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 — A new gait training strategy for patients with stroke seeks to increase walking speed through treadmill training . This study compares the effects of structured speed-dependent treadmill training ( STT ) ( with the use of an interval paradigm to increase the treadmill speed stepwise according to principles of sport physiology ) with limited progressive treadmill training ( LTT ) and conventional gait training ( CGT ) on clinical outcome measures for patients with hemiparesis . Methods — Sixty ambulatory poststroke patients were each r and omly selected to receive 1 of the 3 different gait therapies : 20 subjects were treated with STT , 20 subjects were trained to walk on a treadmill with a 20 % increase of belt speed over the treatment period ( LTT ) , and 20 subjects were treated with CGT . Treatment outcomes were assessed on the basis of overground walking speed , cadence , stride length , and Functional Ambulation Category scores . Results — After a 4-week training period , the STT group scored significantly higher than the LTT and CGT groups for overground walking speed ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , cadence ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) , stride length ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , and Functional Ambulation Category scores ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) . Conclusions — Structured STT in poststroke patients result ed in better walking abilities than LTT or CGT . This gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke OBJECTIVE To compare the effects of speed-dependent treadmill training on gait and balance performance in patients with sub-acute stroke . DESIGN Single-blinded r and omized controlled trial . SUBJECTS A total of 26 patients with sub-acute stroke were r and omly assigned to experimental ( n = 13 ) and control ( n = 13 ) groups . METHODS Subjects in the experimental group underwent short interval walking trials with stepwise increases in treadmill speed ( speed-dependent treadmill training ) , following the principles of sprint training . Control subjects received gait training on the treadmill at a steady speed . Gait speed , stride length , cadence , and Berg 's Balance Score were recorded and analysed before and after the 10 training sessions . RESULTS Results of 2-way repeated measures analysis of variance showed significant group × time interactions for gait speed and stride length ( p < 0.05 ) . Within each subject group there were improvements in all gait parameters and Berg ’s Balance Score after the training programme . In addition , the experimental group showed significantly larger increases in gait speed ( mean 0.15 m/s , 95 % confidence interval 0.04–0.26 ) and stride length ( mean 0.16 m , 95 % confidence interval 0.02–0.30 ) than the control subjects . CONCLUSION Speed-dependent treadmill training in patients with sub-acute stroke result ed in larger gains in gait speed and stride length compared with steady speed . The positive findings provide evidence for clinical practice of speed-dependent treadmill training in enhancing gait function after stroke Objective : To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases . Design : A three group r and omised controlled trial with repeated measures was used . Method : One hundred and one patients with a primary middle cerebral artery stroke were r and omly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on ( 1 ) upper limb function , ( 2 ) lower limb function or ( 3 ) immobilisation with an inflatable pressure splint ( control group ) . Follow up assessment s within and between groups were compared at 6 , 9 , and 12 months after stroke . Results : No statistically significant effects were found for treatment assignment from 6 months onwards . At a group level , the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained . However , no significant differences in functional recovery between groups were found for Barthel index ( BI ) , functional ambulation categories (FAC),action research arm test ( ARAT ) , comfortable and maximal walking speed , Nottingham health profile part 1(NHP-part 1 ) , sickness impact profile-68 ( SIP-68 ) , and Frenchay activities index ( FAI ) from 6 months onwards . At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function ( n=8 and 5 , respectively ) and lower limb function ( n=19 and 9 , respectively ) . Activities of daily living ( ADL ) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards . In particular , patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards . Conclusions : On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme . However , a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity , walking ability , and ADL beyond the error threshold OBJECTIVE To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and h and icap associated with poor walking performance after stroke . DESIGN R and omized , placebo-controlled clinical trial with a 3-month follow-up . SETTING General community . PARTICIPANTS A volunteer sample of 29 ambulatory individuals ( less 2 dropouts ) who were living in the community after having suffered a stroke more than 6 months previously . INTERVENTIONS The experimental group participated in a 30-minute treadmill and overground walking program , 3 times a week for 4 weeks . The control group received a placebo consisting of a low-intensity , home exercise program and regular telephone contact . MAIN OUTCOME MEASURES Walking speed ( over 10 m ) , walking capacity ( distance over 6 min ) , and h and icap ( stroke-adapted 30-item version of the Sickness Impact Profile ) measured by a blinded assessor . RESULTS The 4-week treadmill and overground walking program significantly increased walking speed ( P=.02 ) and walking capacity ( P<.001 ) , but did not decrease h and icap ( P=.85 ) compared with the placebo program . These gains were largely maintained 3 months after the cessation of training ( P</=.05 ) . CONCLUSIONS