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: Clinical studies had shown that EEG-based motor imagery Brain-Computer Interface ( MI-BCI ) combined with robotic feedback is effective in upper limb stroke rehabilitation , and transcranial Direct Current Stimulation ( tDCS ) combined with other rehabilitation techniques further enhanced the facilitating effect of tDCS . This motivated the current clinical study to investigate the effects of combining tDCS with MI-BCI and robotic feedback compared to sham-tDCS for upper limb stroke rehabilitation . The stroke patients recruited were r and omized to receive 20 minutes of tDCS or sham-tDCS prior to 10 sessions of 1-hour MI-BCI with robotic feedback for 2 weeks . The online accuracies of detecting motor imagery from idle condition were assessed and offline accuracies of classifying motor imagery from background rest condition were assessed from the EEG of the evaluation and therapy parts of the 10 rehabilitation sessions respectively . The results showed no evident differences between the online accuracies on the evaluation part from both groups , but the offline analysis on the therapy part yielded higher averaged accuracies for subjects who received tDCS ( n=3 ) compared to  sham-tDCS ( n=2 ) . The results suggest towards tDCS effect in modulating motor imagery in stroke , but a more conclusive result can be drawn when more data are collected in the ongoing study PURPOSE Transcranial direct current stimulation ( tDCS ) of the motor cortex seems to be effective in improving motor performance in patients with chronic stroke , while some recent findings have reported conflicting results for the subacute phase . We aim ed to verify whether upper extremity motor rehabilitation could be enhanced by treatment with tDCS administered before a rehabilitative session . METHODS H and dexterity and force in 16 individuals with subacute stroke were assessed before ( T0 ) and after anodal stimulation ( T1 ) and after a successive session of motor rehabilitation ( T2 ) in a double-blind , r and omized , sham-controlled , crossover trial . To confirm the value of the device as a specific effector , behavioral tests were also administered . RESULTS Anodal and sham stimulation plus rehabilitation significantly improved manual dexterity ( repeated-measure Anova : A-tDCS : p = 0.005 ; S-tDCS : p = 0.042 ) . Post hoc analysis revealed a significant stimulation effect only for A-tDCS ( p = 0.013 between T0 and T1 ) and not for S-tDCS , whereas the rehabilitation effect ( between T1 and T2 ) was not significant in either group . H and force and behavioral features were unchanged . CONCLUSIONS Anodal brain stimulation improves h and dexterity but does not increase the effectiveness of the rehabilitation directly . These results suggest the presence of aftereffects , not priming effects , of A-tDCS superimposed onto motor learning phenomena Background . No rehabilitation intervention has effectively improved functional use of the arm and h and in patients with severe upper limb paresis after stroke . Pilot studies suggest the potential for transcranial direct current stimulation and bilateral robotic training to enhance gains . Objective . In a double-blind , r and omized trial the combination of these interventions was tested . Methods . This study r and omized 96 patients with an ischemic supratentorial lesion of 3 to 8 weeks ’ duration with severe impairment of motor control with a Fugl-Meyer score ( FMS ) for the upper limb < 18 into 3 groups . For 6 weeks , group A received anodal stimulation of the lesioned hemisphere , group B received cathodal stimulation of the nonlesioned side for 20 minutes at 2.0 mA , and group C received sham stimulation . The electrodes were placed over the h and area and above the contralateral orbit . Contemporaneously , the subjects practice d 400 repetitions each of 2 different bilateral movements on a robotic assistive device . Results . The groups were matched at onset . The FMS improved in all patients at 6 weeks ( P < .001 ) . No between-group differences were found ; initial versus finish FMS scores were 7.8 ± 3.8 versus 19.1 ± 14.4 in group A , 7.9 ± 3.4 versus 18.8 ± 10.5 in group B , and 8.2 ± 4.4 versus 19.2 ± 15.0 in group C. No significant changes between groups were present at 3 months . Conclusions . Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness . Unilateral h and training and upregulation of the nonlesioned hemisphere might also be tried in this population Based on the interhemispheric inhibition model of unilateral visuospatial neglect ( USN ) after stroke , the effects of dual-mode transcranial direct current stimulation ( tDCS ) over the parietal cortices were assessed in a double-blind r and om-order cross-over experiment . Ten chronic right hemispheric stroke patients ( 4 men ; mean age : 62.6 years ) with USN were recruited . All participants underwent three r and omly arranged tDCS sessions : ( 1 ) dual-mode , anodal tDCS over the right posterior parietal cortex ( PPC ) and cathodal tDCS over the left PPC ; ( 2 ) single-mode , anodal tDCS over the right PPC ; and ( 3 ) sham mode . Each session lasted 20min . Before and immediately after the stimulation , a line bisection test and star cancelation test were carried out . In the line bisection test , significant improvements were observed after both the dual- and the  single-mode tDCS  ( p<0.05 ) , but not after sham stimulation . Statistical analysis showed a significant interaction between time and tDCS mode , where the dual tDCS had a stronger effect than the single or sham stimulation modes ( p<0.05 ) . The star cancelation test did not show any significant change . These results suggest that dual tDCS over the bilateral PPC is an effective method for the treatment of USN in stroke patients Background Previous studies showed that anodal transcranial DC stimulation ( tDCS ) applied to the primary motor cortex of the affected hemisphere ( M1affected hemisphere ) after subcortical stroke transiently improves performance of complex tasks that mimic activities of daily living ( ADL ) . It is not known if relatively simpler motor tasks are similarly affected . Here we tested the effects of tDCS on pinch force ( PF ) and simple reaction time ( RT ) tasks in patients with chronic stroke in a double-blind cross-over Sham-controlled experimental design . Results Anodal tDCS shortened reaction times and improved pinch force in the paretic h and relative to Sham stimulation , an effect present in patients with higher impairment . Conclusion tDCS of M1affected hemisphere can modulate performance of motor tasks simpler than those previously studied , a finding that could potentially benefit patients with relatively higher impairment levels Abstract : Balanced transcallosal inhibition sustains symmetrical corticomotor excitability and assists the performance of bimanual voluntary movements . After stroke , transcallosal inhibition becomes asymmetric . This finding raised the notion that reducing poststroke asymmetry in transcallosal inhibition might prime the motor system before training and lead to improvements in walking recovery . In this study , we examined three neuromodulatory protocol s applied during walking to determine if they could increase ipsilesional and decrease contralesional motor excitability in patients with chronic stroke .  Inhibitory repetitive transcranial magnetic stimulation and inhibitory paired associative stimulation were applied to the contralesional motor system , and facilitatory anodal transcranial direct current stimulation was applied to the ipsilesional motor system . We tested the bilateral modulatory effects of each stimulation protocol on the tibialis anterior , medial gastrocnemius , medial hamstrings , and vastus lateralis of nine patients with chronic stroke . All stimulation protocol s increased paretic limb and decreased nonparetic limb motor excitability . There was no statistical difference in the extent of modulation between these stimulation protocol s. This result suggests these three protocol s are promising c and i date priming mechanisms for testing the hypothesis in a future study that reducing the poststroke asymmetry of between-hemisphere motor excitability will enhance the effect of gait therapy Objective : Motor recovery after stroke depends on the integrity of ipsilesional motor circuits and interactions between the ipsilesional and contralesional hemispheres . In this sham-controlled r and omized trial , we investigated whether noninvasive modulation of regional excitability of bilateral motor cortices in combination with physical and occupational therapy improves motor outcome after stroke . Methods : Twenty chronic stroke patients were r and omly assigned to receive 5 consecutive sessions of either 1 ) bihemispheric transcranial direct current stimulation ( tDCS ) ( anodal tDCS to upregulate excitability of ipsilesional motor cortex and cathodal tDCS to downregulate excitability of contralesional motor cortex ) with simultaneous physical/occupational therapy or 2 ) sham stimulation with simultaneous physical/occupational therapy .  