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 Early rehabilitation that includes early mobilization and increased amount of motor activity is hypothesized to be one of the most important factors contributing to the beneficial effect of comprehensive stroke unit treatment , whereas too much bed rest is hypothesized to be harmful . The purpose of the present study was to assess the association between early activity/bed rest and functional outcome 3 months later . METHODS This was a prospect i ve cohort study including patients with the diagnosis of stroke admitted to Trondheim University Hospital , Norway . Patients were eligible if they were less than 14 days poststroke and did not receive palliative care . Motor activity/bed rest  was recorded in the acute phase using a st and ard method of observation , and the outcome was assessed by the modified Rankin Scale ( mRS ) score 3 months later . A proportional odds model was used to analyze the association between motor activity/bed rest and outcome . All analyses were adjusted for age , gender , stroke severity , time from stroke to observation , and prestroke function . RESULTS A total of 106 patients ( mean age 79.0 years , 56.6 % men ) were included . The odds ratio for a higher mRS score ( poor outcome ) was 1.04 ( 95 % confidence interval [ CI ] 1.02 - 1.07 , P = .001 ) as time in bed increased and .97 ( 95 % CI .93 - 1.02 , P = .283 ) as time in motor activity increased . CONCLUSIONS This study confirms that time in bed in the early phase is associated with poor functional outcome 3 months later , indicating that too much bed rest should be avoided in the early phase after stroke Background and Purpose — Individuals with chronic stroke often demonstrate a “ plateau , ” or deceleration of motor recovery , which may lead to discharge from physical therapy ( PT ) . However , numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks . We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke , and suggest that further gains can be realized if intensive stepping , or locomotor training ( LT ) is provided after discharge . Methods — Twenty subjects with chronic stroke completed a repeated baseline measures , r and omized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau , followed by 4 weeks of intensive LT and 4 weeks of no intervention . Outcome measures included clinical and physiological ( metabolic ) measures of walking overground and on a treadmill , and measures of daily stepping activity in the home and community , including during clinical PT and subsequent LT sessions . Results — Stepping practice was more than 4-fold higher during LT versus clinical PT sessions , with significant improvements in daily stepping and gait efficiency only after LT . Changes in daily stepping after clinical PT and intensive LT were correlated ( P<0.001 ) with the amount of stepping practice received during these interventions . Conclusions — Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function . These improvements may be related to the amount and intensity of stepping practice Background and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 13 days ) . Only 9 patients were restricted to bed . During the therapeutic day , patients spent > 50 % resting in bed , 28 % sitting out of bed , and only 13 % engaged in activities with the potential to prevent complications and improve recovery of mobility . Patients were alone > 60 % of the time . Conclusions — This is the first multicenter study of physical activity early after stroke . We believe the next step is to conduct a r and omized controlled trial to evaluate the effect of increased levels of  physical activity  early after stroke compared with current st and ards of care QUESTIONS Is treadmill walking with body weight support during inpatient rehabilitation detrimental to walking quality compared with assisted overground walking ? Does it result in better walking capacity , perception of walking or community participation ? DESIGN Analysis of secondary outcomes of a r and omised trial with concealed allocation , assessor blinding and intention-to-treat analysis . PARTICIPANTS 126 patients unable to walk within 4 weeks of a stroke who were undergoing inpatient rehabilitation . INTERVENTION The experimental group undertook up to 30 minutes of treadmill walking with body weight support via an overhead harness per day while the control group undertook up to 30 minutes of overground walking . OUTCOME MEASURES The secondary outcomes were walking quality and capacity , walking perception , community participation and falls . RESULTS Six months after entering the study , there was no difference between the groups of independent walkers in terms of speed ( MD 0.10 m/s , 95 % CI -0.06 to 0.26 ) or stride ( MD 6 cm , 95 % CI -7 to 19 ) . The independent walkers in the experimental group walked 57 m further ( 95 % CI 1 to 113 ) in the 6 min walk than those in the control group . The experimental group ( walkers and non-walkers ) rated their walking 1 point out of 10 ( 95 % CI 0.1 to 1.9 ) higher than the control group . There was no difference between the groups in community participation or