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 . Targeted physical activity drives functional recovery after stroke . This review aim ed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions . Summary of Review . A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions . Seven studies were included ; six observational and one r and omised controlled trial . People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration . The most common activities practice d in a physiotherapy session were walking , sitting , and st and ing with a mean ( SD ) practice time of 8.7 ( 4.3 ) , 4.5 ( 4.0 ) , and 8.3 ( 2.6 ) minutes , respectively . Conclusion . People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity . In light of dosage studies , practice time may be insufficient to drive optimal motor recovery Background and Purpose — The optimum model of physiotherapy service delivery for maximizing active task practice during rehabilitation after stroke is unknown . The purpose of the study was to examine the relative effectiveness of 2 alternative models of physiotherapy service delivery against a usual care control with regard to increasing patient activity . Methods — Sub study within a large 3-armed r and omized controlled trial , which compared 3 different models of physiotherapy service delivery , was provided for 4 weeks during subacute , inpatient rehabilitation ( n=283 ) . The duration of all physiotherapy sessions was recorded . In addition , 32 participants were observed at 10-minute intervals for 1 weekday and 1 weekend day between 8:00 AM and 4:30 PM . At each observation , we recorded physical activity , location , and people present . Results — Participants receiving 7-day-week and circuit class therapy received an additional 3 hours and 22 hours of physiotherapy time , respectively , when compared with usual care . Participants were  st and ing or walking  for a median of 8.2 % of observations . On weekdays , circuit class therapy participants spent more time in therapy-related activity ( 10.2 % of observations ) when compared with usual care participants ( 6.1 % of observations ) . On weekends , 7-day therapy participants spent more time in therapy-related activity ( 4.2 % of observations ) when compared with both usual care and circuit class therapy participants ( 0 % of observations for both groups ) . Activity levels outside of therapy sessions did not differ between groups . Conclusions — A greater dosage of physiotherapy time did not translate into meaningful increases in physical activity across the day . Clinical Trial Registration — URL : http://www.anzctr.org.au/. Unique identifier : ACTRN12610000096055 OBJECTIVE To examine rehabilitation interventions and result ing physical activity patterns of patients managed in acute stroke units to help inform development of a r and omized controlled trial of very early rehabilitation . DESIGN An open observational study of patient activity and therapist report of patient interventions . A survey of stroke unit re sources . METHODS Patients less than 14 days post-stroke from 5 metropolitan stroke units were observed over 2 consecutive weekdays at 10-minute intervals between 08.00 h and 17.00 h. Physical activity , location and person(s ) present were ascertained at each observation . Therapists completed treatment records . Senior staff completed stroke unit surveys . RESULTS Patients after stroke ( n=58 ) were with therapists 5.2 % of the observed day . Few patients ( 17.1 % ) received  daily therapy  by more than one therapist . When patients received therapy , average session times were 24 minutes of physiotherapy , 23 minutes of occupational therapy and 33 minutes of speech pathology .  The more time that family members were present , the longer the treatment time . Four to 11 min of upper-limb therapy was provided . Muscle weakness and left hemiparesis were associated with less upper-limb activity . CONCLUSION These acute stroke care units were re source d according to recommended staff-patient ratios . Patients received little therapy and had low levels of physical activity BACKGROUND AND PURPOSE To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm , the effects of change in motor function over time on the accuracy of prediction were evaluated , and a prediction model for the probability of regaining dexterity at 6 months was developed . METHODS In 102 stroke patients , dexterity and paresis were measured with the  Action Research Arm Test , Motricity Index , and Fugl-Meyer motor evaluation .  For model development , 23 c and i date determinants were selected . Logistic regression analysis was used for prognostic factors and model development . RESULTS At 6 months , some dexterity in the paretic arm was found in 38 % , and complete functional recovery was seen in 11.6 % of the patients . Total anterior circulation infa rcts , right hemisphere strokes , homonymous hemianopia , visual gaze deficit , visual inattention , and paresis were statistically significant related to a poor arm function . Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity ( Action Research Arm Test > or=10 points ) from 74 % ( positive predictive value [ PPV ] , 0.74 ; 95 % confidence interval [ CI ] , 0.63 to 0.86 ) to 94 % ( PPV , 0.83 ; 95 % CI , 0.76 to 0.91 ) at 6 months . No change in probabilities of prediction dexterity was found after 4 weeks . CONCLUSIONS Based on the Fugl-Meyer scores of the flaccid arm , optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset . Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months Background and Purpose — More than 70 % of individuals who have a stroke experience upper limb deficits that impact daily activities . Increased amount of upper limb therapy has positive effects ; however , practical and inexpensive methods of therapy are needed to deliver this increase in therapy . Methods — This was a multi-site single blind r and omized controlled trial to determine the effectiveness of a 4-week self-administered grade d repetitive upper limb supplementary program ( GRASP ) on arm recovery in stroke . 103 in patients with stroke were r and omized to the experimental group ( GRASP group , n=53 ) or the control group ( education protocol , n=50 ) . The primary outcome measure was the Chedoke Arm and H and Activity Inventory ( CAHAI ) , a measure of upper limb function in activities of daily living . Secondary measures were used to evaluate grip strength and paretic upper limb use outside of therapy time . Intention-to-treat analysis was performed . Group differences were tested using analysis of covariance . Results — At the end of the 4-week intervention ( approximately 7 weeks poststroke ) , the GRASP group showed greater improvement in upper limb function ( CAHAI ) compared to the control group ( mean difference 6.2 ; 95 % CI : 3.4 to 9.0 ; P<0.001 ) . The GRASP group maintained this significant gain at 5 months poststroke . Significant differences were also found in favor of the GRASP protocol for grip strength and paretic upper limb use . No serious adverse effects were experienced . Conclusion — A self-administered homework exercise program provides a cost- , time- , and treatment-effective delivery model for improving upper limb recovery in subacute stroke Recent work has suggested that changes in synapse number as well as changes in the expression of the Fos protein may occur within the motor cortex in association with motor learning . The number of synapses per neuron and the percentage of Fos-positive neurons within layer II/III of the rat motor cortex was measured after training on a complex motor learning task . Adult female rats were allocated r and omly to either an acrobatic condition ( AC ) , a motor control condition ( MC ) , or an inactive control condition ( IC ) . AC animals were trained to traverse a complex series of obstacles , and each AC animal was pair matched with an MC animal that traversed an obstacle-free runway . IC animals received no motor training . Animals from each condition were killed at various points during training , and unbiased stereological techniques were used to estimate the number of synapses per neuron and the percentage of Fos-positive cells within layer II/III of the motor cortex . AC animals exhibited an overall increase in the number of synapses per neuron in comparison to MC and IC animals at later stages of training . AC animals also had a significantly higher overall percentage of Fos-positive cells in comparison to both controls , with a trend for the increase to be greater during the acquisition versus the maintenance phase . These data suggest that Fos may be involved in the biochemical processes underlying skill acquisition and that motor learning , as opposed to motor activity , leads to increases in synapse number in the motor cortex UNLABELLED Lang CE , MacDonald JR , Reisman DS , Boyd L , Jacobson Kimberley T , Schindler-Ivens SM , Hornby TG , Ross SA , Scheets PL . Observation of amounts of movement practice  provided during stroke rehabilitation . OBJECTIVE To investigate how much movement practice  occurred during stroke rehabilitation , and what factors might influence doses of practice provided . DESIGN Observational survey of stroke therapy sessions . SETTING Seven inpatient and outpatient rehabilitation sites . PARTICIPANTS We observed a convenience sample of 312 physical and occupational therapy sessions for people with stroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES We recorded numbers of repetitions in specific movement categories and data on potential modifying factors ( patient age , side affected , time since stroke , FIM item scores , years of therapist experience ) . Descriptive statistics were used to characterize amounts of practice . Correlation and regression analyses were used to determine whether potential factors were related to the amount of practice in the 2 important categories of upper extremity functional movements and gait steps . RESULTS Practice of task-specific , functional upper extremity movements occurred in 51 % of the sessions that addressed upper limb rehabilitation , and the average number of repetitions/session was 32 ( 95 % confidence interval [CI]=20 - 44 ) .  Practice of gait occurred in 84 % of sessions that addressed lower limb rehabilitation and the average number of gait steps/session was 357 ( 95 % CI=296 - 418 ) . None of the potential factors listed accounted for significant variance in the amount of practice in either of these 2 categories . CONCLUSIONS The amount of practice provided during poststroke rehabilitation is small compared with animal models . It is possible that current doses of task-specific practice during rehabilitation are not adequate to drive the neural reorganization needed to promote function poststroke optimally Background . The optimal physical therapy dose in acute stroke care is unknown . The authors hypothesized that physical therapy would be significantly different between treatment arms in a trial of very early and frequent mobilization ( VEM ) and that immobility-related adverse events would be associated with therapy dose . Methods . This study was a single-blind , multicenter , r and omized control trial . Patients admitted