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: Hemispatial neglect following right-hemisphere stroke is a common and disabling disorder , for which there is currently no effective pharmacological treatment . Dopamine agonists have been shown to play a role in selective attention and working memory , two core cognitive components of neglect . Here , we investigated whether the dopamine agonist rotigotine would have a beneficial effect on hemispatial neglect in stroke patients . A double-blind , r and omized , placebo-controlled ABA design was used , in which each patient was assessed for 20 testing sessions , in three phases : pretreatment ( Phase A1 ) , on transdermal rotigotine for 7–11 days ( Phase B ) and post-treatment ( Phase A2 ) , with the exact duration of each phase r and omized within limits . Outcome measures included performance on cancellation ( visual search ) , line bisection , visual working memory , selective attention and sustained attention tasks , as well as measures of motor control .  Sixteen right-hemisphere stroke patients were recruited , all of whom completed the trial .  Performance on the Mesulam shape cancellation task improved significantly while on rotigotine , with the number of targets found on the left side increasing by 12.8 % ( P = 0.012 ) on treatment and spatial bias reducing by 8.1 % ( P = 0.016 ) . This improvement in visual search was associated with an enhancement in selective attention but not on our measures of working memory or sustained attention . The positive effect of rotigotine on visual search was not associated with the degree of preservation of prefrontal cortex and occurred even in patients with significant prefrontal involvement . Rotigotine was not associated with any significant improvement in motor performance . This proof-of-concept study suggests a beneficial role of dopaminergic modulation on visual search and selective attention in patients with hemispatial neglect following stroke BACKGROUND In a r and omized controlled type Ib study , the effectiveness of three different forms of therapy for the treatment of visual neglect was assessed by comparing therapy outcomes in three groups of patients after cerebrovascular accidents . METHODS A control group received only st and ard exploration training , whilst the second and third group received exploration training combined with either contralateral transcutaneous electrical nerve stimulation ( TENS ) or optokinetic stimulation ( OKS ) respectively . RESULTS It was found that exploration training alone result ed in no improvement on both st and ard neglect tests ( NTs ) and everyday-relevant measures of reading and writing performance . In contrast , the groups receiving TENS or OKS showed significant improvements in both sets of measures with the difference that for the TENS group the improvement in NT scores at the end of therapy had disappeared 1-week later . However , both treatments result ed in significant improvements in reading and writing which were still present upon retesting 1-week after the end of therapy . CONCLUSION Both methods can be recommended for neglect therapy and are superior to exploration therapy alone The aim of this study was to investigate whether it is possible to strengthen the rehabilitation of spatial hemineglect by combining st and ard training for spatial scanning with optokinetic stimulation . A simple r and omized design was used : one group of neglect patients was treated with a combination of the two techniques , and a second group received only the st and ard treatment . Both treatments were given for six consecutive weeks and produced significant improvements . However , addition of the optokinetic stimulation did not improve the patients ' performance . Also , none of the independent variables ( i.e. , presence/absence of hemianopia ) predicted the positive effect occasionally observed in individual patients Objective : Cortico-cortical circuits originating from the posterior parietal cortex ( PPC ) of the intact left hemisphere ( LH ) may become hyperexcitable in patients with hemispatial neglect due to a right hemispheric ( RH ) stroke . Methods : In the current r and omized , double-blind , sham-controlled study , we investigated safety and efficacy of continuous theta-burst stimulation ( cTBS ) in 10 sessions over 2 weeks applied over the intact PPC of the LH in subacute ischemic stroke patients .  