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 AND PURPOSE It has been suggested that cyclic neuromuscular electrical stimulation ( ES ) may enhance motor recovery after stroke . We have investigated the effects of ES of the wrist extensors on impairment of wrist function and on upper-limb disability in patients being rehabilitated after acute stroke . METHODS We recruited 60 hemiparetic patients ( mean age , 68 years ) 2 to 4 weeks after stroke into a r and omized , controlled , parallel-group study comparing st and ard rehabilitation treatment with st and ard treatment plus ES of wrist extensors ( 3 times 30 minutes daily for 8 weeks ) . Isometric strength of wrist extensors was measured using a device built for that purpose . Upper-limb disability was assessed with use of the  Action Research Arm Test ( ARAT ) . Observations were continued for 32 weeks ( 24 weeks after the finish of ES or the control intervention phase ) . RESULTS The change in isometric strength of wrist extensors ( at an angle of 0 degrees extension ) was significantly greater in the ES group than the control group at both 8 and 32 weeks ( P=0.004 , P=0.014 by Mann Whitney U test ) . At week 8 the grasp and grip subscores of the ARAT increased significantly in the ES group compared with that in the control group ( P=0.013 and P=0.02 , respectively ) ; a similar trend was seen for the total ARAT score ( P=0.11 ) . In the subgroup of 33 patients with some residual wrist extensor strength at study entry ( moment at 0 degrees extension > 0 ) , the ARAT total score had increased at week 8 by a mean of 21.1 ( SD , 12.7 ) in the ES group compared with 10.3 ( SD , 9.0 ) in the control group ( P=0.024 , Mann Whitney U test ) ; however , at 32 weeks the differences between these 2 subgroups were no longer statistically significant . CONCLUSIONS ES of the wrist extensors enhances the recovery of isometric wrist extensor strength in hemiparetic stroke patients .  Upper-limb disability was reduced after 8 weeks of ES therapy , with benefits most apparent in those with some residual motor function at the wrist . However , it is not clear how long the improvements in upper-limb disability are maintained after ES is discontinued Background . Reorganization of the human motor cortex can be induced by specific patterns of peripheral afferent stimulation . The potential for afferent stimulation to facilitate the functional recovery associated with conventional rehabilitative techniques has not previously been investigated . Objective . The authors sought to determine whether combining appropriate afferent stimulation with task-specific training result ed in greater improvements than training alone in patients with impaired upper limb function in the subacute phase following stroke . Method . Twenty patients with hemiparesis due to stroke were allocated r and omly to either a stimulation or control group . All received 9 sessions of task-specific physiotherapy training over 3 weeks . Prior to each training session , associative electrical stimulation of the motor point of 2 h and muscles was given in the stimulation group , whereas the control group received sham stimulation .  Changes in dexterity were assessed using a grip-lift task , and st and ard measures of upper-limb function were made before and following the intervention . Corticospinal excitability was examined using transcranial magnetic stimulation . Results . Both groups showed comparable improvements in functional measures of upper-limb function . Of the 20 patients , only 14 could perform the grip-lift task , which is an objective measure of dexterity . Patients in the stimulation group From the Research Centre for Human Movement Control , School of exhibited significantly greater improvements in this task than the control group . There was no significant change in corticospinal excitability in either group . Conclusion . This pilot study provides preliminary data suggesting that targeted afferent stimulation may facilitate the response to conventional rehabilitation in patients with hemiparesis due to stroke , but these results need to be confirmed in a larger scale study 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 Cerebral vascular disease ( or stroke ) is the main cause of disabilities in adults . Upper-limb dysfunction after stroke usually exists , leading to severe limits of motor capabilities as well as daily activities . Therefore , effective treatment interventions for upper-limb rehabilitation after stroke are needed . Based on the neurophysiological evidence and clinical measures , combined bilateral arm training ( BAT ) with functional electric stimulation ( FES ) could improve h and function in stroke patients . In this study , we attempt to combine BAT with FES applying to the post-stroke paretic arm . A linear guide platform with FES feedback control was developed to execute the training of bilateral reaching movements . 