Efficacy of robot-assisted fingers training in chronic stroke survivors: a pilot randomized-controlled trial Randomized Trial of a Robotic Assistive Device for the Upper Extremity During Early Inpatient Stroke Rehabilitation MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study. Robot-assisted therapy for long-term upper-limb impairment after stroke. Computerized Arm Training Improves the Motor Control of the Severely Affected Arm After Stroke: A Single-Blinded Randomized Trial in Two Centers Brain-computer interface-based robotic end effector system for wrist and hand rehabilitation: results of a three-armed randomized controlled trial for chronic stroke Dose–Response Relationship of Robot-Assisted Stroke Motor Rehabilitation: The Impact of Initial Motor Status Response to upper-limb robotics and functional neuromuscular stimulation following stroke. Effect of gravity on robot-assisted motor training after chronic stroke: a randomized trial. Results of Clinicians Using a Therapeutic Robotic System in an Inpatient Stroke Rehabilitation Unit A pilot study of activity-based therapy in the arm motor recovery post stroke: a randomized controlled trial Effects of task-oriented robot training on arm function, activity, and quality of life in chronic stroke patients: a randomized controlled trial Robotic unilateral and bilateral upper-limb movement training for stroke survivors afflicted by chronic hemiparesis Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial. Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients Robot training enhanced motor outcome in patients with stroke maintained over 3 years Recovery of hand function with robot-assisted therapy in acute stroke patients: a randomized-controlled trial Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: a randomized controlled trial Effects of intensive arm training with an electromechanical orthosis in chronic stroke patients: a preliminary study. Effects of Treatment Intensity in Upper Limb Robot-Assisted Therapy for Chronic Stroke Chronic stroke survivors achieve comparable outcomes following virtual task specific repetitive training guided by a wearable robotic orthosis (UL-EXO7) and actual task specific repetitive training guided by a physical therapist. Intensive Sensorimotor Arm Training Mediated by Therapist or Robot Improves Hemiparesis in Patients With Chronic Stroke GRADE guidelines: 3. Rating the quality of evidence. Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial Does Shorter Rehabilitation Limit Potential Recovery Poststroke? Effects of Computer-Aided Interlimb Force Coupling Training on Paretic Hand and Arm Motor Control following Chronic Stroke: A Randomized Controlled Trial Effect of Therapist-Based Versus Robot-Assisted Bilateral Arm Training on Motor Control, Functional Performance, and Quality of Life After Chronic Stroke: A Clinical Trial Robotic Therapy Provides a Stimulus for Upper Limb Motor Recovery After Stroke That Is Complementary to and Distinct From Conventional Therapy Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial A Randomized Controlled Trial of Gravity-Supported, Computer-Enhanced Arm Exercise for Individuals With Severe Hemiparesis
Background While constraint-induced movement therapy ( CIMT ) is one of the most promising techniques for upper limb rehabilitation after stroke , it requires high residual function to start with . Robotic device , on the other h and , can provide intention-driven assistance and is proven capable to complement conventional therapy . However , with many robotic devices focus on more proximal joints like shoulder and elbow , recovery of h and and fingers functions have become a challenge . Here we propose the use of robotic device to assist h and and fingers functions training and we aim to evaluate the potential efficacy of intention-driven robot-assisted fingers training . Methods Participants ( 6 to 24 months post-stroke ) were r and omly assigned into two groups : robot-assisted ( robot ) and non-assisted ( control ) fingers training groups . Each participant underwent 20-session training .  Action Research Arm Test ( ARAT ) was used as the primary outcome measure , while , Wolf Motor Function Test ( WMFT ) score , its functional tasks ( WMFT-FT ) sub-score , Fugl-Meyer Assessment ( FMA ) , its shoulder and elbow ( FMA-SE ) sub-score , and finger individuation index ( FII ) served as secondary outcome measures . Results Nineteen patients completed the 20-session training ( Trial Registration : HK Clinical Trials.com HKCTR-1554 ) ; eighteen of them came back for a 6-month follow-up . Significant improvements ( p < 0.05 ) were found in the clinical scores for both robot and control group after training . However , only robot group maintained the significant difference in the ARAT and FMA-SE six months after the training . The WMFT-FT score and time post-training improvements of robot group were significantly better than those of the control group . Conclusions This study showed the potential efficacy of robot-assisted fingers training for h and and fingers rehabilitation and its feasibility to facilitate early rehabilitation for a wider population of stroke survivors ; and hence , can be used to complement CIMT Background . A recent Cochrane