Severity of neglect was assessed through the st and ardized Behavioral Inattention Test ( BIT ) . We also measured , by means of bifocal transcranial magnetic stimulation ( TMS ) , how cTBS modified the excitability of the parieto-frontal functional connections in the intact LH . Results : We found that 2 weeks of cTBS , but not sham cTBS , were effective in improving neglect symptoms as measured by BIT score . BIT scores improved by 16.3 % after 2 weeks of cTBS and 22.6 % at 1 month follow-up . We also found that hyperexcitability of LH parieto-frontal circuits was reduced following treatment with real but not sham cTBS . Conclusion : These findings suggest that a 2-week course of cTBS over the LH PPC may be a potential effective strategy in accelerating recovery from visuospatial neglect in subacute stroke patients , possibly counteracting the hyperexcitability of LH parieto-frontal circuits . Classification of evidence : This study provides Class III evidence that left posterior parietal cortex theta-burst stimulation improves hemispatial neglect for up to 2 weeks after treatment Prism adaptation has been shown to alleviate the symptoms of unilateral spatial neglect following stroke in single case and small group studies . The purpose s of this single blinded pilot r and omised controlled trial were to determine the feasibility of delivering prism adaptation treatment in a clinical ly valid sample and to assess its impact on self-care . Thirty seven right hemisphere stroke patients with unilateral spatial neglect were r and omised into either prism adaptation ( using 10 dioptre , 6 degree prisms ) or sham treatment ( using plain glasses ) groups . Treatment was delivered each weekday for two weeks . Pointing accuracy , without vision of the finger , was recorded each day before treatment . Outcome was measured , by blinded assessors , four days and eight weeks after the end of treatment using the Catherine Bergego Scale ( CBS ) and the conventional neuropsychological tests from the Behavioural Inattention Test ( BIT ) . Thirty four patients received treatment : 16 with prisms , 18 sham .  Mean compliance was 99 % and 97 % , respectively . Over the treatment days only the prism treated group showed increased leftward bias in open loop pointing to targets on a touch screen . However , despite the group level changes in pointing behaviour no overall effect of the treatment on self-care or BIT were found Objective : To evaluate the prognostic value of domain-specific cognitive abilities in acute stroke with respect to long-term cognitive and functional outcome in addition to neurologic and demographic predictors . Methods : The authors evaluated 168 patients within the first 3 weeks after first-ever stroke . The prevalence of neuropsychological impairment was calculated vs 75 matched healthy controls . The authors also recorded demographic data , vascular risk factors , lesion characteristics , and clinical factors at admission . Independent predictor variables associated with long-term cognitive impairment ( assessed with a follow-up neuropsychological examination ) and functional impairment ( assessed with the modified Barthel Index and the Frenchay Activities Index ) were identified with stepwise multiple logistic regression . Areas under receiver operator characteristic curves were used to compare the predictive value of three models , i.e. , a st and ard medical model , a purely cognitive model , and a model consisting of both medical and cognitive predictors . Results : Thirty-one percent of patients showed long-term cognitive impairment . Basic and instrumental ADL disturbances remained present in 19 % and 24 % of patients . Domain-specific cognitive functioning predicted cognitive and functional outcome better than any other variable . Moreover , the prediction of instrumental ADL functioning improved when cognitive predictors were added to the st and ard medical model ( p < 0.05 ) . Impairments in abstract reasoning and executive functioning were independent predictors of long-term cognitive impairment . Inattention and perceptual disorders were more important in predicting long-term functional impairment . Conclusion : Domain-specific cognitive abilities in the early phase of stroke are excellent independent predictors of long-term cognitive and functional outcome Purpose . The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect ( USN ) as a result of a right hemisphere stroke , and to compare it to a st and ard computer visual scanning training . Method . Participants included 19 patients with right hemisphere stroke in two groups , 11 in an experimental group were given computer desktop-based Virtual Reality ( VR ) street crossing training and 8 in a control group who were given computer based visual scanning tasks , both for a total of twelve sessions , 9 hours total , over four weeks . Measures included : 1 . St and ard USN assessment s , paper and pencil and ADL checklist ; 2 . Test on the VR street program ; and 3 . Actual street crossing videotaped . Testing was performed pre and post intervention . Results . The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks . They improved more on the VR test and they did better on some measures of the real street crossing . Conclusions . Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN , and further development of the program A large proportion of right-hemisphere stroke patients show hemispatial neglect — a neurological deficit of perception , attention , representation , and /or performing actions within their left-sided space , inducing many functional debilitating effects on everyday life , and responsible for poor functional recovery and ability to benefit from treatment . The frequent parietal locus of the lesion producing neglect reflects the impairment of coordinate transformation used by the nervous system to represent extrapersonal space . Given that adaptation to a visual distortion can provide an efficient way to stimulate neural structures responsible for the transformation of sensorimotor coordinates , the aim of our study was to investigate the effect of prism adaptation on various neglect symptoms , including the pathological shift of the subjective midline to the right . All patients exposed to the optical shift of the visual field to the right were improved on their manual body-midline demonstration and on classical neuropsychological tests . Unlike other physiological manipulations used to improve neglect , this improvement lasted for at least two hours after prism removal and thus could be useful in rehabilitation programmes . The positive effect found for both sensorimotor and more cognitive spatial functions suggests that they share or depend on a common level of space representation linked to multisensory integration Objective To investigate the effect of virtual reality training on unilateral spatial neglect in stroke patients . Method Twenty-four stroke patients ( 14 males and 10 females , mean age=64.7 ) who had unilateral spatial neglect as a result of right hemisphere stroke were recruited . All patients were r and omly assigned to either the virtual reality ( VR ) group ( n=12 ) or the control group ( n=12 ) . The VR group received VR training , which stimulated the left side of their bodies . The control group received conventional neglect therapy such as visual scanning training . Both groups received therapy for 30 minutes a day , five days per week for three weeks . Outcome measurements included star cancellation test , line bisection test , Catherine Bergego scale ( CBS ) , and the Korean version of modified Barthel index ( K-MBI ) . These measurements were taken before and after treatment . Results There were no significant differences in the baseline characteristics and initial values between the two groups . The changes in star cancellation test results and CBS in the VR group were significantly higher than those of the control group after treatment . The changes in line bisection test score and the K-MBI in the VR group were not statistically significant . Conclusion This study suggests that virtual reality training may be a beneficial therapeutic technique on unilateral spatial neglect in stroke patients The aim of this r and omised , double-blind study was to investigate the therapeutic effectiveness of left-h and electrical stimulation for patients with post-stroke left visuo-spatial neglect . This approach was hypothesised to enhance activation of the right hemisphere attention system and to improve visual exploration of extrapersonal space .  Participants ( n = 40 ) in the study were in a relatively early stage of recovery from their first right hemisphere stroke , and were r and omly assigned to the experimental ( E ) or control ( C ) group . Group E received conventional visual scanning training combined with electrostimulation of the left h and , while Group C received scanning training with sham stimulation . Their visuo-spatial neglect was assessed twice , prior to the rehabilitation programme and on its completion , using cancellation tests and a letter-reading task . The effect of electrostimulation on hemineglect was assessed following a single administration and after a month-long rehabilitation programme . Although the immediate effect of stimulation was poor , after a month-long rehabilitation period we found significantly greater improvement in Group E patients than in Group C patients . Interestingly , the presence of hemisensory loss did not weaken the observed effect . Therefore , we cl aim that contralesional h and stimulation combined with visual scanning was a more effective treatment for hemineglect rehabilitation than scanning training alone OBJECTIVE To test whether multiple sessions of inhibitory low-frequency repetitive transcranial magnetic stimulation ( rTMS ) applied to the left parietal area can improve hemispatial neglect after stroke . DESIGN An open-label design . PATIENTS Seven consecutive patients with hemispatial neglect after right hemispheric stroke were compared with 7 retrospectively recruited control patients . METHODS Seven patients received a session of 1 Hz rTMS to the left parietal area immediately prior to occupational therapy for 10 days . Seven control patients received only behavioural therapy . RESULTS Baseline values of the line bisection test and the Albert test were comparable in the two groups . The stimulation group showed a greater improvement in the line bisection test than did the control group . However , no differences were found between the two groups according to the Albert test . CONCLUSION In this pilot study , low-frequency rTMS application to the non-affected left parietal area was found to be safe and to improve line bisection test , which suggests that non-invasive cortical stimulation has a potential role as an adjuvant strategy during cognitive rehabilitation training in patients with hemispatial neglect . A prospect i ve r and omized , sh 
