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 control and execution of movement could potentially be altered by the presence of stroke-induced weakness if muscles are incapable of generating sufficient power . The purpose of this study was to identify compensatory strategies during a forward ( sagittal ) reaching task for 20 persons with chronic stroke and 10 healthy age-matched controls . We hypothesized that the paretic anterior deltoid would be maximally activated ( i.e. , saturated ) during a reaching task and that task completion would require activation of additional muscles , result ing in compensatory movements out of the sagittal plane . For reaching movements by control subjects , joint motion remained largely in the sagittal plane and h and trajectories were smooth and direct . Movement characteristics of the nonparetic arm of stroke subjects were similar to control subjects except for small increases in the abduction angle and the percentage that anterior deltoid was activated . In contrast , reaching movements of the paretic arm of stroke subjects were characterized by increased activation of all muscles , especially the lateral deltoid , in addition to the anterior deltoid , with result ing shoulder abduction power and segmented and indirect h and motion . For the paretic arm of stroke subjects , muscle and kinetic compensations increased with impairment severity and weaker muscles were used at a higher percentage of their available muscle activity . These results suggest that the inability to generate sufficient force with the typical agonists involved during a forward reaching task may necessitate compensatory muscle recruitment strategies to complete the task Abstract In terms of integration of the paretic upper extremity in activities of daily living ( ADLs ) , outcome is poor after stroke . Furthermore , amount of real-world arm use appears only weakly correlated with laboratory motor function scales . Therefore , amount of arm use may depend critically on the location , extent , and type of functional gains , which can be quantified with comprehensive kinematic and EMG analysis of ADL performance . Gains in upper extremity function can occur via compensation or recovery of premorbid movement and EMG patterns , and traditional treatment approaches encourage adoption of compensatory strategies early in the postacute period that can inhibit potential recovery . A new treatment approach called Accelerated Skill Acquisition Program ( ASAP ) focuses on impairment reduction coupled with repetitive , task-specific training of the paretic arm during ADLs . We present pilot data that show recovery in subjects who received the ASAP  , while a usual care control subject showed increased use of compensation over the same period . Finally , we discuss the advantages of data reduction methods such as principal components analysis , confirmatory factor analysis , and structural equation modeling , which can potentially distill large kinematic and EMG data sets into the key latent variables that predict amount of real-world use OBJECTIVE To compare kinematic indices in age-matched healthy subjects and stroke patients , by evaluating various tasks performed with a robotic device , and to provide an objective and st and ardized protocol to assess upper limb impairments in stroke patients . DESIGN A prospect i ve cohort study . SUBJECTS Age-matched healthy subjects ( n = 10 ) and stroke patients ( n = 10 ) . METHODS Various kinematic indices were analysed from 3 r and omly assigned tasks performed by the affected arm in stroke patients and the dominant arm in healthy subjects . These tasks , composed of large-amplitude , targeted and geometrical movements , were st and ardized and performed with the ReaPLAN robotic device . RESULTS For large-amplitude movements , the stroke patients ' path lengths were less constant in amplitude , less rectilinear and less smooth than those for healthy subjects ( p < 0.001 ) . For the targeted movements , the stroke patients ' path lengths were less rectilinear than those of the healthy subjects ( p < 0.001 ) . For the geometrical movements , the stroke patients had greater difficulty making the requested shapes compared with the healthy subjects ( p < 0.01 ) . CONCLUSION Our study proposes an objective and st and ardized protocol to assess stroke patients ' upper limbs with any robotic device . We suggest that further r and omized controlled trials could use this quantitative tool to assess the efficacy of treatments such as robot-assisted therapy Recent evidence suggests that brain injury can impair the ability to independently activate shoulder and elbow muscles . We hypothesized that if muscle activation patterns are constrained , then brain-injured subjects should not be able to accurately grade initial h and movement direction during reaching toward a broad range of target directions . To test this hypothesis , we measured h and trajectories during reaching in three-space by 16 hemiparetic stroke subjects  to an array of 75 targets distributed throughout the workspace . Contrary to our hypothesis , we found that the ability to grade movement direction was largely preserved following mild and moderate stroke . However , the most severely impaired subjects exhibited a degradation of directional control consistent with a loss of independent muscle control . Initial and final h and movement directions for these subjects were grouped roughly in two opposing directions , in a plane parallel with the coronal plane of the body , rather than distributed across the normal range . Selection between the two movement directions appeared partially r and om , in that subjects initiated over 50 % of movements in the direction generally opposite the intended target , for targets to one side of the body . These results suggest that individuals with severe stroke are constrained to use only two gross , stereotypical muscle coactivation patterns for reaching control , and that selection between these patterns is stochastically influenced as the actual direction of motion is not strictly predictable given the desired direction 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 Cycling training is strongly applied in post-stroke rehabilitation , but how its modular control is altered soon after stroke has been not analyzed yet .  