number of falls . CONCLUSION Treadmill training with body weight support results in better walking capacity and perception of walking compared to overground walking without deleterious effects on walking quality 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 Background and Purpose — To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability . Methods — A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population . Prospect i ve cohort study based on 18 repeated measurements over time during the first poststroke year . Baseline characteristics as well as longitudinal information from functional ambulation categories ( FAC ) , Fugl – Meyer leg score ( FM-leg ) , Motricity index leg score ( MI-leg ) , letter cancellation task ( LCT ) , Fugl-Meyer balance ( FM-balance ) , and timed balance test ( TBT ) were obtained . Intervention consisted of a basic rehabilitation program with additional arm , leg , or air splint therapy . Main outcome measure constituted change scores on FAC over time . Results — In total , 1532 of the 1717 change scores were available for regression analysis . The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC ( & bgr;=0.094 ; P<0.001 ) followed by changes scores on FM-leg ( & bgr;=0.014 ; P<0.001 ) and reduction in LCT omissions ( & bgr;=−0.010 ; P<0.001 ) and MI leg test ( & bgr;=0.001 ; P<0.001 ) . In addition , time itself was significantly negatively associated with improvement ( & bgr;=−0.002 ; P<0.001 ) . Conclusion — Improvement in st and ing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability , whereas reduction in visuospatial inattention is independently related to improvement of gait . Finally , time itself is an independent covariate that is negatively associated with change on FAC , suggesting that most pronounced improvements occur earlier after stroke Objective : To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients . Design : R and omized controlled trial . Setting : Four German neurological rehabilitation centres . Subjects : One hundred and fifty-five non-ambulatory patients ( first-time stroke < 60 days ) . Intervention : Group A received 20 min locomotor training and 25 min physiotherapy ; group B had 45 min physiotherapy every week day for four weeks . Main outcome measures : Primary variables were gait ability ( Functional Ambulation Category , 0 - 5 ) and the Barthel Index ( 0 - 100 ) , blindly assessed at study onset , end , and six months later for follow-up . Responders to the therapy had to become ambulatory ( Functional Ambulation Category 4 or 5 ) or reach a Barthel Index of ≥ 75 . Secondary variables were walking velocity , endurance , mobility and leg power . Results : The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently : 41 of 77 versus 17 of 78 in group B ( P B < 0.0001 ) at treatment end . Also , significantly more group A patients had reached a Barthel Index ≥ 75 : 44 of 77 versus 21 of 78 ( P B < 0.0001 ) . At six-month follow-up , the superior gait ability in group A persisted ( 54 of 77 versus 28 of 78 , P B < 0.0001 ) , while the Barthel Index responder rate did not differ . For all secondary variables , group A patients had improved significantly more ( P B < 0.0001 ) during the treatment period , but not during follow-up . Conclusions : Intensive locomotor training plus physiotherapy result ed in a significantly better gait ability and daily living competence in subacute stroke patients  compared with physiotherapy alone BACKGROUND This study was a prospect i ve , r and omized , open , blinded-endpoint trial with the aim of examining whether gait training with a gait-assistance robot ( GAR ) improves gait disturbances in subacute non-ambulatory hemiplegic stroke patients more than overground conventional gait training . The GAR adopts a robot arm control system with full weight bearing and foot pressure visual biofeedback . METHODS Twenty-six hemiplegic patients were r and omly assigned to either the  GAR-assisted gait training ( GAGT ) group or the  overground conventional gait training ( OCGT ) group . Both groups underwent 60 min of st and ard physical therapy and 20 min of GAGT or OCGT 5 days a week for 4 weeks . The primary outcome measure was the Functional Ambulation Classification ( FAC ) . The secondary outcome measures were the peak torque of the extensor muscles in the lower extremities and a 10-m walking test . The lower extremity function was evaluated using the Fugl-Meyer Assessment , and activities of daily living were assessed using the Functional Independence Measure . RESULTS The GAGT group demonstrated significantly greater improvements in FAC and peak torque on the unaffected side ( p=0.02 ) than the OCGT group . Additionally , gait speed tended to be faster ( p=0.07 ) in the GAGT group . CONCLUSIONS GAGT combined with st and ard physical therapy in subacute non-ambulatory hemiplegic patients led to significant improvements in gait and peak torque on the unaffected side compared to OCGT Objective . To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke . Methods . A total of 63 participants < 6 months poststroke with an initial walking speed between 0.1 to 0 