Changes in motor impairment ( Upper Extremity Fugl-Meyer ) and motor activity ( Wolf Motor Function Test ) assessment s were outcome measures while functional imaging parameters were used to identify neural correlates of motor improvement . Results : The improvement of motor function was significantly greater in the real stimulation group ( 20.7 % in Fugl-Meyer and 19.1 % in Wolf Motor Function Test scores ) when compared to the sham group ( 3.2 % in Fugl-Meyer and 6.0 % in Wolf Motor Function Test scores ) . The effects outlasted the stimulation by at least 1 week . In the real-stimulation group , stronger activation of intact ipsilesional motor regions during paced movements of the affected limb were found postintervention whereas no significant activation changes were seen in the control group . Conclusions : The combination of bihemispheric tDCS and peripheral sensorimotor activities improved motor functions in chronic stroke patients that outlasted the intervention period . This novel approach may potentiate cerebral adaptive processes that facilitate motor recovery after stroke . Classification of evidence : This study provides Class I evidence that for adult patients with ischemic stroke treated at least 5 months after their first and only stroke , bihemispheric tDCS and simultaneous physical/occupational therapy given over 5 consecutive sessions significantly improves motor function as measured by the Upper Extremity Fugl-Meyer assessment ( raw change treated 6.1 ± 3.4 , sham 1.2 ± 1.0 ) OBJECTIVE To investigate the effects of combination cathodal transcranial direct current stimulation ( tDCS ) and virtual reality ( VR ) therapy for upper extremity ( UE ) training in patients with subacute stroke . DESIGN Pilot r and omized controlled trial . Patients were r and omly assigned to 1 of 3 groups : group A received cathodal tDCS , group B received VR , and group C received combination therapy ( cathodal tDCS was simultaneously applied during VR therapy ) . SETTING University hospital . PARTICIPANTS Patients ( N=59 ) with impaired unilateral UE motor function after stroke . INTERVENTION Fifteen sessions of treatment over a 3-week period . MAIN OUTCOME MEASURES The Modified Ashworth Scale , manual muscle test ( MMT ) , Manual Function Test ( MFT ) , Fugl-Meyer Scale ( FMS ) , and Box and Block Test were used to assess UE function . To evaluate activities of daily living , the Korean-Modified Barthel Index ( K-MBI ) was used . All outcomes were measured before and immediately after treatment . RESULTS After treatment , all groups demonstrated significant improvements in MMT , MFT , FMS , and K-MBI scores . The change in MFT and FMS scores was different between the 3 groups . Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups . CONCLUSIONS In the present pilot study , the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone . This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke OBJECTIVES 1 ) To investigate the feasibility of combining transcranial direct current stimulation ( tDCS ) to the lower extremity ( LE ) motor cortex with novel locomotor training to facilitate gait in subjects with chronic stroke and low ambulatory status , and 2 ) to obtain insight from study subjects and their caregivers to inform future trial design . METHODS Double-blind , r and omized controlled study with additional qualitative exploratory descriptive design . One-month follow-up.10 subjects with stroke were recruited and r and omized to active tDCS or sham tDCS for 12 sessions . Both groups participated in identical locomotor training with a robotic gait orthosis ( RGO ) following each tDCS session . RGO training protocol was design ed to harness cortical neuroplasticity . Data analysis included assessment of functional and participation outcome measures and qualitative thematic analysis . RESULTS Eight subjects completed the study . Both groups demonstrated trends toward improvement , but the active tDCS group showed greater improvement than the sham group . Qualitative analyses indicated beneficial effects of this combined intervention . CONCLUSIONS It is feasible to combine tDCS targeting the LE motor cortex with our novel locomotor training . It appears that tDCS has the potential to enhance the effectiveness of gait training in chronic stroke . Insights from participants provide additional guidance in design ing future trials OBJECTIVE The purpose of this study was to examine the effects of combined therapy using transcranial direct current stimulation ( tDCS ) with robot-assisted arm training ( AT ) for impairment of the upper limb in chronic stroke patients , and to clarify whether differences exist in the effect of anodal tDCS on the affected hemisphere ( tDCS(a ) + AT ) 