Participants: (56.8% men, 56.6% women, aged 40-85) Inclusion criteria: (i) Verified stroke (ischemic or hemorrhagic) (ii) Aged between 40 and 85 years old (iii) Time since the stroke is between 2 weeks and 6 months (iv) Cognitive and language abilities to understand intervention Intervention setting: multicenter
Intervention: Robotic group () 25 sessions facilitated by a physical therapist. Session included treatment of proximal and distal UE with three different types of robotic devices. During treatment, subjects performed motor and cognitive tasks and received a vibratory treatment. Control group: Conventional therapy () Daily therapy for 45 minutes, 5 days a week, for 30 sessions Subjects performed functional improvement through exercises, ADLs, sensory input, and meaningful activities to participants
There was no significant difference based on FMA between the intervention and control groups Predictors of recovery were identified as age and baseline FMA value
Participants: adults poststroke (median age 67 y R_Group; 59 y C_Group, 47% female) Inclusion criteria: (i) First ischemic or hemorrhagic stroke (ii) A score between 1 and 3 on the upper limb subitem of the Italian version of the National Institutes of Health Stroke Scale (iii) A score higher than 6/66 on Fugl-Meyer Intervention setting: hospital
Intervention: Robot group (R_Group; ) (i) Rehab treatment of affected upper limb consisting of 20 sessions, 45 min each, 5x/week (ii) Robot-based training using planar robotic manipulation for shoulder and elbow movements in the horizontal plane (iii) Robot had 2 modes: assist-as-needed and resistive Control: (C_Group; ) (i) Rehab treatment of affected upper limb consisting of 20 sessions, 45 min each, 5x/week (ii) PROM, active mobilization of scapula, shoulder, elbow, wrist followed by task-oriented exercises
Instrumented assessments: (i) Shoulder/Elbow Coordination Index (ii) Measures of shoulder flexion, elbow extension, trunk compensation index Clinical assessments: (i) FMA (ii) Reaching Performance Scale (RPS) (iii) Modified Ashworth Scale (MAS) (iv) Functional Independence Measure (FIM)
Significant findings: Scores were significantly different between R_Group and C_Group on all instrumental assessments. R_Group showed larger improvement of interjoint coordination, elbow extension, and decrease in trunk compensation Nonsignificant findings: No significant difference between R_Group and C_Group scores on any of the clinical assessments
Inclusion criteria: (i) Diagnosis of stroke with unilateral cerebral infarction or hemorrhage whose time poststroke was more than six months (ii) No evidence of any other cerebral pathology (iii) Have an eligibility screening score on the Fugl-Meyer upper extremity motor assessment ranging from 23-53 corresponding with poor to notable arm-hand capacity (iv) No reported prestroke difficulties in verbal communication (v) No impairment was revealed in eligibility screening tests on the minimental state examination (MMSE) score above 24 and Lowenstein occupational therapy cognitive assessment (LOTCA), item scores at or above 8 for visual perception, 6 for spatial perceptions, 6 for praxis, and 14 for visuomotor organization (vi) Have prestroke right-handedness Intervention setting: community-dwelling setting
Intervention: () Usual care which consisted of 10-minute sensorimotor stimulation session—repetitive upper limb range of motion exercises, proprioceptive neuromuscular facilitation using the Rood approach as well as the 40-minute robotic-assisted therapy with bilateral practice (RTBP) program for the wrist and forearm Control: () Just “usual” care
Outcome measures: (i) Task performance using the Motor Activity Log (ii) Motor performance using sEMG (iii) FMA
Significant findings: (i) The RTBP (robotic therapy with bilateral practice) group, significant treatment effects have been found in the motor performance of total, wrist and shoulder parts as measured by the FMA Nonsignificant findings: (i) In the posthoc analysis, the hand component of the FMA-UE score significantly differed at the endpoint and follow-up only in the control group as compared to the baseline
Level 1B Single-blind RCT Risk of bias: Moderate risk
