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: The relationship between patterns of visual spatial inattention and activities of daily living ( ADL ) performance was investigated in 64 Chinese patients with right brain lesions , using the Klein-Bell ADL Scale and the R and om Chinese Word Cancellation Test . The result showed that patients demonstrating hemi-inattention were significantly worse in ADL performance than patients with nonlateralized inattention or patients with normal attention , but that the latter two groups did not differ from each other . Although ADL performance was also found to be significantly related to somatosensation , motor status , and visual factors , after controlling the effects of these variables by partial correlation , hemi-inattention still was highly related to ADL performance . Independence in dressing , mobility , and elimination appeared to be more adversely affected by hemi-inattention than were bathing/hygiene , eating , and telephone use CONTEXT Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % ] ; P<.001 ) and in the MAL Amount of Use ( on a 0 - 5 scale , increase from 1.21 to 2.13 vs from 1.15 to 1.65 ; between-group difference , 0.43 [ 95 % CI , 0.05 - 0.80 ] ; P<.001 ) and MAL Quality of Movement ( on a 0 - 5 scale , increase from 1.26 to 2.23 vs 1.18 to 1.66 ; between-group difference , 0.48 [ 95 % CI , 0.13 - 0.84 ] ; P<.001 ) . The CIMT group achieved a decrease of 19.5 in self-perceived h and function difficulty ( Stroke Impact Scale h and domain ) vs a decrease of 10.1 for the control group ( between-group difference , 9.42 [ 95 % CI , 0.27 - 18.57 ] ; P=.05 ) . CONCLUSION Among patients who had a stroke within the previous 3 to 9 months , CIMT produced statistically significant and clinical ly relevant improvements in arm motor function that persisted for at least 1 year . Trial Registration clinical trials.gov Identifier : NCT00057018 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 The study aims to assess the therapeutic benefits of motor imagery training in stroke patients with persistent motor weakness . There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements . Imagining h and movements could stimulate the redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Methods / Design A multi-centre r and omised controlled trial recruiting individuals between one and six months post-stroke ( n = 135 ) . Patients are assessed before and after a four-week evaluation period . In this trial , 45 patients daily mentally rehearse movements with their affected arm under close supervision . Their recovery is compared to 45 patients  who perform closely supervised non-motor mental rehearsal , and 45 patients  who are not engaged in a training program . Motor imagery training effectiveness is evaluated using outcome measures of motor function , psychological processes , and level of disability . Discussion The idea of enhancing motor recovery through the use of motor imagery rehabilitation techniques is important with potential implication s for clinical practice . The techniques evaluated as part of this r and omised controlled trial are informed by the current underst and ing in cognitive neuroscience and the trial is both of scientific and applied interest Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Background and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 13 days ) . Only 9 patients were restricted to bed . During the therapeutic day , patients spent > 50 % resting in bed , 28 % sitting out of bed , and only 13 % engaged in activities with the potential to prevent complications and improve recovery of mobility . Patients were alone > 60 % of the time . Conclusions — This is the first multicenter study of physical activity early after stroke . We believe the next step is to conduct a r and omized controlled trial to evaluate the effect of increased levels of  physical activity  early after stroke compared with current st and ards of care Background and Purpose — In prehension tasks with objects placed within arm ’s reach , patients with hemiparesis caused by stroke use excessive trunk movement to compensate for arm motor impairments . Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term . Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination . To evaluate the potential of this technique as a therapeutic intervention , we compared the effects of short-term reach-to-grasp training ( 60-trial training session ) with and without physical trunk restraint on arm movement patterns in patients with chronic hemiparesis . Methods — A total of 28 patients with hemiparesis were assigned to 2 groups : 1 group practice d reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness ( trunk restraint ) , and the second group practice d the same task while verbally instructed not to move the trunk ( control ) .  Kinematics of reaching and grasping an object placed within arm ’s length were recorded before , immediately after , and 24 hours after training . Results — The trunk restraint group used more elbow extension , less anterior trunk displacement , and had better interjoint coordination than the control group after training , and range of motion was maintained 24 hours later in only the trunk restraint group . Conclusions — Restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements in patients with chronic stroke than practice alone , and longer-term effects of this intervention should be evaluated This r and omized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness . There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements . Imagining h and movements could stimulate restitution and redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to method ological limitations . This r and omized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke ( on average <3 months post-stroke ) . R and omization was performed using an automated statistical minimizing procedure . The primary outcome measure was a blinded rating on the Action Research Arm test . The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week , compared to 31 patients who performed equally intensive non-motor mental rehearsal , and 32 patients receiving normal care without additional training . No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test ( ANCOVA statistical P = 0.77 , and effect size partial η2 = 0.005 ) or any of the secondary outcome measures . Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke . In light of the evidence , it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right Background Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation . A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain . This trial investigates whether mental practice can contribute to a quicker and /or better recovery of stroke in two Dutch nursing homes . The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual . In addition , we will investigate prognostic variables and feasibility ( process evaluation ) . Methods A r and omised , controlled , observer masked prospect i ve trial will be conducted with adult stroke patients in the (sub)acute phase of stroke recovery . Over a six weeks intervention period the control group will receive multi professional therapy as usual . Patients in the experimental group will be instructed how to perform mental practice , and will receive care as usual in which mental practice is embedded in physical , occupation and speech therapy sessions . Outcome will be assessed at six weeks and six months . The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale . Secondary outcomes are : Motricity Index , Nine Hole Peg Test , Barthel Index , Timed up and Go , 10 metres walking test , Rivermead Mobility Index . A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility . All patients are asked to keep a log to determine unguided training intensity . Discussion Advantages and disadvantages of several aspects of the chosen 
