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: We are applying robotics and information technology to assist , enhance , and quantify neuro-rehabilitation . Our goal is a new class of interactive , user-affectionate clinical devices design ed not only for evaluating patients , but also-for delivering meaningful therapy via engaging " video games " . Notably , the novel robot MIT-MANUS has been design ed and programmed for clinical neurological applications , and has undergone extensive clinical trials for more than four years at Burke Rehabilitation Hospital - White Plains , NY . This paper will review results of the first clinical trial of 20 patients , which showed that : - Stroke patients treated daily with additional robot-aided therapy during acute rehabilitation had improved outcome in motor activity at hospital discharge , when compared to a control group that received only st and ard acute rehabilitation treatment . - This improved outcome was sustained after three years . - The neuro-recovery process continued far beyond the commonly accepted 3 months post-stroke interval Background and Purpose Alterations of gait cycle and foot-drop on the paretic limb are characteristic of stroke patients .  Electromyographic biofeedback treatment has been used in rehabilitation of walking , but results are controversial . We performed gait analysis to evaluate the efficacy of electromyographic biofeedback compared with physical therapy . Methods Sixteen patients with ischemic stroke were enrolled in the study . The experimental group ( 4 men , 4 women ) received electromyographic biofeedback treatment together with physical therapy . The control group ( 5 men , 3 women ) was treated with physical therapy only .  Clinical and functional evaluations before and after treatment were performed using Canadian Neurological , Adams , Ashworth , Basmajian , and Barthel Index scales . Computerized gait analysis was performed in all patients . Results Electromyographic biofeedback patients showed significantly increased scores on the Adams scale ( P<.05 ) and Basmajian scale ( P<.01 ) . Gait analysis in this group showed a recovery of foot-drop in the swing phase ( P<.02 ) after training . Conclusions Our data confirm that the electromyographic biofeedback technique increases muscle strength and improves recovery of functional locomotion in patients with hemiparesis and foot-drop after cerebral ischemia OBJECTIVE To evaluate gait biomechanics after training with a virtual reality ( VR ) system and to eluci date underlying mechanisms that contributed to the observed functional improvement in gait speed and distance . DESIGN A single blind r and omized control study . SETTING Gait analysis laboratory in a rehabilitation hospital and the community . PARTICIPANTS Fifteen men and three women with hemiparesis caused by stroke . INTERVENTIONS Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation . Subjects were r and omized to either a VR group ( n=9 ) or non-VR group ( NVR , n=9 ) . Training was performed three times a week for 4 weeks for approximately 1h each visit . MAIN OUTCOME MEASURES Kinematic and kinetic gait parameters . RESULTS Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training ( p=0.036 ) . The VR group had greater change in ankle ROM post-training ( 19.5 % ) as compared to the NVR group ( 3.3 % ) . Significant differences were found in knee ROM on the affected side during stance and swing , with greater change in the VR group . No significant changes were observed in kinematics or kinetics of the hip post-training . CONCLUSIONS These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis . It is likely that the effects of training included improved motor control at the ankle , which enabled the cascade of changes that produced the functional improvements seen after training A new st and ing biofeedback training device , which includes a height-adjustable work table , weight-bearing sensors , and a real-time visual and auditory feedback system , has been developed for postural training . Sixty persons with hemiplegia after acute stroke or traumatic brain injury were r and omly divided into Group A ( experimental ) and Group B ( control ) . After a training period of 4 weeks , the percentage of postural asymmetry in Group A and Group B was reduced from 17.2 + /- 10.8 % and 17.0 + /- 10.0 % to 3.5 + /- 2.2 % and 10.1 + /- 6.4 percent , respectively ( p = 0.003 ) . There was no significant difference between subjects with right or left hemiplegia .  