to a stroke unit < 24 hours of stroke r and omized to st and ard care ( SC ) or intervention , SC plus additional early out-of-bed therapy ( VEM ) . Timing , amount , and type of therapy recorded throughout the trial . Adverse events were recorded to 3 months . Results . A total of 71 patients ( SC n = 33 , VEM n = 38 ) received 788 therapy sessions in the first 2 weeks of stroke . Schedule ( hours to first mobilization , dose per day , frequency and session duration ) and nature ( percentage out-of-bed activity ) of therapy differed significantly between groups ( P ≤ .001 for all components ) . Mobilization was earlier , happened on average 3 times per day in those receiving VEM , with the proportion of out-of-bed activity double in VEM session ( median SC 42.5 % , VEM 85.5 % ) . SC consisted of 17 minutes of occupational and physiotherapy per day and was the same between groups . Number of immobility-related adverse events 3 months poststroke was not associated with therapy dose or frequency . Conclusions . The authors detailed usual care and intervention therapy provided to patients from admission to 14 days after stroke . The therapy schedule was markedly different in the intervention arm , but whether this schedule reduces complications or improves outcome is unknown UNLABELLED Horn SD , DeJong G , Smout RJ , Gassaway J , James R , Conroy B. Stroke rehabilitation patients , practice , and outcomes : is earlier and more aggressive therapy better ? OBJECTIVE To examine associations of patient characteristics , rehabilitation therapies , neurotropic medications , nutritional support , and timing of initiation of rehabilitation with functional outcomes and discharge destination for inpatient stroke rehabilitation patients . DESIGN Prospect i ve observational cohort study . SETTING Five U.S. inpatient rehabilitation facilities . PARTICIPANTS Post-stroke rehabilitation patients ( N=830 ; age , > 18 y ) with moderate or severe strokes , from the Post-Stroke Rehabilitation Outcomes Project data base . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Discharge total , motor , and cognitive FIM scores and discharge destination . RESULTS Controlling for patient differences , various activities and interventions were associated with better outcomes including earlier initiation of rehabilitation , more time spent per day in higher-level rehabilitation activities such as gait , upper-extremity control , and problem solving , use of newer psychiatric medications , and enteral feeding . Several findings part with conventional practice , such as starting gait training in the first 3 hours of physical therapy , even for low-level patients , was associated with better outcomes . CONCLUSIONS Specific therapy activities and interventions are associated with better outcomes . 
    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 . Targeted physical activity drives functional recovery after stroke . This review aim ed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions . Summary of Review . A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions . Seven studies were included ; six observational and one r and omised controlled trial . People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration . The most common activities practice d in a physiotherapy session were walking , sitting , and st and ing with a mean ( SD ) practice time of 8.7 ( 4.3 ) , 4.5 ( 4.0 ) , and 8.3 ( 2.6 ) minutes , respectively . Conclusion . People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity . In light of dosage studies , practice time may be insufficient to drive optimal motor recovery Background and Purpose — The optimum model of physiotherapy service delivery for maximizing active task practice during rehabilitation after stroke is unknown . The purpose of the study was to examine the relative effectiveness of 2 alternative models of physiotherapy service delivery against a usual care control with regard to increasing patient activity . Methods — Sub study within a large 3-armed r and omized controlled trial , which compared 3 different models of physiotherapy service delivery , was provided for 4 weeks during subacute , inpatient rehabilitation ( n=283 ) . The duration of all physiotherapy sessions was recorded . In addition , 32 participants were observed at 10-minute intervals for 1 weekday and 1 weekend day between 8:00 AM and 4:30 PM . At each observation , we recorded physical activity , location , and people present . Results — Participants receiving 7-day-week and circuit class therapy received an additional 3 hours and 22 hours of physiotherapy time , respectively , when compared with usual care . Participants were  st and ing or walking  for a median of 8.2 % of observations . On weekdays , circuit class therapy participants spent more time in therapy-related activity ( 10.2 % of observations ) when compared with usual care participants ( 6.1 % of observations ) . On weekends , 7-day therapy participants spent more time in therapy-related activity ( 4.2 % of observations ) when compared with both usual care and circuit class therapy participants ( 0 % of observations for both groups ) . Activity levels outside of therapy sessions did not differ between groups . Conclusions — A greater dosage of physiotherapy time did not translate into meaningful increases in physical activity across the day . Clinical Trial Registration — URL : http://www.anzctr.org.au/. Unique identifier : ACTRN12610000096055 OBJECTIVE To examine rehabilitation interventions and result ing physical activity patterns of patients managed in acute stroke units to help inform