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: Clinical studies had shown that EEG-based motor imagery Brain-Computer Interface ( MI-BCI ) combined with robotic feedback is effective in upper limb stroke rehabilitation , and transcranial Direct Current Stimulation ( tDCS ) combined with other rehabilitation techniques further enhanced the facilitating effect of tDCS . This motivated the current clinical study to investigate the effects of combining tDCS with MI-BCI and robotic feedback compared to sham-tDCS for upper limb stroke rehabilitation . The stroke patients recruited were r and omized to receive 20 minutes of tDCS or sham-tDCS prior to 10 sessions of 1-hour MI-BCI with robotic feedback for 2 weeks . The online accuracies of detecting motor imagery from idle condition were assessed and offline accuracies of classifying motor imagery from background rest condition were assessed from the EEG of the evaluation and therapy parts of the 10 rehabilitation sessions respectively . The results showed no evident differences between the online accuracies on the evaluation part from both groups , but the offline analysis on the therapy part yielded higher averaged accuracies for subjects who received tDCS ( n=3 ) compared to  sham-tDCS ( n=2 ) . The results suggest towards tDCS effect in modulating motor imagery in stroke , but a more conclusive result can be drawn when more data are collected in the ongoing study PURPOSE Transcranial direct current stimulation ( tDCS ) of the motor cortex seems to be effective in improving motor performance in patients with chronic stroke , while some recent findings have reported conflicting results for the subacute phase . We aim ed to verify whether upper extremity motor rehabilitation could be enhanced by treatment with tDCS administered before a rehabilitative session . METHODS H and dexterity and force in 16 individuals with subacute stroke were assessed before ( T0 ) and after anodal stimulation ( T1 ) and after a successive session of motor rehabilitation ( T2 ) in a double-blind , r and omized , sham-controlled , crossover trial . To confirm the value of the device as a specific effector , behavioral tests were also administered . RESULTS Anodal and sham stimulation plus rehabilitation significantly improved manual dexterity ( repeated-measure Anova : A-tDCS : p = 0.005 ; S-tDCS : p = 0.042 ) . Post hoc analysis revealed a significant stimulation effect only for A-tDCS ( p = 0.013 between T0 and T1 ) and not for S-tDCS , whereas the rehabilitation effect ( between T1 and T2 ) was not significant in either group . H and force and behavioral features were unchanged . CONCLUSIONS Anodal brain stimulation improves h and dexterity but does not increase the effectiveness of the rehabilitation directly . These results suggest the presence of aftereffects , not priming effects , of A-tDCS superimposed onto motor learning phenomena Background . No rehabilitation intervention has effectively improved functional use of the arm and h and in patients with severe upper limb paresis after stroke . Pilot studies suggest the potential for transcranial direct current stimulation and bilateral robotic training to enhance gains . Objective . In a double-blind , r and omized trial the combination of these interventions was tested . Methods . This study r and omized 96 patients with an ischemic supratentorial lesion of 3 to 8 weeks ’ duration with severe impairment of motor control with a Fugl-Meyer score ( FMS ) for the upper limb < 18 into 3 groups . For 6 weeks , group A received anodal stimulation of the lesioned hemisphere , group B received cathodal stimulation of the nonlesioned side for 20 minutes at 2.0 mA , and group C received sham stimulation . The electrodes were placed over the h and area and above the contralateral orbit . Contemporaneously , the subjects practice d 400 repetitions each of 2 different bilateral movements on a robotic assistive device . Results . The groups were matched at onset . The FMS improved in all patients at 6 weeks ( P < .001 ) . No between-group differences were found ; initial versus finish FMS scores were 7.8 ± 3.8 versus 19.1 ± 14.4 in group A , 7.9 ± 3.4 versus 18.8 ± 10.5 in group B , and 8.2 ± 4.4 versus 19.2 ± 15.0 in group C. No significant changes between groups were present at 3 months . Conclusions . Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness . Unilateral h and training and upregulation of the nonlesioned hemisphere might also be tried in this population Based on the interhemispheric inhibition model of unilateral visuospatial neglect ( USN ) after stroke , the effects of dual-mode transcranial direct current stimulation ( tDCS ) over the parietal cortices were assessed in a double-blind r and om-order cross-over experiment . Ten chronic right hemispheric stroke patients ( 4 men ; mean age : 62.6 years ) with USN were recruited . All participants underwent three r and omly arranged tDCS sessions : ( 1 ) dual-mode , anodal tDCS over the right posterior parietal cortex ( PPC ) and cathodal tDCS over the left PPC ; ( 2 ) single-mode , anodal tDCS over the right PPC ; and ( 3 ) sham mode . Each session lasted 20min . Before and immediately after the stimulation , a line bisection test and star cancelation test were carried out . In the line bisection test , significant improvements were observed after both the dual- and the  single-mode tDCS  ( p<0.05 ) , but not after sham stimulation . Statistical analysis showed a significant interaction between time and tDCS mode , where the dual tDCS had a stronger effect than the single or sham stimulation modes ( p<0.05 ) . The star cancelation test did not show any significant change . These results suggest that dual tDCS over the bilateral PPC is an effective method for the treatment of USN in stroke patients Background Previous studies showed that anodal transcranial DC stimulation ( tDCS ) applied to the primary motor cortex of the affected hemisphere ( M1affected hemisphere ) after subcortical stroke transiently improves performance of complex tasks that mimic activities of daily living ( ADL ) . It is not known if relatively simpler motor tasks are similarly affected . Here we tested the effects of tDCS on pinch force ( PF ) and simple reaction time ( RT ) tasks in patients with chronic stroke in a double-blind cross-over Sham-controlled experimental design . Results Anodal tDCS shortened reaction times and improved pinch force in the paretic h and relative to Sham stimulation , an effect present in patients with higher impairment . Conclusion tDCS of M1affected hemisphere can modulate performance of motor tasks simpler than those previously studied , a finding that could potentially benefit patients with relatively higher impairment levels Abstract : Balanced transcallosal inhibition sustains symmetrical corticomotor excitability and assists the performance of bimanual voluntary movements . After stroke , transcallosal inhibition becomes asymmetric . This finding raised the notion that reducing poststroke asymmetry in transcallosal inhibition might prime the motor system before training and lead to improvements in walking recovery . In this study , we examined three neuromodulatory protocol s applied during walking to determine if they could increase ipsilesional and decrease contralesional motor excitability in patients with chronic stroke .  Inhibitory repetitive transcranial magnetic stimulation and inhibitory paired associative stimulation were applied to the contralesional motor system , and facilitatory anodal transcranial direct current stimulation was applied to the ipsilesional motor system . We tested the bilateral modulatory effects of each stimulation protocol on the tibialis anterior , medial gastrocnemius , medial hamstrings , and vastus lateralis of nine patients with chronic stroke . All stimulation protocol s increased paretic limb and decreased nonparetic limb motor excitability . There was no statistical difference in the extent of modulation between these stimulation protocol s. This result suggests these three protocol s are promising c and i date priming mechanisms for testing the hypothesis in a future study that reducing the poststroke asymmetry of between-hemisphere motor excitability will enhance the effect of gait therapy Objective : Motor recovery after stroke depends on the integrity of ipsilesional motor circuits and interactions between the ipsilesional and contralesional hemispheres . In this sham-controlled r and omized trial , we investigated whether noninvasive modulation of regional excitability of bilateral motor cortices in combination with physical and occupational therapy improves motor outcome after stroke . Methods : Twenty chronic stroke patients were r and omly assigned to receive 5 consecutive sessions of either 1 ) bihemispheric transcranial direct current stimulation ( tDCS ) ( anodal tDCS to upregulate excitability of ipsilesional motor cortex and cathodal tDCS to downregulate excitability of contralesional motor cortex ) with simultaneous physical/occupational therapy or 2 ) sham stimulation with simultaneous physical/occupational therapy .  