Review showed that early robotic training of the upper limb in stroke survivors can be more effective than other interventions when improving activities of daily living involving the arm function is the aim of therapy . Objective . We tested for efficacy of the study a protocol which involved the use of the NeReBot therapy in partial substitution of st and ard upper limb rehabilitation in post – acute stroke patients . Methods . In this dose-matched , r and omized controlled clinical trial , 34 hemiparetic participants with movement against gravity in shoulder , elbow , and wrist muscle groups were enrolled within 15 days of the onset of stroke . All participants received a total daily rehabilitation treatment for 120 minutes , 5 days per week for 5 weeks . The control group received st and ard therapy for the upper limb . The experimental group received st and ard therapy ( 65 % of exercise time ) associated with robotic training ( 35 % of exercise time ) . Muscle tone ( Modified Ashworth Scale ) , strength ( Medical Research Council ) , and synergism ( Fugl-Meyer motor scores ) were measured at impairment level , whereas dexterity ( Box and Block Test and Frenchay Arm Test ) and activities of daily living ( Functional Independence Measure ) were measured at activity level . All assessment s were performed at baseline , at the end of therapy ( time T1 ) , at 3 months ( time T2 ) , and at 7 months ( time T3 ) after entry . All between-group analyses were tested using nonparametric test with Bonferroni ’s adjustments for multiple testing . Results . No significant between-group differences were found with respect to demographic characteristics , motor , dexterity , and ADLs at baseline , postintervention ( T1 ) and at follow-up ( T2 and T3 ) . Conclusions . The robot therapy by NeReBot did not lead to better outcomes compared with conventional inpatient rehabilitation This study presents results from a r and omized controlled clinical trial of the Mirror Image Movement Enabler ( MIME ) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients , including data on the use of its bilateral training mode . MIME incorporates a PUMA 560 robot ( Staubli Unimation Inc , Duncan , South Carolina ) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions . Robot-assisted treatment ( bilateral , unilateral , and combined bilateral and unilateral ) was compared with conventional therapy . Similar to a previous study in chronic stroke , combined unilateral and bilateral robotic training had advantages compared with conventional therapy , producing larger improvements on a motor impairment scale and a measure of abnormal synergies . However , gains in all treatment groups were equivalent at the 6-month follow-up . Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training , although the combined group had more hypertonia and less movement out of synergy at baseline . Robot-assisted treatment gains exceeded those expected from spontaneous recovery . These results are discussed in light of the need for further device development and continued clinical trials BACKGROUND Effective rehabilitative therapies are needed for patients with long-term deficits after stroke . METHODS In this multicenter , r and omized , controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke , we r and omly assigned 49 patients to receive intensive robot-assisted therapy  , 50 to receive intensive comparison therapy , and 28 to receive usual care . Therapy consisted of 36 1-hour sessions over a period of 12 weeks . The primary outcome was a change in motor function , as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke , at 12 weeks . Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale . Secondary analyses assessed the treatment effect at 36 weeks . RESULTS At 12 weeks , the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care ( difference , 2.17 points ; 95 % confidence interval [ CI ] , -0.23 to 4.58 ) and worse than that for patients receiving intensive comparison therapy ( difference , -0.14 points ; 95 % CI , -2.94 to 2.65 ) , but the differences were not significant . The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care ( difference , 7.64 points ; 95 % CI , 2.03 to 13.24 ) . No other treatment comparisons were significant at 12 weeks . Secondary analyses showed that at 36 weeks , robot-assisted therapy significantly improved the Fugl-Meyer score ( difference , 2.88 points ; 95 % CI , 0.57 to 5.18 ) and the time on the Wolf Motor Function Test ( difference , -8.10 seconds ; 95 % CI , -13.61 to -2.60 ) as compared with usual care but not with intensive therapy . No serious adverse events were reported . CONCLUSIONS In patients with long-term upper-limb deficits after stroke , robot-assisted therapy did not significantly improve motor function at 12 weeks , as compared with usual care or intensive therapy . In secondary analyses , robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy . ( Clinical Trials.gov number , NCT00372411 . Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach The objective of this study was to investigate the efficacy of an Electroencephalography (EEG)-based Motor Imagery ( MI ) Brain-Computer Interface ( BCI ) coupled with a Haptic Knob ( HK ) robot for arm rehabilitation in stroke patients . In this three-arm , single-blind , r and omized controlled trial ; 21 chronic hemiplegic stroke patients ( Fugl-Meyer Motor Assessment ( FMMA ) score 10–50 ) , recruited after pre-screening for MI BCI ability , were r and omly allocated to BCI-HK , HK or St and ard Arm Therapy ( SAT ) groups . All groups received 18 sessions of intervention over 6 weeks , 3 sessions per week , 90 min per session . The BCI-HK group received 1 h of BCI coupled with HK intervention , and the HK group received 1 h of HK intervention per session . Both BCI-HK and HK groups received 120 trials of robot-assisted h and grasping and knob manipulation followed by 30 min of therapist-assisted arm mobilization . The SAT group received 1.5 h of therapist-assisted arm mobilization and forearm pronation-supination movements incorporating wrist control and grasp-release functions . In all , 14 males , 7 females , mean age 54.2 years , mean stroke duration 385.1 days , with baseline FMMA score 27.0 were recruited . The primary outcome measure was upper extremity FMMA scores measured mid-intervention at week 3 , end-intervention at week 6 , and follow-up at weeks 12 and 24 . Seven , 8 and 7 subjects underwent BCI-HK , HK and SAT interventions respectively . FMMA score improved in all groups , but no intergroup differences were found at any time points . Significantly larger motor gains were observed in the BCI-HK group compared to the SAT group at weeks 3 , 12 , and 24 , but motor gains in the HK group did not differ from the SAT group at any time point . In conclusion , BCI-HK is effective , safe , and may have the potential for enhancing motor recovery in chronic stroke when combined with therapist-assisted arm mobilization Background and Purpose — The increasing availability of robot-assisted therapy ( RT ) , which provides quantifiable , reproducible , interactive , and intensive practice , holds promise for stroke rehabilitation , but data on its dose – response relation are scanty . This study used 2 different intensities of RT to examine the treatment effects of RT and the effect on outcomes of the severity of initial motor deficits . Methods — Fifty-four patients with stroke were r and omized to a 4-week intervention of higher-intensity RT , lower-intensity RT , or control treatment . The primary outcome , the Fugl-Meyer Assessment , was administered at baseline , midterm , and posttreatment . Secondary outcomes included the Medical Research Council scale , the Motor Activity Log , and the physical domains of the Stroke Impact Scale . Results — The higher-intensity RT group showed significantly greater improvements on the Fugl-Meyer Assessment than the lower-intensity RT and control treatment groups at midterm ( P=0.003 and P=0.02 ) and at posttreatment ( P=0.04 and P=0.02 ) . Within-group gains on the secondary outcomes were significant , but the differences among the 3 groups did not reach significance . Recovery rates of the higher-intensity RT group were higher than those of the lower-intensity RT group , particularly on the Fugl-Meyer Assessment . Scatterplots with curve fitting showed that patients with moderate motor deficits gained more improvements than those with severe or mild deficits after the higher-intensity RT . Conclusions — This study demonstrated the higher treatment intensity provided by RT was associated with better motor outcome for patients with stroke , which may shape further stroke rehabilitation . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique identifier : NCT00917605 Twelve moderately to severely involved chronic stroke survivors ( > 12 mo ) were r and omized to one of two treatments : robotics and motor learning ( ROB-ML ) or functional neuromuscular stimulation and motor learning ( FNS-ML ) . Treatment was 5 h/d , 5 d/wk for 12 wk . ROB-ML group had 1.5 h per session devoted to robotics shoulder and elbow ( S/E ) training . FNS-ML had 1.5 h per session devoted to functional neuromuscular stimulation ( surface electrodes ) for wrist and h and ( W/H ) flexors/extensors . The primary outcome measure was the functional measure Arm Motor Ability Test ( AMAT ) . Secondary measures were AMAT-S/E and AMAT-W/H , Fugl-Meyer ( FM ) upper-limb coordination , and the motor control measures of target accuracy ( TA ) and smoothness of movement ( SM ) .  ROB-ML produced significant gains in AMAT , AMAT-S/E , FM upper-limb coordination , TA , and SM .  FNS-ML produced significant gains in AMAT-W/H and FM upper-limb coordination OBJECTIVES To determine the efficacy of 2 distinct 6-week robot-assisted reaching programs compared with an intensive conventional arm exercise program ( ICAE ) for  chronic , stroke-related upper-extremity ( UE ) impairment . To examine whether the addition of  robot-assisted training out of the horizontal plane leads to improved outcomes . DESIGN R and omized controlled trial , single-blinded , with 12-week follow-up . SETTING Research setting in a large medical center . PARTICIPANTS Adults ( N=62 ) with chronic , stroke-related arm weakness stratified by impairment severity using baseline UE motor assessment s. INTERVENTIONS Sixty minutes , 3 times a week for 6 weeks of  robot-assisted planar reaching ( gravity compensated ) , combined