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 While constraint-induced movement therapy ( CIMT ) is one of the most promising techniques for upper limb rehabilitation after stroke , it requires high residual function to start with . Robotic device , on the other h and , can provide intention-driven assistance and is proven capable to complement conventional therapy . However , with many robotic devices focus on more proximal joints like shoulder and elbow , recovery of h and and fingers functions have become a challenge . Here we propose the use of robotic device to assist h and and fingers functions training and we aim to evaluate the potential efficacy of intention-driven robot-assisted fingers training . Methods Participants ( 6 to 24 months post-stroke ) were r and omly assigned into two groups : robot-assisted ( robot ) and non-assisted ( control ) fingers training groups . Each participant underwent 20-session training .  Action Research Arm Test ( ARAT ) was used as the primary outcome measure , while , Wolf Motor Function Test ( WMFT ) score , its functional tasks ( WMFT-FT ) sub-score , Fugl-Meyer Assessment ( FMA ) , its shoulder and elbow ( FMA-SE ) sub-score , and finger individuation index ( FII ) served as secondary outcome measures . Results Nineteen patients completed the 20-session training ( Trial Registration : HK Clinical Trials.com HKCTR-1554 ) ; eighteen of them came back for a 6-month follow-up . Significant improvements ( p < 0.05 ) were found in the clinical scores for both robot and control group after training . However , only robot group maintained the significant difference in the ARAT and FMA-SE six months after the training . The WMFT-FT score and time post-training improvements of robot group were significantly better than those of the control group . Conclusions This study showed the potential efficacy of robot-assisted fingers training for h and and fingers rehabilitation and its feasibility to facilitate early rehabilitation for a wider population of stroke survivors ; and hence , can be used to complement CIMT Background . A recent Cochrane Review showed that early robotic training of the upper limb in stroke survivors can be more effective than other interventions when improving activities of daily living involving the arm function is the aim of therapy . Objective . We tested for efficacy of the study a protocol which involved the use of the NeReBot therapy in partial substitution of st and ard upper limb rehabilitation in post – acute stroke patients . Methods . In this dose-matched , r and omized controlled clinical trial , 34 hemiparetic participants with movement against gravity in shoulder , elbow , and wrist muscle groups were enrolled within 15 days of the onset of stroke . All participants received a total daily rehabilitation treatment for 120 minutes , 5 days per week for 5 weeks . The control group received st and ard therapy for the upper limb . The experimental group received st and ard therapy ( 65 % of exercise time ) associated with robotic training ( 35 % of exercise time ) . Muscle tone ( Modified Ashworth Scale ) , strength ( Medical Research Council ) , and synergism ( Fugl-Meyer motor scores ) were measured at impairment level , whereas dexterity ( Box and Block Test and Frenchay Arm Test ) and activities of daily living ( Functional Independence Measure ) were measured at activity level . All assessment s were performed at baseline , at the end of therapy ( time T1 ) , at 3 months ( time T2 ) , and at 7 months ( time T3 ) after entry . All between-group analyses were tested using nonparametric test with Bonferroni ’s adjustments for multiple testing . Results . No significant between-group differences were found with respect to demographic characteristics , motor , dexterity , and ADLs at baseline , postintervention ( T1 ) and at follow-up ( T2 and T3 ) . Conclusions . The robot therapy by NeReBot did not lead to better outcomes compared with conventional inpatient rehabilitation This study presents results from a r and omized controlled clinical trial of the Mirror Image Movement Enabler ( MIME ) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients , including data on the use of its bilateral training mode . MIME incorporates a PUMA 560 robot ( Staubli Unimation Inc , Duncan , South Carolina ) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions . Robot-assisted treatment ( bilateral , unilateral , and combined bilateral and unilateral ) was compared with conventional therapy . Similar to a previous study in chronic stroke , combined unilateral and bilateral robotic training had advantages compared with conventional therapy , producing larger improvements on a motor impairment scale and a measure of abnormal synergies . However , gains in all treatment groups were equivalent at the 6-month follow-up . Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training , although the combined group had more hypertonia and less movement out of synergy at baseline . Robot-assisted treatment gains exceeded those expected from spontaneous recovery . These results are discussed in light of the need for further device development and continued clinical trials BACKGROUND Effective rehabilitative therapies are needed for patients with long-term deficits after stroke . METHODS In this multicenter , r and omized , controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke , we r and omly assigned 49 patients to receive intensive robot-assisted therapy  , 50 to receive intensive comparison therapy , and 28 to receive usual care . Therapy consisted of 36 1-hour sessions over a period of 12 weeks . The primary outcome was a change in motor function , as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke , at 12 weeks . Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale . Secondary analyses assessed the treatment effect at 36 weeks . RESULTS At 12 weeks , the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care ( difference , 2.17 points ; 95 % confidence interval [ CI ] , -0.23 to 4.58 ) and worse than that for patients receiving intensive comparison therapy ( difference , -0.14 points ; 95 % CI , -2.94 to 2.65 ) , but the differences were not significant . The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care ( difference , 7.64 points ; 95 % CI , 2.03 to 13.24 ) . No other treatment comparisons were significant at 12 weeks . Secondary analyses showed that at 36 weeks , robot-assisted therapy significantly improved the Fugl-Meyer score ( difference , 2.88 points ; 95 % CI , 0.57 to 5.18 ) and the time on the Wolf Motor Function Test ( difference , -8.10 seconds ; 95 % CI , -13.61 to -2.60 ) as compared with usual care but not with intensive therapy . No serious adverse events were reported . CONCLUSIONS In patients with long-term upper-limb deficits after stroke , robot-assisted therapy did not significantly improve motor function at 12 weeks , as compared with usual care or intensive therapy . In secondary analyses , robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy . ( Clinical Trials.gov number , NCT00372411 . Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach The objective of this study was to investigate the efficacy of an Electroencephalography (EEG)-based Motor Imagery ( MI ) Brain-Computer Interface ( BCI ) coupled with a Haptic Knob ( HK ) robot for arm rehabilitation in stroke patients . In this three-arm , single-blind , r and omized controlled trial ; 21 chronic hemiplegic stroke patients ( Fugl-Meyer Motor Assessment ( FMMA ) score 10–50 ) , recruited after pre-screening for MI BCI ability , were r and omly allocated to BCI-HK , HK or St and ard Arm Therapy ( SAT ) groups . All groups received 18 sessions of intervention over 6 weeks , 3 sessions per week , 90 min per session . The BCI-HK group received 1 h of BCI coupled with HK intervention , and the HK group received 1 h of HK intervention per session . Both BCI-HK and HK groups received 120 trials of robot-assisted h and grasping and knob manipulation followed by 30 min of therapist-assisted arm mobilization . The SAT group received 1.5 h of therapist-assisted arm mobilization and forearm pronation-supination movements incorporating wrist control and grasp-release functions . In all , 14 males , 7 females , mean age 54.2 years , mean stroke duration 385.1 days , with baseline FMMA score 27.0 were recruited . The primary outcome measure was upper extremity FMMA scores measured mid-intervention at week 3 , end-intervention at week 6 , and follow-up at weeks 12 and 24 . Seven , 8 and 7 subjects underwent BCI-HK , HK and SAT interventions respectively . FMMA score improved in all groups , but no intergroup differences were found at any time points . Significantly larger motor gains were observed in the BCI-HK group compared to the SAT group at weeks 3 , 12 , and 24 , but motor gains in the HK group did not differ from the SAT group at any time point . In conclusion , BCI-HK is effective , safe , and may have the potential for enhancing motor recovery in chronic stroke when combined with therapist-assisted arm mobilization Background and