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: It has been proposed that somatosensory stimulation in the form of electromyographically triggered neuromuscular electrical stimulation ( NMES ) to the peripheral nerve can influence functional measures of motor performance in subjects with stroke and can additionally produce changes in cortical excitability . Using a controlled , double-blind design , we studied the effects of intensive ( 60 h/3 weeks ) treatment at home with NMES compared with a sham treatment , applied to the extensor muscles of the hemiplegic forearm to facilitate h and opening in 16 chronic stroke subjects . We investigated improvement in functional use of the h and and change in cortical activation as measured by functional magnetic resonance imaging ( fMRI ) . Following treatment , subjects improved on measures of grasp and release of objects ( Box and Block Test and Jebsen Taylor H and Function Test [ JTHFT ] : small objects , stacking , heavy cans ) , isometric finger extension strength , and self-rated Motor Activity Log ( MAL ) : Amount of Use and How Well score . The sham subjects did not improve on any grasp and release measure or self-rated scale , but did improve on isometric finger extension strength . Importantly , however , following crossover , these subjects improved further in the measure of strength , grasp and release ( Box and Block [ JTHFT ] : page turning ) , and self-rated MAL : Amount of Use score and How Well score . Using fMRI and a finger-tracking task , an index of cortical intensity in the ipsilateral somatosensory cortex increased significantly from pre-test to post-test following treatment . Cortical activation , as measured by voxel count , did not change . These findings suggest that NMES may have an important role in stimulating cortical sensory areas allowing for improved motor function Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients Objective : ( 1 ) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the dem and on therapist re sources . ( 2 ) To explore whether extended mitt use alone may enhance outcome . Design : A combined case-control and r and omized controlled study with pre- and post-treatment measures by blinded observers . Setting : A university hospital rehabilitation department . Participants : Sixteen stroke patients ( nine men and seven women ; mean age 56.7 years ; on average 28.9 months post stroke , five of whom were 6 - 9 months post stroke ) with moderate motor impairments in the contralateral upper limb . Intervention : Constraint-induced therapy ( mitt on the less affected h and 90 % of waking hours for 12 days ) with 2 - 3 patients per therapist and 6 h of group training per day . After the training period , the patients were r and omized either to using the mitt at home every other day for two-week periods for another three months ( in total 21 days ) or to no further treatment . Outcome measures : Modified Motor Assessment Scale , Sollerman H and Function Test , Two-Point Discrimination test and Motor Activity Log . Results : The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale ( 1.44 ( 95 % confidence interval ( 95 % CI ) 0.59 - 2.28 ) points ; P = 0.003 ) and on Sollerman H and Function Test ( 3.81 ( 95 % CI 0.26 - 7.36 ) points ; P = 0.037 ) but showed no sensory change in the Two-Point Discrimination Test ( P = 0.283 ) . The median difference in self-reported motor ability ( Motor Activity Log ) also improved ( P B=0.001 ) . However , no additional effect was seen from wearing a mitt for another three months . Conclusion : Constraint-induced group therapy , allowing several patients per therapist , seems to be a feasible alternative to improve upper limb motor function . The restraint alone , extended in time , did not enhance the treatment effect Background and Purpose — The Wolf Motor Function Test ( WMFT ) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements . This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population . Methods — Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment . Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment ( FMA ) on 2 occasions ( 12 to 16 days apart ) , with scoring performed independently by 2 r and om raters . Results — The  WMFT and FMA demonstrated agreement ( P < 0.0001 ) between raters at each session .  