ) , and at the end of the treatment ( T2 ) : Fugl-Meyer Assessment Scale ( FM ) , Modified Ashworth Scale-Shoulder ( MAS-S ) , Modified Ashworth Scale-Elbow ( MAS-E ) , Total Passive Range of Motion-Shoulder/Elbow ( pROM ) , and Motricity Index ( MI ) . Results Evidence of significant improvements in MAS-S ( p = 0.004 ) , MAS-E ( p = 0.018 ) and pROM ( p < 0.0001 ) was found in the Experimental Group . Significant improvement was demonstrated in both Experimental and Control Group in FM ( EG : p < 0.0001 , CG : p < 0.0001 ) and MI ( EG : p < 0.0001 , CG : p < 0.0001 ) , with an higher improvement in the Experimental Group . Conclusions Robot-assisted upper limb rehabilitation treatment can contribute to increasing motor recovery in subacute stroke patients . Focusing on the early phase of stroke recovery has a high potential impact in clinical practice OBJECTIVE To compare the effects of robot-assisted movement training with conventional techniques for the rehabilitation of upper-limb motor function after stroke . DESIGN R and omized controlled trial , 6-month follow-up . SETTING A Department of Veterans Affairs rehabilitation research and development center . PARTICIPANTS Consecutive sample of 27 subjects with chronic hemiparesis ( > 6mo after cerebrovascular accident ) r and omly allocated to group . INTERVENTIONS All subjects received twenty-four 1-hour sessions over 2 months . Subjects in the robot group practice d shoulder and elbow movements while assisted by a robot manipulator . Subjects in the control group received neurodevelopmental therapy ( targeting proximal upper limb function ) and 5 minutes of exposure to the robot in each session . MAIN OUTCOME MEASURES Fugl-Meyer assessment of motor impairment , FIMtrade mark instrument , and biomechanic measures of strength and reaching kinematics . Clinical evaluations were performed by a therapist blinded to group assignments . RESULTS Compared with the control group , the robot group had larger improvements in the proximal movement portion of the Fugl-Meyer test after 1 month of treatment ( P<.05 ) and also after 2 months of treatment ( P<.05 ) . The robot group had larger gains in strength ( P<.02 ) and larger increases in reach extent ( P<.01 ) after 2 months of treatment . At the 6-month follow-up , the groups no longer differed in terms of the Fugl-Meyer test ( P>.30 ) ; however , the robot group had larger improvements in the FIM ( P<.04 ) . CONCLUSIONS Compared with conventional treatment , robot-assisted movements had advantages in terms of clinical and biomechanical measures . Further research into the use of robotic manipulation for motor rehabilitation is justified The successful motor rehabilitation of stroke patients requires early intensive and task-specific therapy . A recent Cochrane Review , although based on a limited number of r and omized controlled trials ( RCTs ) , showed that early robotic training of the upper limb ( i.e. , during acute or subacute phase ) can enhance motor learning and improve functional abilities more than chronic-phase training . In this article , a new subacute-phase RCT with the Neuro-Rehabilitation-roBot ( NeReBot ) is presented . While in our first study we used the NeReBot in addition to conventional therapy , in this new trial we used the same device in substitution of st and ard proximal upper-limb 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: Background and Purpose — The Motor Activity Log ( MAL ) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and h and ( amount of use [ AOU ] ) and quality of movement [ QOM ] ) during activities of daily living . Scores range from 0 to 5 . The following clinimetric properties of the MAL were quantified : internal consistency ( Cronbach α ) , test – retest agreement ( Bl and and Altman method ) , cross-sectional construct validity ( correlation between AOU and QOM and with the Action Research Arm [ ARA ] test ) , longitudinal construct validity ( correlation of change on the MAL during the intervention with a global change rating [ GCR ] and with change on the ARA ) , and responsiveness ( effect size ) . Methods — Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm ( forced use ) were performed in 56 chronic stroke patients . Results — Internal consistency was high ( AOU : α=0.88 ; QOM : α=0.91 ) . The limits of agreement were −0.70 to 0.85 and −0.61 to 0.71 for AOU and QOM , respectively . The correlation with the ARA score ( Spearman ρ ) was 0.63 ( AOU and QOM ) . However , the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA , Spearman ρ was between 0.16 and 0.22 . The responsiveness ratio was 1.9 ( AOU ) and 2.0 ( QOM ) . Conclusion — The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention . The cross-sectional construct validity of the MAL is reasonable , but the results raise doubt about its longitudinal construct validity BACKGROUND Effective rehabilitative therapies are needed for patients with long-term deficits after stroke . METHODS In this multicenter , r and omized , controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke , we r and omly assigned 49 patients to receive intensive robot-assisted therapy  , 50 to receive intensive comparison therapy , and 28 to receive usual care . Therapy consisted of 36 1-hour sessions over a period of 12 weeks . The primary outcome was a change in motor function , as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke , at 12 weeks . Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale . Secondary analyses assessed the treatment effect at 36 weeks . RESULTS At 12 weeks , the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care ( difference , 2.17 points ; 95 % confidence interval [ CI ] , -0.23 to 4.58 ) and worse than that for patients receiving intensive comparison therapy ( difference , -0.14 points ; 95 % CI , -2.94 to 2.65 ) , but the differences were not significant . The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care ( difference , 7.64 points ; 95 % CI , 2.03 to 13.24 ) . No other treatment comparisons were significant at 12 weeks . Secondary analyses showed that at 36 weeks , robot-assisted therapy significantly improved the Fugl-Meyer score ( difference , 2.88 points ; 95 % CI , 0.57 to 5.18 ) and the time on the Wolf Motor Function Test ( difference , -8.10 seconds ; 95 % CI , -13.61 to -2.60 ) as compared with usual care but not with intensive therapy . No serious adverse events were reported . CONCLUSIONS In patients with long-term upper-limb deficits after stroke , robot-assisted therapy did not significantly improve motor function at 12 weeks , as compared with usual care or intensive therapy . In secondary analyses , robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy . ( Clinical Trials.gov number , NCT00372411 . Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach 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 This r and omized , controlled , multisite Department of Veterans Affairs clinical trial assessed robot-assisted ( RA ) upper-limb therapy with the Mirror Image Movement Enabler ( MIME ) in the acute stroke rehabilitation setting . Hemiparetic subjects ( n = 54 ) received RA therapy using MIME for either up to 15 hours ( low-dose ) or 30 hours ( high-dose ) or received up to 15 hours of additional conventional therapy in addition to usual care ( control ) . The primary outcome measure was the Fugl-Meyer Assessment ( FMA ) . The secondary outcome measures were the Functional Independence Measure ( FIM ) , Wolf Motor Function Test , Motor Power , and Ashworth scores at intake , discharge , and 6-month follow-up . Mean duration of study treatment was 8.6 , 15.8 , and 9.4 hours for the low-dose , high-dose , and control groups , respectively . Gains in the primary outcome measure were not significantly different between groups at follow-up . Significant correlations were found at discharge between FMA gains and the dose and intensity of RA . Intensity also correlated with FMA gain at 6 months . The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months . As used during acute rehabilitation , motor-control changes at follow-up were no less with MIME than with additional conventional therapy . Intensity of training with MIME was positively correlated with motor-control gains Background and purpose There is little evidence available on the use of robot-assisted therapy in subacute stroke patients . A r and omized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset . Methods Fifty-three subacute stroke patients at their first-ever stroke were enrolled 30 ± 7 days after the acute event and r and omized into two groups , both exposed to st and ard therapy . Additional 30 sessions of robot-assisted therapy were provided to the Experimental Group . Additional 30 sessions of usual therapy were provided to the Control Group . The following impairment evaluations were performed at the beginning ( T0 ) , after 15 sessions ( T1 ) , and at the end of the treatment ( T2 ) : Fugl-Meyer Assessment Scale ( FM ) , Modified Ashworth Scale-Shoulder ( MAS-S ) , Modified Ashworth Scale-Elbow ( MAS-E ) , Total Passive Range of Motion-Shoulder/Elbow ( pROM ) , and Motricity Index ( MI ) . Results Evidence of significant improvements in MAS-S ( p = 0.004 ) , MAS-E ( p = 0.018 ) and pROM ( p < 0.0001 ) was found in the Experimental Group . Significant improvement was demonstrated in both Experimental and Control Group in FM ( EG : p < 0.0001 , CG : p < 0.0001 ) and MI ( EG : p < 0.0001 , CG : p < 0.0001 ) , with an higher improvement in the Experimental Group . Conclusions Robot-assisted upper limb rehabilitation treatment can contribute to increasing motor recovery in subacute stroke patients . Focusing on the early phase of stroke recovery has a high potential impact in clinical practice OBJECTIVE To compare the effects of robot-assisted movement training with conventional techniques for the rehabilitation of upper-limb motor function after stroke . DESIGN R and omized controlled trial , 6-month follow-up . SETTING A Department of Veterans Affairs rehabilitation research and development center . PARTICIPANTS Consecutive sample of 27 subjects with chronic hemiparesis ( > 6mo after cerebrovascular accident ) r and omly allocated to group . INTERVENTIONS All subjects received twenty-four 1-hour sessions over 2 months . Subjects in the robot group practice d shoulder and elbow movements while assisted by a robot manipulator . Subjects in the control group received neurodevelopmental therapy ( targeting proximal upper limb function ) and 5 minutes of exposure to the robot in each session . MAIN OUTCOME MEASURES Fugl-Meyer assessment of motor impairment , FIMtrade mark instrument , and biomechanic measures of strength and reaching kinematics . Clinical evaluations were performed by a therapist blinded to group assignments . RESULTS Compared with the control group , the robot group had larger improvements in the proximal movement portion of the Fugl-Meyer test after 1 month of treatment ( P<.05 ) and also after 2 months of treatment ( P<.05 ) . The robot group had larger gains in strength ( P<.02 ) and larger increases in reach extent ( P<.01 ) after 2 months of treatment . At the 6-month follow-up , the groups no longer differed in terms of the Fugl-Meyer test ( P>.30 ) ; however , the robot group had larger improvements in the FIM ( P<.04 ) . CONCLUSIONS Compared with conventional treatment , robot-assisted movements had advantages in terms of clinical and biomechanical measures . Further research into the use of robotic manipulation for motor rehabilitation is justified The successful motor rehabilitation of stroke patients requires early intensive and task-specific therapy . A recent Cochrane Review , although based on a limited number of r and omized controlled trials ( RCTs ) , showed that early robotic training of the upper limb ( i.e. , during acute or subacute phase ) can enhance motor learning and improve functional abilities more than chronic-phase training . In this article , a new subacute-phase RCT with the Neuro-Rehabilitation-roBot ( NeReBot ) is presented . While in our first study we used the NeReBot in addition to conventional therapy , in this new trial we used the same device in substitution of st and ard proximal upper-limb re 
    Output:
    