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: AIM To evaluate the effects of ' ' Playstation EyeToy Games ' ' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke . METHODS The authors design ed a r and omized , controlled , assessor-blinded , 4-week trial , with follow-up at 3 months . A total of 20 hemiparetic in patients ( mean age 61.1 years ) , all within 12 months post-stroke , received 30 minutes of treatment with ' ' Playstation EyeToy Games ' ' per day , consisting of flexion and extension of the paretic shoulder , elbow and wrist as well as abduction of the paretic shoulder or placebo therapy ( watching the games for the same duration without physical involvement into the games ) in addition to conventional program , 5 days a week , 2 - 5 hours/day for 4 weeks . Brunnstrom 's staging and self-care sub-items of the functional independence measure ( FIM ) were performed at 0 month ( baseline ) , 4 weeks ( post-treatment ) , and 3 months ( follow-up ) after the treatment . RESULTS The mean change score ( 95 % confidence interval ) of the FIM self-care score ( 5.5 [ 2.9 - 8.0 ] vs 1.8 [ 0.1 - 3.7 ] , P=0.018 ) showed significantly more improvement in the EyeToy group compared to the control group . No significant differences were found between the groups for the Brunnstrom stages for h and and upper extremity . CONCLUSION ' ' Playstation EyeToy Games ' ' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients Objective To investigate the effect of virtual reality on the recovery of cognitive impairment in stroke patients . Method Twenty-eight patients ( 11 males and 17 females , mean age 64.2 ) with cognitive impairment following stroke were recruited for this study . All patients were r and omly assigned to one of two groups , the virtual reality ( VR ) group ( n=15 ) or the control group ( n=13 ) . The VR group received both virtual reality training and computer-based cognitive rehabilitation , whereas the control group received only computer-based cognitive rehabilitation . To measure , activity of daily living cognitive and motor functions , the following assessment tools were used : computerized neuropsychological test and the Tower of London ( TOL ) test for cognitive function assessment , Korean-Modified Barthel index ( K-MBI ) for functional status evaluation , and the motricity index ( MI ) for motor function assessment . All recruited patients underwent these evaluations before rehabilitation and four weeks after rehabilitation . Results The VR group showed significant improvement in the K-MMSE , visual and auditory continuous performance tests ( CPT ) , forward digit span test ( DST ) , forward and backward visual span tests ( VST ) , visual and verbal learning tests , TOL , K-MBI , and MI scores , while the control group showed significant improvement in the K-MMSE , forward DST , visual and verbal learning tests , trail-making test-type A , TOL , K-MBI , and MI scores after rehabilitation . The changes in the visual CPT and backward VST in the VR group after rehabilitation were significantly higher than those in the control group . Conclusion Our findings suggest that virtual reality training combined with computer-based cognitive rehabilitation may be of additional benefit for treating cognitive impairment in stroke patients Background Acquired brain injury ( ABI ) is the main cause of death and disability among young adults . In most cases , survivors can experience balance instability , result ing in functional impairments that are associated with diminished health-related quality of life . Traditional rehabilitation therapy may be tedious . This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders . We present eBaViR ( easy Balance Virtual Rehabilitation ) , a system based on the Nintendo ® Wii Balance Board ® ( WBB ) , which has been design ed by clinical therapists to improve st and ing balance in patients with ABI through motivational and adaptative exercises . We hypothesize that eBaViR , is feasible , safe and potentially effective in enhancing st and ing balance . Methods In this contribution , we present a r and omized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients . This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation ( n = 9 ) versus st and ard rehabilitation ( n = 8) . Effectiveness was evaluated by means of traditional static and dynamic balance scales . Results The final sample consisted of 11 men and 6 women . Mean ± SD age was 47.3 ± 17.8 and mean ± SD chronicity was 570.9 ± 313.2 days . Patients using eBaViR had a significant improvement in static balance ( p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test ) compared to patients who underwent traditional therapy . Regarding dynamic balance , the results showed significant improvement over time in all these measures , but no significant group effect or group-by-time interaction was detected for any of them , which suggests that both groups improved in the same way . There were no serious adverse events during treatment in either group . Conclusions The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population . These results have encouraged us to reinforce the virtual treatment with new exercises , so an evolution of the system is currently being developed This exploratory study was undertaken to investigate the mechanisms that contributed to improvements in upper limb function following a novel training program . Surface electromyography ( EMG ) was used to examine training-induced changes