The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke . This suggests that the routine provision of accessible , long-term , community-based walking programs would be beneficial in reducing disability after stroke Background and Purpose — Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability . Gait is a complex sensorimotor function controlled by integrated cortical , subcortical , and spinal networks . The mechanisms of gait recovery after stroke are not well understood . This study examines the hypothesis that progressive task-repetitive treadmill exercise ( T-EX ) improves fitness and gait function in subjects with chronic hemiparetic stroke by inducing adaptations in the brain ( plasticity ) . Methods — A r and omized controlled trial determined the effects of 6-month T-EX  ( n=37 ) versus comparable duration stretching ( CON , n=34 ) on walking , aerobic fitness and in a subset ( n=15/17 ) on brain activation measured by functional MRI . Results — T-EX significantly improved treadmill-walking velocity by 51 % and cardiovascular fitness by 18 % ( 11 % and −3 % for CON , respectively ; P<0.05 ) . T-EX but not CON affected brain activation during paretic , but not during nonparetic limb movement , showing 72 % increased activation in posterior cerebellar lobe and 18 % in midbrain ( P<0.005 ) . Exercise-mediated improvements in walking velocity correlated with increased activation in cerebellum and midbrain . Conclusions — T-EX  improves walking , fitness and recruits cerebellum-midbrain circuits , likely reflecting neural network plasticity . This neural recruitment is associated with better walking . These findings demonstrate the effectiveness of T-EX rehabilitation in promoting gait recovery of stroke survivors with long-term mobility impairment and provide evidence of neuroplastic mechanisms that could lead to further refinements in these paradigms to improve functional outcomes BACKGROUND Results of recent studies have suggested that restraint of non-paretic lower limb movement could improve locomotion in hemiplegic patients . The aim of this study was therefore to determine if a mass applied to the non-paretic lower limb during a single gait training session ( GTS ) would specifically improve spatio-temporal , kinematic and kinetic gait parameters ( GP ) of the paretic lower limb . METHODS Sixty chronic hemiplegic subjects were included in this r and omized study . Each participated in one of four GTS conditions : overground or on a treadmill while wearing or not wearing an ankle mass . All subjects were assessed before , immediately after and 20 min after the end of the GTS using 3D gait analysis . RESULTS The results showed that restraining the non-paretic lower limb during a GTS had no specific effect on GP of the paretic limb , whereas it increased braking force of the non-paretic limb . CONCLUSION Restraining the non-paretic lower limb of hemiparetic patients with a mass applied to the ankle does not seem to be an effective approach to improve paretic lower limb parameters during a single GTS 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 . Aerobic treadmill exercise ( T-EX ) therapy has been shown to benefit walking and cardiorespiratory fitness in stroke survivors with chronic gait impairment even long after their stroke . The response , however , varies between individuals . Objective . The purpose of this post hoc analysis of 2 r and omized controlled T-EX trials was to identify predictors for therapy response . Methods . In all , 52 participants received T-EX for 3 ( Germany ) or 6 ( United States ) months . Improvements in overground walking velocity ( 10 m/6-min walk ) and fitness ( peak VO2 ) were indicators of therapy response . Lesion location and volume were measured on T1-weighted magnetic resonance scans . Results . T-EX significantly improved gait and fitness , with gains in 10-m walk tests ranging between + 113 % and −25 % and peak VO2 between −12 % and 88 % . Baseline walking impairments or fitness deficits were not predictive of therapy response ; 10-m walk velocity improved more in those with subcortical rather than cortical lesions and in patients with smaller lesions . Improvements in 6-minute walk velocity were greater in those with more recent strokes and left-sided lesions . No variable other than training intensity , which was different between trials , predicted fitness gains . Conclusions . Despite proving overall effectiveness , the response to T-EX varies markedly between individuals . Whereas intensity of aerobic training seems to be an important predictor of gains in cardiovascular fitness , lesion size and location as well as interval between stroke onset and therapy delivery likely affect therapy response . These findings may be used to guide the timing of training and identify subgroups of patients for whom training modalities could be optimized Background . Numerous studies have reported the effects of gait training on motor performance after stroke . However , there is limited information on treatment-induced changes in corticomotor excitability . Objectives . The purpose of the study was to investigate the effects of additional gait training on motor performance and corticomotor excitability and to demonstrate the relationship between motor improvement and corticomotor excitability change in patients with chronic stroke . Methods . Fourteen patients were r and omly assigned to the experimental or control group . Participants in both groups participated in general physical therapy . Those in the experimental group received additional body weight− supported treadmill training for 4 weeks . All participants received baseline and posttreatment assessment s. The outcome measures included assessment of the Berg Balance Scale ( BBS ) and gait parameters . Focal transcranial magnetic stimulation was used to measure the motor threshold , map size , and location of the amplitude-weighted center of gravity of the motor map for the tibialis anterior ( TA ) and abductor hallucis ( AH ) muscles . Results . After 
