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: CONTEXT Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % ] ; P<.001 ) and in the MAL Amount of Use ( on a 0 - 5 scale , increase from 1.21 to 2.13 vs from 1.15 to 1.65 ; between-group difference , 0.43 [ 95 % CI , 0.05 - 0.80 ] ; P<.001 ) and MAL Quality of Movement ( on a 0 - 5 scale , increase from 1.26 to 2.23 vs 1.18 to 1.66 ; between-group difference , 0.48 [ 95 % CI , 0.13 - 0.84 ] ; P<.001 ) . The CIMT group achieved a decrease of 19.5 in self-perceived h and function difficulty ( Stroke Impact Scale h and domain ) vs a decrease of 10.1 for the control group ( between-group difference , 9.42 [ 95 % CI , 0.27 - 18.57 ] ; P=.05 ) . CONCLUSION Among patients who had a stroke within the previous 3 to 9 months , CIMT produced statistically significant and clinical ly relevant improvements in arm motor function that persisted for at least 1 year . Trial Registration clinical trials.gov Identifier : NCT00057018 OBJECTIVE To estimate minimal clinical ly important difference ( MCID ) values of several upper-extremity measures early after stroke . DESIGN Data in this report were collected during the Very Early Constraint-induced Therapy for Recovery of Stroke trial , an acute , single-blind r and omized controlled trial of constraint-induced movement therapy . Subjects were tested at the prer and omization baseline assessment ( average days poststroke , 9.5d ) and the first posttreatment assessment ( average days poststroke , 25.9d ) . At each time point , the affected upper extremity was evaluated with a battery of 6 tests . At the second assessment , subjects were also asked to provide a global rating of perceived changes in their affected upper extremity . Anchor-based MCID values were calculated separately for the affected dominant upper extremities and the affected nondominant upper extremities for each of the 6 tests . SETTING Inpatient rehabilitation hospital . PARTICIPANTS Fifty-two people with hemiparesis poststroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Estimated MCID values for grip strength , composite upper-extremity strength , Action Research Arm Test ( ARAT ) , Wolf Motor Function Test ( WMFT ) , Motor Activity Log ( MAL ) , and duration of upper-extremity use as measured with accelerometry . RESULTS MCID values for grip strength were 5.0 and 6.2 kg for the affected dominant and nondominant sides , respectively . MCID values for the ARAT were 12 and 17 points , for the WMFT function score were 1.0 and 1.2 points , and for the MAL quality of movement score were 1.0 and 1.1 points for the 2 sides , respectively . MCID values were indeterminate for the dominant ( composite strength ) , the nondominant ( WMFT time score ) , and both affected sides ( duration of use ) for the other measures . CONCLUSIONS Our data provide some of the first estimates of MCID values for upper-extremity st and ardized measures early after stroke . Future studies with larger sample sizes are needed to refine these estimates and to determine whether MCID values are modified by time poststroke CONTEXT Reorganization in central motor networks occurs during early recovery from hemiparetic stroke . In chronic stroke survivors , specific rehabilitation therapy can improve upper extremity function . OBJECTIVE To test the hypothesis that in patients who have chronic motor impairment following stroke , specific rehabilitation therapy that improves arm function is associated with reorganization of cortical networks . DESIGN , SETTING , AND PATIENTS A r and omized controlled clinical trial conducted in a US ambulatory rehabilitation program with 21 patients ( median [ IQR ] , 50.3 [ 34.8 - 77.3 ] months after unilateral stroke ) . Data were collected between 2001 and 2004 . INTERVENTIONS Patients were r and omly assigned to bilateral arm training with rhythmic auditory cueing ( BATRAC ) ( n = 9 ) or st and ardized dose-matched therapeutic exercises ( DMTE ) ( n = 12 ) . Both were conducted for 1 hour , 3 times a week , for 6 weeks . MAIN OUTCOME MEASURES Within 2 weeks before and after the intervention , brain activation during elbow movement assessed by functional magnetic resonance imaging ( fMRI ) and functional outcome assessed using arm function scores . RESULTS Patients in the BATRAC group but not in the DMTE group increased hemispheric activation during paretic arm movement ( P = .03 ) . Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum ( P = .009 ) . BATRAC was associated with significant increases in activation in pre central ( P<.001 ) and post central gyri ( P = .03 ) and the cerebellum ( P<.001 ) , although 3 BATRAC patients showed no fMRI changes . Considering all patients , there were no differences in functional outcome between groups . When only BATRAC patients with fMRI response were included ( n = 6 ) , BATRAC improved arm function more than DMTE did ( P = .02 ) . CONCLUSIONS These preliminary findings suggest that BATRAC induces reorganization in contralesional motor networks and provide biological plausibility for repetitive bilateral training as a potential therapy for upper extremity rehabilitation in hemiparetic stroke BACKGROUND Bilateral arm training ( BAT ) and constraint-induced therapy ( CIT ) have shown beneficial effects in improving motor control and function of the upper extremities ( UE ) for patients with stroke . Thus far , no study has directly investigated the relative effects of BAT versus CIT on brain reorganization . This study compared the effects of BAT with distributed CIT ( dCIT ) on brain reorganization and motor function in 6 stroke patients . METHODS In a pre-post r and omized controlled trial , 6 stroke patients received BAT ( intensive bilateral simultaneous and symmetrical training ) or dCIT ( restraint of the unaffected UE combined with intensive training of the affected UE ) for a period of 3 weeks , 5 days per week . Functional magnetic resonance imaging ( fMRI ) examination and 3 clinical measures ( Fugl-Meyer Assessment , Action Research Arm Test , and Motor Activity Log ) were administered before and after the intervention . RESULTS After intervention , patients showed varied patterns of fMRI changes and improved motor function . Two well-recovered patients , one from each group , showed large increases in bilateral hemisphere activation , especially in the ipsilesional hemisphere during affected h and movement and in the contralesional hemisphere during unaffected h and movement . During bilateral elbow movement , 3 of the 4 BAT patients showed increased bilateral cerebellum activation , especially in the left cerebellum , whereas 2 dCIT patients showed decreased cerebellar activation . CONCLUSIONS The findings of this preliminary research revealed that neuroplastic changes after stroke motor rehabilitation may be specific to the intervention . Further research using a larger sample and more complex fMRI tasks is warranted to vali date the findings Background : Constraint-induced movement therapy ( CIMT ) is among the most developed training approaches for motor restoration of the upper extremity ( UE ) . Methods : Very Early Constraint-Induced Movement during Stroke Rehabilitation ( VECTORS ) was a single-blind phase II trial of CIMT during acute inpatient rehabilitation comparing traditional UE therapy with dose-matched and high-intensity CIMT protocol s. Participants were adaptively r and omized on rehabilitation admission , and received 2 weeks of study -related treatments . The primary endpoint was the total Action Research Arm Test ( ARAT ) score on the more affected side at 90 days after stroke onset . A mixed model analysis was performed . Results : A total of 52 participants ( mean age 63.9 ± 14 years ) were r and omized 9.65 ± 4.5 days after onset . Mean NIHSS was 5.3 ± 1.8 ; mean total ARAT score was 22.5 ± 15.6 ; 77 % had ischemic stroke . Groups were equivalent at baseline on all r and omization variables . As expected , all groups improved with time on the total ARAT score . There was a significant time x group interaction ( F = 3.1 , p < 0.01 ) , such that the high intensity CIT group had significantly less improvement at day 90 . No significant differences were found between the dose-matched CIMT and control groups at day 90 . MRI of a sub sample showed no evidence of activity-dependent lesion enlargement . Conclusion : Constraint-induced movement therapy ( CIMT ) was equally as effective but not superior to an equal dose of traditional therapy during inpatient stroke rehabilitation . Higher intensity CIMT result ed in less motor improvement at 90 days , indicating an inverse dose-response relationship . Motor intervention trials should control for dose , and higher doses of motor training can not be assumed to be more beneficial , particularly early after stroke Background and Purpose Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke . We investigated the hypothesis that bilateral arm training with rhythmic auditory cueing ( BATRAC ) will improve motor function in the hemiparetic arm of stroke patients . Methods In this single group pilot study we