The results indicated that this device had a positive training effect on stance symmetry in hemiplegic subjects OBJECTIVE To examine the effect of a light touch cue provided through a cane on mediolateral ( ML ) pelvic stability during walking in subjects poststroke . DESIGN Crossover trial examining ML pelvic stability during walking using a cane with the force contact and touch contact methods . SETTING Physical therapy clinic , tertiary care center . PARTICIPANTS Subacute patients ( N=40 ) with stroke with a mean age of 59.6 years and mean stroke duration of 46.8 days . The average gait speed with a cane was .13 m/s ( .05-.29 m/s ) . INTERVENTION Using a cane with the force contact and touch contact methods during walking . MAIN OUTCOME MEASURES ML pelvic stability as measured by averaged peak-to-peak pelvic acceleration , muscle activation of bilateral tensor fascia latae ( TFL ) , semitendinosus ( ST ) , and vastus medialis ( VM ) using an electromyography system , and vertical cane force . RESULTS The average amount of cane force during touch contact and force contact cane use conditions was 2.3N and 49.3N , respectively . A light touch cue through a cane was required only when the paretic leg accepted the body weight , and this cue can provide ML pelvic stability ( .16 g of average pelvic acceleration ) during walking to the same degree as the force contact method of cane use . However , significant increases in single-limb support duration with higher activations of TFL , VM , and ST muscles on the paretic leg were found during the paretic stance phase when using a cane in the touch contact fashion ( P<.05 ) . CONCLUSIONS A light touch cue can be provided during walking through the use of a cane . This augmented somatosensory information provides lateral stability during walking for subjects with stroke by facilitating the activations of weight-bearing muscles on the paretic leg during the stance phase Objective : To examine the effects of electromyographic ( EMG ) biofeedback training on the recovery of gait in the acute phase post stroke . Design : Patients were r and omly assigned to EMG biofeedback or control groups . They received treatment three times a week for six weeks . All patients were assessed prior to treatment , after 18 treatment sessions , and at three months follow-up . Setting : The study was carried out at Scunthorpe General Hospital in North Lincolnshire . The subjects were acute stroke patients who had been admitted on to the medical and elderly wards . Interventions : The EMG biofeedback group were treated using EMG as an adjunct to physiotherapy . The patients were encouraged to facilitate or inhibit abnormal muscle tone via auditory or visual signals transmitted from electrodes placed over the appropriate muscles . The control group were treated using the same techniques , electrodes were used with this group of patients , but the EMG machine was turned off and faced away from the patient and the therapist to control the placebo effect . Outcome measures : A large battery of outcome measures was used for physical and psychological assessment . The physical measures consisted of active movement , muscle tone , sensation , proprioception , mobility and activities of daily living ( ADL ) . The psychological measures included orientation , memory , spatial performance , language and IQ . Results : Twenty-one patients were included in the study . Scores were combined into four groups : mild EMG , severe EMG , mild control and severe control . Results showed that there was an improvement in physical scores for active movement , mobility and ADL over time , but there was no significant difference between the EMG and control groups . Scores on the psychological tests were within normal limits , and there was no difference in performance between the EMG and control groups . Conclusions : This study showed no significant differences in the rate of improvement after stroke between the two groups . Although EMG biofeed-back was used as an adjunct to physiotherapy and represented clinical practice , the results provide little evidence to support the clinical significance of using EMG biofeedback to improve gait in the acute phase after stroke This research provides a preliminary investigation of the relative efficacy of electromyographic ( EMG ) versus a novel biofeedback ( BFB ) approach to improve ankle control and functional gait in stroke patients . A computerized system was design ed to provide audiovisual feedback of either muscle activity or ankle position during dorsiflexion and plantar flexion . The novel approach also included rhythmic pacing to emphasize the rapid timing of ankle motion necessary to switch from stance to swing during walking . Thirty-seven subjects were r and omly assigned to one of the following groups : ( 1 ) no-treatment control , ( 2 ) EMG BFB , and ( 3 ) rhythmic positional BFB . Blind evaluations of ankle performance , gait , and perceived exertion were performed at regular intervals . Analyses of covariance revealed that subjects receiving rhythmic positional BFB significantly increased their walking speeds relative to other groups at posttest ( p = .02 ) and at three-month follow-up ( p = .035 ) , without any increase