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 Arm function recovery is notoriously poor in stroke patients . The effect of treatment modalities , particularly those directed at improving upper limb function , has been studied primarily in chronic stroke patients . The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke . METHODS In a single-blind , r and omized , controlled multicenter trial , 100 consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group . The intervention was applied for 6 weeks . Patients were evaluated for level of impairment ( Brunnström-Fugl-Meyer test ) and disability ( Action Research Arm test , Barthel Index ) before , midway , and after the intervention period and at follow-up 6 and 12 months after stroke . RESULTS Patients in the experimental group performed better on the Brunnström-Fugl-Meyer test than those in the control group throughout the study period , but differences were significant only at follow-up . Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability . The effect of the therapy was attributed to the repetitive stimulation of muscle activity . The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention . No adverse effects due to the intervention were found . CONCLUSIONS Adding a specific intervention during the acute phase after stroke improved motor recovery , which was apparent 1 year later . These results emphasize the potential beneficial effect of therapeutic interventions for the arm BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care Background : St and ing is believed to have benefits in addressing motor and sensory impairments after stroke . One device to facilitate st and ing for severely disabled patients is the Oswestry St and ing Frame . Objective : To evaluate the effectiveness of the Oswestry St and ing Frame for severely disabled stroke patients . Design : A single centre , r and omized controlled trial . Setting : An inpatient stroke rehabilitation unit . Subjects : Patients were recruited if they had a clinical diagnosis of stroke , were medically stable and unable to achieve any score on the Trunk Control Test or unable to st and in mid-line without the assistance of two therapists . Intervention : The intervention ( n=71 ) and control ( n=69 ) groups both received usual stroke unit care but the intervention group also received a minimum of 14 consecutive days ' treatment using the st and ing frame . Main outcome measures : The primary outcome measure was the Rivermead Mobility Index ( RMI ) . Secondary measures included the Barthel Index ; the Rivermead Motor Assessment ; the balanced sitting and sitting to st and ing components of the Motor Assessment Scale ; the Trunk Control Test and the Hospital Anxiety and Depression Scale . Blind assessment was undertaken at baseline , six weeks , 12 weeks and six months post stroke . Information on re source use was also collected . Results : There was no statistically significant difference between groups in any of the outcome measures or for re source use . Mann-Whitney U-tests for the RMI change from baseline scores to six weeks , 12 weeks and six months post stroke were p=0.310 ; p=0.970 and p=0.282 , respectively . Conclusion : Use of the Oswestry St and ing Frame did not improve clinical outcome or provide re source savings for this severely disabled patient group Objective : To determine the benefits of additional therapy specifically directed at the h and in people with acquired brain impairment . Design : An assessor-blinded r and omized controlled trial . Setting : Rehabilitation hospital . Participants : A sample of 39 adults with h and impairment following stroke ( 90 % ) or traumatic brain injury ( 10 % ) . The median ( interquartile ) time since injury was 1.6 months ( 0.5—3.5 months ) . Intervention : The experimental group ( n = 20 ) received an additional one-hour session of task-specific motor training for the h and five times a week over a six-week period . The training was administered on a one-to-one basis . The control group ( n = 19 ) received st and ard care which consisted of 10 minutes of h and therapy three times a week . Both groups continued to receive therapy directed at the shoulder and elbow . Outcome measures : Primary outcomes were the Action Research Arm and Summed Manual Muscle Tests measured at the beginning and end of the six-week period . Results : The mean ( SD ) Action Research Arm Test values for experimental participants improved from the beginning to the end of study from 10 points ( 15 ) to 21 points ( 23 ) and the equivalent values for the Summed Manual Muscle Test improved from 35 % ( 33 ) to 49 % ( 35 ) . There were similar improvements in control participants . The mean between-group differences for the Action Research Arm and Summed Manual Muscle Tests were -6 points ( 95 % confidence interval ( CI ) , -20 to 8) and 3 % ( 95 % CI , -10 to 16 ) , respectively . Conclusion : H and and overall arm function of all participants improved over the six-week period , however there was not a clear benefit from providing additional h and therapy BACKGROUND The incidence of stroke is predicted to rise because of the rapidly ageing population . However , over the past two decades , findings of r and omised trials have identified several interventions that are effective in prevention of stroke . Reliable data on time-trends in stroke incidence , major risk factors , and use of preventive treatments in an ageing population are required to ascertain whether implementation of preventive strategies can offset the predicted rise in stroke incidence . We aim ed to obtain these data . METHODS We ascertained changes in incidence of transient ischaemic attack and stroke , risk factors , and premorbid use of preventive treatments from 1981 - 84 ( Oxford Community Stroke Project ; OCSP ) to 2002 - 04 ( Oxford Vascular Study ; OXVASC ) . FINDINGS Of 476 patients with transient ischaemic attacks or strokes in OXVASC , 262 strokes and 93 transient ischaemic attacks were incident events . Despite more complete case-ascertainment than in OCSP , age-adjusted and sex-adjusted incidence of first-ever stroke fell by 29 % ( relative incidence 0.71 , 95 % CI 0.61 - 0.83 , p=0.0002 ) . Incidence declined by more than 50 % for primary intracerebral haemorrhage ( 0.47 , 0.27 - 0.83 , p=0.01 ) but was unchanged for subarachnoid haemorrhage ( 0.83 , 0.44 - 1.57 , p=0.57 ) . Thus , although 28 % more incident strokes ( 366 vs 286 ) were expected in OXVASC due to demographic change alone ( 33 % increase in those aged 75 or older ) , the observed number fell ( 262 vs 286 ) . Major reductions were recorded in mortality rates for incident stroke ( 0.63 , 0.44 - 0.90 , p=0.02 ) and in incidence of disabling or fatal stroke ( 0.60 , 0.50 - 0.73 , p<0.0001 ) , but no change was seen in case-fatality due to incident stroke ( 17.2 % vs 17.8 % ; age and sex adjusted relative risk 0.85 , 95 % CI 0.57 - 1.28 , p=0.45 ) . Comparison of premorbid risk factors revealed substantial reductions in the proportion of smokers , mean total cholesterol , and mean systolic and diastolic blood pressures and major increases in premorbid treatment with antiplatelet , lipid-lowering , and blood pressure lowering drugs ( all p<0.0001 ) . INTERPRETATION The age-specific incidence of major stroke in Oxfordshire has fallen by 40 % over the past 20 years in association with increased use of preventive treatments and major reductions in premorbid risk factors Background and Purpose — The success of gait rehabilitation after stroke depends on active walking exercises . However , the disabling after-effects of stroke often make such exercises impossible at the onset of therapy . To facilitate treadmill training of paraparetic patients , a robot-driven gait orthosis ( Lokomat ) was developed . We investigated the effects of the Lokomat when used with hemiparetic patients . Methods — The authors conducted a r and omized , controlled pilot study of 30 acute stroke survivors . The treatment group received 30 minutes of robotic training daily and the control group 30 minutes of conventional physiotherapy daily in addition to 30 minutes of conventional physiotherapy for each group . Outcome measures were independence of gait , gait speed , gait parameters , and body tissue composition . Results — After 4 weeks of therapy , the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved . The functional ambulation category ( median± interquartile range ) was at baseline 0±0 in control and 0±1 in the therapy group and increased after therapy to 1±3 in both groups significantly ( P=0.01 ) . There was no significant difference in gain of these parameters between the groups . The Lokomat group had a significantly longer single stance phase ( sec ; mean±SEM ) on the paretic leg when walking on the floor . At baseline , it was 0.19±0.17 and after therapy 0.49±0.07 ( P=0.014 ) . The control group had increased their body weight approximately 1.33±1.40 kg ( mean±SEM ; P=0.046 ) , mostly as fat mass , whereas the Lokomat group had lost fat mass approximately −2.9±1.0 kg ( mean±SEM ; P=0.016 ) and increased their muscle mass approximately 3.36±1.4 kg ( mean± SEM ; P=0.031 ) . Conclusions — This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation . Although there was no difference between groups in gain of functional scores , the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition Objective : To evaluate the efficacy of a task-orientated intervention in enhancing competence in walking in people with stroke . Design : Two-centre observer-blinded stratified block-r and omized controlled trial . Setting : General community . Subjects : Between May 2000 and February 2003 , 91 individuals with a residual walking deficit within one year of a first or recurrent stroke consented to participate . Interventions : The experimental intervention comprised 10 functional tasks design ed to strengthen the lower extremities and enhance walking balance , speed and distance . The control intervention involved the practice of upper extremity activities . Subjects in both groups attended sessions three times a week for six weeks . Main measures : Six-minute walk test ( SMWT ) , 5-m walk ( comfortable and maximum pace ) , Berg Balance Scale , timed ‘ up and go ’ . Results : At baseline , subjects in the experimental ( n = 44 ) and control ( n = 47 ) groups walked an average distance of 209 m ( SD = 126 ) and 204 m ( SD = 131 ) , respectively , on the SMWT . Mean improvements of 40 m ( SD = 72 ) , and 5 m ( SD = 66 ) were observed following the experimental and control interventions , respectively . The between-group difference was 35 m ( 95 % confidence interval ( CI ) 7 , 64 ) . Significant between-group effects of 0.21 m/s ( 95 % CI 0.12 , 0.30 ) and of 0.11 m/s ( 95 % CI 0.0 