    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 Early rehabilitation that includes early mobilization and increased amount of motor activity is hypothesized to be one of the most important factors contributing to the beneficial effect of comprehensive stroke unit treatment , whereas too much bed rest is hypothesized to be harmful . The purpose of the present study was to assess the association between early activity/bed rest and functional outcome 3 months later . METHODS This was a prospect i ve cohort study including patients with the diagnosis of stroke admitted to Trondheim University Hospital , Norway . Patients were eligible if they were less than 14 days poststroke and did not receive palliative care . Motor activity/bed rest  was recorded in the acute phase using a st and ard method of observation , and the outcome was assessed by the modified Rankin Scale ( mRS ) score 3 months later . A proportional odds model was used to analyze the association between motor activity/bed rest and outcome . All analyses were adjusted for age , gender , stroke severity , time from stroke to observation , and prestroke function . RESULTS A total of 106 patients ( mean age 79.0 years , 56.6 % men ) were included . The odds ratio for a higher mRS score ( poor outcome ) was 1.04 ( 95 % confidence interval [ CI ] 1.02 - 1.07 , P = .001 ) as time in bed increased and .97 ( 95 % CI .93 - 1.02 , P = .283 ) as time in motor activity increased . CONCLUSIONS This study confirms that time in bed in the early phase is associated with poor functional outcome 3 months later , indicating that too much bed rest should be avoided in the early phase after stroke Background and Purpose — Individuals with chronic stroke often demonstrate a “ plateau , ” or deceleration of motor recovery , which may lead to discharge from physical therapy ( PT ) . However , numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks . We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke , and suggest that further gains can be realized if intensive stepping , or locomotor training ( LT ) is provided after discharge . Methods — Twenty subjects with chronic stroke completed a repeated baseline measures , r and omized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau , followed by 4 weeks of intensive LT and 4 weeks of no intervention . Outcome measures included clinical and physiological ( metabolic ) measures of walking overground and on a treadmill , and measures of daily stepping activity in the home and community , including during clinical PT and subsequent LT sessions . Results — Stepping practice was more than 4-fold higher during LT versus clinical PT sessions , with significant improvements in daily stepping and gait efficiency only after LT . Changes in daily stepping after clinical PT and intensive LT were correlated ( P<0.001 ) with the amount of stepping practice received during these interventions . Conclusions — Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function . These improvements may be related to the amount and intensity of stepping practice Background and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 13 days ) . Only 9 patients were restricted to bed . During the therapeutic day , patients spent > 50 % resting in bed , 28 % sitting out of bed , and only 13 % engaged in activities with the potential to prevent complications and improve recovery of mobility . Patients were alone > 60 % of the time . Conclusions — This is the first multicenter study of physical activity early after stroke . We believe the next step is to conduct a r and omized controlled trial to evaluate the effect of increased levels of  physical activity  early after stroke compared with current st and ards of care QUESTIONS Is treadmill walking with body weight support during inpatient rehabilitation detrimental to walking quality compared with assisted overground walking ? Does it result in better walking capacity , perception of walking or community participation ? DESIGN Analysis of secondary outcomes of a r and omised trial with concealed allocation , assessor blinding and intention-to-treat analysis . PARTICIPANTS 126 patients unable to walk within 4 weeks of a stroke who were undergoing inpatient rehabilitation . INTERVENTION The experimental group undertook up to 30 minutes of treadmill walking with body weight support via an overhead harness per day while the control group undertook up to 30 minutes of overground walking . OUTCOME MEASURES The secondary outcomes were walking quality and capacity , walking perception , community participation and falls . RESULTS Six months after entering the study , there was no difference between the groups of independent walkers in terms of speed ( MD 0.10 m/s , 95 % CI -0.06 to 0.26 ) or stride ( MD 6 cm , 95 % CI -7 to 19 ) . The independent walkers in the experimental group walked 57 m further ( 95 % CI 1 to 113 ) in the 6 min walk than those in the control group . The experimental group ( walkers and non-walkers ) rated their walking 1 point out of 10 ( 95 % CI 0.1 to 1.9 ) higher than the control group . There was no difference between the groups in community participation or number