determined the effects of 6 weeks of BATRAC on 14 patients with chronic hemiparetic stroke ( median time after stroke , 30 months ) immediately after training and at 2 months after training . Four 5-minute periods per session ( 3 times per week ) of BATRAC were performed with the use of a custom- design ed arm training machine . Results The patients showed significant and potentially durable increases in the following : Fugl-Meyer Upper Extremity Motor Performance Test of impairment ( P < 0.0004 ) , Wolf Motor Function Test ( performance time measure , P < 0.02 ) , and University of Maryl and Arm Question naire for Stroke measuring daily use of the hemiparetic arm ( P < 0.002 ) . Isometric strength improved in elbow flexion ( P < 0.05 ) and wrist flexion ( P < 0.02 ) for the paretic arm and in elbow flexion ( P < 0.02 ) and wrist extension ( P < 0.02 ) for the nonparetic arm . Active range of motion improved for paretic-side shoulder extension ( P < 0.01 ) , wrist flexion ( P < 0.004 ) , and thumb opposition ( P < 0.002 ) , and passive range of motion improved for paretic wrist flexion ( P < 0.03 ) . Conclusions Six weeks of BATRAC improves functional motor performance of the paretic upper extremity as well as a few changes in isometric strength and range of motion . These benefits are largely sustained at 8 weeks after training cessation Background and Purpose Motor dysfunction after unilateral deafferentation in primates can be overcome by restraining the unaffected limb . We asked whether a constraint-induced movement ( CIM ) program could be implemented within 2 weeks after stroke and whether CIM is more effective than traditional upper-extremity ( UE ) therapies during this period . Methods Twenty-three persons were enrolled in a pilot r and omized , controlled trial that compared CIM with traditional therapies . A blinded observer rated the primary end point , the Action Research Arm Test ( ARA ) .  Inclusion criteria were the following : ischemic stroke within 14 days , persistent hemiparesis , evidence of preserved cognitive function , and presence of a protective motor response . Differences between the groups were compared by using Student ’s t tests , ANCOVA , and Mann-Whitney U tests . Results Twenty subjects completed the 
    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: CONTEXT Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % ] ; P<.001 ) and in the MAL Amount of Use ( on a 0 - 5 scale , increase from 1.21 to 2.13 vs from 1.15 to 1.65 ; between-group difference , 0.43 [ 95 % CI , 0.05 - 0.80 ] ; P<.001 ) and MAL Quality of Movement ( on a 0 - 5 scale , increase from 1.26 to 2.23 vs 1.18 to 1.66 ; between-group difference , 0.48 [ 95 % CI , 0.13 - 0.84 ] ; P<.001 ) . The CIMT group achieved a decrease of 19.5 in self-perceived h and function difficulty ( Stroke Impact Scale h and domain ) vs a decrease of 10.1 for the control group ( between-group difference , 9.42 [ 95 % CI , 0.27 - 18.57 ] ; P=.05 ) . CONCLUSION Among patients who had a stroke within the previous 3 to 9 months , CIMT produced statistically significant and clinical ly relevant improvements in arm motor function that persisted for at least 1 year . Trial Registration clinical trials.gov Identifier : NCT00057018 OBJECTIVE To estimate minimal clinical ly important difference ( MCID ) values of several upper-extremity measures early after stroke . DESIGN Data in this report were collected during the Very Early Constraint-induced Therapy for Recovery of Stroke trial , an acute , single-blind r and omized controlled trial of constraint-induced movement therapy . Subjects were tested at the prer and omization baseline assessment ( average days poststroke , 9.5d ) and the first posttreatment assessment ( average days poststroke , 25.9d ) . At each time point , the affected upper extremity was evaluated with a battery of 6 tests . At the second assessment , subjects were also asked to provide a global rating of perceived changes in their affected upper extremity . Anchor-based MCID values were calculated separately for the affected dominant upper extremities and the affected nondominant upper extremities for each of the 6 tests . SETTING Inpatient rehabilitation hospital . PARTICIPANTS Fifty-two people with hemiparesis poststroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Estimated MCID values for grip strength , composite upper-extremity strength , Action Research Arm Test ( ARAT ) , Wolf Motor Function Test ( WMFT ) , Motor Activity Log ( MAL ) , and duration of upper-extremity use as measured