in subjectively reported energy cost . The ability of positional BFB to emphasize the timing events during walking provided optimistic results for carry-over into gait functioning . The degree of sensorimotor recovery and time since onset of stroke were considered important factors in determining outcomes Bourbonnais D , Bilodeau S , Lepage Y , Beaudoin N , Gravel D , Forget R : Effect of force-feedback treatments in patients with chronic motor deficits after a stroke . Am J Phys Med Rehabil 2002;81:890–897 . Objective To assess the effects a motor reeducation approach based on static dynamometers used to provide feedback on the force produced . Design The study design was a single-blind , r and omized , controlled trial . Chronic stroke subjects participated in a 6-wk , thrice-weekly , force-feedback program of either the upper paretic limb ( n = 13 ) or the  lower paretic limb ( n = 12 ) . Baseline and postintervention assessment s of the performance of both the upper and the lower limb were measured for each subject , the untreated paretic limb  of each group serving as a control for the other group . Results With the exception of the h and grip force , strength measurements of the treated limb increased after completion of the treatment . The outcome measurements of the upper limb of the subjects included in the upper paretic limb were not significantly different after treatment from those measured in the lower paretic limb . In contrast , gait velocity and the distance walked in 2 min increased after treatment in the lower paretic limb as compared with the upper paretic limb , whereas the scores in the Fugl-Meyer test for the lower limb and the timed up- and -go test did not increase for either group after treatment . Conclusion The results indicate that treatment of the lower limb based on force feedback produces an improvement of gait velocity Electromyographic biofeedback was compared with simple exercise therapy as to its effectiveness in improving  foot-drop in 22 stroke patients . The study was design ed to be a rigorous trial of biofeedback and the patients tested were aged and had stroke of long duration . One group of 11 patients underwent 6 weeks of exercise therapy 2 sessions per week for 15 minutes per session ; the 2nd group of 11 patients underwent similar therapy with EMG feedback . All therapy was conducted by a research assistant who was not a trained therapist . The groups were assessed blind before treatment , after treatment and a 6-week follow-up . The significantly greater improvements in the biofeedback group in terms of muscle strength at the end of treatment were maintained at follow-up . On the range of movement and gait analysis measures , both groups showed some improvement after treatment . However , at follow-up this improvement had relapsed for the exercise group while for the biofeedback group it had been maintained . It is argued that controlled trials are possible in biofeedback and that using patients as their own controls is not justified in view of the present findings and the previously reported literature OBJECTIVES We tried to examine whether visual biofeedback tracking training ( VBTT ) can improve both the gait performance and cortical activation pattern in chronic stroke patients . DESIGN We enrolled 10 chronic hemiparetic patients with stroke(mean age 46.3 + /- 5.19 years ) . The patients were r and omly assigned to the training group ( 5 patients ) or the control group ( 5 patients ) . VBTT was to follow the PC-generated sine waves with the knee joint electrogoniometer , and the two sine waves should appear as close to overlapping as possible on the PC monitor . The training was performed for 39 minutes/day , 5 days/week , for 4 weeks . Pre-training and post-training accuracy of tracking , functional status of gait , and functional MRI ( fMRI ) were measured . fMRI was performed at 1.5 T in parallel with timed knee flexion-extension movements at a fixed rate . RESULTS The accuracy of the tracking performance , walking speed , and motor scale for gait improved in the training group . Primary sensorimotor cortex ( SM1 ) cortical activation shifted significantly from the unaffected to the affected hemisphere in the training group . CONCLUSIONS We demonstrated that cortical activation changes occurred with gait function improvement in chronic stroke patients throughout the 4-week VBTT program . It seems that the cortical reorganization was induced by VBTT Objective : To investigate the effects of balance training , using force platform biofeedback , on quantitative gait characteristics of hemiparetic patients late after stroke . Design : R and omized , controlled , assessor-blinded trial . Setting : Rehabilitation ward and gait laboratory of a university hospital . Subjects : Forty-one patients ( mean ( st and ard deviation ; SD ) age of 60.9 ( 11.7 ) years 
