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 Freezing is a disabling symptom in patients with Parkinson 's disease . We investigated the effectiveness of a new rehabilitation strategy based on treadmill training associated with auditory and visual cues .  Forty Parkinsonian patients with freezing were r and omly assigned to two groups : Group 1 underwent a rehabilitation program based on treadmill training associated with auditory and visual cues , while Group 2 followed a rehabilitation protocol using cues and not associated with treadmill . Functional evaluation was based on the Unified Parkinson 's Disease Rating Scale Motor Section ( UPDRS III ) , Freezing of Gait Question naire ( FOGQ ) , 6-minute walking test ( 6MWT ) , gait speed , and stride cycle . Patients in both the groups had significant improvements in all variables considered by the end of the rehabilitation program ( all P = 0.0001 ) . Patients treated with the protocol including treadmill , had more improvement than patients in Group 2 in most functional indicators ( P = 0.007 , P = 0.0004 , P = 0.0126 , and P = 0.0263 for FOGQ , 6MWT , gait speed , stride cycle , respectively ) . The most striking result was obtained for 6MWT , with a mean increase of 130 m in Group 1 compared with 57 m in Group 2 . Our results suggest that treadmill training associated with auditory and visual cues might give better results than more conventional treatments . Treadmill training probably acts as a supplementary external cue Objective : To detect the effectiveness of incremental speed-dependent treadmill training on postural instability , dynamic balance and fear of falling in patients with idiopathic Parkinson 's disease . Design : R and omized controlled trial . Setting : Ankara Education and Research Hospital , 2nd PM&R Clinic , Cardiopulmonary Rehabilitation Unit . Subjects : Fifty-four patients with idiopathic Parkinson 's disease in stage 2 or 3 of the Hoehn Yahr staging entered , and 31 patients ( 21 training , 10 control ) had outcome data . Interventions : Postural instability of patients with Parkinson 's disease was assessed using the motor component of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale .  Twenty-one patients with Parkinson 's disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training . Before and after the training programme , balance , gait , fear of falling and walking distance and speed on treadmill were assessed in both Parkinson 's disease groups . Main measures : Walking distance and speed on treadmill , UPDRS , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale . Results : Initial total walking distance of the training group on treadmill was 266.45 ± 82.14 m and this was progressively increased to 726.36 ± 93.1 m after 16 training session ( P < 0.001 ) . Tolerated maximum speed of the training group on treadmill at baseline was 1.9 ± 0.75 km/h and improved to 2.61 ± 0.77 km/h ( P < 0.001 ) . Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme ( P < 0.01 ) . There was no significant improvement in any of the outcome measurements in the control group ( P > 0.05 ) . Conclusions : Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility , reduce postural instability and fear of falling in patients with Parkinson 's disease Abstract Background Over the last years , the introduction of robotic technologies into Parkinson ’s disease rehabilitation setting s has progressed from concept to reality . However , the benefit of robotic training remains elusive . This pilot r and omized controlled observer trial is aim ed at investigating the feasibility , the effectiveness and the efficacy of new end-effector robot training in people with mild Parkinson ’s disease . Methods Design . Pilot r and omized controlled trial . Setting . Robot assisted gait training ( EG ) compared to treadmill training ( CG ) . Participants . Twenty cognitively intact participants with mild Parkinson ’s disease and gait disturbance . Interventions . The EG underwent a rehabilitation programme of robot assisted walking for 40 minutes , 5 times a week for 4 weeks . The CG received a treadmill training programme for 40 minutes , 5 times a week for 4 weeks . Main outcome measures . The outcome measure of efficacy was recorded by gait analysis laboratory . The assessment s were performed at the beginning ( T0 ) and at the end of the treatment ( T1 ) . The main outcome was the change in velocity . The feasibility of the intervention was assessed by recording exercise adherence and acceptability by specific test . Results Robot training was feasible , acceptable , safe , and the participants completed 100 % of the prescribed training sessions . A statistically