Participants: Inclusion criteria: (i) First-time supratentorial stroke (hemorrhagic or ischemic), lesion (ii) Age 18-90 years (iii) Able to get out of bed and mobilized in a wheelchair or were able to walk (iv) Participating in an inpatient rehabilitation program of at least six weeks (v) Nonfunctional or minimally functional upper limb (Fugl-Meyer score, , or Fugl-Meyer score 19-35) [15] (vi) No severe arm spasticity, i.e., scored 3 or less on the modified Ashworth Scale score (vii) No hemiparetic shoulder pain requiring physical therapy or pain medication (viii) No swollen hand impeding closing of the fist (ix) No other neurological or orthopedic arm impairments requiring physical therapy or pain medication (x) Able to give informed consent in the study Intervention setting: two inpatient neuro rehab centers
Intervention: () (i) Patients received a 30-minute session of robot-assisted group therapy + a 30-minute individual arm therapy per workday for four weeks Control: () (i) Patients received individual arm therapy sessions per workday for four weeks
Outcome: (i) FMA
Nonsignificant findings: (i) The blinded FMA score improvements during the intervention and follow-up period did not differ between groups (ii) The blinded FMA score improvements over time were significant in both groups Significant findings: (i) The blinded FMA score improvements over time were significant in both groups
Participants: (M age 64; 35% female) Inclusion criteria: (i) First ischemic or hemorrhagic stroke as confirmed by CT/MRI (ii) Age 35-85 years (iii) Less than 30 days since stroke (iv) Impaired upper limb motor function and unilateral hemiplegia (v) Sufficient cognition to understand purpose and instructions of study (vi) Ability to participate in robotic therapy (Brunnstrom 3-6) (vii) No visual problems Intervention setting: Inpatient ward of a hospital
Intervention: RAT (). Received therapy for 30 minutes twice a day, 5 days/week for 2 weeks. In addition, the RAT group received conventional rehabilitation therapy 30 minutes twice a day, 5 days/week for 2 weeks. Control: Conventional rehabilitation (CR) (). Received therapy for 30 minutes twice a day, 5 days/week for 2 weeks
Motor function: (i) FMA (ii) Motricity Index Activities of daily living: (i) Functional Independence Measure (ii) Barthel Index
Significant findings: There were positive effects on motor function and ADL after short-term RAT. Study shows that RAT can improve upper limb motor function in stroke patients as measured by FMA score
Participants: (27 females, 46 males) aged 18-80 Inclusion criteria: (i) Single CVA in a chronic state with moderate to severe arm paresis (ii) A difference of up to 3 points on the FMA-UE (iii) Minimum 18 years Intervention setting: Four clinical centers in Switzerland
Intervention: RAT () Control: Conventional therapy () Robotic and conventional therapy was applied for a period of 8 weeks, 3 times a week. The minimum time for therapy was 45 minutes
Primary: (i) Change in FMA-UE score Secondary: (i) WMFT (ii) The quality of 124 movement section of the Motor Activity Log (MAL-QOM) (iii) The Stroke Impact Scale (iv) The Goal Attainment scale (v) The Modified Ashworth Scale
Significant findings: Robotic training with ARMin reduced motor impairment with respect to arm and hand function more effectively than conventional therapy. About one third of the subjects in the ARMin group achieved meaningful gains (increase in ), compared to one fourth in the control group Nonsignificant findings: Besides mean strength, no other secondary outcome measure showed significant differences in favor of either of the two treatments
Participants: (64% male, 33.3% female, aged 21-74) Inclusion criteria: (i) First stroke with hemiplegia (ii) Subacute or chronic stroke (iii) Able to understand instructions (iv) Brunnstrom Stage II-V of recovery (v) Sensory impairments (vi) MAS score below 3 (vii) Aged 21-74 (viii) Able to see and hear feedback from device Intervention setting: Medical university hospital