with accelerometry . RESULTS MCID values for grip strength were 5.0 and 6.2 kg for the affected dominant and nondominant sides , respectively . MCID values for the ARAT were 12 and 17 points , for the WMFT function score were 1.0 and 1.2 points , and for the MAL quality of movement score were 1.0 and 1.1 points for the 2 sides , respectively . MCID values were indeterminate for the dominant ( composite strength ) , the nondominant ( WMFT time score ) , and both affected sides ( duration of use ) for the other measures . CONCLUSIONS Our data provide some of the first estimates of MCID values for upper-extremity st and ardized measures early after stroke . Future studies with larger sample sizes are needed to refine these estimates and to determine whether MCID values are modified by time poststroke CONTEXT Reorganization in central motor networks occurs during early recovery from hemiparetic stroke . In chronic stroke survivors , specific rehabilitation therapy can improve upper extremity function . OBJECTIVE To test the hypothesis that in patients who have chronic motor impairment following stroke , specific rehabilitation therapy that improves arm function is associated with reorganization of cortical networks . DESIGN , SETTING , AND PATIENTS A r and omized controlled clinical trial conducted in a US ambulatory rehabilitation program with 21 patients ( median [ IQR ] , 50.3 [ 34.8 - 77.3 ] months after unilateral stroke ) . Data were collected between 2001 and 2004 . INTERVENTIONS Patients were r and omly assigned to bilateral arm training with rhythmic auditory cueing ( BATRAC ) ( n = 9 ) or st and ardized dose-matched therapeutic exercises ( DMTE ) ( n = 12 ) . Both were conducted for 1 hour , 3 times a week , for 6 weeks . MAIN OUTCOME MEASURES Within 2 weeks before and after the intervention , brain activation during elbow movement assessed by functional magnetic resonance imaging ( fMRI ) and functional outcome assessed using arm function scores . RESULTS Patients in the BATRAC group but not in the DMTE group increased hemispheric activation during paretic arm movement ( P = .03 ) . Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum ( P = .009 ) . BATRAC was associated with significant increases in activation in pre central ( P<.001 ) and post central gyri ( P = .03 ) and the cerebellum ( P<.001 ) , although 3 BATRAC patients showed no fMRI changes . Considering all patients , there were no differences in functional outcome between groups . When only BATRAC patients with fMRI response were included ( n = 6 ) , BATRAC improved arm function more than DMTE did ( P = .02 ) . CONCLUSIONS These preliminary findings suggest that BATRAC induces reorganization in contralesional motor networks and provide biological plausibility for repetitive bilateral training as a potential therapy for upper extremity rehabilitation in hemiparetic stroke BACKGROUND Bilateral arm training ( BAT ) and constraint-induced therapy ( CIT ) have shown beneficial effects in improving motor control and function of the upper extremities ( UE ) for patients with stroke . Thus far , no study has directly investigated the relative effects of BAT versus CIT on brain reorganization . This study compared the effects of BAT with distributed CIT ( dCIT ) on brain reorganization and motor function in 6 stroke patients . METHODS In a pre-post r and omized controlled trial , 6 stroke patients received BAT ( intensive bilateral simultaneous and symmetrical training ) or dCIT ( restraint of the unaffected UE combined with intensive training of the affected UE ) for a period of 3 weeks , 5 days per week . Functional magnetic resonance imaging ( fMRI ) examination and 3 clinical measures ( Fugl-Meyer Assessment , Action Research Arm Test , and Motor Activity Log ) were administered before and after the intervention . RESULTS After intervention , patients showed varied patterns of fMRI changes and improved motor function . Two well-recovered patients , one from each group , showed large increases in bilateral hemisphere activation , especially in the ipsilesional hemisphere during affected h and movement and in the contralesional hemisphere during unaffected h and movement . During bilateral elbow movement , 3 of the 4 BAT patients showed increased bilateral cerebellum activation , especially in the left cerebellum , whereas 2 dCIT patients showed decreased cerebellar activation . CONCLUSIONS The findings of this preliminary research revealed that neuroplastic changes after stroke motor rehabilitation may be specific to the