    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: Hemispatial neglect following right-hemisphere stroke is a common and disabling disorder , for which there is currently no effective pharmacological treatment . Dopamine agonists have been shown to play a role in selective attention and working memory , two core cognitive components of neglect . Here , we investigated whether the dopamine agonist rotigotine would have a beneficial effect on hemispatial neglect in stroke patients . A double-blind , r and omized , placebo-controlled ABA design was used , in which each patient was assessed for 20 testing sessions , in three phases : pretreatment ( Phase A1 ) , on transdermal rotigotine for 7–11 days ( Phase B ) and post-treatment ( Phase A2 ) , with the exact duration of each phase r and omized within limits . Outcome measures included performance on cancellation ( visual search ) , line bisection , visual working memory , selective attention and sustained attention tasks , as well as measures of motor control .  Sixteen right-hemisphere stroke patients were recruited , all of whom completed the trial .  Performance on the Mesulam shape cancellation task improved significantly while on rotigotine , with the number of targets found on the left side increasing by 12.8 % ( P = 0.012 ) on treatment and spatial bias reducing by 8.1 % ( P = 0.016 ) . This improvement in visual search was associated with an enhancement in selective attention but not on our measures of working memory or sustained attention . The positive effect of rotigotine on visual search was not associated with the degree of preservation of prefrontal cortex and occurred even in patients with significant prefrontal involvement . Rotigotine was not associated with any significant improvement in motor performance . This proof-of-concept study suggests a beneficial role of dopaminergic modulation on visual search and selective attention in patients with hemispatial neglect following stroke BACKGROUND In a r and omized controlled type Ib study , the effectiveness of three different forms of therapy for the treatment of visual neglect was assessed by comparing therapy outcomes in three groups of patients after cerebrovascular accidents . METHODS A control group received only st and ard exploration training , whilst the second and third group received exploration training combined with either contralateral transcutaneous electrical nerve stimulation ( TENS ) or optokinetic stimulation ( OKS ) respectively . RESULTS It was found that exploration training alone result ed in no improvement on both st and ard neglect tests ( NTs ) and everyday-relevant measures of reading and writing performance . In contrast , the groups receiving TENS or OKS showed significant improvements in both sets of measures with the difference that for the TENS group the improvement in NT scores at the end of therapy had disappeared 1-week later . However , both treatments result ed in significant improvements in reading and writing which were still present upon retesting 1-week after the end of therapy . CONCLUSION Both methods can be recommended for neglect therapy and are superior to exploration therapy alone The aim of this study was to investigate whether it is possible to strengthen the rehabilitation of spatial hemineglect by combining st and ard training for spatial scanning with optokinetic stimulation . A simple r and omized design was used : one group of neglect patients was treated with a combination of the two techniques , and a second group received only the st and ard treatment . Both treatments were given for six consecutive weeks and produced significant improvements . However , addition of the optokinetic stimulation did not improve the patients ' performance . Also , none of the independent variables ( i.e. , presence/absence of hemianopia ) predicted the positive effect occasionally observed in individual patients Objective : Cortico-cortical circuits originating from the posterior parietal cortex ( PPC ) of the intact left hemisphere ( LH ) may become hyperexcitable in patients with hemispatial neglect due to a right hemispheric ( RH ) stroke . Methods : In the current r and omized , double-blind , sham-controlled study , we investigated safety and efficacy of continuous theta-burst stimulation ( cTBS ) in 10 sessions over 2 weeks applied over the intact PPC of the LH in subacute ischemic stroke patients .  