Purpose — The increasing availability of robot-assisted therapy ( RT ) , which provides quantifiable , reproducible , interactive , and intensive practice , holds promise for stroke rehabilitation , but data on its dose – response relation are scanty . This study used 2 different intensities of RT to examine the treatment effects of RT and the effect on outcomes of the severity of initial motor deficits . Methods — Fifty-four patients with stroke were r and omized to a 4-week intervention of higher-intensity RT , lower-intensity RT , or control treatment . The primary outcome , the Fugl-Meyer Assessment , was administered at baseline , midterm , and posttreatment . Secondary outcomes included the Medical Research Council scale , the Motor Activity Log , and the physical domains of the Stroke Impact Scale . Results — The higher-intensity RT group showed significantly greater improvements on the Fugl-Meyer Assessment than the lower-intensity RT and control treatment groups at midterm ( P=0.003 and P=0.02 ) and at posttreatment ( P=0.04 and P=0.02 ) . Within-group gains on the secondary outcomes were significant , but the differences among the 3 groups did not reach significance . Recovery rates of the higher-intensity RT group were higher than those of the lower-intensity RT group , particularly on the Fugl-Meyer Assessment . Scatterplots with curve fitting showed that patients with moderate motor deficits gained more improvements than those with severe or mild deficits after the higher-intensity RT . Conclusions — This study demonstrated the higher treatment intensity provided by RT was associated with better motor outcome for patients with stroke , which may shape further stroke rehabilitation . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique identifier : NCT00917605 Twelve moderately to severely involved chronic stroke survivors ( > 12 mo ) were r and omized to one of two treatments : robotics and motor learning ( ROB-ML ) or functional neuromuscular stimulation and motor learning ( FNS-ML ) . Treatment was 5 h/d , 5 d/wk for 12 wk . ROB-ML group had 1.5 h per session devoted to robotics shoulder and elbow ( S/E ) training . FNS-ML had 1.5 h per session devoted to functional neuromuscular stimulation ( surface electrodes ) for wrist 
    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 While constraint-induced movement therapy ( CIMT ) is one of the most promising techniques for upper limb rehabilitation after stroke , it requires high residual function to start with . Robotic device , on the other h and , can provide intention-driven assistance and is proven capable to complement conventional therapy . However , with many robotic devices focus on more proximal joints like shoulder and elbow , recovery of h and and fingers functions have become a challenge . Here we propose the use of robotic device to assist h and and fingers functions training and we aim to evaluate the potential efficacy of intention-driven robot-assisted fingers training . Methods Participants ( 6 to 24 months post-stroke ) were r and omly assigned into two groups : robot-assisted ( robot ) and non-assisted ( control ) fingers training groups . Each participant underwent 20-session training .  Action Research Arm Test ( ARAT ) was used as the primary outcome measure , while , Wolf Motor Function Test ( WMFT ) score , its functional tasks ( WMFT-FT ) sub-score , Fugl-Meyer Assessment ( FMA ) , its shoulder and elbow ( FMA-SE ) sub-score , and finger individuation index ( FII ) served as secondary outcome measures . Results Nineteen patients completed the 20-session training ( Trial Registration : HK Clinical Trials.com HKCTR-1554 ) ; eighteen of them came back for a 6-month follow-up . Significant improvements ( p < 0.05 ) were found in the clinical scores for both robot and control group after training . However , only robot group maintained the significant difference in the ARAT and FMA-SE six months after the training . The WMFT-FT score and time post-training improvements of robot group were significantly better than those of the control group . Conclusions This study showed the potential efficacy of robot-assisted fingers training for h and and fingers rehabilitation and its feasibility to facilitate early rehabilitation for a wider population of stroke survivors ; and hence , can be used to complement CIMT Background . A recent Cochrane Review showed that early robotic training of the upper limb in stroke survivors can be more effective than other interventions when improving activities of daily living involving