development of a r and omized controlled trial of very early rehabilitation . DESIGN An open observational study of patient activity and therapist report of patient interventions . A survey of stroke unit re sources . METHODS Patients less than 14 days post-stroke from 5 metropolitan stroke units were observed over 2 consecutive weekdays at 10-minute intervals between 08.00 h and 17.00 h. Physical activity , location and person(s ) present were ascertained at each observation . Therapists completed treatment records . Senior staff completed stroke unit surveys . RESULTS Patients after stroke ( n=58 ) were with therapists 5.2 % of the observed day . Few patients ( 17.1 % ) received  daily therapy  by more than one therapist . When patients received therapy , average session times were 24 minutes of physiotherapy , 23 minutes of occupational therapy and 33 minutes of speech pathology .  The more time that family members were present , the longer the treatment time . Four to 11 min of upper-limb therapy was provided . Muscle weakness and left hemiparesis were associated with less upper-limb activity . CONCLUSION These acute stroke care units were re source d according to recommended staff-patient ratios . Patients received little therapy and had low levels of physical activity BACKGROUND AND PURPOSE To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm , the effects of change in motor function over time on the accuracy of prediction were evaluated , and a prediction model for the probability of regaining dexterity at 6 months was developed . METHODS In 102 stroke patients , dexterity and paresis were measured with the  Action Research Arm Test , Motricity Index , and Fugl-Meyer motor evaluation .  For model development , 23 c and i date determinants were selected . Logistic regression analysis was used for prognostic factors and model development . RESULTS At 6 months , some dexterity in the paretic arm was found in 38 % , and complete functional recovery was seen in 11.6 % of the patients . Total anterior circulation infa rcts , right hemisphere strokes , homonymous hemianopia , visual gaze deficit , visual inattention , and paresis were statistically significant related to a poor arm function . Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity ( Action Research Arm Test > or=10 points ) from 74 % ( positive predictive value [ PPV ] , 0.74 ; 95 % confidence interval [ CI ] , 0.63 to 0.86 ) to 94 % ( PPV , 0.83 ; 95 % CI , 0.76 to 0.91 ) at 6 months . No change in probabilities of prediction dexterity was found after 4 weeks . CONCLUSIONS Based on the Fugl-Meyer scores of the flaccid arm , optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset . Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months Background and Purpose — More than 70 % of individuals who have a stroke experience upper limb deficits that impact daily activities . Increased amount of upper limb therapy has positive effects ; however , practical and inexpensive methods of therapy are needed to deliver this increase in therapy . Methods — This was a multi-site single blind r and omized controlled trial to determine the effectiveness of a 4-week self-administered grade d repetitive upper limb supplementary program ( GRASP ) on arm recovery in stroke . 103 in patients with stroke were r and omized to the experimental group ( GRASP group , n=53 ) or the control group ( education protocol , n=50 ) . The primary outcome measure was the Chedoke Arm and H and Activity Inventory ( CAHAI ) , a measure of upper limb function in activities of daily living . Secondary measures were used to evaluate grip strength and paretic upper limb use outside of therapy time . Intention-to-treat analysis was performed . Group differences were tested using analysis of covariance . Results — At the end of the 4-week intervention ( approximately 7 weeks poststroke ) , the GRASP group showed greater improvement in upper limb function ( CAHAI ) compared to the control group ( mean difference 6.2 ; 95 % CI : 3.4 to 9.0 ; P<0.001 ) . The GRASP group maintained this significant gain at 5 months poststroke . Significant differences were also found in favor of the GRASP protocol for grip strength and paretic upper limb use . No serious adverse effects were experienced . Conclusion — A self-administered homework exercise program provides a cost- , time- , and treatment-effective delivery model for improving upper limb recovery in subacute stroke Recent work has suggested that changes in synapse number as well as changes in the expression of the Fos protein may occur within the motor cortex in association with motor learning . The number of synapses per neuron and the percentage of Fos-positive neurons within layer II/III of the rat motor cortex was measured after training on a complex motor learning task . Adult female rats were allocated r and omly to either an acrobatic condition ( AC ) , a motor control condition ( MC ) , or an inactive control condition ( IC ) . AC animals were trained to traverse a complex series of obstacles , and each AC animal was pair matched with an MC animal that traversed an obstacle-free runway . IC animals received no motor training . Animals from each condition were killed at various points during training , and unbiased stereological techniques were used to estimate the number of synapses per neuron and the percentage of Fos-positive cells within layer II/III of the motor cortex . AC animals exhibited an overall increase in the number of synapses per neuron in comparison to MC and IC animals at later stages of training . AC animals also had a significantly higher