WMFT  scores for the dominant and nondominant extremities of individuals without impairment were different ( P ≤0.05 ) from the more and less affected extremities of subjects after stroke . The FMA score for the more affected extremity of subjects after stroke was different ( P ≤0.05 ) from the dominant and nondominant extremities . However , the FMA score for the less affected upper extremity of individuals after stroke was not different ( P > 0.05 ) from the dominant and nondominant extremities of individuals without impairment . The WMFT and FMA scores were related ( P < 0.02 ) for the more affected extremity in individuals after stroke . Conclusions — The interrater reliability , construct validity , and criterion validity of the WMFT , as used in these subject sample s , are supported Background and Purpose — Severe upper limb paresis is a major contributor to disability after stroke . This study investigated the efficacy of a new nonrobotic training device , the Sensorimotor Active Rehabilitation Training ( SMART ) Arm , that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension , permitting stroke survivors with severe paresis to practice a constrained reaching task . Methods — A single-blind , r and omized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis . Thirty-three participants completed the study , of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation , 13 received training using the SMART Arm alone , and 10 received no intervention ( control ) . Training consisted of 12 1-hour sessions over 4 weeks . The primary outcome measure was “ upper arm function , ” item 6 of the Motor Assessment Scale . Secondary outcome measures included impairment measures ; triceps muscle strength , reaching force , modified Ashworth scale ; and activity measures : reaching distance and Motor Assessment Scale . Assessment s were administered before ( 0 weeks ) and after training ( 4 weeks ) and at 2 months follow-up ( 12 weeks ) . Results — Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up . There was no significant difference between these 2 groups . There was no change in the control group . Conclusions — Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis , highlighting the benefits of intensive task-oriented practice , even in the context of severe paresis We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment . We compared the degree of satisfaction of patients undergoing a virtual reality ( VR ) therapy programme at home ( Tele-VR group ) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting ( VR-group ) . The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient 's movement was represented . In tele-therapy , the patient equipment was installed in their homes , connected to the hospital by four ISDN lines at a total b and width of 512 kbit/s . Rehabilitation data were transmitted via one line and videoconferencing via the other three . Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke , were r and omized into VR or Tele-VR groups . A question naire was used at the end of treatment to measure each patient 's degree of satisfaction . Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated , except one . In motor performance , the Tele-VR group improved significantly ( P ≤ 0.05 ) , while the VR group showed no significant change . Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required Background and Purpose Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke . We investigated the hypothesis that bilateral arm training with rhythmic auditory cueing ( BATRAC ) will improve motor function in the hemiparetic arm of stroke patients . Methods In this single group pilot study we determined the effects of 6 weeks of BATRAC on 14 patients with chronic hemiparetic stroke ( median time after stroke , 30 months ) immediately after training and at 2 months after training . Four 5-minute periods per session ( 3 times per week ) of BATRAC were performed with the use of a custom- design ed arm training machine . Results The patients showed significant and potentially durable increases in the following : Fugl-Meyer Upper Extremity Motor Performance Test of impairment ( P < 0.0004 ) , Wolf Motor Function Test ( performance time measure , P < 0.02 ) , and University of Maryl and Arm Question naire for Stroke measuring daily use of the hemiparetic arm ( P < 0.002 ) . Isometric strength improved in elbow flexion ( P < 0.05 ) and wrist flexion ( P < 0.02 ) for the paretic arm and in elbow flexion ( P < 0.02 ) and wrist extension ( P < 0.02 ) for the nonparetic arm . Active range of motion improved for paretic-side shoulder extension ( P < 0.01 ) , wrist flexion ( P < 0.004 ) , and thumb opposition ( P < 0.002 ) , and passive range of motion improved for paretic wrist flexion ( P < 0.03 ) . Conclusions Six weeks of BATRAC improves functional motor performance of the paretic upper extremity as well as a few changes in isometric strength and range of motion . These benefits are largely sustained at 8 weeks after training cessation BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care BACKGROUND Effective rehabilitative therapies are needed for patients with long-term deficits after stroke . METHODS In this multicenter , r and omized , controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke , we r and omly assigned 49 patients to receive intensive robot-assisted therapy  , 50 to receive intensive comparison therapy , and 28 to receive usual care . Therapy consisted of 36 1-hour sessions over a period of 12 weeks . The primary outcome was a change in motor function , as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke , at 12 weeks . Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale . Secondary analyses assessed 