EMG signals from 9 leg muscles and pedal forces were measured bilaterally during recumbent pedaling in 16 post-acute stroke patients and 12 age-matched healthy controls . Patients were asked to walk over a GaitRite mat and st and ard gait parameters  were computed . Four muscle synergies were extracted through nonnegative matrix factorization in healthy subjects and patients unaffected legs . Two to four synergies were identified in the affected sides and the number of synergies significantly correlated with the Motricity Index ( Spearman ’s coefficient = 0.521 ) . The reduced coordination complexity result ed in a reduced biomechanical performance , with the two-module sub-group showing the lowest work production and mechanical effectiveness in the affected side . These patients also exhibited locomotor impairments ( reduced gait speed , asymmetrical stance time , prolonged double support time ) . Significant correlations were found between cycling-based metrics and gait parameters , suggesting that neuro-mechanical quantities of pedaling can inform on walking dysfunctions . Our findings support the use of pedaling as a rehabilitation method and an assessment tool after stroke , mainly in the early phase , when patients can be unable to perform a safe and active gait training Background . Previous research has shown that during simulated activities of daily living , right-h and ed stroke patients use their contralesional arm more after left- than right-hemisphere stroke . These findings were attributed to a h and preference effect . However , these decisions about when to use the contralesional arm may be modulated by where in the work space the task is performed , a factor that could be used in physical rehabilitation to influence recovery by decreasing learned nonuse . Objective . To examine how target location and side of stroke influences arm selection choices for simple reaching movements . Methods . A total of 14 right-h and ed stroke patients ( 7 with left-hemisphere and 7 with right-hemisphere damage [ RHD ] ) , with similar degrees of hemiparesis ( Fugl-Meyer motor score ) , and 16 right-h and ed controls  participated in this experiment . In a pseudor and om fashion , 32 targets were presented throughout the reachable horizontal plane work space , and the participants were asked to select 1 h and to reach the target on each trial . Results . The group with left-hemisphere damage chose their contralesional arm significantly more often than the group with RHD . Patients with RHD also chose their left ( contralesional ) arm significantly less often than the control group . However , these patterns of choice were most pronounced in the center of the workspace . Conclusion . Both the side of hemisphere damage and work space location played a significant role in the choice of whether to use the contralesional arm for reaching . These findings have implication s for structuring rehabilitation for unilateral stroke patients Background After a stroke , patients show significant modifications of neural control of movement , such as abnormal muscle co-activation , and reduced selectivity and modulation of muscle activity . Nonetheless , results reported in literature do not allow to unequivocally explain whether and , in case , how a cerebrovascular accident affects muscle synergies underlying the control of the upper limb . These discrepancies suggest that a complete underst and ing of the modular re-organization of muscle activity due to a stroke is still lacking . This pilot study aim ed at investigating the effects of the conjunction between the natural ongoing of the pathology and the intense robot-mediated treatment on muscle synergies of the paretic upper limb of subacute post-stroke patients . Methods Six subacute patients , homogenous with respect to the age and the time elapsed from the trauma , and ten healthy age-matched subjects were enrolled . The protocol consisted in achieving planar movement of the upper limb while h and ling the end-effector of a robotic platform . Patients underwent 6 weeks long treatment while clinical scores , kinematics of the end-effector and muscle activity were recorded . Then we verified whether muscle coordination underlying the motor task was significantly affected by the cerebrovascular accident and how muscle synergies were modified along the treatment . Results Results show that although muscle synergies in subacute stroke patients were qualitatively comparable to those of healthy subjects , those underlying the movement of the shoulder can reflect the functional deficit induced by the pathology . Moreover , the improvement of motor performance due to the treatment was achieved in conjunction with slight modifications of muscle synergies . In this regard , modifications of muscle synergies appeared to be influenced by the different recovering mechanisms across patients presumably due to the heterogeneity of lesions , sides and location of the accident . Conclusions The results support the hypothesis that muscle synergies reflect the injury of the cerebrovascular accident and could document the effects of the functional recovery due to a suitable and customized treatment . Therefore , they open up new possibilities for the development of more effective neuro-rehabilitation protocol 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 