    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 — A new gait training strategy for patients with stroke seeks to increase walking speed through treadmill training . This study compares the effects of structured speed-dependent treadmill training ( STT ) ( with the use of an interval paradigm to increase the treadmill speed stepwise according to principles of sport physiology ) with limited progressive treadmill training ( LTT ) and conventional gait training ( CGT ) on clinical outcome measures for patients with hemiparesis . Methods — Sixty ambulatory poststroke patients were each r and omly selected to receive 1 of the 3 different gait therapies : 20 subjects were treated with STT , 20 subjects were trained to walk on a treadmill with a 20 % increase of belt speed over the treatment period ( LTT ) , and 20 subjects were treated with CGT . Treatment outcomes were assessed on the basis of overground walking speed , cadence , stride length , and Functional Ambulation Category scores . Results — After a 4-week training period , the STT group scored significantly higher than the LTT and CGT groups for overground walking speed ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , cadence ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) , stride length ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , and Functional Ambulation Category scores ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) . Conclusions — Structured STT in poststroke patients result ed in better walking abilities than LTT or CGT . This gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke OBJECTIVE To compare the effects of speed-dependent treadmill training on gait and balance performance in patients with sub-acute stroke . DESIGN Single-blinded r and omized controlled trial . SUBJECTS A total of 26 patients with sub-acute stroke were r and omly assigned to experimental ( n = 13 ) and control ( n = 13 ) groups . METHODS Subjects in the experimental group underwent short interval walking trials with stepwise increases in treadmill speed ( speed-dependent treadmill training ) , following the principles of sprint training . Control subjects received gait training on the treadmill at a steady speed . Gait speed , stride length , cadence , and Berg 's Balance Score were recorded and analysed before and after the 10 training sessions . RESULTS Results of 2-way repeated measures analysis of variance showed significant group × time interactions for gait speed and stride length ( p < 0.05 ) . Within each subject group there were improvements in all gait parameters and Berg ’s Balance Score after the training programme . In addition , the experimental group showed significantly larger increases in gait speed ( mean 0.15 m/s , 95 % confidence interval 0.04–0.26 ) and stride length ( mean 0.16 m , 95 % confidence interval 0.02–0.30 ) than the control subjects . CONCLUSION Speed-dependent treadmill training in patients with sub-acute stroke result ed in larger gains in gait speed and stride length compared with steady speed . The positive findings provide evidence for clinical practice of speed-dependent treadmill training in enhancing gait function after stroke Objective : To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases . Design : A three group r and omised controlled trial with repeated measures was used . Method : One hundred and one patients with a primary middle cerebral artery stroke were r and omly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on ( 1 ) upper limb function , ( 2 ) lower limb function or ( 3 ) immobilisation with an inflatable pressure splint ( control group ) . Follow up assessment s within and between groups were compared at 6 , 9 , and 12 months after stroke . Results : No statistically significant effects were found for treatment assignment from 6 months onwards . At a group level , the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained . However , no significant differences in functional recovery between groups were found for Barthel index ( BI ) , functional ambulation categories (FAC),action research arm test ( ARAT ) , comfortable and maximal walking speed , Nottingham health profile part 1(NHP-part 1 ) , sickness impact profile-68 ( SIP-68 ) , and Frenchay activities index ( FAI ) from 6 months onwards . At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function ( n=8 and 5 , respectively ) and lower limb function ( n=19 and 9 , respectively ) . Activities of daily living ( ADL ) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards . In particular , patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards . Conclusions : On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme . However , a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity , walking ability , and ADL beyond the error threshold OBJECTIVE To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and h and icap associated with poor walking performance after stroke . DESIGN R and omized , placebo-controlled clinical trial with a 3-month follow-up . SETTING General community . PARTICIPANTS A volunteer sample of 29 ambulatory individuals ( less 2 dropouts ) who were living in the community after having suffered a stroke more than 6 months previously . INTERVENTIONS The experimental group participated in a 30-minute treadmill and overground walking program , 3 times a week for 4 weeks . The control group received a placebo consisting of a low-intensity , home exercise program and regular telephone contact . MAIN OUTCOME MEASURES Walking speed ( over 10 m ) , walking capacity ( distance over 6 min ) , and h and icap ( stroke-adapted 30-item version of the Sickness Impact Profile ) measured by a blinded assessor . RESULTS The 4-week treadmill and overground walking program significantly increased walking speed ( P=.02 ) and walking capacity ( P<.001 ) , but did not decrease h and icap ( P=.85 ) compared with the placebo program . These gains were largely maintained 3 months after the cessation of training ( P</=.05 ) . CONCLUSIONS