Intervention: Robotic first group () 12-hour sessions, facilitated by an occupational therapist. Session included the use of the Gloreha Sinfonia device, a glove that detects individual finger movements. During treatment, subjects performed weight bearing, rhythm activities, continuous whole-hand and individual finger PROM, and active assisted activities and games Control: conventional therapy first group () 12-hour-long sessions Subjects performed weight bearing, rhythm activities, bilateral hand tasks, and pinch and grasp activities
Primary: FMA Secondary: Surface EMG, Semmes-Weinstein hand monofilament test, rNSA proprioception ranges, dynamometer, Box and Blocks test, MBI
Significant findings: The RAT first group showed significant improvement in UE motor control and ADL ability, and when compared to the conventional therapy first group showed more efficient hand extensor muscles
Participants: (63.3% male, 36.6% female) Inclusion criteria: (i) Stroke induced hemiplegia within 6 months (ii) Able to communicate on their own (iii) 21 points on MMSE-K (iv) MAS below 2 (v) FMA score of minimally functional Intervention setting: Rehabilitation center
Intervention: Robotic group () 40 30 min general OT sessions and 40 30 min RAT sessions, facilitated by an occupational therapist. Session included stretching exercises, neurodevelopmental therapy, resistance exercise, fine motor training, REJOYCE robot training with five functional activities Control: conventional therapy first group () 40-hour-long sessions Session included stretching exercises, neurodevelopmental therapy, resistance exercise, and fine motor training
Primary: FMA Secondary: MBI
Significant findings: Both control and experimental groups showed significant increases posttherapy in FMA There was a statistically significant increase in all assessment scores when compared to the control group
Inclusion criteria: (i) Persistent (>1 y) upper extremity impairment (ii) Trace muscle contraction in wrist extensors (iii) Single unilateral stroke (iv) Mobility and function sufficient for independent performance of activities (v) Stable medical condition (vi) No other prior neurologic condition (vii) Ability to follow 2-step commands Intervention setting: Medical center
Intervention Group 1 (FES + ML; ) Treatment 5 days/week for 5 hours/day for 60 sessions (1.5 h FES). Functional electrical stimulation used to stimulate finger flexors/extensors and forearm supinators/pronators Intervention Group 2 (ROB + ML; ) Treatment 5 days/week for 5 hours/day for 60 sessions (1.5 h robotics). Robotics training using InMotion2Shoulder-Elbow Robot to target shoulder/elbow movements of flexion/extension and horizontal shoulder movements Control (ML; ) Treatment 5 days/week for 5 hours/day for 60 sessions. Exercises provided for training-isolated joint movement coordination of scapula, shoulder, elbow, forearm, wrist, fingers, and thumb; task component movements; whole arm/hand functional training
Primary: (i) Arm Motor Ability Test (AMAT) Secondary: FMA
Significant findings: (i) All 3 groups showed significant improvement as measured by AMAT and FMA Nonsignificant findings: (i) No significant difference across group as measured by AMAT or FMA
Participants: (M age 55 control, 56 intervention; 65% male) Inclusion criteria: (i) Adult patients (>30 years old) (ii) Diagnosis of hemorrhagic or ischemic stroke (iii) Experience severe upper extremity hemiparesis (Fugl-Meyer >8 and <30) Intervention setting: Neurologic rehabilitation unit
Intervention: RAT () Treatment 5x/week for 40 sessions 1 hour each. Passive activities, partial assistance or resistance, active movements Control: Classical occupational therapy; () Treatment 5x/week for 40 sessions 1 hour each. Treated with massage and conventional occupational exercises—passive motion, strengthening, fine motor
Primary: (i) FMA (ii) Motricity Index (MI)
Significant findings: (i) Improvement in FMA score for robotic intervention group and control group (ii) Improvement in FMA score was greater for the intervention group than for the control group
Participants: (M age, 61 y; 61% male) Median time since stroke: 240 days Inclusion criteria: (i) Adults (ii) First stroke (iii) Stroke occurred between 1 week and 5 years ago (iv) Moderate to severe upper limb functional limitation (ARAT score 0-39) Intervention setting: four different outpatient centers in the UK