    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: The relationship between patterns of visual spatial inattention and activities of daily living ( ADL ) performance was investigated in 64 Chinese patients with right brain lesions , using the Klein-Bell ADL Scale and the R and om Chinese Word Cancellation Test . The result showed that patients demonstrating hemi-inattention were significantly worse in ADL performance than patients with nonlateralized inattention or patients with normal attention , but that the latter two groups did not differ from each other . Although ADL performance was also found to be significantly related to somatosensation , motor status , and visual factors , after controlling the effects of these variables by partial correlation , hemi-inattention still was highly related to ADL performance . Independence in dressing , mobility , and elimination appeared to be more adversely affected by hemi-inattention than were bathing/hygiene , eating , and telephone use CONTEXT Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % ] ; P<.001 ) and in the MAL Amount of Use ( on a 0 - 5 scale , increase from 1.21 to 2.13 vs from 1.15 to 1.65 ; between-group difference , 0.43 [ 95 % CI , 0.05 - 0.80 ] ; P<.001 ) and MAL Quality of Movement ( on a 0 - 5 scale , increase from 1.26 to 2.23 vs 1.18 to 1.66 ; between-group difference , 0.48 [ 95 % CI , 0.13 - 0.84 ] ; P<.001 ) . The CIMT group achieved a decrease of 19.5 in self-perceived h and function difficulty ( Stroke Impact Scale h and domain ) vs a decrease of 10.1 for the control group ( between-group difference , 9.42 [ 95 % CI , 0.27 - 18.57 ] ; P=.05 ) . CONCLUSION Among patients who had a stroke within the previous 3 to 9 months , CIMT produced statistically significant and clinical ly relevant improvements in arm motor function that persisted for at least 1 year . Trial Registration clinical trials.gov Identifier : NCT00057018 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 The study aims to assess the therapeutic benefits of motor imagery training in stroke patients with persistent motor weakness . There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements . Imagining h and movements could stimulate the redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Methods / Design A multi-centre r and omised controlled trial recruiting individuals between one and six months post-stroke ( n = 135 ) . Patients are assessed before and after a four-week evaluation period . In this trial , 45 patients daily mentally rehearse movements with their affected arm under close supervision . Their recovery is compared to 45 patients  who perform closely supervised non-motor mental rehearsal , and 45 patients  who are not engaged in a training program . Motor imagery training effectiveness is evaluated using outcome measures of motor function , psychological processes , and level of disability . Discussion The idea of enhancing motor recovery through the use of motor imagery rehabilitation techniques is important with potential implication s for clinical practice . The techniques evaluated as part of this r and omised controlled trial are informed by the current underst and ing in cognitive neuroscience and the trial is both of scientific and applied interest Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Background and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 13 days ) . Only 9 patients were restricted to bed . During the therapeutic day , patients spent > 50 % resting in bed , 28 % sitting out of bed , and only 13 % engaged in activities with the potential to prevent complications and improve recovery of mobility . Patients were alone > 60 % of the time . Conclusions — This is the first multicenter study of physical activity early after stroke . We believe the next step is to conduct a r and omized controlled trial to evaluate the effect of increased levels of  physical activity  early after stroke compared with current st and ards of care Background and Purpose — In prehension tasks with objects placed within arm ’s reach , patients with hemiparesis caused by stroke use excessive trunk movement to compensate for arm motor impairments . Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term . Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination . To evaluate the potential of this technique as a therapeutic intervention , we compared the effects of short-term reach-to-grasp training ( 60-trial training session ) with and without physical trunk restraint on arm movement patterns in patients with chronic hemiparesis . Methods — A total of 28 patients with hemiparesis were assigned to 2 groups : 1 group practice d reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness ( trunk restraint ) , and the second group practice d the same task while verbally instructed not to move the trunk ( control ) .  Kinematics of reaching and grasping an object placed within arm ’s length were recorded before , immediately after , and 24 hours after training . Results — The trunk restraint group used more elbow extension , less anterior trunk displacement , and had better interjoint coordination than the control group after training , and range of motion was maintained 24 hours later in only the trunk restraint group . Conclusions — Restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements in patients with chronic stroke than practice alone , and longer-term effects of this intervention should be evaluated This r and omized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness . There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements . Imagining h and movements could stimulate restitution and redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to method ological limitations . This r and omized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke ( on average <3 months post-stroke ) . R and omization was performed using an automated statistical minimizing procedure . The primary outcome measure was a blinded rating on the Action Research Arm test . The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week , compared to 31 patients who performed equally intensive non-motor mental rehearsal , and 32 patients receiving normal care without additional training . No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test ( ANCOVA statistical P = 0.77 , and effect size partial η2 = 0.005 ) or any of the secondary outcome measures . Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke . In light of the evidence , it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right Background Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation . A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain . This trial investigates whether mental practice can contribute to a quicker and /or better recovery of stroke in two Dutch nursing homes . The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual . In addition , we will investigate prognostic variables and feasibility ( process evaluation ) . Methods A r and omised , controlled , observer masked prospect i ve trial will be conducted with adult stroke patients in the (sub)acute phase of stroke recovery . Over a six weeks intervention period the control group will receive multi professional therapy as usual . Patients in the experimental group will be instructed how to perform mental practice , and will receive care as usual in which mental practice is embedded in physical , occupation and speech therapy sessions . Outcome will be assessed at six weeks and six months . The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale . Secondary outcomes are : Motricity Index , Nine Hole Peg Test , Barthel Index , Timed up and Go , 10 metres walking test , Rivermead Mobility Index . A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility . All patients are asked to keep a log to determine unguided training intensity . Discussion Advantages and disadvantages of several aspects of the chosen 
    Output:
    