in the pattern of triceps and biceps activation during reaching tasks in stroke survivors with severe paresis in the chronic stage of recovery . The EMG data were obtained in the context of a single blind r and omised clinical trial conducted with 42 stroke survivors with minimal upper limb muscle activity and who were more than 6 months post-stroke . Of the 33 participants who completed the study , 10 received training of reaching using a non-robotic upper limb training device , the SMART Arm , with EMG triggered functional electrical stimulation ( EMG-stim ) , 13 received training of reaching using the SMART Arm alone , and 10 received no intervention . Each intervention group engaged in 12 1-h training sessions over a 4-week period . Clinical and laboratory measures of upper limb function were administered prior to training ( 0 weeks ) , at completion ( 4 weeks ) and 2 months ( 12 weeks ) after training . The primary outcome measure was ‘ upper arm function ’ which is Item 6 of the Motor Assessment Scale ( MAS ) . Laboratory measures consisted of two multijoint reaching tasks to assess ‘ maximum isometric force ’ and ‘ maximum distance reached ’ . Surface EMG  was used to monitor triceps brachii and biceps brachii during the two reaching tasks . To provide a comparison with normal values , seven healthy adults were tested on one of the reaching tasks according to the same procedure . Study findings demonstrated a statistically significant improvement in upper limb function for stroke participants in the two training groups compared to those who received no training however no difference was found between the two training groups . For the reaching tasks , all stroke participants , when compared to normal healthy adults , exhibited lower triceps and biceps activation and a lower ratio of triceps to biceps activation . Following training , stroke participants demonstrated increased triceps activation and an increased ratio of triceps to biceps activation for the task that was trained . Better performance was associated with greater triceps activation and a higher ratio of triceps to biceps activation . The findings suggest that increased activation of triceps as an agonist and an improved coordination between triceps and biceps could have mediated the observed changes in arm function . The changes in EMG activity were small relative to the changes in arm function indicating that factors , such as the contribution of other muscles of reaching , may also be implicated Objectives . To study whether the reinforced feedback in virtual environment ( RFVE ) is more effective than traditional rehabilitation ( TR ) for the treatment of upper limb motor function after stroke , regardless of stroke etiology ( i.e. , ischemic , hemorrhagic ) . Design . R and omized controlled trial . Participants . Forty-four patients affected by stroke . Intervention . The patients were r and omized into two groups : RFVE ( N = 23 ) and TR ( N = 21 ) , and stratified according to stroke etiology . The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality , while in the TR treatment the same exercises were provided without augmented feedbacks . Outcome Measures . Fugl-Meyer upper extremity scale ( F-M UE ) , Functional Independence Measure scale ( FIM ) , and kinematics parameters ( speed , time , and peak ) . Results . The F-M UE ( P = 0.030 ) , FIM ( P = 0.021 ) , time ( P = 0.008 ) , and peak ( P = 0.018 ) , were significantly higher in the RFVE group after treatment , but not speed ( P = 0.140 ) . The patients affected by hemorrhagic stroke significantly improved FIM ( P = 0.031 ) , time ( P = 0.011 ) , and peak ( P = 0.020 ) after treatment , whereas the patients affected by ischemic stroke improved significantly only speed ( P = 0.005 ) when treated by RFVE . Conclusion . These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function . This trial is registered with NCT01955291 OBJECTIVE To investigate the effects of combination cathodal transcranial direct current stimulation ( tDCS ) and virtual reality ( VR ) therapy for upper extremity ( UE ) training in patients with subacute stroke . DESIGN Pilot r and omized controlled trial . Patients were r and omly assigned to 1 of 3 groups : group A received cathodal tDCS , group B received VR , and group C received combination therapy ( cathodal tDCS was simultaneously applied during VR therapy ) . SETTING University hospital . PARTICIPANTS Patients ( N=59 ) with impaired unilateral UE motor function after stroke . INTERVENTION Fifteen sessions of treatment over a 3-week period . MAIN OUTCOME MEASURES The Modified Ashworth Scale , manual muscle test ( MMT ) , Manual Function Test ( MFT ) , Fugl-Meyer Scale ( FMS ) , and Box and Block Test were used to assess UE function . To evaluate activities of daily living , the Korean-Modified Barthel Index ( K-MBI ) was used . All outcomes were measured before and immediately after treatment . RESULTS After treatment , all groups demonstrated significant improvements in MMT , MFT , FMS , and K-MBI scores . The change in MFT and FMS scores was different between the 3 groups . Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups . CONCLUSIONS In the present pilot study , the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone . This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke Background and Purpose — Virtual reality ( VR ) is a new promising computer-assisted technology to promote motor recovery in stroke patients .  