of falls . CONCLUSION Treadmill training with body weight support results in better walking capacity and perception of walking compared to overground walking without deleterious effects on walking quality 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 Background and Purpose — To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability . Methods — A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population . Prospect i ve cohort study based on 18 repeated measurements over time during the first poststroke year . Baseline characteristics as well as longitudinal information from functional ambulation categories ( FAC ) , Fugl – Meyer leg score ( FM-leg ) , Motricity index leg score ( MI-leg ) , letter cancellation task ( LCT ) , Fugl-Meyer balance ( FM-balance ) , and timed balance test ( TBT ) were obtained . Intervention consisted of a basic rehabilitation program with additional arm , leg , or air splint therapy . Main outcome measure constituted change scores on FAC over time . Results — In total , 1532 of the 1717 change scores were available for regression analysis . The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC ( & bgr;=0.094 ; P<0.001 ) followed by changes scores on FM-leg ( & bgr;=0.014 ; P<0.001 ) and reduction in LCT omissions ( & bgr;=−0.010 ; P<0.001 ) and MI leg test ( & bgr;=0.001 ; P<0.001 ) . In addition , time itself was significantly negatively associated with improvement ( & bgr;=−0.002 ; P<0.001 ) . Conclusion — Improvement in st and ing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability , whereas reduction in visuospatial inattention is independently related to improvement of gait . Finally , time itself is an independent covariate that is negatively associated with change on FAC , suggesting that most pronounced improvements occur earlier after stroke Objective : To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients . Design : R and omized controlled trial . Setting : Four German neurological rehabilitation centres . Subjects : One hundred and fifty-five non-ambulatory patients ( first-time stroke < 60 days ) . Intervention : Group A received 20 min locomotor training and 25 min physiotherapy ; group B had 45 min physiotherapy every week day for four weeks . Main outcome measures : Primary variables were gait ability ( Functional Ambulation Category , 0 - 5 ) and the Barthel Index ( 0 - 100 ) , blindly assessed at study onset , end , and six months later for follow-up . Responders to the therapy had to become ambulatory ( Functional Ambulation Category 4 or 5 ) or reach a Barthel Index of ≥ 75 . Secondary variables were walking velocity , endurance , mobility and leg power . Results : The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently : 41 of 77 versus 17 of 78 in group B ( P B < 0.0001 ) at treatment end . Also , significantly more group A patients had reached a Barthel Index ≥ 75 : 44 of 77 versus 21 of 78 ( P B < 0.0001 ) . At six-month follow-up , the superior gait ability in group A persisted ( 54 of 77 versus 28 of 78 , P B < 0.0001 ) , while the Barthel Index responder rate did not differ . For all secondary variables , group A patients had improved significantly more ( P B < 0.0001 ) during the treatment period , but not during follow-up . Conclusions : Intensive locomotor training plus physiotherapy result ed in a significantly better gait ability and daily living competence in subacute stroke patients  compared with physiotherapy alone BACKGROUND This study was a prospect i ve , r and omized , open , blinded-endpoint trial with the aim of examining whether gait training with a gait-assistance robot ( GAR ) improves gait disturbances in subacute non-ambulatory hemiplegic stroke patients more than overground conventional gait training . The GAR adopts a robot arm control system with full weight bearing and foot pressure visual biofeedback . METHODS Twenty-six hemiplegic patients were r and omly assigned to either the  GAR-assisted gait training ( GAGT ) group or the  overground conventional gait training ( OCGT ) group . Both groups underwent 60 min of st and ard physical therapy and 20 min of GAGT or OCGT 5 days a week for 4 weeks . The primary outcome measure was the Functional Ambulation Classification ( FAC ) . The secondary outcome measures were the peak torque of the extensor muscles in the lower extremities and a 10-m walking test . The lower extremity function was evaluated using the Fugl-Meyer Assessment , and activities of daily living were assessed using the Functional Independence Measure . RESULTS The GAGT group demonstrated significantly greater improvements in FAC and peak torque on the unaffected side ( p=0.02 ) than the OCGT group . Additionally , gait speed tended to be faster ( p=0.07 ) in the GAGT group . CONCLUSIONS GAGT combined with st and ard physical therapy in subacute non-ambulatory hemiplegic patients led to significant improvements in gait and peak torque on the unaffected side compared to OCGT Objective . To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke . Methods . A total of 63 participants < 6 months poststroke with an initial walking speed between 0.1 to 0 
    Output:
    