significant improvement in gait index was found in favour of the EG ( T0 versus T1 ) . In particular , the statistical analysis of primary outcome ( gait speed ) using the Friedman test showed statistically significant improvements for the EG ( p = 0,0195 ) . The statistical analysis performed by Friedman test of Step length left ( p = 0,0195 ) and right ( p = 0,0195 ) and Stride length left ( p = 0,0078 ) and right ( p = 0,0195 ) showed a significant statistical gain . No statistically significant improvements on the CG were found . Conclusions Robot training is a feasible and safe form of rehabilitative exercise for cognitively intact people with mild PD . This original approach can contribute to increase a short time lower limb motor recovery in idiopathic PD patients . The focus on the gait recovery is a further characteristic that makes this research relevant to clinical practice . On the whole , the simplicity of treatment , the lack of side effects , and the positive results from patients support the recommendation to extend the use of this treatment . Further investigation regarding the long-time effectiveness of robot training is warranted . Trial registration Clinical Trials.gov OBJECTIVE To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed , strength , and fitness for patients with Parkinson disease . DESIGN A comparative , prospect i ve , r and omized , single-blinded clinical trial of 3 types of physical exercise . SETTING The Parkinson 's Disease and Movement Disorders Center at the University of Maryl and and the Baltimore Veterans Affairs Medical Center , Geriatric Research Education and Clinical Center . PATIENTS A total of 67 patients with Parkinson disease who had gait impairment were r and omly assigned to 1 of 3 arms of the trial . INTERVENTIONS ; ( 1 ) A higher-intensity treadmill exercise ( 30 minutes at 70%-80 % of heart rate reserve ) , ( 2 ) a lower-intensity treadmill exercise ( 50 minutes at 40%-50 % of heart rate reserve ) , and ( 3 ) stretching and resistance exercises ( 2 sets of 10 repetitions on each leg on 3 resistance machines [ leg press , leg extension , and curl ] ) . These exercises were performed 3 times a week for 3 months . MAIN OUTCOME MEASURES The primary outcome measures were gait speed ( 6-minute walk ) , cardiovascular fitness ( peak oxygen consumption per unit time [ $ $ VO2 ] , and muscle strength ( 1-repetition maximum strength ) . RESULTS All 3 types of physical exercise improved distance on the 6-minute walk : lower-intensity treadmill exercise  ( 12 % increase ; P=.001 ) ,  stretching and resistance exercises  ( 9 % increase ; P<.02 ) , and higher-intensity treadmill exercise  ( 6 % increase ; P=.07 ) , with no between-group differences . Both treadmill exercises improved peak $ $ VO2 ( 7%-8 % increase ; P<.05 ) more than did the stretching and resistance exercises . Only stretching and resistance improved muscle strength ( 16 % increase ; P<.001 ) . CONCLUSIONS The effects of exercise were seen across all 3 exercise groups . The lower-intensity treadmill exercise result ed in the greatest improvement in gait speed . Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness . Only the stretching and resistance exercises improved muscle strength . Therefore , exercise can improve gait speed , muscle strength , and fitness for patients with Parkinson disease . The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation Objective : To investigate the feasibility and effectiveness of six weeks of home-based treadmill training in people with mild Parkinson ’s disease . Design : Pilot r and omized controlled trial of a six-week intervention followed by a further six weeks follow-up . Setting : Home-based treadmill training with outcome measures taken at a hospital clinic . Participants : Twenty cognitively intact participants with mild Parkinson ’s disease and gait disturbance . Two participants from the treadmill training group and one from the control group dropped out . Interventions : The treadmill training group undertook a semi-supervised home-based programme of treadmill walking for 20–40 minutes , four times a week for six weeks . The control group received usual care . Main outcome measures : The feasibility of the intervention was assessed by recording exercise adherence and acceptability , exercise intensity , fatigue , muscle soreness and adverse events . The primary outcome measure of efficacy was walking capacity ( 6-minute walk test distance ) . Results : Home-based treadmill training was feasible , acceptable and safe with participants completing 78 % ( SD 36 ) of the prescribed training sessions . The treadmill training group did not improve their walking