VR-induced neuroplasticity supporting locomotor recovery is not known . We investigated the effects of VR intervention on cortical reorganization and associated locomotor recovery in stroke patients . Methods — Ten chronic stroke patients were assigned r and omly to either the control group or the  VR  group . VR was design ed to provide interactive real-life practice environments in which practice parameters can be individualized to optimize motor relearning . Laterality index ( LI ) in the regions of interests ( ROIs ) and locomotor recovery were measured before and after VR using functional MRI ( fMRI ) and st and ardized locomotor tests , respectively . The t test and nonparametric test were performed to compare the mean differences at P<0.05 . Results — There was a significant difference in the interval change in the LI score for the primary sensorimotor cortex ( SMC ) between the groups ( P<0.05 ) , indicating that VR practice produced a greater increase in LI for the control group . However , the interval changes in the other ROIs were not significantly different ( P>0.05 ) . Motor function was significantly improved after VR ( P<0.05 ) . Conclusions — Our novel findings suggest that VR could induce cortical reorganization from aberrant ipsilateral to contralateral SMC activation . This enhanced cortical reorganization might play an important role in recovery of locomotor function in patients with chronic stroke . This is the first fMRI study in the literature that provides evidence for neuroplasticity and associated locomotor recovery after VR Objective To investigate the effect of virtual reality ( VR ) and a tetra-ataxiometric posturography ( Tetrax ) program on stroke patients with impaired st and ing balance . Methods Thirty acute stroke patients with impaired st and ing balance were recruited and r and omly assigned to a VR , Tetrax , or control group . All patients received conventional balance training as a baseline ; and VR and Tetrax patients received VR or Tetrax treatment , in addition . The primary outcome measures to evaluate the overall st and ing balance were the Berg Balance Scale ( BBS ) and the falling index ( FI ) . The secondary outcome measures were the stability index ( SI ) and the weight distribution index ( WDI ) , which were used to evaluate the balance status according to specific body positions . The FI , SI , and WDI were measured using the Tetrax instrument . Results The BBS and FI scores were improved in all groups , with no significant differences between groups . In open-eyed positions , the VR group showed significantly greater improvement in SI and WDI scores than the control group ( p<0.017 ) . In closed-eyed positions , the Tetrax group showed significantly greater improvement in SI and 
    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: AIM To evaluate the effects of ' ' Playstation EyeToy Games ' ' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke . METHODS The authors design ed a r and omized , controlled , assessor-blinded , 4-week trial , with follow-up at 3 months . A total of 20 hemiparetic in patients ( mean age 61.1 years ) , all within 12 months post-stroke , received 30 minutes of treatment with ' ' Playstation EyeToy Games ' ' per day , consisting of flexion and extension of the paretic shoulder , elbow and wrist as well as abduction of the paretic shoulder or placebo therapy ( watching the games for the same duration without physical involvement into the games ) in addition to conventional program , 5 days a week , 2 - 5 hours/day for 4 weeks . Brunnstrom 's staging and self-care sub-items of the functional independence measure ( FIM ) were performed at 0 month ( baseline ) , 4 weeks ( post-treatment ) , and 3 months ( follow-up ) after the treatment . RESULTS The mean change score ( 95 % confidence interval ) of the FIM self-care score ( 5.5 [ 2.9 - 8.0 ] vs 1.8 [ 0.1 - 3.7 ] , P=0.018 ) showed significantly more improvement in the EyeToy group compared to the control group . No significant differences were found between the groups for the Brunnstrom stages for h and and upper extremity . CONCLUSION ' ' Playstation EyeToy Games ' ' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients Objective To investigate the effect of virtual reality on the recovery of cognitive impairment in stroke patients . Method Twenty-eight patients ( 11 males and 17 females , mean age 64.2 ) with cognitive impairment following stroke were recruited for this study . All patients were r and omly assigned to one of two groups , the virtual reality ( VR ) group ( n=15 ) or the control group ( n=13 ) . The VR group received both virtual reality training and computer-based cognitive rehabilitation , whereas the control group received only computer-based cognitive rehabilitation . To measure , activity of daily living cognitive and motor functions , the following assessment tools were used : computerized neuropsychological test and the Tower of London ( TOL ) test for cognitive function assessment , Korean-Modified Barthel index ( K-MBI ) for functional status evaluation , and the motricity index ( MI ) for motor function assessment . All recruited patients underwent these evaluations before rehabilitation and four weeks after rehabilitation . Results The VR group showed significant improvement in the K-MMSE , visual and auditory continuous performance tests ( CPT ) , forward digit span test ( DST ) , forward and backward visual span tests ( VST ) , visual and verbal learning tests , TOL , K-MBI , and MI