    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: We are applying robotics and information technology to assist , enhance , and quantify neuro-rehabilitation . Our goal is a new class of interactive , user-affectionate clinical devices design ed not only for evaluating patients , but also-for delivering meaningful therapy via engaging " video games " . Notably , the novel robot MIT-MANUS has been design ed and programmed for clinical neurological applications , and has undergone extensive clinical trials for more than four years at Burke Rehabilitation Hospital - White Plains , NY . This paper will review results of the first clinical trial of 20 patients , which showed that : - Stroke patients treated daily with additional robot-aided therapy during acute rehabilitation had improved outcome in motor activity at hospital discharge , when compared to a control group that received only st and ard acute rehabilitation treatment . - This improved outcome was sustained after three years . - The neuro-recovery process continued far beyond the commonly accepted 3 months post-stroke interval Background and Purpose Alterations of gait cycle and foot-drop on the paretic limb are characteristic of stroke patients .  Electromyographic biofeedback treatment has been used in rehabilitation of walking , but results are controversial . We performed gait analysis to evaluate the efficacy of electromyographic biofeedback compared with physical therapy . Methods Sixteen patients with ischemic stroke were enrolled in the study . The experimental group ( 4 men , 4 women ) received electromyographic biofeedback treatment together with physical therapy . The control group ( 5 men , 3 women ) was treated with physical therapy only .  Clinical and functional evaluations before and after treatment were performed using Canadian Neurological , Adams , Ashworth , Basmajian , and Barthel Index scales . Computerized gait analysis was performed in all patients . Results Electromyographic biofeedback patients showed significantly increased scores on the Adams scale ( P<.05 ) and Basmajian scale ( P<.01 ) . Gait analysis in this group showed a recovery of foot-drop in the swing phase ( P<.02 ) after training . Conclusions Our data confirm that the electromyographic biofeedback technique increases muscle strength and improves recovery of functional locomotion in patients with hemiparesis and foot-drop after cerebral ischemia OBJECTIVE To evaluate gait biomechanics after training with a virtual reality ( VR ) system and to eluci date underlying mechanisms that contributed to the observed functional improvement in gait speed and distance . DESIGN A single blind r and omized control study . SETTING Gait analysis laboratory in a rehabilitation hospital and the community . PARTICIPANTS Fifteen men and three women with hemiparesis caused by stroke . INTERVENTIONS Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation . Subjects were r and omized to either a VR group ( n=9 ) or non-VR group ( NVR , n=9 ) . Training was performed three times a week for 4 weeks for approximately 1h each visit . MAIN OUTCOME MEASURES Kinematic and kinetic gait parameters . RESULTS Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training ( p=0.036 ) . The VR group had greater change in ankle ROM post-training ( 19.5 % ) as compared to the NVR group ( 3.3 % ) . Significant differences were found in knee ROM on the affected side during stance and swing , with greater change in the VR group . No significant changes were observed in kinematics or kinetics of the hip post-training . CONCLUSIONS These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis . It is likely that the effects of training included improved motor control at the ankle , which enabled the cascade of changes that produced the functional improvements seen after training A new st and ing biofeedback training device , which includes a height-adjustable work table , weight-bearing sensors , and a real-time visual and auditory feedback system , has been developed for postural training . Sixty persons with hemiplegia after acute stroke or traumatic brain injury were r and omly divided into Group A ( experimental ) and Group B ( control ) . After a training period of 4 weeks , the percentage of postural asymmetry in Group A and Group B was reduced from 17.2 + /- 10.8 % and 17.0 + /- 10.0 % to 3.5 + /- 2.2 % and 10.1 + /- 6.4 percent , respectively ( p = 0.003 ) . There was no significant difference between subjects with right or left hemiplegia .  