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 : The aim of this study was to evaluate the effectiveness of Cognitive Sensory Motor Training Therapy ( Perfetti ’s method ) vis-à-vis conventional occupational therapy in the recovery of arm function after acute stroke . Design : Prospect i ve r and omized controlled trial . Setting : Two rehabilitation centers in Bangkok , Thail and . Subjects : Forty first-time acute stroke patients without severe cognitive or language impairment . Intervention : All subjects were r and omly divided into two groups ; one was treated using Perfetti ’s method and the other using conventional occupational therapy . Each group underwent therapy for 30 minutes , five times a week for four weeks . Main measures : The primary variable was arm function as assessed by the Action Research Arm Test ; secondary variables were the extended Barthel Index and the box and block test score . Results : The intention-to-treat analysis revealed no statistically significant differences between the two groups at the end of treatment for any variable . Conclusions : There was no evidence of a difference between Cognitive Sensory Motor Training Therapy of Perfetti ’s method and conventional occupational therapy with respect to the restoration of h and and arm function after a stroke Background . Peripheral nerve stimulation may induce cortical adaptations as it improves pinch strength in chronic stroke patients immediately after stimulation . Objective . Test the effects of peripheral sensory stimulation on pinch strength in patients with acute and subacute stroke . Methods . Stroke patients ( N = 20 ) who had onset less than 6 months previously and could voluntarily pinch the thumb to the index finger participated in a r and omized , single-blinded , controlled study . Ten patients received 2 hours of simultaneous electrical stimulation over the median and ulnar nerves at the wrist to the level of appreciating paresthesias ( peripheral sensory stimulation group ) . Ten control patients received stimulation to the level of perception ( sham-control group ) . Pinch strength of the thumb pad to tip and to lateral side of the index finger of the paretic h and and the Action Research Arm test were tested before and immediately after the stimulation . Results . Lateral and tip pinch strength were significantly increased in both groups ( P < .05 ) . Mean ± SD of increased lateral pinch strength of peripheral sensory stimulation and sham-control groups were 1.24 ± 0.54 pounds and 0.20 ± 0.28 pounds , respectively . Mean ± SD of increased tip pinch strength of peripheral sensory stimulation and sham-control groups were 1.00 ± 0.72 pounds and 0.37 ± 0.36 pounds , respectively . Increase pinch strength of the peripheral sensory stimulation group was greater than the sham-control group , with significant difference ( P < .05 ) . The Action Research Arm test was not significantly changed after stimulation in both groups ( P > .05 ) . Conclusion . Peripheral sensory stimulation of the paretic h and may increase pinch strength of acute and subacute stroke patients immediately after stimulation 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 Background . Somatosensory stimulation in the form of repetitive peripheral nerve stimulation ( RPSS ) is a promising strategy to improve motor function of the upper limb in chronic stroke . Home-based RPSS may be an alternative to hospital-based RPSS . Objectives . To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance h and motor function in patients in the chronic phase after stroke . Methods . Twenty patients were r and omized to either active or sham RPSS associated with daily motor training performed at home over 4 consecutive weeks . All the patients were able to perform tasks of the Jebsen – Taylor Test ( JTT ) . The primary outcome measures were feasibility , evaluated by self-reported compliance with the intervention , and safety ( adverse events ) . Secondary outcomes comprised improvements in h and function in the JTT after end of treatment and after a 4-month follow-up period . Results . There were no relevant adverse events . Compliance with RPSS and motor training was significantly greater in the active group than in the sham group . Upper extremity performance improved significantly more in the active group compared with the sham group at the end of treatment . This difference remained significant 4 months later , even when differences in compliance with motor training were considered . Conclusions . Home-based active RPSS associated with motor training was feasible , was safe , and led to long-lasting enhancement of paretic arm performance in the chronic phase after stroke for those who can perform the JTT . These results point to the need for an efficacy trial