Changes in motor impairment ( Upper Extremity Fugl-Meyer ) and motor activity ( Wolf Motor Function Test ) assessment s were outcome measures while functional imaging parameters were used to identify neural correlates of motor improvement . Results : The improvement of motor function was significantly greater in the real stimulation group ( 20.7 % in Fugl-Meyer and 19.1 % in Wolf Motor Function Test scores ) when compared to the sham group ( 3.2 % in Fugl-Meyer and 6.0 % in Wolf Motor Function Test scores ) . The effects outlasted the stimulation by at least 1 week . In the real-stimulation group , stronger activation of intact ipsilesional motor regions during paced movements of the affected limb were found postintervention whereas no significant activation changes were seen in the control group . Conclusions : The combination of bihemispheric tDCS and peripheral sensorimotor activities improved motor functions in chronic stroke patients that outlasted the intervention period . This novel approach may potentiate cerebral adaptive processes that facilitate motor recovery after stroke . Classification of evidence : This study provides Class I evidence that for adult patients with ischemic stroke treated at least 5 months after their first and only stroke , bihemispheric tDCS and simultaneous physical/occupational therapy given over 5 consecutive sessions significantly improves motor function as measured by the Upper Extremity Fugl-Meyer assessment ( raw change treated 6.1 ± 3.4 , sham 1.2 ± 1.0 ) OBJECTIVE To investigate the effects of combination cathodal transcranial direct current stimulation ( tDCS ) and virtual reality ( VR ) therapy for upper extremity ( UE ) training in patients with subacute stroke . DESIGN Pilot r and omized controlled trial . Patients were r and omly assigned to 1 of 3 groups : group A received cathodal tDCS , group B received VR , and group C received combination therapy ( cathodal tDCS was simultaneously applied during VR therapy ) . SETTING University hospital . PARTICIPANTS Patients ( N=59 ) with impaired unilateral UE motor function after stroke . INTERVENTION Fifteen sessions of treatment over a 3-week period . MAIN OUTCOME MEASURES The Modified Ashworth Scale , manual muscle test ( MMT ) , Manual Function Test ( MFT ) , Fugl-Meyer Scale ( FMS ) , and Box and Block Test were used to assess UE function . To evaluate activities of daily living , the Korean-Modified Barthel Index ( K-MBI ) was used . All outcomes were measured before and immediately after treatment . RESULTS After treatment , all groups demonstrated significant improvements in MMT , MFT , FMS , and K-MBI scores . The change in MFT and FMS scores was different between the 3 groups . Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups . CONCLUSIONS In the present pilot study , the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone . This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke OBJECTIVES 1 ) To investigate the feasibility of combining transcranial direct current stimulation ( tDCS ) to the lower extremity ( LE ) motor cortex with novel locomotor training to facilitate gait in subjects with chronic stroke and low ambulatory status , and 2 ) to obtain insight from study subjects and their caregivers to inform future trial design . METHODS Double-blind , r and omized controlled study with additional qualitative exploratory descriptive design . One-month follow-up.10 subjects with stroke were recruited and r and omized to active tDCS or sham tDCS for 12 sessions . Both groups participated in identical locomotor training with a robotic gait orthosis ( RGO ) following each tDCS session . RGO training protocol was design ed to harness cortical neuroplasticity . Data analysis included assessment of functional and participation outcome measures and qualitative thematic analysis . RESULTS Eight subjects completed the study . Both groups demonstrated trends toward improvement , but the active tDCS group showed greater improvement than the sham group . Qualitative analyses indicated beneficial effects of this combined intervention . CONCLUSIONS It is feasible to combine tDCS targeting the LE motor cortex with our novel locomotor training . It appears that tDCS has the potential to enhance the effectiveness of gait training in chronic stroke . Insights from participants provide additional guidance in design ing future trials OBJECTIVE The purpose of this study was to examine the effects of combined therapy using transcranial direct current stimulation ( tDCS ) with robot-assisted arm training ( AT ) for impairment of the upper limb in chronic stroke patients , and to clarify whether differences exist in the effect of anodal tDCS on the affected hemisphere ( tDCS(a ) + AT ) and 
    Output:
    