    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: It has been proposed that somatosensory stimulation in the form of electromyographically triggered neuromuscular electrical stimulation ( NMES ) to the peripheral nerve can influence functional measures of motor performance in subjects with stroke and can additionally produce changes in cortical excitability . Using a controlled , double-blind design , we studied the effects of intensive ( 60 h/3 weeks ) treatment at home with NMES compared with a sham treatment , applied to the extensor muscles of the hemiplegic forearm to facilitate h and opening in 16 chronic stroke subjects . We investigated improvement in functional use of the h and and change in cortical activation as measured by functional magnetic resonance imaging ( fMRI ) . Following treatment , subjects improved on measures of grasp and release of objects ( Box and Block Test and Jebsen Taylor H and Function Test [ JTHFT ] : small objects , stacking , heavy cans ) , isometric finger extension strength , and self-rated Motor Activity Log ( MAL ) : Amount of Use and How Well score . The sham subjects did not improve on any grasp and release measure or self-rated scale , but did improve on isometric finger extension strength . Importantly , however , following crossover , these subjects improved further in the measure of strength , grasp and release ( Box and Block [ JTHFT ] : page turning ) , and self-rated MAL : Amount of Use score and How Well score . Using fMRI and a finger-tracking task , an index of cortical intensity in the ipsilateral somatosensory cortex increased significantly from pre-test to post-test following treatment . Cortical activation , as measured by voxel count , did not change . These findings suggest that NMES may have an important role in stimulating cortical sensory areas allowing for improved motor function Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients Objective : ( 1 ) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the dem and on therapist re sources . ( 2 ) To explore whether extended mitt use alone may enhance outcome . Design : A combined case-control and r and omized controlled study with pre- and post-treatment measures by blinded observers . Setting : A university hospital rehabilitation department . Participants : Sixteen stroke patients ( nine men and seven women ; mean age 56.7 years ; on average 28.9 months post stroke , five of whom were 6 - 9 months post stroke ) with moderate motor impairments in the contralateral upper limb . Intervention : Constraint-induced therapy ( mitt on the less affected h and 90 % of waking hours for 12 days ) with 2 - 3 patients per therapist and 6 h of group training per day . After the training period , the patients were r and omized either to using the mitt at home every other day for two-week periods for another three months ( in total 21 days ) or to no further treatment . Outcome measures : Modified Motor Assessment Scale , Sollerman H and Function Test , Two-Point Discrimination test and Motor Activity Log . Results : The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale ( 1.44 ( 95 % confidence interval ( 95 % CI ) 0.59 - 2.28 ) points ; P = 0.003 ) and on Sollerman H and Function Test ( 3.81 ( 95 % CI 0.26 - 7.36 ) points ; P = 0.037 ) but showed no sensory change in the Two-Point Discrimination Test ( P = 0.283 ) . The median difference in self-reported motor ability ( Motor Activity Log ) also improved ( P B=0.001 ) . However , no additional effect was seen from wearing a mitt for another three months . Conclusion : Constraint-induced group therapy , allowing several patients per therapist , seems to be a feasible alternative to improve upper limb motor function . The restraint alone , extended in time , did not enhance the treatment effect Background and Purpose — The Wolf Motor Function Test ( WMFT ) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements . This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population . Methods — Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment . Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment ( FMA ) on 2 occasions ( 12 to 16 days apart ) , with scoring performed independently by 2 r and om raters . Results — The  WMFT and FMA demonstrated agreement ( P < 0.0001 ) between raters at each session .  