Background and Purpose — Thermal stimulation ( TS ) is commonly used in orthopedic rehabilitation , but the role of TS in the facilitation of sensorimotor recovery in hemiplegic patients remains unknown . This study addressed the issue of TS intervention in the facilitation of functional outcomes . Methods — Forty-six stroke survivors were r and omly assigned to st and ard rehabilitation treatment and st and ard treatment plus TS ( 30 minutes daily for 6 weeks ) . Twenty-nine patients completed the experiment . Six measures , including Brunnstrom stage , modified motor assessment scale , grasping strength , angles of wrist extension and flexion , sensation by monofilament , and muscle tone by modified Ashworth scale , were performed weekly to evaluate sensory and motor functional outcomes . Results — The performance of Brunnstrom stage and wrist extension and sensation were improved significantly after TS intervention . Recovery rates of 6 measures after TS were significantly higher than those of the control , except for grasping . Similar muscle tones were found in both groups . Conclusion — TS on the paretic h and significantly enhances the recovery of several aspects of sensory and motor functions in hemiplegic 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 Objective : To investigate whether cutaneous electrical stimulation has a role in the enhancement of sensorimotor function in chronic stroke . Subjects and setting : Fifty-nine patients with chronic stroke received cutaneous stimulation during their three-week-long inpatient rehabilitation . Thirty-two received active treatment in the paretic h and and eight received no-current placebo treatment in the paretic h and . Nineteen patients received active stimulation of the paretic foot . None received stimulation in both upper and lower limbs . Intervention : Cutaneous stimulation was delivered twice daily via a special glove/sock electrode . Main outcome measures : Modified Motor Assessment Scale , 10-metre walking test , paretic limb function , limb skin sensation and somatosensory evoked potentials ( SEP ) were performed before and after the treatment . Results : Modified Motor Assessment Scale ( p < 0.001 ) , 10-metre walking test ( p < 0.05 ) , paretic h and function ( p < 0.01 ) , upper limb skin sensation ( p < 0.01 ) and SEP normality classification of paretic upper limb ( p < 0.01 ) and paretic lower limb ( p < 0.5 ) improved significantly in the treatment group ( n = 51 ) after three weeks of stimulation . When active h and treatment and placebo h and treatment were compared , a significant improvement in the sensory and motor function was observed only in the actively treated group . Conclusions : Cutaneous stimulation had positive effects in the motor performance , limb sensation and the configuration of SEP of the paretic limb in chronic stroke patients Background and Purpose — To examine the effect of thermal stimulation ( TS ) on upper extremity ( UE ) motor recovery in patients at least 3 months after stroke . Methods — Participants were r and omly assigned to either the experimental group or the control group . In addition to regular rehabilitation programs , the experimental group received an UE-TS protocol for 30 minutes per day ( 3 days/week for 8 weeks ) ; the control group received the same TS protocol on lower extremity . The UE subscale of the Stroke Rehabilitation Assessment of Movement and the Action Research Arm Test were primary outcome measures . The Modified Ashworth Scale and the Barthel Index were secondary outcome measures . All measures were administered at baseline , after TS , and at 1-month follow-up . Results — Twenty-three participants ( 12 in the experimental group ) completed the study . After treatment , the experimental group showed significant improvement compared to the control group in the scores of the UE subscale of the Stroke Rehabilitation Assessment of Movement and Action Research Arm Test . At follow-up examination , a significant improvement in the experimental group was observed on the UE subscale of the Stroke Rehabilitation Assessment of Movement . Conclusions — The 8-week additional UE-TS protocol improved UE motor recovery for stroke patients 3 months after onset Background : Sensory amplitude electrical stimulation ( SES ) and repetitive task practice reduce impairments and arm dysfunction when delivered separately following stroke . Objective : To determine if home-based , task-specific arm exercise was more effective when administered concurrent with SES . Methods : Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment ( FMA ) score 28/66 ( 15–45 ) participated . Subjects were r and omly assigned to an SES ( n = 20 ) or sham stimulation ( n = 18 ) group . Subjects engaged in task-based home exercise 