Severity of neglect was assessed through the st and ardized Behavioral Inattention Test ( BIT ) . We also measured , by means of bifocal transcranial magnetic stimulation ( TMS ) , how cTBS modified the excitability of the parieto-frontal functional connections in the intact LH . Results : We found that 2 weeks of cTBS , but not sham cTBS , were effective in improving neglect symptoms as measured by BIT score . BIT scores improved by 16.3 % after 2 weeks of cTBS and 22.6 % at 1 month follow-up . We also found that hyperexcitability of LH parieto-frontal circuits was reduced following treatment with real but not sham cTBS . Conclusion : These findings suggest that a 2-week course of cTBS over the LH PPC may be a potential effective strategy in accelerating recovery from visuospatial neglect in subacute stroke patients , possibly counteracting the hyperexcitability of LH parieto-frontal circuits . Classification of evidence : This study provides Class III evidence that left posterior parietal cortex theta-burst stimulation improves hemispatial neglect for up to 2 weeks after treatment Prism adaptation has been shown to alleviate the symptoms of unilateral spatial neglect following stroke in single case and small group studies . The purpose s of this single blinded pilot r and omised controlled trial were to determine the feasibility of delivering prism adaptation treatment in a clinical ly valid sample and to assess its impact on self-care . Thirty seven right hemisphere stroke patients with unilateral spatial neglect were r and omised into either prism adaptation ( using 10 dioptre , 6 degree prisms ) or sham treatment ( using plain glasses ) groups . Treatment was delivered each weekday for two weeks . Pointing accuracy , without vision of the finger , was recorded each day before treatment . Outcome was measured , by blinded assessors , four days and eight weeks after the end of treatment using the Catherine Bergego Scale ( CBS ) and the conventional neuropsychological tests from the Behavioural Inattention Test ( BIT ) . Thirty four patients received treatment : 16 with prisms , 18 sham .  Mean compliance was 99 % and 97 % , respectively . Over the treatment days only the prism treated group showed increased leftward bias in open loop pointing to targets on a touch screen . However , despite the group level changes in pointing behaviour no overall effect of the treatment on self-care or BIT were found Objective : To evaluate the prognostic value of domain-specific cognitive abilities in acute stroke with respect to long-term cognitive and functional outcome in addition to neurologic and demographic predictors . Methods : The authors evaluated 168 patients within the first 3 weeks after first-ever stroke . The prevalence of neuropsychological impairment was calculated vs 75 matched healthy controls . The authors also recorded demographic data , vascular risk factors , lesion characteristics , and clinical factors at admission . Independent predictor variables associated with long-term cognitive impairment ( assessed with a follow-up neuropsychological examination ) and functional impairment ( assessed with the modified Barthel Index and the Frenchay Activities Index ) were identified with stepwise multiple logistic regression . Areas under receiver operator characteristic curves were used to compare the predictive value of three models , i.e. , a st and ard medical model , a purely cognitive model , and a model consisting of both medical and cognitive predictors . Results : Thirty-one percent of patients showed long-term cognitive impairment . Basic and instrumental ADL disturbances remained present in 19 % and 24 % of patients . Domain-specific cognitive functioning predicted cognitive and functional outcome better than any other variable . Moreover , the prediction of instrumental ADL functioning improved when cognitive predictors were added to the st and ard medical model ( p < 0.05 ) . Impairments in abstract reasoning and executive functioning were independent predictors of long-term cognitive impairment . Inattention and perceptual disorders were more important in predicting long-term functional impairment . Conclusion : Domain-specific cognitive abilities in the early phase of stroke are excellent independent predictors of long-term cognitive and functional outcome Purpose . The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect ( USN ) as a result of a right hemisphere stroke , and to compare it to a st and ard computer visual scanning training . Method . Participants included 19 patients with right hemisphere stroke in two groups , 11 in an experimental group were given computer desktop-based Virtual Reality ( VR ) street crossing training and 8 in a control group who were given computer based visual scanning tasks , both for a total of twelve sessions , 9 hours total , over four weeks . Measures included : 1 . St and ard USN assessment s , paper and pencil and ADL checklist ; 2 . Test on the VR street program ; and 3 . Actual street crossing videotaped . Testing was performed pre and post intervention . Results . The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks . They improved more on the VR test and they did better on some measures of the real street crossing . Conclusions . Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN , and further development of the program A large proportion of right-hemisphere stroke patients show hemispatial neglect — a neurological deficit of perception , attention , representation , and /or performing actions within their left-sided space , inducing many functional debilitating effects on everyday life , and responsible for poor functional recovery and ability to benefit from treatment . The frequent parietal locus of the lesion producing neglect reflects the impairment of coordinate transformation used by the nervous system to represent extrapersonal space . Given that adaptation to a visual distortion can provide an efficient way to stimulate neural structures responsible for the transformation of sensorimotor coordinates , the aim of our study was to investigate the effect of prism adaptation on various neglect symptoms , including the pathological shift of the subjective midline to the right . All patients exposed to the optical shift of the visual field to the right were improved on their manual body-midline demonstration and on classical neuropsychological tests . Unlike other physiological manipulations used to improve neglect , this improvement lasted for at least two hours after prism removal and thus could be useful in rehabilitation programmes . The positive effect found for both sensorimotor and more cognitive spatial functions suggests that they share or depend on a common level of space representation linked to multisensory integration Objective To investigate the effect of virtual reality training on unilateral spatial neglect in stroke patients . Method Twenty-four stroke patients ( 14 males and 10 females , mean age=64.7 ) who had unilateral spatial neglect as a result of right hemisphere stroke were recruited . All patients were r and omly assigned to either the virtual reality ( VR ) group ( n=12 ) or the control group ( n=12 ) . The VR group received VR training , which stimulated the left side of their bodies . The control group received conventional neglect therapy such as visual scanning training . Both groups received therapy for 30 minutes a day , five days per week for three weeks . Outcome measurements included star cancellation test , line bisection test , Catherine Bergego scale ( CBS ) , and the Korean version of modified Barthel index ( K-MBI ) . These measurements were taken before and after treatment . Results There were no significant differences in the baseline characteristics and initial values between the two groups . The changes in star cancellation test results and CBS in the VR group were significantly higher than those of the control group after treatment . The changes in line bisection test score and the K-MBI in the VR group were not statistically significant . Conclusion This study suggests that virtual reality training may be a beneficial therapeutic technique on unilateral spatial neglect in stroke patients The aim of this r and omised , double-blind study was to investigate the therapeutic effectiveness of left-h and electrical stimulation for patients with post-stroke left visuo-spatial neglect . This approach was hypothesised to enhance activation of the right hemisphere attention system and to improve visual exploration of extrapersonal space .  Participants ( n = 40 ) in the study were in a relatively early stage of recovery from their first right hemisphere stroke , and were r and omly assigned to the experimental ( E ) or control ( C ) group . Group E received conventional visual scanning training combined with electrostimulation of the left h and , while Group C received scanning training with sham stimulation . Their visuo-spatial neglect was assessed twice , prior to the rehabilitation programme and on its completion , using cancellation tests and a letter-reading task . The effect of electrostimulation on hemineglect was assessed following a single administration and after a month-long rehabilitation programme . Although the immediate effect of stimulation was poor , after a month-long rehabilitation period we found significantly greater improvement in Group E patients than in Group C patients . Interestingly , the presence of hemisensory loss did not weaken the observed effect . Therefore , we cl aim that contralesional h and stimulation combined with visual scanning was a more effective treatment for hemineglect rehabilitation than scanning training alone OBJECTIVE To test whether multiple sessions of inhibitory low-frequency repetitive transcranial magnetic stimulation ( rTMS ) applied to the left parietal area can improve hemispatial neglect after stroke . DESIGN An open-label design . PATIENTS Seven consecutive patients with hemispatial neglect after right hemispheric stroke were compared with 7 retrospectively recruited control patients . METHODS Seven patients received a session of 1 Hz rTMS to the left parietal area immediately prior to occupational therapy for 10 days . Seven control patients received only behavioural therapy . RESULTS Baseline values of the line bisection test and the Albert test were comparable in the two groups . The stimulation group showed a greater improvement in the line bisection test than did the control group . However , no differences were found between the two groups according to the Albert test . CONCLUSION In this pilot study , low-frequency rTMS application to the non-affected left parietal area was found to be safe and to improve line bisection test , which suggests that non-invasive cortical stimulation has a potential role as an adjuvant strategy during cognitive rehabilitation training in patients with hemispatial neglect . A prospect i ve r and omized , sh 
    Output:
    