35 stroke subjects were recruited and divided into two groups ( BAT with FES and BAT alone )  . 23 participants completed this experiment with 3-week intervention . According to our preliminary results , a favorable trend toward improvement in experimental group ( BAT with FES )  existed after treatment and at follow-up . Further analysis would be conducted to investigate the kinematic change on motor performance . Moreover , various treatment doses as well as more functional approaches would also be considered for better effects of upper limb rehabilitation after stroke Background . Functional electrical stimulation ( FES ) allows active exercises in stroke patients with upper extremity paralysis . Objective . To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and /or h and paralysis . Methods . For this pilot study , 23 acute and subacute stroke patients were r and omly assigned to the intervention ( n = 12 ) and control group ( n = 11 ) . Distributed over 4 weeks , FES training replaced 12 conventional training sessions in the intervention group . An Extended Barthel Index ( EBI ) subscore assessed the performance of activities of daily living ( ADL ) . The Chedoke McMaster Stroke Assessment ( CMSA ) measured h and and arm function and shoulder pain . The Modified Ashworth Scale ( MAS ) assessed resistance to passive movement . Unblinded assessment s were performed prior to and following the end of the training period . Results . The EBI subscore and CMSA arm score improved significantly in both groups . The CMSA h and function improved significantly in the FES group . Resistance to passive movement of finger and wrist flexors increased significantly in the FES group . Shoulder pain did not change significantly . None of the outcome measures , however , demonstrated significant gain differences between the groups . Conclusions . We did not find clear evidence for superiority or inferiority of FES . Our findings , and those of similar trials , suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences Background Measuring change is fundamental to evaluations , health services research and quality management . To date , the Gold-St and ard is the prospect i ve assessment of pre- to postoperative change . However , this is not always possible ( e.g. in emergencies ) . Instead a retrospective approach to the measurement of change is one alternative of potential validity . In this study , the Gold-St and ard ' conventional ' method was compared with two variations of the retrospective approach : a perceived-change design ( model A ) and a design that featured observed follow-up minus baseline recall ( model B ) . Methods In a prospect i ve longitudinal observational study of 185 hernia patients and 130 laparoscopic cholecystectomy patients ( T0 : 7 - 8 days pre-operative ; T1 : 14 days post-operative and T2 : 6 months post-operative ) changes in symptoms ( Hernia : 9 Items , Cholecystectomy : 8 Items ) were assessed at the three time points by patients and the conventional method was compared to the two alternatives . Comparisons were made regarding the percentage of missing values per question naire item , correlation between conventional and retrospective measurements , and the degree to which retrospective measures either over- or underestimated changes and time-dependent effects . Results Single item missing values in model A were more frequent than in model B ( e.g. Hernia repair at T1 : model A : 23.5 % , model B : 7.9 % . In all items and at both postoperative points of measurement , correlation of change between the conventional method and model B was higher than between the conventional method and model A. For both models A and B , correlation with the change calculated with the conventional method was higher at T1 than at T2 . Compared to the conventional model both models A and B also overestimated symptom-change ( i.e. improvement ) with similar frequency , but the overestimation was higher in model A than in model B. In both models , overestimation was lower at T1 than at T2 and lower after hernia repair than after cholecystectomy . Conclusions The retrospective method of measuring change was associated with a larger improvement in symptoms than was the conventional method . Retrospective assessment of change results in a more optimistic evaluation of improvement by patients than does the conventional method ( at least for hernia repair and laparoscopic cholecystectomy ) Background Functional electrical stimulation ( FES ) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke . Reduction in impairment is strongly associated with how closely FES assists performance , with advanced iterative learning control ( ILC ) technology providing precise upper-limb assistance . The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke . Methods Five stroke participants with established hemiplegia undertook eighteen intervention sessions , each of one hour duration . During each session FES was applied to the anterior deltoid , triceps , and wrist/finger extensors to assist performance of functional tasks with real-objects , including closing a drawer and pressing a light switch . Advanced model-based ILC controllers used kinematic data from previous attempts at each task to up date the FES applied to each muscle on the subsequent trial . This produced stimulation profiles that facilitated accurate completion of each task while encouraging voluntary effort by the participant . Kinematic data were collected using a Microsoft Kinect , and mechanical arm support was provided by a SaeboMAS . Participants completed Fugl-Meyer and Action Research Arm Test clinical assessment s pre- and post-intervention , as well as FES-unassisted tasks during each intervention session . Results Fugl-Meyer and Action Research Arm Test scores both significantly improved from pre- to post-intervention by 4.4 points . Improvements were also found in FES-unassisted performance , and the amount of arm support required to successfully perform the tasks was reduced . Conclusions This feasibility study indicates that technology comprising low-cost hardware fused with advanced FES controllers accurately assists upper limb movement and may reduce upper limb impairments following stroke Objective . The aim of this study was to establish the efficacy of a therapeutic intervention based on functional electrical stimulation ( FES ) therapy to improve reaching and grasping function after severe hemiplegia due to stroke . Methods . A total of 21 subjects with acute stroke were r and omized into 2 groups , FES plus conventional occupational and physiotherapy ( FES group ) or only conventional therapy ( control group ) 5 days a week for 12 to 16 weeks . A third group of 7 subjects with chronic hemiplegia ( at least 5 months poststroke ) received only FES therapy ( chronic group ) and pre — post training changes were compared . FES was applied to proximal and then distal muscle groups during specific motor tasks . At baseline and at the end of treatment , grasping function was assessed using the Rehabilitation Engineering Laboratory H and Function Test , along with more st and ard measures of rehabilitation outcome . Results . The FES group improved significantly more than the control group in terms of object manipulation , palmar grip torque , pinch grip pulling force , Barthel Index , Upper Extremity Fugl — Meyer scores , and 
    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 AND PURPOSE It has been suggested that cyclic neuromuscular electrical stimulation ( ES ) may enhance motor recovery after stroke . We have investigated the effects of ES of the wrist extensors on impairment of wrist function and on upper-limb disability in patients being rehabilitated after acute stroke . METHODS We recruited 60 hemiparetic patients ( mean age , 68 years ) 2 to 4 weeks after stroke into a r and omized , controlled , parallel-group study comparing st and ard rehabilitation treatment with st and ard treatment plus ES of wrist extensors ( 3 times 30 minutes daily for 8 weeks ) . Isometric strength of wrist extensors was measured using a device built for that purpose . Upper-limb disability was assessed with use of the  Action Research Arm Test ( ARAT ) . Observations were continued for 32 weeks ( 24 weeks after the finish of ES or the control intervention phase ) . RESULTS The change in isometric strength of wrist extensors ( at an angle of 0 degrees extension ) was significantly greater in the ES group than the control group at both 8 and 32 weeks ( P=0.004 , P=0.014 by Mann Whitney U test ) . At week 8 the grasp and grip subscores of the ARAT increased significantly in the ES group compared with that in the control group ( P=0.013 and P=0.02 , respectively ) ; a similar trend was seen for the total ARAT score ( P=0.11 ) . In the subgroup of 33 patients with some residual wrist extensor strength at study entry ( moment at 0 degrees extension > 0 ) , the ARAT total score had increased at week 8 by a mean of 21.1 ( SD , 12.7 ) in the ES group compared with 10.3 ( SD , 9.0 ) in the control group ( P=0.024 , Mann Whitney U test ) ; however , at 32 weeks the differences between these 2 subgroups were no longer statistically significant . CONCLUSIONS ES of the wrist extensors enhances the recovery of isometric wrist extensor strength in hemiparetic stroke patients .  