The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke . This suggests that the routine provision of accessible , long-term , community-based walking programs would be beneficial in reducing disability after stroke Background and Purpose — Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability . Gait is a complex sensorimotor function controlled by integrated cortical , subcortical , and spinal networks . The mechanisms of gait recovery after stroke are not well understood . This study examines the hypothesis that progressive task-repetitive treadmill exercise ( T-EX ) improves fitness and gait function in subjects with chronic hemiparetic stroke by inducing adaptations in the brain ( plasticity ) . Methods — A r and omized controlled trial determined the effects of 6-month T-EX  ( n=37 ) versus comparable duration stretching ( CON , n=34 ) on walking , aerobic fitness and in a subset ( n=15/17 ) on brain activation measured by functional MRI . Results — T-EX significantly improved treadmill-walking velocity by 51 % and cardiovascular fitness by 18 % ( 11 % and −3 % for CON , respectively ; P<0.05 ) . T-EX but not CON affected brain activation during paretic , but not during nonparetic limb movement , showing 72 % increased activation in posterior cerebellar lobe and 18 % in midbrain ( P<0.005 ) . Exercise-mediated improvements in walking velocity correlated with increased activation in cerebellum and midbrain . Conclusions — T-EX  improves walking , fitness and recruits cerebellum-midbrain circuits , likely reflecting neural network plasticity . This neural recruitment is associated with better walking . These findings demonstrate the effectiveness of T-EX rehabilitation in promoting gait recovery of stroke survivors with long-term mobility impairment and provide evidence of neuroplastic mechanisms that could lead to further refinements in these paradigms to improve functional outcomes BACKGROUND Results of recent studies have suggested that restraint of non-paretic lower limb movement could improve locomotion in hemiplegic patients . The aim of this study was therefore to determine if a mass applied to the non-paretic lower limb during a single gait training session ( GTS ) would specifically improve spatio-temporal , kinematic and kinetic gait parameters ( GP ) of the paretic lower limb . METHODS Sixty chronic hemiplegic subjects were included in this r and omized study . Each participated in one of four GTS conditions : overground or on a treadmill while wearing or not wearing an ankle mass . All subjects were assessed before , immediately after and 20 min after the end of the GTS using 3D gait analysis . RESULTS The results showed that restraining the non-paretic lower limb during a GTS had no specific effect on GP of the paretic limb , whereas it increased braking force of the non-paretic limb . CONCLUSION Restraining the non-paretic lower limb of hemiparetic patients with a mass applied to the ankle does not seem to be an effective approach to improve paretic lower limb parameters during a single GTS 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 . Aerobic treadmill exercise ( T-EX ) therapy has been shown to benefit walking and cardiorespiratory fitness in stroke survivors with chronic gait impairment even long after their stroke . The response , however , varies between individuals . Objective . The purpose of this post hoc analysis of 2 r and omized controlled T-EX trials was to identify predictors for therapy response . Methods . In all , 52 participants received T-EX for 3 ( Germany ) or 6 ( United States ) months . Improvements in overground walking velocity ( 10 m/6-min walk ) and fitness ( peak VO2 ) were indicators of therapy response . Lesion location and volume were measured on T1-weighted magnetic resonance scans . Results . T-EX significantly improved gait and fitness , with gains in 10-m walk tests ranging between + 113 % and −25 % and peak VO2 between −12 % and 88 % . Baseline walking impairments or fitness deficits were not predictive of therapy response ; 10-m walk velocity improved more in those with subcortical rather than cortical lesions and in patients with smaller lesions . Improvements in 6-minute walk velocity were greater in those with more recent strokes and left-sided lesions . No variable other than training intensity , which was different between trials , predicted fitness gains . Conclusions . Despite proving overall effectiveness , the response to T-EX varies markedly between individuals . Whereas intensity of aerobic training seems to be an important predictor of gains in cardiovascular fitness , lesion size and location as well as interval between stroke onset and therapy delivery likely affect therapy response . These findings may be used to guide the timing of training and identify subgroups of patients for whom training modalities could be optimized Background . Numerous studies have reported the effects of gait training on motor performance after stroke . However , there is limited information on treatment-induced changes in corticomotor excitability . Objectives . The purpose of the study was to investigate the effects of additional gait training on motor performance and corticomotor excitability and to demonstrate the relationship between motor improvement and corticomotor excitability change in patients with chronic stroke . Methods . Fourteen patients were r and omly assigned to the experimental or control group . Participants in both groups participated in general physical therapy . Those in the experimental group received additional body weight− supported treadmill training for 4 weeks . All participants received baseline and posttreatment assessment s. The outcome measures included assessment of the Berg Balance Scale ( BBS ) and gait parameters . Focal transcranial magnetic stimulation was used to measure the motor threshold , map size , and location of the amplitude-weighted center of gravity of the motor map for the tibialis anterior ( TA ) and abductor hallucis ( AH ) muscles . Results . After 
    Output:
    