The results indicated that this device had a positive training effect on stance symmetry in hemiplegic subjects OBJECTIVE To examine the effect of a light touch cue provided through a cane on mediolateral ( ML ) pelvic stability during walking in subjects poststroke . DESIGN Crossover trial examining ML pelvic stability during walking using a cane with the force contact and touch contact methods . SETTING Physical therapy clinic , tertiary care center . PARTICIPANTS Subacute patients ( N=40 ) with stroke with a mean age of 59.6 years and mean stroke duration of 46.8 days . The average gait speed with a cane was .13 m/s ( .05-.29 m/s ) . INTERVENTION Using a cane with the force contact and touch contact methods during walking . MAIN OUTCOME MEASURES ML pelvic stability as measured by averaged peak-to-peak pelvic acceleration , muscle activation of bilateral tensor fascia latae ( TFL ) , semitendinosus ( ST ) , and vastus medialis ( VM ) using an electromyography system , and vertical cane force . RESULTS The average amount of cane force during touch contact and force contact cane use conditions was 2.3N and 49.3N , respectively . A light touch cue through a cane was required only when the paretic leg accepted the body weight , and this cue can provide ML pelvic stability ( .16 g of average pelvic acceleration ) during walking to the same degree as the force contact method of cane use . However , significant increases in single-limb support duration with higher activations of TFL , VM , and ST muscles on the paretic leg were found during the paretic stance phase when using a cane in the touch contact fashion ( P<.05 ) . CONCLUSIONS A light touch cue can be provided during walking through the use of a cane . This augmented somatosensory information provides lateral stability during walking for subjects with stroke by facilitating the activations of weight-bearing muscles on the paretic leg during the stance phase Objective : To examine the effects of electromyographic ( EMG ) biofeedback training on the recovery of gait in the acute phase post stroke . Design : Patients were r and omly assigned to EMG biofeedback or control groups . They received treatment three times a week for six weeks . All patients were assessed prior to treatment , after 18 treatment sessions , and at three months follow-up . Setting : The study was carried out at Scunthorpe General Hospital in North Lincolnshire . The subjects were acute stroke patients who had been admitted on to the medical and elderly wards . Interventions : The EMG biofeedback group were treated using EMG as an adjunct to physiotherapy . The patients were encouraged to facilitate or inhibit abnormal muscle tone via auditory or visual signals transmitted from electrodes placed over the appropriate muscles . The control group were treated using the same techniques , electrodes were used with this group of patients , but the EMG machine was turned off and faced away from the patient and the therapist to control the placebo effect . Outcome measures : A large battery of outcome measures was used for physical and psychological assessment . The physical measures consisted of active movement , muscle tone , sensation , proprioception , mobility and activities of daily living ( ADL ) . The psychological measures included orientation , memory , spatial performance , language and IQ . Results : Twenty-one patients were included in the study . Scores were combined into four groups : mild EMG , severe EMG , mild control and severe control . Results showed that there was an improvement in physical scores for active movement , mobility and ADL over time , but there was no significant difference between the EMG and control groups . Scores on the psychological tests were within normal limits , and there was no difference in performance between the EMG and control groups . Conclusions : This study showed no significant differences in the rate of improvement after stroke between the two groups . Although EMG biofeed-back was used as an adjunct to physiotherapy and represented clinical practice , the results provide little evidence to support the clinical significance of using EMG biofeedback to improve gait in the acute phase after stroke This research provides a preliminary investigation of the relative efficacy of electromyographic ( EMG ) versus a novel biofeedback ( BFB ) approach to improve ankle control and functional gait in stroke patients . A computerized system was design ed to provide audiovisual feedback of either muscle activity or ankle position during dorsiflexion and plantar flexion . The novel approach also included rhythmic pacing to emphasize the rapid timing of ankle motion necessary to switch from stance to swing during walking . Thirty-seven subjects were r and omly assigned to one of the following groups : ( 1 ) no-treatment control , ( 2 ) EMG BFB , and ( 3 ) rhythmic positional BFB . Blind evaluations of ankle performance , gait , and perceived exertion were performed at regular intervals . Analyses of covariance revealed that subjects receiving rhythmic positional BFB significantly increased their walking speeds relative to other groups at posttest ( p = .02 ) and at three-month follow-up ( p = .035 ) , without any increase in