the arm function is the aim of therapy . Objective . We tested for efficacy of the study a protocol which involved the use of the NeReBot therapy in partial substitution of st and ard upper limb rehabilitation in post – acute stroke patients . Methods . In this dose-matched , r and omized controlled clinical trial , 34 hemiparetic participants with movement against gravity in shoulder , elbow , and wrist muscle groups were enrolled within 15 days of the onset of stroke . All participants received a total daily rehabilitation treatment for 120 minutes , 5 days per week for 5 weeks . The control group received st and ard therapy for the upper limb . The experimental group received st and ard therapy ( 65 % of exercise time ) associated with robotic training ( 35 % of exercise time ) . Muscle tone ( Modified Ashworth Scale ) , strength ( Medical Research Council ) , and synergism ( Fugl-Meyer motor scores ) were measured at impairment level , whereas dexterity ( Box and Block Test and Frenchay Arm Test ) and activities of daily living ( Functional Independence Measure ) were measured at activity level . All assessment s were performed at baseline , at the end of therapy ( time T1 ) , at 3 months ( time T2 ) , and at 7 months ( time T3 ) after entry . All between-group analyses were tested using nonparametric test with Bonferroni ’s adjustments for multiple testing . Results . No significant between-group differences were found with respect to demographic characteristics , motor , dexterity , and ADLs at baseline , postintervention ( T1 ) and at follow-up ( T2 and T3 ) . Conclusions . The robot therapy by NeReBot did not lead to better outcomes compared with conventional inpatient rehabilitation This study presents results from a r and omized controlled clinical trial of the Mirror Image Movement Enabler ( MIME ) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients , including data on the use of its bilateral training mode . MIME incorporates a PUMA 560 robot ( Staubli Unimation Inc , Duncan , South Carolina ) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions . Robot-assisted treatment ( bilateral , unilateral , and combined bilateral and unilateral ) was compared with conventional therapy . Similar to a previous study in chronic stroke , combined unilateral and bilateral robotic training had advantages compared with conventional therapy , producing larger improvements on a motor impairment scale and a measure of abnormal synergies . However , gains in all treatment groups were equivalent at the 6-month follow-up . Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training , although the combined group had more hypertonia and less movement out of synergy at baseline . Robot-assisted treatment gains exceeded those expected from spontaneous recovery . These results are discussed in light of the need for further device development and continued clinical trials BACKGROUND Effective rehabilitative therapies are needed for patients with long-term deficits after stroke . METHODS In this multicenter , r and omized , controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke , we r and omly assigned 49 patients to receive intensive robot-assisted therapy  , 50 to receive intensive comparison therapy , and 28 to receive usual care . Therapy consisted of 36 1-hour sessions over a period of 12 weeks . The primary outcome was a change in motor function , as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke , at 12 weeks . Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale . Secondary analyses assessed the treatment effect at 36 weeks . RESULTS At 12 weeks , the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care ( difference , 2.17 points ; 95 % confidence interval [ CI ] , -0.23 to 4.58 ) and worse than that for patients receiving intensive comparison therapy ( difference , -0.14 points ; 95 % CI , -2.94 to 2.65 ) , but the differences were not significant . The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care ( difference , 7.64 points ; 95 % CI , 2.03 to 13.24 ) . No other treatment comparisons were significant at 12 weeks . Secondary analyses showed that at 36 weeks , robot-assisted therapy significantly improved the Fugl-Meyer score ( difference , 2.88 points ; 95 % CI , 0.57 to 5.18 ) and the time on the Wolf Motor Function Test ( difference , -8.10 seconds ; 95 % CI , -13.61 to -2.60 ) as compared with usual care but not with intensive therapy . No serious adverse events were reported . CONCLUSIONS In patients with long-term upper-limb deficits after stroke , robot-assisted therapy did not significantly improve motor function at 12 weeks , as compared with usual care or intensive therapy . In secondary analyses , robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy . ( Clinical Trials.gov number , NCT00372411 . Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach The objective of this study was to investigate the efficacy of an Electroencephalography (EEG)-based Motor Imagery ( MI ) Brain-Computer Interface ( BCI ) coupled with a Haptic Knob ( HK ) robot for arm rehabilitation in stroke patients . In this three-arm , single-blind , r and omized controlled trial ; 21 chronic hemiplegic stroke patients ( Fugl-Meyer Motor Assessment ( FMMA ) score 10–50 ) , recruited after pre-screening for MI BCI ability , were r and omly allocated to BCI-HK , HK or St and ard Arm Therapy ( SAT ) groups . All groups received 18 sessions of intervention over 6 weeks , 3 sessions per week , 90 min per session . The BCI-HK group received 1 h of BCI coupled with HK intervention , and the HK group received 1 h of HK intervention per session . Both BCI-HK and HK groups received 120 trials of robot-assisted h and grasping and knob manipulation followed by 30 min of therapist-assisted arm mobilization . The SAT group received 1.5 h of therapist-assisted arm mobilization and forearm pronation-supination movements incorporating wrist control and grasp-release functions . In all , 14 males , 7 females , mean age 54.2 years , mean stroke duration 385.1 days , with baseline FMMA score 27.0 were recruited . The primary outcome measure was upper extremity FMMA scores measured mid-intervention at week 3 , end-intervention at week 6 , and follow-up at weeks 12 and 24 . Seven , 8 and 7 subjects underwent BCI-HK , HK and SAT interventions respectively . FMMA score improved in all groups , but no intergroup differences were found at any time points . Significantly larger motor gains were observed in the BCI-HK group compared to the SAT group at weeks 3 , 12 , and 24 , but motor gains in the HK group did not differ from the SAT group at any time point . In conclusion , BCI-HK is effective , safe , and may have the potential for enhancing motor recovery in chronic stroke when combined with therapist-assisted arm mobilization Background and Purpose — The increasing availability of robot-assisted therapy ( RT ) , which provides quantifiable , reproducible , interactive , and intensive practice , holds promise for stroke rehabilitation , but data on its dose – response relation are scanty . This study used 2 different intensities of RT to examine the treatment effects of RT and the effect on outcomes of the severity of initial motor deficits . Methods — Fifty-four patients with stroke were r and omized to a 4-week intervention of higher-intensity RT , lower-intensity RT , or control treatment . The primary outcome , the Fugl-Meyer Assessment , was administered at baseline , midterm , and posttreatment . Secondary outcomes included the Medical Research Council scale , the Motor Activity Log , and the physical domains of the Stroke Impact Scale . Results — The higher-intensity RT group showed significantly greater improvements on the Fugl-Meyer Assessment than the lower-intensity RT and control treatment groups at midterm ( P=0.003 and P=0.02 ) and at posttreatment ( P=0.04 and P=0.02 ) . Within-group gains on the secondary outcomes were significant , but the differences among the 3 groups did not reach significance . Recovery rates of the higher-intensity RT group were higher than those of the lower-intensity RT group , particularly on the Fugl-Meyer Assessment . Scatterplots with curve fitting showed that patients with moderate motor deficits gained more improvements than those with severe or mild deficits after the higher-intensity RT . Conclusions — This study demonstrated the higher treatment intensity provided by RT was associated with better motor outcome for patients with stroke , which may shape further stroke rehabilitation . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique identifier : NCT00917605 Twelve moderately to severely involved chronic stroke survivors ( > 12 mo ) were r and omized to one of two treatments : robotics and motor learning ( ROB-ML ) or functional neuromuscular stimulation and motor learning ( FNS-ML ) . Treatment was 5 h/d , 5 d/wk for 12 wk . ROB-ML group had 1.5 h per session devoted to robotics shoulder and elbow ( S/E ) training . FNS-ML had 1.5 h per session devoted to functional neuromuscular stimulation ( surface electrodes ) for wrist 
    Output:
    