planar with vertical robot-assisted reaching , or intensive conventional arm exercise program . MAIN OUTCOME MEASURE UE Fugl-Meyer Assessment ( FMA ) mean change from baseline to final training . RESULTS All groups showed modest gains in the FMA from baseline to final with no significant between group differences . Most change occurred in the planar robot group ( mean change ± SD , 2.94 ± 0.77 ; 95 % confidence interval [ CI ] , 1.40 - 4.47 ) . Participants with greater motor impairment ( n=41 ) demonstrated a larger difference in response ( mean change ± SD , 2.29 ± 0.72 ; 95 % CI , 0.85 - 3.72 ) for planar robot-assisted exercise compared with the intensive conventional arm exercise program ( mean change ± SD , 0.43 ± 0.72 ; 95 % CI , -1.00 to 1.86 ) . CONCLUSIONS Chronic UE deficits because of stroke are responsive to intensive motor task training . However , training outside the horizontal plane in a gravity present environment using a combination of vertical with planar robots was not superior to training with the planar robot alone Background Physical rehabilitation is an area where robotics could contribute significantly to improved motor return for individuals following a stroke . This paper presents the results of a preliminary r and omized controlled trial ( RCT ) of a robot system used in the rehabilitation of the paretic arm following a stroke . Methods The study 's objectives were to explore the efficacy of this new type of robotic therapy as compared to st and ard physiotherapy treatment in treating the post-stroke arm ; to evaluate client satisfaction with the proposed robotic system ; and to provide data for sample size calculations for a proposed larger multicenter RCT . Twenty clients admitted to an inpatient stroke rehabilitation unit were r and omly allocated to one of two groups , an experimental ( robotic arm therapy ) group or a control group ( conventional therapy ) . An occupational therapist blinded to patient allocation administered two reliable measures , the Chedoke Arm and H and Activity Inventory ( CAHAI-7 ) and the Chedoke McMaster Stroke Assessment of the Arm and H and ( CMSA ) at admission and discharge . For both groups , at admission , the CMSA motor impairment stage of the affected arm was between 1 and 3 . Results Data were compared to determine the effectiveness of robot-assisted versus conventional therapy treatments . At the functional level , both groups performed well , with improvement in scores on the CAHAI-7 showing clinical and statistical significance . The CAHAI-7 ( range7 - 49 ) is a measure of motor performance using functional items . Individuals in the robotic therapy group , on average , improved by 62 % ( 95 % CI : 26 % to 107 % ) while those in the conventional therapy group changed by 30 % ( 95 % CI : 4 % to 61 % ) . Although performance on this measure is influenced by h and recovery , our results showed that both groups had similar stages of motor impairment in the h and . Furthermore , the degree of shoulder pain , as measured by the CMSA pain inventory scale , did not worsen for either group over the course of treatment . Conclusion Our findings indicated that robotic arm therapy alone , without additional physical therapy interventions tailored to the paretic arm , was as effective as  st and ard physiotherapy treatment for all responses and more effective than conventional treatment for the CMSA Arm ( p = 0.04 ) and H and ( p = 0.04 ) . At the functional level , both groups performed equally well Objective : To determine the efficacy of activity-based therapies using arm ergometer or robotic or group occupational therapy for motor recovery of the paretic arm in patients with an acute stroke ( ≤4 weeks ) admitted to an inpatient rehabilitation facility , and to obtain information to plan a large r and omized controlled trial . Design : Prospect i ve , r and omized controlled study . Setting : Stroke unit in a rehabilitation hospital . Subjects : Thirty patients with an acute stroke ( ≤4 weeks ) who had arm weakness ( Medical Research Council grade 2 or less at the shoulder joint ) . Intervention : Occupational therapy ( OT ) group ( control ) ( n = 10 ) , arm ergometer ( n = 10 ) or robotic ( n = 10 ) therapy group . All patients received st and ard , inpatient , post-stroke rehabilitation training for 3 hours a day , plus 12 additional 40-minute sessions of the activity-based therapy . Main measures : The primary outcome measures were discharge scores in the Fugl-Meyer Assessment Scale for upper limb impairment , Motor Status Scale , total Functional Independence Measure ( FIM ) and FIM-motor and FIM-cognition subscores . Results : The three groups ( OT group versus arm ergometer versus robotic ) were comparable on clinical demographic measures except the robotic group was significantly older and there were more  haemorrhagic  stroke patients in the arm ergometer group . After adjusting for age , stroke type and outcome measures at baseline , a similar degree of improvement in the discharge scores was found in all of the primary outcome measures . Conclusion : This study suggests that activity-based therapies using an arm ergometer or robot when used over shortened training periods have the same effect as OT group therapy in