capacity compared to the control group . The treadmill training group showed a greater improvement than the control group in fatigue at post test ( P = 0.04 ) and in quality of life at six weeks follow-up testing ( P = 0.02 ) . Conclusions : Semi-supervised home-based treadmill training is a feasible and safe form of exercise for cognitively intact people with mild Parkinson ’s disease . Further investigation regarding the effectiveness of home-based treadmill training is warranted INTRODUCTION Frequent falls and risk of injury are evident in individuals with Parkinson 's disease ( PD ) as the disease progresses . There have been no reports of any interventions that reduce the incidence of falls in idiopathic PD . PURPOSE Assess the benefit of gait and step perturbation training in individuals with PD . DESIGN R and omized , controlled trial . SETTING Outpatient research , education and clinical center in a tertiary care Veterans Affairs Medical Center . OUTCOME MEASURES Gait parameters , 5-step test , report of falls . SUBJECTS Eighteen men with idiopathic PD in stage 2 or 3 of the Hoehn and Yahr staging . METHODS Subjects were r and omly assigned to a trained or control group . They were asked about any falls  2 weeks prior to and after an 8 week period .  Gait speed , cadence , and step length  were tested on an instrumented walkway . Subjects were timed while stepping onto and back down from an 8.8 cm step for 5 consecutive steps . Gait training consisted of walking on a treadmill at a speed greater than over ground walking speed while walking in 4 directions and while supported in a harness for safety . Step training consisted of suddenly turning the treadmill on and off while the subject stood in the safety harness facing either forwards , backwards , or sideways . Training occurred 1 hour per day , three times per week for 8 weeks . A two-factor ( time and group ) analysis of variance with repeated measures was used to compare the groups . RESULTS Substantial reduction occurred in falls in the trained group , but not in the control group . Gait speed increased in the trained group from 1.28+/-0.33 meters/sec to 1.45+/-0.37 meters/sec , but not in the control group ( from 1.26 to 1.27 m/s ) . The cadence increased for both groups : from 112.8 to 120.3 steps/min for the trained group and 117.7 to 124.3 
    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 Freezing is a disabling symptom in patients with Parkinson 's disease . We investigated the effectiveness of a new rehabilitation strategy based on treadmill training associated with auditory and visual cues .  Forty Parkinsonian patients with freezing were r and omly assigned to two groups : Group 1 underwent a rehabilitation program based on treadmill training associated with auditory and visual cues , while Group 2 followed a rehabilitation protocol using cues and not associated with treadmill . Functional evaluation was based on the Unified Parkinson 's Disease Rating Scale Motor Section ( UPDRS III ) , Freezing of Gait Question naire ( FOGQ ) , 6-minute walking test ( 6MWT ) , gait speed , and stride cycle . Patients in both the groups had significant improvements in all variables considered by the end of the rehabilitation program ( all P = 0.0001 ) . Patients treated with the protocol including treadmill , had more improvement than patients in Group 2 in most functional indicators ( P = 0.007 , P = 0.0004 , P = 0.0126 , and P = 0.0263 for FOGQ , 6MWT , gait speed , stride cycle , respectively ) . The most striking result was obtained for 6MWT , with a mean increase of 130 m in Group 1 compared with 57 m in Group 2 . Our results suggest that treadmill training associated with auditory and visual cues might give better results than more conventional treatments . Treadmill training probably acts as a supplementary external cue Objective : To detect the effectiveness of incremental speed-dependent treadmill training on postural instability , dynamic balance and fear of falling in patients with idiopathic Parkinson 's disease . Design : R and omized controlled trial . Setting : Ankara Education and Research Hospital , 2nd PM&R Clinic , Cardiopulmonary Rehabilitation Unit . Subjects : Fifty-four patients with idiopathic Parkinson 's disease in stage 2 or 3 of the Hoehn Yahr staging entered , and 31 patients ( 21 training , 10 control ) had outcome data . Interventions : Postural instability of patients with Parkinson 's disease was assessed using the motor component of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale .  Twenty-one patients with Parkinson 's disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training . Before and after the training programme , balance , gait , fear of falling and walking distance and speed on treadmill were assessed in both Parkinson 's disease groups . Main measures : Walking distance and speed on treadmill , UPDRS , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale . Results : Initial total walking distance of the training group on treadmill was 266.45 ± 82.14 m and this was progressively increased to 726.36 ± 93.1 m after 16 training session ( P < 0.001 ) . Tolerated maximum speed of the training group on treadmill at baseline was 1.9 ± 0.75 km/h and improved to 2.61 ± 0.77 km/h ( P < 0.001 ) . Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme ( P < 0.01 ) . There was no significant improvement in any of the outcome measurements in the control group ( P > 0.05 ) . Conclusions : Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility , reduce postural instability and fear of falling in patients with Parkinson 's disease Abstract Background Over the last years , the introduction of robotic technologies into Parkinson ’s disease rehabilitation setting s has progressed from concept to reality . However , the benefit of robotic training remains elusive . This pilot r and omized controlled observer trial is aim ed at investigating the feasibility , the effectiveness and the efficacy of new end-effector robot training in people with mild Parkinson ’s disease . Methods Design . Pilot r and omized controlled trial . Setting . Robot assisted gait training ( EG ) compared to treadmill training ( CG ) . Participants . Twenty cognitively intact participants with mild Parkinson ’s disease and gait disturbance . Interventions . The EG underwent a rehabilitation programme of robot assisted walking for 40 minutes , 5 times a week for 4 weeks . The CG received a treadmill training programme for 40 minutes , 5 times a week for 4 weeks . Main outcome measures . The outcome measure of efficacy was recorded by gait analysis laboratory . The assessment s were performed at the beginning ( T0 ) and at the end of the treatment ( T1 ) . The main outcome was the change in velocity . The feasibility of the intervention was assessed by recording exercise adherence and acceptability by specific test . Results Robot training was feasible , acceptable , safe , and the participants completed 100 % of the prescribed training sessions . A statistically significant improvement in gait index was found in favour of the EG ( T0 versus T1 ) . In particular , the statistical analysis of primary outcome ( gait speed ) using the Friedman test showed statistically significant improvements for the EG ( p = 0,0195 ) . The statistical analysis performed by Friedman test of Step length left ( p = 0,0195 ) and right ( p = 0,0195 ) and Stride length left ( p = 0,0078 ) and right ( p = 0,0195 ) showed a significant statistical gain . No statistically significant improvements on the CG were found . Conclusions Robot training is a feasible and safe form of rehabilitative exercise for cognitively intact people with mild PD . This original approach can contribute to increase a short time lower limb motor recovery in idiopathic PD patients . The focus on the gait recovery is a further characteristic that makes this research relevant to clinical practice . On the whole , the simplicity of treatment , the lack of side effects , and the positive results from patients support the recommendation to extend the use of this treatment . Further investigation regarding the long-time effectiveness of robot training is warranted . Trial registration Clinical Trials.gov OBJECTIVE To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed , strength , and fitness for patients with Parkinson disease . DESIGN A comparative , prospect i ve , r and omized , single-blinded clinical trial of 3 types of physical exercise . SETTING The Parkinson 's Disease and Movement Disorders Center at the University of Maryl and and the Baltimore Veterans Affairs Medical Center , Geriatric Research Education and Clinical Center . PATIENTS A total of 67 patients with Parkinson disease who had gait impairment were r and omly assigned to 1 of 3 arms of the trial . INTERVENTIONS ; ( 1 ) A higher-intensity treadmill exercise ( 30 minutes at 70%-80 % of heart rate reserve ) , ( 2 ) a lower-intensity treadmill exercise ( 50 minutes at 40%-50 % of heart rate reserve ) , and ( 3 ) stretching and resistance exercises ( 2 sets of 10 repetitions on each leg on 3 resistance machines [ leg press , leg extension , and curl ] ) . These exercises were performed 3 times a week for 3 months . MAIN OUTCOME MEASURES The primary outcome measures were gait speed ( 6-minute walk ) , cardiovascular fitness ( peak oxygen consumption per unit time [ $ $ VO2 ] , and muscle strength ( 1-repetition maximum strength ) . RESULTS All 3 types of physical exercise improved distance on the 6-minute walk : lower-intensity treadmill exercise  ( 12 % increase ; P=.001 ) ,  stretching and resistance exercises  ( 9 % increase ; P<.02 ) , and higher-intensity treadmill exercise  ( 6 % increase ; P=.07 ) , with no between-group differences . Both treadmill exercises improved peak $ $ VO2 ( 7%-8 % increase ; P<.05 ) more than did the stretching and resistance exercises . Only stretching and resistance improved muscle strength ( 16 % increase ; P<.001 ) . CONCLUSIONS The effects of exercise were seen across all 3 exercise groups . The lower-intensity treadmill exercise result ed in the greatest improvement in gait speed . Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness . Only the stretching and resistance exercises improved muscle strength . Therefore , exercise can improve gait speed , muscle strength , and fitness for patients with Parkinson disease . The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation Objective : To investigate the feasibility and effectiveness of six weeks of home-based treadmill training in people with mild Parkinson ’s disease . Design : Pilot r and omized controlled trial of a six-week intervention followed by a further six weeks follow-up . Setting : Home-based treadmill training with outcome measures taken at a hospital clinic . Participants : Twenty cognitively intact participants with mild Parkinson ’s disease and gait disturbance . Two participants from the treadmill training group and one from the control group dropped out . Interventions : The treadmill training group undertook a semi-supervised home-based programme of treadmill walking for 20–40 minutes , four times a week for six weeks . The control group received usual care . Main outcome measures : The feasibility of the intervention was assessed by recording exercise adherence and acceptability , exercise intensity , fatigue , muscle soreness and adverse events . The primary outcome measure of efficacy was walking capacity ( 6-minute walk test distance ) . Results : Home-based treadmill training was feasible , acceptable and safe with participants completing 78 % ( SD 36 ) of the prescribed training sessions . The treadmill training group did not improve their walking capacity compared to the control group . The treadmill training group showed a greater improvement than the control group in fatigue at post test ( P = 0.04 ) and in quality of life at six weeks follow-up testing ( P = 0.02 ) . Conclusions : Semi-supervised home-based treadmill training is a feasible and safe form of exercise for cognitively intact people with mild Parkinson ’s disease . Further investigation regarding the effectiveness of home-based treadmill training is warranted INTRODUCTION Frequent falls and risk of injury are evident in individuals with Parkinson 's disease ( PD ) as the disease progresses . There have been no reports of any interventions that reduce the incidence of falls in idiopathic PD . PURPOSE Assess the benefit of gait and step perturbation training in individuals with PD . DESIGN R and omized , controlled trial . SETTING Outpatient research , education and clinical center in a tertiary care Veterans Affairs Medical Center . OUTCOME MEASURES Gait parameters , 5-step test , report of falls . SUBJECTS Eighteen men with idiopathic PD in stage 2 or 3 of the Hoehn and Yahr staging . METHODS Subjects were r and omly assigned to a trained or control group . They were asked about any falls  2 weeks prior to and after an 8 week period .  Gait speed , cadence , and step length  were tested on an instrumented walkway . Subjects were timed while stepping onto and back down from an 8.8 cm step for 5 consecutive steps . Gait training consisted of walking on a treadmill at a speed greater than over ground walking speed while walking in 4 directions and while supported in a harness for safety . Step training consisted of suddenly turning the treadmill on and off while the subject stood in the safety harness facing either forwards , backwards , or sideways . Training occurred 1 hour per day , three times per week for 8 weeks . A two-factor ( time and group ) analysis of variance with repeated measures was used to compare the groups . RESULTS Substantial reduction occurred in falls in the trained group , but not in the control group . Gait speed increased in the trained group from 1.28+/-0.33 meters/sec to 1.45+/-0.37 meters/sec , but not in the control group ( from 1.26 to 1.27 m/s ) . The cadence increased for both groups : from 112.8 to 120.3 steps/min for the trained group and 117.7 to 124.3 
    Output:
    