overall percentage of Fos-positive cells in comparison to both controls , with a trend for the increase to be greater during the acquisition versus the maintenance phase . These data suggest that Fos may be involved in the biochemical processes underlying skill acquisition and that motor learning , as opposed to motor activity , leads to increases in synapse number in the motor cortex UNLABELLED Lang CE , MacDonald JR , Reisman DS , Boyd L , Jacobson Kimberley T , Schindler-Ivens SM , Hornby TG , Ross SA , Scheets PL . Observation of amounts of movement practice  provided during stroke rehabilitation . OBJECTIVE To investigate how much movement practice  occurred during stroke rehabilitation , and what factors might influence doses of practice provided . DESIGN Observational survey of stroke therapy sessions . SETTING Seven inpatient and outpatient rehabilitation sites . PARTICIPANTS We observed a convenience sample of 312 physical and occupational therapy sessions for people with stroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES We recorded numbers of repetitions in specific movement categories and data on potential modifying factors ( patient age , side affected , time since stroke , FIM item scores , years of therapist experience ) . Descriptive statistics were used to characterize amounts of practice . Correlation and regression analyses were used to determine whether potential factors were related to the amount of practice in the 2 important categories of upper extremity functional movements and gait steps . RESULTS Practice of task-specific , functional upper extremity movements occurred in 51 % of the sessions that addressed upper limb rehabilitation , and the average number of repetitions/session was 32 ( 95 % confidence interval [CI]=20 - 44 ) .  Practice of gait occurred in 84 % of sessions that addressed lower limb rehabilitation and the average number of gait steps/session was 357 ( 95 % CI=296 - 418 ) . None of the potential factors listed accounted for significant variance in the amount of practice in either of these 2 categories . CONCLUSIONS The amount of practice provided during poststroke rehabilitation is small compared with animal models . It is possible that current doses of task-specific practice during rehabilitation are not adequate to drive the neural reorganization needed to promote function poststroke optimally Background . The optimal physical therapy dose in acute stroke care is unknown . The authors hypothesized that physical therapy would be significantly different between treatment arms in a trial of very early and frequent mobilization ( VEM ) and that immobility-related adverse events would be associated with therapy dose . Methods . This study was a single-blind , multicenter , r and omized control trial . Patients admitted to a stroke unit < 24 hours of stroke r and omized to st and ard care ( SC ) or intervention , SC plus additional early out-of-bed therapy ( VEM ) . Timing , amount , and type of therapy recorded throughout the trial . Adverse events were recorded to 3 months . Results . A total of 71 patients ( SC n = 33 , VEM n = 38 ) received 788 therapy sessions in the first 2 weeks of stroke . Schedule ( hours to first mobilization , dose per day , frequency and session duration ) and nature ( percentage out-of-bed activity ) of therapy differed significantly between groups ( P ≤ .001 for all components ) . Mobilization was earlier , happened on average 3 times per day in those receiving VEM , with the proportion of out-of-bed activity double in VEM session ( median SC 42.5 % , VEM 85.5 % ) . SC consisted of 17 minutes of occupational and physiotherapy per day and was the same between groups . Number of immobility-related adverse events 3 months poststroke was not associated with therapy dose or frequency . Conclusions . The authors detailed usual care and intervention therapy provided to patients from admission to 14 days after stroke . The therapy schedule was markedly different in the intervention arm , but whether this schedule reduces complications or improves outcome is unknown UNLABELLED Horn SD , DeJong G , Smout RJ , Gassaway J , James R , Conroy B. Stroke rehabilitation patients , practice , and outcomes : is earlier and more aggressive therapy better ? OBJECTIVE To examine associations of patient characteristics , rehabilitation therapies , neurotropic medications , nutritional support , and timing of initiation of rehabilitation with functional outcomes and discharge destination for inpatient stroke rehabilitation patients . DESIGN Prospect i ve observational cohort study . SETTING Five U.S. inpatient rehabilitation facilities . PARTICIPANTS Post-stroke rehabilitation patients ( N=830 ; age , > 18 y ) with moderate or severe strokes , from the Post-Stroke Rehabilitation Outcomes Project data base . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Discharge total , motor , and cognitive FIM scores and discharge destination . RESULTS Controlling for patient differences , various activities and interventions were associated with better outcomes including earlier initiation of rehabilitation , more time spent per day in higher-level rehabilitation activities such as gait , upper-extremity control , and problem solving , use of newer psychiatric medications , and enteral feeding . Several findings part with conventional practice , such as starting gait training in the first 3 hours of physical therapy , even for low-level patients , was associated with better outcomes . CONCLUSIONS Specific therapy activities and interventions are associated with better outcomes . 
    Output:
    