Upper-limb disability was reduced after 8 weeks of ES therapy , with benefits most apparent in those with some residual motor function at the wrist . However , it is not clear how long the improvements in upper-limb disability are maintained after ES is discontinued Background . Reorganization of the human motor cortex can be induced by specific patterns of peripheral afferent stimulation . The potential for afferent stimulation to facilitate the functional recovery associated with conventional rehabilitative techniques has not previously been investigated . Objective . The authors sought to determine whether combining appropriate afferent stimulation with task-specific training result ed in greater improvements than training alone in patients with impaired upper limb function in the subacute phase following stroke . Method . Twenty patients with hemiparesis due to stroke were allocated r and omly to either a stimulation or control group . All received 9 sessions of task-specific physiotherapy training over 3 weeks . Prior to each training session , associative electrical stimulation of the motor point of 2 h and muscles was given in the stimulation group , whereas the control group received sham stimulation .  Changes in dexterity were assessed using a grip-lift task , and st and ard measures of upper-limb function were made before and following the intervention . Corticospinal excitability was examined using transcranial magnetic stimulation . Results . Both groups showed comparable improvements in functional measures of upper-limb function . Of the 20 patients , only 14 could perform the grip-lift task , which is an objective measure of dexterity . Patients in the stimulation group From the Research Centre for Human Movement Control , School of exhibited significantly greater improvements in this task than the control group . There was no significant change in corticospinal excitability in either group . Conclusion . This pilot study provides preliminary data suggesting that targeted afferent stimulation may facilitate the response to conventional rehabilitation in patients with hemiparesis due to stroke , but these results need to be confirmed in a larger scale study 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 Cerebral vascular disease ( or stroke ) is the main cause of disabilities in adults . Upper-limb dysfunction after stroke usually exists , leading to severe limits of motor capabilities as well as daily activities . Therefore , effective treatment interventions for upper-limb rehabilitation after stroke are needed . Based on the neurophysiological evidence and clinical measures , combined bilateral arm training ( BAT ) with functional electric stimulation ( FES ) could improve h and function in stroke patients . In this study , we attempt to combine BAT with FES applying to the post-stroke paretic arm . A linear guide platform with FES feedback control was developed to execute the training of bilateral reaching movements . 35 stroke subjects were recruited and divided into two groups ( BAT with FES and BAT alone )  . 23 participants completed this experiment with 3-week intervention . According to our preliminary results , a favorable trend toward improvement in experimental group ( BAT with FES )  existed after treatment and at follow-up . Further analysis would be conducted to investigate the kinematic change on motor performance . Moreover , various treatment doses as well as more functional approaches would also be considered for better effects of upper limb rehabilitation after stroke Background . Functional electrical stimulation ( FES ) allows active exercises in stroke patients with upper extremity paralysis . Objective . To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and /or h and paralysis . Methods . For this pilot study , 23 acute and subacute stroke patients were r and omly assigned to the intervention ( n = 12 ) and control group ( n = 11 ) . Distributed over 4 weeks , FES training replaced 12 conventional training sessions in the intervention group . An Extended Barthel Index ( EBI ) subscore assessed the performance of activities of daily living ( ADL ) . The Chedoke McMaster Stroke Assessment ( CMSA ) measured h and and arm function and shoulder pain . The Modified Ashworth Scale ( MAS ) assessed resistance to passive movement . Unblinded assessment s were performed prior to and following the end of the training period . Results . The EBI subscore and CMSA arm score improved significantly in both groups . The CMSA h and function improved significantly in the FES group . Resistance to passive movement of finger and wrist flexors increased significantly in the FES group . Shoulder pain did not change significantly . None of the outcome measures , however , demonstrated significant gain differences between the groups . Conclusions . We did not find clear evidence for superiority or inferiority of FES . Our findings , and those of similar trials , suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences Background Measuring change is fundamental to evaluations , health services research and quality management . To date , the Gold-St and ard is the prospect i ve assessment of pre- to postoperative change . However , this is not always possible ( e.g. in emergencies ) . Instead a retrospective approach to the measurement of change is one alternative of potential validity . In this study , the Gold-St and ard ' conventional ' method was compared