WMFT  scores for the dominant and nondominant extremities of individuals without impairment were different ( P ≤0.05 ) from the more and less affected extremities of subjects after stroke . The FMA score for the more affected extremity of subjects after stroke was different ( P ≤0.05 ) from the dominant and nondominant extremities . However , the FMA score for the less affected upper extremity of individuals after stroke was not different ( P > 0.05 ) from the dominant and nondominant extremities of individuals without impairment . The WMFT and FMA scores were related ( P < 0.02 ) for the more affected extremity in individuals after stroke . Conclusions — The interrater reliability , construct validity , and criterion validity of the WMFT , as used in these subject sample s , are supported Background and Purpose — Severe upper limb paresis is a major contributor to disability after stroke . This study investigated the efficacy of a new nonrobotic training device , the Sensorimotor Active Rehabilitation Training ( SMART ) Arm , that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension , permitting stroke survivors with severe paresis to practice a constrained reaching task . Methods — A single-blind , r and omized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis . Thirty-three participants completed the study , of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation , 13 received training using the SMART Arm alone , and 10 received no intervention ( control ) . Training consisted of 12 1-hour sessions over 4 weeks . The primary outcome measure was “ upper arm function , ” item 6 of the Motor Assessment Scale . Secondary outcome measures included impairment measures ; triceps muscle strength , reaching force , modified Ashworth scale ; and activity measures : reaching distance and Motor Assessment Scale . Assessment s were administered before ( 0 weeks ) and after training ( 4 weeks ) and at 2 months follow-up ( 12 weeks ) . Results — Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up . There was no significant difference between these 2 groups . There was no change in the control group . Conclusions — Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis , highlighting the benefits of intensive task-oriented practice , even in the context of severe paresis We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment . We compared the degree of satisfaction of patients undergoing a virtual reality ( VR ) therapy programme at home ( Tele-VR group ) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting ( VR-group ) . The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient 's movement was represented . In tele-therapy , the patient equipment was installed in their homes , connected to the hospital by four ISDN lines at a total b and width of 512 kbit/s . Rehabilitation data were transmitted via one line and videoconferencing via the other three . Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke , were r and omized into VR or Tele-VR groups . A question naire was used at the end of treatment to measure each patient 's degree of satisfaction . Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated , except one . In motor performance , the Tele-VR group improved significantly ( P ≤ 0.05 ) , while the VR group showed no significant change . Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required Background and Purpose Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke . We investigated the hypothesis that bilateral arm training with rhythmic auditory cueing ( BATRAC ) will improve motor function in the hemiparetic arm of stroke patients . Methods In this single group pilot study we determined the effects of 6 weeks of BATRAC on 14 patients with chronic hemiparetic stroke ( median time after stroke , 30 months ) immediately after training and at 2 months after training . Four 5-minute periods per session ( 3 times per week ) of BATRAC were performed with the use of a custom- design ed arm training machine . Results The patients showed significant and potentially durable increases in the following : Fugl-Meyer Upper Extremity Motor Performance Test of impairment ( P < 0.0004 ) , Wolf Motor Function Test ( performance time measure , P < 0.02 ) , and University of Maryl and Arm Question naire for Stroke measuring daily use of the hemiparetic arm ( P < 0.002 ) . Isometric strength improved in elbow flexion ( P < 0.05 ) and wrist flexion ( P < 0.02 ) for the paretic arm and in elbow flexion ( P < 0.02 ) and wrist extension ( P < 0.02 ) for the nonparetic arm . Active range of motion improved for paretic-side shoulder extension ( P < 0.01 ) , wrist flexion ( P < 0.004 ) , and thumb opposition ( P < 0.002 ) , and passive range of motion improved for paretic wrist flexion ( P < 0.03 ) . Conclusions Six weeks of BATRAC improves functional motor performance of the paretic upper extremity as well as a few changes in isometric strength and range of motion . These benefits are largely sustained at 8 weeks after training cessation BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care BACKGROUND Effective rehabilitative therapies are needed for patients with long-term deficits after stroke . METHODS In this multicenter , r and omized , controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke , we r and omly assigned 49 patients to receive intensive robot-assisted therapy  , 50 to receive intensive comparison therapy , and 28 to receive usual care . Therapy consisted of 36 1-hour sessions over a period of 12 weeks . The primary outcome was a change in motor function , as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke , at 12 weeks . Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale . Secondary analyses assessed 
    Output:
    