intervention . Further research using a larger sample and more complex fMRI tasks is warranted to vali date the findings Background : Constraint-induced movement therapy ( CIMT ) is among the most developed training approaches for motor restoration of the upper extremity ( UE ) . Methods : Very Early Constraint-Induced Movement during Stroke Rehabilitation ( VECTORS ) was a single-blind phase II trial of CIMT during acute inpatient rehabilitation comparing traditional UE therapy with dose-matched and high-intensity CIMT protocol s. Participants were adaptively r and omized on rehabilitation admission , and received 2 weeks of study -related treatments . The primary endpoint was the total Action Research Arm Test ( ARAT ) score on the more affected side at 90 days after stroke onset . A mixed model analysis was performed . Results : A total of 52 participants ( mean age 63.9 ± 14 years ) were r and omized 9.65 ± 4.5 days after onset . Mean NIHSS was 5.3 ± 1.8 ; mean total ARAT score was 22.5 ± 15.6 ; 77 % had ischemic stroke . Groups were equivalent at baseline on all r and omization variables . As expected , all groups improved with time on the total ARAT score . There was a significant time x group interaction ( F = 3.1 , p < 0.01 ) , such that the high intensity CIT group had significantly less improvement at day 90 . No significant differences were found between the dose-matched CIMT and control groups at day 90 . MRI of a sub sample showed no evidence of activity-dependent lesion enlargement . Conclusion : Constraint-induced movement therapy ( CIMT ) was equally as effective but not superior to an equal dose of traditional therapy during inpatient stroke rehabilitation . Higher intensity CIMT result ed in less motor improvement at 90 days , indicating an inverse dose-response relationship . Motor intervention trials should control for dose , and higher doses of motor training can not be assumed to be more beneficial , particularly early after stroke Background and Purpose Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke . We investigated the hypothesis that bilateral arm training with rhythmic auditory cueing ( BATRAC ) will improve motor function in the hemiparetic arm of stroke patients . Methods In this single group pilot study we determined the effects of 6 weeks of BATRAC on 14 patients with chronic hemiparetic stroke ( median time after stroke , 30 months ) immediately after training and at 2 months after training . Four 5-minute periods per session ( 3 times per week ) of BATRAC were performed with the use of a custom- design ed arm training machine . Results The patients showed significant and potentially durable increases in the following : Fugl-Meyer Upper Extremity Motor Performance Test of impairment ( P < 0.0004 ) , Wolf Motor Function Test ( performance time measure , P < 0.02 ) , and University of Maryl and Arm Question naire for Stroke measuring daily use of the hemiparetic arm ( P < 0.002 ) . Isometric strength improved in elbow flexion ( P < 0.05 ) and wrist flexion ( P < 0.02 ) for the paretic arm and in elbow flexion ( P < 0.02 ) and wrist extension ( P < 0.02 ) for the nonparetic arm . Active range of motion improved for paretic-side shoulder extension ( P < 0.01 ) , wrist flexion ( P < 0.004 ) , and thumb opposition ( P < 0.002 ) , and passive range of motion improved for paretic wrist flexion ( P < 0.03 ) . Conclusions Six weeks of BATRAC improves functional motor performance of the paretic upper extremity as well as a few changes in isometric strength and range of motion . These benefits are largely sustained at 8 weeks after training cessation Background and Purpose Motor dysfunction after unilateral deafferentation in primates can be overcome by restraining the unaffected limb . We asked whether a constraint-induced movement ( CIM ) program could be implemented within 2 weeks after stroke and whether CIM is more effective than traditional upper-extremity ( UE ) therapies during this period . Methods Twenty-three persons were enrolled in a pilot r and omized , controlled trial that compared CIM with traditional therapies . A blinded observer rated the primary end point , the Action Research Arm Test ( ARA ) .  Inclusion criteria were the following : ischemic stroke within 14 days , persistent hemiparesis , evidence of preserved cognitive function , and presence of a protective motor response . Differences between the groups were compared by using Student ’s t tests , ANCOVA , and Mann-Whitney U tests . Results Twenty subjects completed the 
    Output:
    