with two variations of the retrospective approach : a perceived-change design ( model A ) and a design that featured observed follow-up minus baseline recall ( model B ) . Methods In a prospect i ve longitudinal observational study of 185 hernia patients and 130 laparoscopic cholecystectomy patients ( T0 : 7 - 8 days pre-operative ; T1 : 14 days post-operative and T2 : 6 months post-operative ) changes in symptoms ( Hernia : 9 Items , Cholecystectomy : 8 Items ) were assessed at the three time points by patients and the conventional method was compared to the two alternatives . Comparisons were made regarding the percentage of missing values per question naire item , correlation between conventional and retrospective measurements , and the degree to which retrospective measures either over- or underestimated changes and time-dependent effects . Results Single item missing values in model A were more frequent than in model B ( e.g. Hernia repair at T1 : model A : 23.5 % , model B : 7.9 % . In all items and at both postoperative points of measurement , correlation of change between the conventional method and model B was higher than between the conventional method and model A. For both models A and B , correlation with the change calculated with the conventional method was higher at T1 than at T2 . Compared to the conventional model both models A and B also overestimated symptom-change ( i.e. improvement ) with similar frequency , but the overestimation was higher in model A than in model B. In both models , overestimation was lower at T1 than at T2 and lower after hernia repair than after cholecystectomy . Conclusions The retrospective method of measuring change was associated with a larger improvement in symptoms than was the conventional method . Retrospective assessment of change results in a more optimistic evaluation of improvement by patients than does the conventional method ( at least for hernia repair and laparoscopic cholecystectomy ) Background Functional electrical stimulation ( FES ) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke . Reduction in impairment is strongly associated with how closely FES assists performance , with advanced iterative learning control ( ILC ) technology providing precise upper-limb assistance . The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke . Methods Five stroke participants with established hemiplegia undertook eighteen intervention sessions , each of one hour duration . During each session FES was applied to the anterior deltoid , triceps , and wrist/finger extensors to assist performance of functional tasks with real-objects , including closing a drawer and pressing a light switch . Advanced model-based ILC controllers used kinematic data from previous attempts at each task to up date the FES applied to each muscle on the subsequent trial . This produced stimulation profiles that facilitated accurate completion of each task while encouraging voluntary effort by the participant . Kinematic data were collected using a Microsoft Kinect , and mechanical arm support was provided by a SaeboMAS . Participants completed Fugl-Meyer and Action Research Arm Test clinical assessment s pre- and post-intervention , as well as FES-unassisted tasks during each intervention session . Results Fugl-Meyer and Action Research Arm Test scores both significantly improved from pre- to post-intervention by 4.4 points . Improvements were also found in FES-unassisted performance , and the amount of arm support required to successfully perform the tasks was reduced . Conclusions This feasibility study indicates that technology comprising low-cost hardware fused with advanced FES controllers accurately assists upper limb movement and may reduce upper limb impairments following stroke Objective . The aim of this study was to establish the efficacy of a therapeutic intervention based on functional electrical stimulation ( FES ) therapy to improve reaching and grasping function after severe hemiplegia due to stroke . Methods . A total of 21 subjects with acute stroke were r and omized into 2 groups , FES plus conventional occupational and physiotherapy ( FES group ) or only conventional therapy ( control group ) 5 days a week for 12 to 16 weeks . A third group of 7 subjects with chronic hemiplegia ( at least 5 months poststroke ) received only FES therapy ( chronic group ) and pre — post training changes were compared . FES was applied to proximal and then distal muscle groups during specific motor tasks . At baseline and at the end of treatment , grasping function was assessed using the Rehabilitation Engineering Laboratory H and Function Test , along with more st and ard measures of rehabilitation outcome . Results . The FES group improved significantly more than the control group in terms of object manipulation , palmar grip torque , pinch grip pulling force , Barthel Index , Upper Extremity Fugl — Meyer scores , and 
    Output:
    