    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 : The aim of this study was to evaluate the effectiveness of Cognitive Sensory Motor Training Therapy ( Perfetti ’s method ) vis-à-vis conventional occupational therapy in the recovery of arm function after acute stroke . Design : Prospect i ve r and omized controlled trial . Setting : Two rehabilitation centers in Bangkok , Thail and . Subjects : Forty first-time acute stroke patients without severe cognitive or language impairment . Intervention : All subjects were r and omly divided into two groups ; one was treated using Perfetti ’s method and the other using conventional occupational therapy . Each group underwent therapy for 30 minutes , five times a week for four weeks . Main measures : The primary variable was arm function as assessed by the Action Research Arm Test ; secondary variables were the extended Barthel Index and the box and block test score . Results : The intention-to-treat analysis revealed no statistically significant differences between the two groups at the end of treatment for any variable . Conclusions : There was no evidence of a difference between Cognitive Sensory Motor Training Therapy of Perfetti ’s method and conventional occupational therapy with respect to the restoration of h and and arm function after a stroke Background . Peripheral nerve stimulation may induce cortical adaptations as it improves pinch strength in chronic stroke patients immediately after stimulation . Objective . Test the effects of peripheral sensory stimulation on pinch strength in patients with acute and subacute stroke . Methods . Stroke patients ( N = 20 ) who had onset less than 6 months previously and could voluntarily pinch the thumb to the index finger participated in a r and omized , single-blinded , controlled study . Ten patients received 2 hours of simultaneous electrical stimulation over the median and ulnar nerves at the wrist to the level of appreciating paresthesias ( peripheral sensory stimulation group ) . Ten control patients received stimulation to the level of perception ( sham-control group ) . Pinch strength of the thumb pad to tip and to lateral side of the index finger of the paretic h and and the Action Research Arm test were tested before and immediately after the stimulation . Results . Lateral and tip pinch strength were significantly increased in both groups ( P < .05 ) . Mean ± SD of increased lateral pinch strength of peripheral sensory stimulation and sham-control groups were 1.24 ± 0.54 pounds and 0.20 ± 0.28 pounds , respectively . Mean ± SD of increased tip pinch strength of peripheral sensory stimulation and sham-control groups were 1.00 ± 0.72 pounds and 0.37 ± 0.36 pounds , respectively . Increase pinch strength of the peripheral sensory stimulation group was greater than the sham-control group , with significant difference ( P < .05 ) . The Action Research Arm test was not significantly changed after stimulation in both groups ( P > .05 ) . Conclusion . Peripheral sensory stimulation of the paretic h and may increase pinch strength of acute and subacute stroke patients immediately after stimulation 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 Background . Somatosensory stimulation in the form of repetitive peripheral nerve stimulation ( RPSS ) is a promising strategy to improve motor function of the upper limb in chronic stroke . Home-based RPSS may be an alternative to hospital-based RPSS . Objectives . To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance h and motor function in patients in the chronic phase after stroke . Methods . Twenty patients were r and omized to either active or sham RPSS associated with daily motor training performed at home over 4 consecutive weeks . All the patients were able to perform tasks of the Jebsen – Taylor Test ( JTT ) . The primary outcome measures were feasibility , evaluated by self-reported compliance with the intervention , and safety ( adverse events ) . Secondary outcomes comprised improvements in h and function in the JTT after end of treatment and after a 4-month follow-up period . Results . There were no relevant adverse events . Compliance with RPSS and motor training was significantly greater in the active group than in the sham group . Upper extremity performance improved significantly more in the active group compared with the sham group at the end of treatment . This difference remained significant 4 months later , even when differences in compliance with motor training were considered . Conclusions . Home-based active RPSS associated with motor training was feasible , was safe , and led to long-lasting enhancement of paretic arm performance in the chronic phase after stroke for those who can perform the JTT . These results point to the need for an efficacy trial Background