    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 control and execution of movement could potentially be altered by the presence of stroke-induced weakness if muscles are incapable of generating sufficient power . The purpose of this study was to identify compensatory strategies during a forward ( sagittal ) reaching task for 20 persons with chronic stroke and 10 healthy age-matched controls . We hypothesized that the paretic anterior deltoid would be maximally activated ( i.e. , saturated ) during a reaching task and that task completion would require activation of additional muscles , result ing in compensatory movements out of the sagittal plane . For reaching movements by control subjects , joint motion remained largely in the sagittal plane and h and trajectories were smooth and direct . Movement characteristics of the nonparetic arm of stroke subjects were similar to control subjects except for small increases in the abduction angle and the percentage that anterior deltoid was activated . In contrast , reaching movements of the paretic arm of stroke subjects were characterized by increased activation of all muscles , especially the lateral deltoid , in addition to the anterior deltoid , with result ing shoulder abduction power and segmented and indirect h and motion . For the paretic arm of stroke subjects , muscle and kinetic compensations increased with impairment severity and weaker muscles were used at a higher percentage of their available muscle activity . These results suggest that the inability to generate sufficient force with the typical agonists involved during a forward reaching task may necessitate compensatory muscle recruitment strategies to complete the task Abstract In terms of integration of the paretic upper extremity in activities of daily living ( ADLs ) , outcome is poor after stroke . Furthermore , amount of real-world arm use appears only weakly correlated with laboratory motor function scales . Therefore , amount of arm use may depend critically on the location , extent , and type of functional gains , which can be quantified with comprehensive kinematic and EMG analysis of ADL performance . Gains in upper extremity function can occur via compensation or recovery of premorbid movement and EMG patterns , and traditional treatment approaches encourage adoption of compensatory strategies early in the postacute period that can inhibit potential recovery . A new treatment approach called Accelerated Skill Acquisition Program ( ASAP ) focuses on impairment reduction coupled with repetitive , task-specific training of the paretic arm during ADLs . We present pilot data that show recovery in subjects who received the ASAP  , while a usual care control subject showed increased use of compensation over the same period . Finally , we discuss the advantages of data reduction methods such as principal components analysis , confirmatory factor analysis , and structural equation modeling , which can potentially distill large kinematic and EMG data sets into the key latent variables that predict amount of real-world use OBJECTIVE To compare kinematic indices in age-matched healthy subjects and stroke patients , by evaluating various tasks performed with a robotic device , and to provide an objective and st and ardized protocol to assess upper limb impairments in stroke patients . DESIGN A prospect i ve cohort study . SUBJECTS Age-matched healthy subjects ( n = 10 ) and stroke patients ( n = 10 ) . METHODS Various kinematic indices were analysed from 3 r and omly assigned tasks performed by the affected arm in stroke patients and the dominant arm in healthy subjects . These tasks , composed of large-amplitude , targeted and geometrical movements , were st and ardized and performed with the ReaPLAN robotic device . RESULTS For large-amplitude movements , the stroke patients ' path lengths were less constant in amplitude , less rectilinear and less smooth than those for healthy subjects ( p < 0.001 ) . For the targeted movements , the stroke patients ' path lengths were less rectilinear than those of the healthy subjects ( p < 0.001 ) . For the geometrical movements , the stroke patients had greater difficulty making the requested shapes compared with the healthy subjects ( p < 0.01 ) . CONCLUSION Our study proposes an objective and st and ardized protocol to assess stroke patients ' upper limbs with any robotic device . We suggest that further r and omized controlled trials could use this quantitative tool to assess the efficacy of treatments such as robot-assisted therapy Recent evidence suggests that brain injury can impair the ability to independently activate shoulder and elbow muscles . We hypothesized that if muscle activation patterns are constrained , then brain-injured subjects should not be able to accurately grade initial h and movement direction during reaching toward a broad range of target directions . To test this hypothesis , we measured h and trajectories during reaching in three-space by 16 hemiparetic stroke subjects  to an array of 75 targets distributed throughout the workspace . Contrary to our hypothesis , we found that the ability to grade movement direction was largely preserved following mild and moderate stroke . However , the most severely impaired subjects exhibited a degradation of directional control consistent with a loss of independent muscle control . Initial and final h and movement directions for these subjects were grouped roughly in two opposing directions , in a plane parallel with the coronal plane of the body , rather than distributed across the normal range . Selection between the two movement directions appeared partially r and om , in that subjects initiated over 50 % of movements in the direction generally opposite the intended target , for targets to one side of the body . These results suggest that individuals with severe stroke are constrained to use only two gross , stereotypical muscle coactivation patterns for reaching control , and that selection between these patterns is stochastically influenced as the actual direction of motion is not strictly predictable given the desired direction 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 Cycling training is strongly applied in post-stroke rehabilitation , but how its modular control is altered soon after stroke has been not analyzed yet .  