Intervention Group 1: RAT () 45-minute sessions, 3 times per week for 12 weeks in addition to usual care Intervention Group 2: enhanced upper limb therapy () 45-minute sessions, 3 times per week for 12 weeks in addition to usual care Control: Usual care ()
Primary: Action Reach Arm Test Secondary: (i) FMA (ii) Barthel ADL Index (iii) Stroke Impact Scale
Significant findings: (i) Enhanced upper limb therapy resulted in benefits in mobility, compared with usual care participants Nonsignificant findings: (i) Robot-assisted therapy did not result in significantly different stroke recovery
Participants: (M age, 67 y; 22 female, 31 male) Inclusion criteria: (i) Subacute stroke patients (ii) First acute event of cerebrovascular stroke—unilateral paresis—ability to understand and follow simple instructions (iii) Ability to remain in a sitting posture Intervention setting: inpatient rehabilitation center
Intervention: The experimental group (robot-assisted proximal UE treatment) performed 30 sessions (5 days a week for 6 weeks) using the IM2 robot Control: The control group (usual physical therapy) received therapy 30 sessions (5 days a week for 6 weeks) of conventional rehabilitative treatment
Primary: (i) FMA (ii) The Modified Ashworth Scale Shoulder and Elbow Secondary: (i) PROM (ii) Motricity Index
Significant findings: (i) Intensive RAT in subacute stroke patients may significantly reduce motor impairment in the paretic upper limb Nonsignificant findings: n/a
Participants: (Median age, 68 y; 61.5% male) Median time since stroke: 37 days Inclusion criteria: (i) Diagnosis of 1st unilateral ischemic stroke verified by brain imaging (ii) Less than 8 weeks since stroke (iii) Upper limb impairment ( and <55 on the Fugl-Meyer) (iv) Age 18-80 (v) No other neurological conditions that may affect motor function Intervention setting: hospital
Intervention: 30 sessions (5 sessions/wk) of robot-assisted arm therapy and hand functional electrical stimulation () Control: time-matched intensive conventional therapy ()
Primary: FMA Secondary: Wolf Motor Function Assessment, Modified Ashworth Scale, and the Barthel Index
Significant findings: Both groups significantly improved for all outcome measures Nonsignificant findings: There were no significant differences in recovery between the intervention group and the control group
Level 2B Prospective, exploratory randomized trial Risk of bias: Low
Participants:
Inclusion criteria: (i) Age between 20 and 80 years old (ii) First stroke in previous 4-8 weeks (iii) UE Brunnstrom stage II to IV movement Intervention setting: Inpatient stroke centers
Intervention: () Received 40 minutes of standard therapy plus 40 minutes of RAT. Standard therapy consisted of UE exercises for stretching, range of motion, reaching, grasp, ADL training. RAT had 5 levels of assistance targeting proximal upper limb function Control: () Received 40 minutes of standard therapy plus 40 minutes of self-guided therapy. Self-guided therapy techniques were selected from a list while a therapist supervised from a distance
Motor function: (i) FMA (ii) Wolf Motor Function Test (iii) Motor Activity Log
Significant findings: (i) Changes in FMA proximal UE and FMA flexor synergy were different between groups (ii) Lower UE function class () had a greater increase in FMA score in the RAT group only Nonsignificant findings: (i) Change in total FMA UE score not different between groups
RCT: randomized controlled trial; UE: upper extremity; ADL: activities of daily living; FMA: Fugl-Meyer Assessment; ARAT: Action Reach Arm Test; PROM: passive range of motion; NMES: neuromuscular electrical stimulation; FES: functional electrical stimulation; TTT: transition to task therapy; WMFT: the Wolf Motor Function Test; SIS: Stroke Impact Scale; MI: Motricity Index; MRC: Medical Research Council; MAS: Modified Ashworth Scale; DN4: Neuropathic Pain Diagnostic Questionnaire; NRS: Neurological Rating Scale of Pain; mBI: Modified Barthel Index; FAT: Frenchay Arm Test; ARAT: Action Research Arm Test; SF36: 36-item Short Form Health Survey; PCS: Physical Composite Score; MCS: Mental Composite Score; rNSA: Revised Nottingham Sensation Assessment.