subjectively reported energy cost . The ability of positional BFB to emphasize the timing events during walking provided optimistic results for carry-over into gait functioning . The degree of sensorimotor recovery and time since onset of stroke were considered important factors in determining outcomes Bourbonnais D , Bilodeau S , Lepage Y , Beaudoin N , Gravel D , Forget R : Effect of force-feedback treatments in patients with chronic motor deficits after a stroke . Am J Phys Med Rehabil 2002;81:890–897 . Objective To assess the effects a motor reeducation approach based on static dynamometers used to provide feedback on the force produced . Design The study design was a single-blind , r and omized , controlled trial . Chronic stroke subjects participated in a 6-wk , thrice-weekly , force-feedback program of either the upper paretic limb ( n = 13 ) or the  lower paretic limb ( n = 12 ) . Baseline and postintervention assessment s of the performance of both the upper and the lower limb were measured for each subject , the untreated paretic limb  of each group serving as a control for the other group . Results With the exception of the h and grip force , strength measurements of the treated limb increased after completion of the treatment . The outcome measurements of the upper limb of the subjects included in the upper paretic limb were not significantly different after treatment from those measured in the lower paretic limb . In contrast , gait velocity and the distance walked in 2 min increased after treatment in the lower paretic limb as compared with the upper paretic limb , whereas the scores in the Fugl-Meyer test for the lower limb and the timed up- and -go test did not increase for either group after treatment . Conclusion The results indicate that treatment of the lower limb based on force feedback produces an improvement of gait velocity Electromyographic biofeedback was compared with simple exercise therapy as to its effectiveness in improving  foot-drop in 22 stroke patients . The study was design ed to be a rigorous trial of biofeedback and the patients tested were aged and had stroke of long duration . One group of 11 patients underwent 6 weeks of exercise therapy 2 sessions per week for 15 minutes per session ; the 2nd group of 11 patients underwent similar therapy with EMG feedback . All therapy was conducted by a research assistant who was not a trained therapist . The groups were assessed blind before treatment , after treatment and a 6-week follow-up . The significantly greater improvements in the biofeedback group in terms of muscle strength at the end of treatment were maintained at follow-up . On the range of movement and gait analysis measures , both groups showed some improvement after treatment . However , at follow-up this improvement had relapsed for the exercise group while for the biofeedback group it had been maintained . It is argued that controlled trials are possible in biofeedback and that using patients as their own controls is not justified in view of the present findings and the previously reported literature OBJECTIVES We tried to examine whether visual biofeedback tracking training ( VBTT ) can improve both the gait performance and cortical activation pattern in chronic stroke patients . DESIGN We enrolled 10 chronic hemiparetic patients with stroke(mean age 46.3 + /- 5.19 years ) . The patients were r and omly assigned to the training group ( 5 patients ) or the control group ( 5 patients ) . VBTT was to follow the PC-generated sine waves with the knee joint electrogoniometer , and the two sine waves should appear as close to overlapping as possible on the PC monitor . The training was performed for 39 minutes/day , 5 days/week , for 4 weeks . Pre-training and post-training accuracy of tracking , functional status of gait , and functional MRI ( fMRI ) were measured . fMRI was performed at 1.5 T in parallel with timed knee flexion-extension movements at a fixed rate . RESULTS The accuracy of the tracking performance , walking speed , and motor scale for gait improved in the training group . Primary sensorimotor cortex ( SM1 ) cortical activation shifted significantly from the unaffected to the affected hemisphere in the training group . CONCLUSIONS We demonstrated that cortical activation changes occurred with gait function improvement in chronic stroke patients throughout the 4-week VBTT program . It seems that the cortical reorganization was induced by VBTT Objective : To investigate the effects of balance training , using force platform biofeedback , on quantitative gait characteristics of hemiparetic patients late after stroke . Design : R and omized , controlled , assessor-blinded trial . Setting : Rehabilitation ward and gait laboratory of a university hospital . Subjects : Forty-one patients ( mean ( st and ard deviation ; SD ) age of 60.9 ( 11.7 ) years 
    Output:
    