    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 Arm function recovery is notoriously poor in stroke patients . The effect of treatment modalities , particularly those directed at improving upper limb function , has been studied primarily in chronic stroke patients . The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke . METHODS In a single-blind , r and omized , controlled multicenter trial , 100 consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group . The intervention was applied for 6 weeks . Patients were evaluated for level of impairment ( Brunnström-Fugl-Meyer test ) and disability ( Action Research Arm test , Barthel Index ) before , midway , and after the intervention period and at follow-up 6 and 12 months after stroke . RESULTS Patients in the experimental group performed better on the Brunnström-Fugl-Meyer test than those in the control group throughout the study period , but differences were significant only at follow-up . Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability . The effect of the therapy was attributed to the repetitive stimulation of muscle activity . The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention . No adverse effects due to the intervention were found . CONCLUSIONS Adding a specific intervention during the acute phase after stroke improved motor recovery , which was apparent 1 year later . These results emphasize the potential beneficial effect of therapeutic interventions for the arm BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care Background : St and ing is believed to have benefits in addressing motor and sensory impairments after stroke . One device to facilitate st and ing for severely disabled patients is the Oswestry St and ing Frame . Objective : To evaluate the effectiveness of the Oswestry St and ing Frame for severely disabled stroke patients . Design : A single centre , r and omized controlled trial . Setting : An inpatient stroke rehabilitation unit . Subjects : Patients were recruited if they had a clinical diagnosis of stroke , were medically stable and unable to achieve any score on the Trunk Control Test or unable to st and in mid-line without the assistance of two therapists . Intervention : The intervention ( n=71 ) and control ( n=69 ) groups both received usual stroke unit care but the intervention group also received a minimum of 14 consecutive days ' treatment using the st and ing frame . Main outcome measures : The primary outcome measure was the Rivermead Mobility Index ( RMI ) . Secondary measures included the Barthel Index ; the Rivermead Motor Assessment ; the balanced sitting and sitting to st and ing components of the Motor Assessment Scale ; the Trunk Control Test and the Hospital Anxiety and Depression Scale . Blind assessment was undertaken at baseline , six weeks , 12 weeks and six months post stroke . Information on re source use was also collected . Results : There was no statistically significant difference between groups in any of the outcome measures or for re source use . Mann-Whitney U-tests for the RMI change from baseline scores to six weeks , 12 weeks and six months post stroke were p=0.310 ; p=0.970 and p=0.282 , respectively . Conclusion : Use of the Oswestry St and ing Frame did not improve clinical outcome or provide re source savings for this severely disabled patient group Objective : To determine the benefits of additional therapy specifically directed at the h and in people with acquired brain impairment . Design : An assessor-blinded r and omized controlled trial . Setting : Rehabilitation hospital . Participants : A sample of 39 adults with h and impairment following stroke ( 90 % ) or traumatic brain injury ( 10 % ) . The median ( interquartile ) time since injury was 1.6 months ( 0.5—3.5 months ) . Intervention : The experimental group ( n = 20 ) received an additional one-hour session of task-specific motor training for the h and five times a week over a six-week period . The training was administered on a one-to-one basis . The control group ( n = 19 ) received st and ard care which consisted of 10 minutes of h and therapy three times a week . Both groups continued to receive therapy directed at the shoulder and elbow . Outcome measures : Primary outcomes were the Action Research Arm and Summed Manual Muscle Tests measured at the beginning and end of the six-week period . Results : The mean ( SD ) Action Research Arm Test values for experimental participants improved from the beginning to the end of study from 10 points ( 15 ) to 21 points ( 23 ) and the equivalent values for the Summed Manual Muscle Test improved from 35 % ( 33 ) to 49 % ( 35 ) . There were similar improvements in control participants . The mean between-group differences for the Action Research Arm and Summed Manual Muscle Tests were -6 points ( 95 % confidence interval ( CI ) , -20 to 8) and 3 % ( 95 % CI , -10 to 16 ) , respectively . Conclusion : H and and overall arm function of all participants improved over the six-week period , however there was not a clear benefit from providing additional h and therapy BACKGROUND The incidence of stroke is predicted to rise because of the rapidly ageing population . However , over the past two decades , findings of r and omised trials have identified several interventions that are effective in prevention of stroke . Reliable data on time-trends in stroke incidence , major risk factors , and