EMG signals from 9 leg muscles and pedal forces were measured bilaterally during recumbent pedaling in 16 post-acute stroke patients and 12 age-matched healthy controls . Patients were asked to walk over a GaitRite mat and st and ard gait parameters  were computed . Four muscle synergies were extracted through nonnegative matrix factorization in healthy subjects and patients unaffected legs . Two to four synergies were identified in the affected sides and the number of synergies significantly correlated with the Motricity Index ( Spearman ’s coefficient = 0.521 ) . The reduced coordination complexity result ed in a reduced biomechanical performance , with the two-module sub-group showing the lowest work production and mechanical effectiveness in the affected side . These patients also exhibited locomotor impairments ( reduced gait speed , asymmetrical stance time , prolonged double support time ) . Significant correlations were found between cycling-based metrics and gait parameters , suggesting that neuro-mechanical quantities of pedaling can inform on walking dysfunctions . Our findings support the use of pedaling as a rehabilitation method and an assessment tool after stroke , mainly in the early phase , when patients can be unable to perform a safe and active gait training Background . Previous research has shown that during simulated activities of daily living , right-h and ed stroke patients use their contralesional arm more after left- than right-hemisphere stroke . These findings were attributed to a h and preference effect . However , these decisions about when to use the contralesional arm may be modulated by where in the work space the task is performed , a factor that could be used in physical rehabilitation to influence recovery by decreasing learned nonuse . Objective . To examine how target location and side of stroke influences arm selection choices for simple reaching movements . Methods . A total of 14 right-h and ed stroke patients ( 7 with left-hemisphere and 7 with right-hemisphere damage [ RHD ] ) , with similar degrees of hemiparesis ( Fugl-Meyer motor score ) , and 16 right-h and ed controls  participated in this experiment . In a pseudor and om fashion , 32 targets were presented throughout the reachable horizontal plane work space , and the participants were asked to select 1 h and to reach the target on each trial . Results . The group with left-hemisphere damage chose their contralesional arm significantly more often than the group with RHD . Patients with RHD also chose their left ( contralesional ) arm significantly less often than the control group . However , these patterns of choice were most pronounced in the center of the workspace . Conclusion . Both the side of hemisphere damage and work space location played a significant role in the choice of whether to use the contralesional arm for reaching . These findings have implication s for structuring rehabilitation for unilateral stroke patients Background After a stroke , patients show significant modifications of neural control of movement , such as abnormal muscle co-activation , and reduced selectivity and modulation of muscle activity . Nonetheless , results reported in literature do not allow to unequivocally explain whether and , in case , how a cerebrovascular accident affects muscle synergies underlying the control of the upper limb . These discrepancies suggest that a complete underst and ing of the modular re-organization of muscle activity due to a stroke is still lacking . This pilot study aim ed at investigating the effects of the conjunction between the natural ongoing of the pathology and the intense robot-mediated treatment on muscle synergies of the paretic upper limb of subacute post-stroke patients . Methods Six subacute patients , homogenous with respect to the age and the time elapsed from the trauma , and ten healthy age-matched subjects were enrolled . The protocol consisted in achieving planar movement of the upper limb while h and ling the end-effector of a robotic platform . Patients underwent 6 weeks long treatment while clinical scores , kinematics of the end-effector and muscle activity were recorded . Then we verified whether muscle coordination underlying the motor task was significantly affected by the cerebrovascular accident and how muscle synergies were modified along the treatment . Results Results show that although muscle synergies in subacute stroke patients were qualitatively comparable to those of healthy subjects , those underlying the movement of the shoulder can reflect the functional deficit induced by the pathology . Moreover , the improvement of motor performance due to the treatment was achieved in conjunction with slight modifications of muscle synergies . In this regard , modifications of muscle synergies appeared to be influenced by the different recovering mechanisms across patients presumably due to the heterogeneity of lesions , sides and location of the accident . Conclusions The results support the hypothesis that muscle synergies reflect the injury of the cerebrovascular accident and could document the effects of the functional recovery due to a suitable and customized treatment . Therefore , they open up new possibilities for the development of more effective neuro-rehabilitation protocol 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 
    Output:
    