scores , while the control group showed significant improvement in the K-MMSE , forward DST , visual and verbal learning tests , trail-making test-type A , TOL , K-MBI , and MI scores after rehabilitation . The changes in the visual CPT and backward VST in the VR group after rehabilitation were significantly higher than those in the control group . Conclusion Our findings suggest that virtual reality training combined with computer-based cognitive rehabilitation may be of additional benefit for treating cognitive impairment in stroke patients Background Acquired brain injury ( ABI ) is the main cause of death and disability among young adults . In most cases , survivors can experience balance instability , result ing in functional impairments that are associated with diminished health-related quality of life . Traditional rehabilitation therapy may be tedious . This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders . We present eBaViR ( easy Balance Virtual Rehabilitation ) , a system based on the Nintendo ® Wii Balance Board ® ( WBB ) , which has been design ed by clinical therapists to improve st and ing balance in patients with ABI through motivational and adaptative exercises . We hypothesize that eBaViR , is feasible , safe and potentially effective in enhancing st and ing balance . Methods In this contribution , we present a r and omized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients . This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation ( n = 9 ) versus st and ard rehabilitation ( n = 8) . Effectiveness was evaluated by means of traditional static and dynamic balance scales . Results The final sample consisted of 11 men and 6 women . Mean ± SD age was 47.3 ± 17.8 and mean ± SD chronicity was 570.9 ± 313.2 days . Patients using eBaViR had a significant improvement in static balance ( p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test ) compared to patients who underwent traditional therapy . Regarding dynamic balance , the results showed significant improvement over time in all these measures , but no significant group effect or group-by-time interaction was detected for any of them , which suggests that both groups improved in the same way . There were no serious adverse events during treatment in either group . Conclusions The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population . These results have encouraged us to reinforce the virtual treatment with new exercises , so an evolution of the system is currently being developed This exploratory study was undertaken to investigate the mechanisms that contributed to improvements in upper limb function following a novel training program . Surface electromyography ( EMG ) was used to examine training-induced changes in the pattern of triceps and biceps activation during reaching tasks in stroke survivors with severe paresis in the chronic stage of recovery . The EMG data were obtained in the context of a single blind r and omised clinical trial conducted with 42 stroke survivors with minimal upper limb muscle activity and who were more than 6 months post-stroke . Of the 33 participants who completed the study , 10 received training of reaching using a non-robotic upper limb training device , the SMART Arm , with EMG triggered functional electrical stimulation ( EMG-stim ) , 13 received training of reaching using the SMART Arm alone , and 10 received no intervention . Each intervention group engaged in 12 1-h training sessions over a 4-week period . Clinical and laboratory measures of upper limb function were administered prior to training ( 0 weeks ) , at completion ( 4 weeks ) and 2 months ( 12 weeks ) after training . The primary outcome measure was ‘ upper arm function ’ which is Item 6 of the Motor Assessment Scale ( MAS ) . Laboratory measures consisted of two multijoint reaching tasks to assess ‘ maximum isometric force ’ and ‘ maximum distance reached ’ . Surface EMG  was used to monitor triceps brachii and biceps brachii during the two reaching tasks . To provide a comparison with normal values , seven healthy adults were tested on one of the reaching tasks according to the same procedure . Study findings demonstrated a statistically significant improvement in upper limb function for stroke participants in the two training groups compared to those who received no training however no difference was found between the two training groups . For the reaching tasks , all stroke participants , when compared to normal healthy adults , exhibited lower triceps and biceps activation and a lower ratio of triceps to biceps activation . Following training , stroke participants demonstrated increased triceps activation and an increased ratio of triceps to biceps activation for the task that was trained . Better performance was associated with greater triceps activation and a higher ratio of triceps to biceps activation . The findings suggest that increased activation of triceps as an agonist and an improved coordination between triceps and biceps could have mediated the observed changes in arm function . The changes in EMG activity were small relative to the changes in arm function indicating that factors , such as the contribution of other muscles of reaching , may also be implicated Objectives . To study whether the reinforced feedback in virtual environment ( RFVE ) is more effective than traditional rehabilitation ( TR ) for the treatment of upper limb motor function after stroke , regardless of stroke etiology ( i.e. , ischemic , hemorrhagic ) . Design . R and omized controlled trial . Participants . Forty-four patients affected by stroke . Intervention . The patients were r and omized into two groups : RFVE ( N = 23 ) and TR ( N = 21 ) , and stratified according to stroke etiology . The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality , while in the TR treatment the same exercises were provided without augmented feedbacks . Outcome Measures . Fugl-Meyer upper extremity scale ( F-M UE ) , Functional Independence Measure scale ( FIM ) , and kinematics parameters ( speed , time , and peak ) . Results . The F-M UE ( P = 0.030 ) , FIM ( P = 0.021 ) , time ( P = 0.008 ) , and peak ( P = 0.018 ) , were significantly higher in the RFVE group after treatment , but not speed ( P = 0.140 ) . The patients affected by hemorrhagic stroke significantly improved FIM ( P = 0.031 ) , time ( P = 0.011 ) , and peak ( P = 0.020 ) after treatment , whereas the patients affected by ischemic stroke improved significantly only speed ( P = 0.005 ) when treated by RFVE . Conclusion . These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function . This trial is registered with NCT01955291 OBJECTIVE To investigate the effects of combination cathodal transcranial direct current stimulation ( tDCS ) and virtual reality ( VR ) therapy for upper extremity ( UE ) training in patients with subacute stroke . DESIGN Pilot r and omized controlled trial . Patients were r and omly assigned to 1 of 3 groups : group A received cathodal tDCS , group B received VR , and group C received combination therapy ( cathodal tDCS was simultaneously applied during VR therapy ) . SETTING University hospital . PARTICIPANTS Patients ( N=59 ) with impaired unilateral UE motor function after stroke . INTERVENTION Fifteen sessions of treatment over a 3-week period . MAIN OUTCOME MEASURES The Modified Ashworth Scale , manual muscle test ( MMT ) , Manual Function Test ( MFT ) , Fugl-Meyer Scale ( FMS ) , and Box and Block Test were used to assess UE function . To evaluate activities of daily living , the Korean-Modified Barthel Index ( K-MBI ) was used . All outcomes were measured before and immediately after treatment . RESULTS After treatment , all groups demonstrated significant improvements in MMT , MFT , FMS , and K-MBI scores . The change in MFT and FMS scores was different between the 3 groups . Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups . CONCLUSIONS In the present pilot study , the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone . This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke Background and Purpose — Virtual reality ( VR ) is a new promising computer-assisted technology to promote motor recovery in stroke patients .  VR-induced neuroplasticity supporting locomotor recovery is not known . We investigated the effects of VR intervention on cortical reorganization and associated locomotor recovery in stroke patients . Methods — Ten chronic stroke patients were assigned r and omly to either the control group or the  VR  group . VR was design ed to provide interactive real-life practice environments in which practice parameters can be individualized to optimize motor relearning . Laterality index ( LI ) in the regions of interests ( ROIs ) and locomotor recovery were measured before and after VR using functional MRI ( fMRI ) and st and ardized locomotor tests , respectively . The t test and nonparametric test were performed to compare the mean differences at P<0.05 . Results — There was a significant difference in the interval change in the LI score for the primary sensorimotor cortex ( SMC ) between the groups ( P<0.05 ) , indicating that VR practice produced a greater increase in LI for the control group . However , the interval changes in the other ROIs were not significantly different ( P>0.05 ) . Motor function was significantly improved after VR ( P<0.05 ) . Conclusions — Our novel findings suggest that VR could induce cortical reorganization from aberrant ipsilateral to contralateral SMC activation . This enhanced cortical reorganization might play an important role in recovery of locomotor function in patients with chronic stroke . This is the first fMRI study in the literature that provides evidence for neuroplasticity and associated locomotor recovery after VR Objective To investigate the effect of virtual reality ( VR ) and a tetra-ataxiometric posturography ( Tetrax ) program on stroke patients with impaired st and ing balance . Methods Thirty acute stroke patients with impaired st and ing balance were recruited and r and omly assigned to a VR , Tetrax , or control group . All patients received conventional balance training as a baseline ; and VR and Tetrax patients received VR or Tetrax treatment , in addition . The primary outcome measures to evaluate the overall st and ing balance were the Berg Balance Scale ( BBS ) and the falling index ( FI ) . The secondary outcome measures were the stability index ( SI ) and the weight distribution index ( WDI ) , which were used to evaluate the balance status according to specific body positions . The FI , SI , and WDI were measured using the Tetrax instrument . Results The BBS and FI scores were improved in all groups , with no significant differences between groups . In open-eyed positions , the VR group showed significantly greater improvement in SI and WDI scores than the control group ( p<0.017 ) . In closed-eyed positions , the Tetrax group showed significantly greater improvement in SI and 
    Output:
    