and Purpose — Thermal stimulation ( TS ) is commonly used in orthopedic rehabilitation , but the role of TS in the facilitation of sensorimotor recovery in hemiplegic patients remains unknown . This study addressed the issue of TS intervention in the facilitation of functional outcomes . Methods — Forty-six stroke survivors were r and omly assigned to st and ard rehabilitation treatment and st and ard treatment plus TS ( 30 minutes daily for 6 weeks ) . Twenty-nine patients completed the experiment . Six measures , including Brunnstrom stage , modified motor assessment scale , grasping strength , angles of wrist extension and flexion , sensation by monofilament , and muscle tone by modified Ashworth scale , were performed weekly to evaluate sensory and motor functional outcomes . Results — The performance of Brunnstrom stage and wrist extension and sensation were improved significantly after TS intervention . Recovery rates of 6 measures after TS were significantly higher than those of the control , except for grasping . Similar muscle tones were found in both groups . Conclusion — TS on the paretic h and significantly enhances the recovery of several aspects of sensory and motor functions in hemiplegic 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 Objective : To investigate whether cutaneous electrical stimulation has a role in the enhancement of sensorimotor function in chronic stroke . Subjects and setting : Fifty-nine patients with chronic stroke received cutaneous stimulation during their three-week-long inpatient rehabilitation . Thirty-two received active treatment in the paretic h and and eight received no-current placebo treatment in the paretic h and . Nineteen patients received active stimulation of the paretic foot . None received stimulation in both upper and lower limbs . Intervention : Cutaneous stimulation was delivered twice daily via a special glove/sock electrode . Main outcome measures : Modified Motor Assessment Scale , 10-metre walking test , paretic limb function , limb skin sensation and somatosensory evoked potentials ( SEP ) were performed before and after the treatment . Results : Modified Motor Assessment Scale ( p < 0.001 ) , 10-metre walking test ( p < 0.05 ) , paretic h and function ( p < 0.01 ) , upper limb skin sensation ( p < 0.01 ) and SEP normality classification of paretic upper limb ( p < 0.01 ) and paretic lower limb ( p < 0.5 ) improved significantly in the treatment group ( n = 51 ) after three weeks of stimulation . When active h and treatment and placebo h and treatment were compared , a significant improvement in the sensory and motor function was observed only in the actively treated group . Conclusions : Cutaneous stimulation had positive effects in the motor performance , limb sensation and the configuration of SEP of the paretic limb in chronic stroke patients Background and Purpose — To examine the effect of thermal stimulation ( TS ) on upper extremity ( UE ) motor recovery in patients at least 3 months after stroke . Methods — Participants were r and omly assigned to either the experimental group or the control group . In addition to regular rehabilitation programs , the experimental group received an UE-TS protocol for 30 minutes per day ( 3 days/week for 8 weeks ) ; the control group received the same TS protocol on lower extremity . The UE subscale of the Stroke Rehabilitation Assessment of Movement and the Action Research Arm Test were primary outcome measures . The Modified Ashworth Scale and the Barthel Index were secondary outcome measures . All measures were administered at baseline , after TS , and at 1-month follow-up . Results — Twenty-three participants ( 12 in the experimental group ) completed the study . After treatment , the experimental group showed significant improvement compared to the control group in the scores of the UE subscale of the Stroke Rehabilitation Assessment of Movement and Action Research Arm Test . At follow-up examination , a significant improvement in the experimental group was observed on the UE subscale of the Stroke Rehabilitation Assessment of Movement . Conclusions — The 8-week additional UE-TS protocol improved UE motor recovery for stroke patients 3 months after onset Background : Sensory amplitude electrical stimulation ( SES ) and repetitive task practice reduce impairments and arm dysfunction when delivered separately following stroke . Objective : To determine if home-based , task-specific arm exercise was more effective when administered concurrent with SES . Methods : Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment ( FMA ) score 28/66 ( 15–45 ) participated . Subjects were r and omly assigned to an SES ( n = 20 ) or sham stimulation ( n = 18 ) group . Subjects engaged in task-based home exercise 
    Output:
    