use of preventive treatments in an ageing population are required to ascertain whether implementation of preventive strategies can offset the predicted rise in stroke incidence . We aim ed to obtain these data . METHODS We ascertained changes in incidence of transient ischaemic attack and stroke , risk factors , and premorbid use of preventive treatments from 1981 - 84 ( Oxford Community Stroke Project ; OCSP ) to 2002 - 04 ( Oxford Vascular Study ; OXVASC ) . FINDINGS Of 476 patients with transient ischaemic attacks or strokes in OXVASC , 262 strokes and 93 transient ischaemic attacks were incident events . Despite more complete case-ascertainment than in OCSP , age-adjusted and sex-adjusted incidence of first-ever stroke fell by 29 % ( relative incidence 0.71 , 95 % CI 0.61 - 0.83 , p=0.0002 ) . Incidence declined by more than 50 % for primary intracerebral haemorrhage ( 0.47 , 0.27 - 0.83 , p=0.01 ) but was unchanged for subarachnoid haemorrhage ( 0.83 , 0.44 - 1.57 , p=0.57 ) . Thus , although 28 % more incident strokes ( 366 vs 286 ) were expected in OXVASC due to demographic change alone ( 33 % increase in those aged 75 or older ) , the observed number fell ( 262 vs 286 ) . Major reductions were recorded in mortality rates for incident stroke ( 0.63 , 0.44 - 0.90 , p=0.02 ) and in incidence of disabling or fatal stroke ( 0.60 , 0.50 - 0.73 , p<0.0001 ) , but no change was seen in case-fatality due to incident stroke ( 17.2 % vs 17.8 % ; age and sex adjusted relative risk 0.85 , 95 % CI 0.57 - 1.28 , p=0.45 ) . Comparison of premorbid risk factors revealed substantial reductions in the proportion of smokers , mean total cholesterol , and mean systolic and diastolic blood pressures and major increases in premorbid treatment with antiplatelet , lipid-lowering , and blood pressure lowering drugs ( all p<0.0001 ) . INTERPRETATION The age-specific incidence of major stroke in Oxfordshire has fallen by 40 % over the past 20 years in association with increased use of preventive treatments and major reductions in premorbid risk factors Background and Purpose — The success of gait rehabilitation after stroke depends on active walking exercises . However , the disabling after-effects of stroke often make such exercises impossible at the onset of therapy . To facilitate treadmill training of paraparetic patients , a robot-driven gait orthosis ( Lokomat ) was developed . We investigated the effects of the Lokomat when used with hemiparetic patients . Methods — The authors conducted a r and omized , controlled pilot study of 30 acute stroke survivors . The treatment group received 30 minutes of robotic training daily and the control group 30 minutes of conventional physiotherapy daily in addition to 30 minutes of conventional physiotherapy for each group . Outcome measures were independence of gait , gait speed , gait parameters , and body tissue composition . Results — After 4 weeks of therapy , the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved . The functional ambulation category ( median± interquartile range ) was at baseline 0±0 in control and 0±1 in the therapy group and increased after therapy to 1±3 in both groups significantly ( P=0.01 ) . There was no significant difference in gain of these parameters between the groups . The Lokomat group had a significantly longer single stance phase ( sec ; mean±SEM ) on the paretic leg when walking on the floor . At baseline , it was 0.19±0.17 and after therapy 0.49±0.07 ( P=0.014 ) . The control group had increased their body weight approximately 1.33±1.40 kg ( mean±SEM ; P=0.046 ) , mostly as fat mass , whereas the Lokomat group had lost fat mass approximately −2.9±1.0 kg ( mean±SEM ; P=0.016 ) and increased their muscle mass approximately 3.36±1.4 kg ( mean± SEM ; P=0.031 ) . Conclusions — This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation . Although there was no difference between groups in gain of functional scores , the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition Objective : To evaluate the efficacy of a task-orientated intervention in enhancing competence in walking in people with stroke . Design : Two-centre observer-blinded stratified block-r and omized controlled trial . Setting : General community . Subjects : Between May 2000 and February 2003 , 91 individuals with a residual walking deficit within one year of a first or recurrent stroke consented to participate . Interventions : The experimental intervention comprised 10 functional tasks design ed to strengthen the lower extremities and enhance walking balance , speed and distance . The control intervention involved the practice of upper extremity activities . Subjects in both groups attended sessions three times a week for six weeks . Main measures : Six-minute walk test ( SMWT ) , 5-m walk ( comfortable and maximum pace ) , Berg Balance Scale , timed ‘ up and go ’ . Results : At baseline , subjects in the experimental ( n = 44 ) and control ( n = 47 ) groups walked an average distance of 209 m ( SD = 126 ) and 204 m ( SD = 131 ) , respectively , on the SMWT . Mean improvements of 40 m ( SD = 72 ) , and 5 m ( SD = 66 ) were observed following the experimental and control interventions , respectively . The between-group difference was 35 m ( 95 % confidence interval ( CI ) 7 , 64 ) . Significant between-group effects of 0.21 m/s ( 95 % CI 0.12 , 0.30 ) and of 0.11 m/s ( 95 % CI 0.0 
    Output:
    