decreasing impairment and improving disability in the paretic arm of severely affected stroke patients in the subacute phase Background Over fifty percent of stroke patients experience chronic arm h and performance problems , compromising independence in daily life activities and quality of life . Task-oriented training may improve arm h and performance after stroke , whereby augmented therapy may lead to a better treatment outcome . Technology-supported training holds opportunities for increasing training intensity . However , the effects of robot-supported task-oriented training with real life objects in stroke patients are not known to date . The aim of the present study was to investigate the effectiveness and added value of the Haptic Master robot combined with task-oriented arm h and training in chronic stroke patients . Methods In a single-blind r and omized controlled trial , 22 chronic stroke patients were r and omly allocated to receive either task-oriented robot-assisted arm-h and training ( experimental group ) or task-oriented non-robotic arm-h and training ( control group ) . For training , the T-TOAT ( Technology-supported Task-Oriented Arm Training ) method was applied . Training was provided during 8 weeks , 4 times/week , 2 × 30 min/day . Results A significant improvement after training on the Action Research Arm Test ( ARAT ) was demonstrated in the experimental group ( p = 0.008 ) . Results were maintained until 6 months after cessation of the training . On the perceived performance measure ( Motor Activity Log ( MAL ) ) , both , the experimental and control group improved significantly after training ( control group p = 0.008 ; experimental group p = 0.013 ) . The improvements on MAL in both groups were maintained until 6 months after cessation of the training . With regard to quality of life , only in the control group a significant improvement after training was found ( EuroQol-5D p = 0.015 , SF-36 physical p = 0.01 ) . However , the improvement on SF-36 in the control group was not maintained ( p = 0.012 ) . No between-group differences could be demonstrated on any of the outcome measures . Conclusion Arm h and performance improved in chronic stroke patients , after eight weeks of task oriented training . The use of a Haptic Master robot in support of task-oriented arm training did not show additional value over the video-instructed task-oriented exercises in highly functional stroke patients . Clinical trial registration informationCurrent Controlled Trials IS RCT Stroke is the leading cause of long-term neurological disability and the principle reason for seeking rehabilitative services in the US . Learning based rehabilitation training enables independent mobility in the majority of patients post stroke , however , restoration of fine manipulation , motor function and task specific functions of the hemiplegic arm and h and is noted in fewer than 15 % of the stroke patients . Brain plasticity is the innate mechanism enabling the recovery of motor skills through neurological reorganization of the brain as a response to limbs ' manipulation . The objective of this research was to evaluate the therapeutic efficacy for the upper limbs with a dual arm exoskeleton system ( EXO-UL7 ) using three different modalities : bilateral mirror image with symmetric movements of both arms , unilateral movement of the affected arm and st and ard care .  Five hemiparetic subjects were r and omly assigned to each therapy modality . An upper limb exoskeleton was used to provide bilateral and unilateral treatments . St and ard care was provided by a licensed physical therapist . Subjects were evaluated before and after the interventions using 13 different clinical measures . Following these treatments all of the subjects demonstrated significant improved of their fine motor control and gross control across all the treatment modalities . Subjects exhibited significant improvements in range of motion of the shoulder , and improved muscle strength for bilateral training and st and ard care , but not for unilateral training . In conclusion , a synergetic approach in which robotic treatments ( unilateral and bilateral depending on the level of the motor control ) are supplemented by the st and ard of care may maximize the outcome of the motor control recover following stroke This r and omized , controlled , multisite Department of Veterans Affairs clinical trial assessed robot-assisted ( RA ) upper-limb therapy with the Mirror Image Movement Enabler ( MIME ) in the acute stroke rehabilitation setting . Hemiparetic subjects ( n = 54 ) received RA therapy using MIME for either up to 15 hours ( low-dose ) or 30 hours ( high-dose ) or received up to 15 hours of additional conventional therapy in addition to usual care ( control ) . The primary outcome measure was the Fugl-Meyer Assessment ( FMA ) . The secondary outcome measures were the Functional Independence Measure ( FIM ) , Wolf Motor Function Test , Motor Power , and Ashworth scores at intake , discharge , and 6-month follow-up . Mean duration of study treatment was 8.6 , 15.8 , and 9.4 hours for the low-dose , high-dose , and control groups , respectively . Gains in the primary outcome measure were not significantly different between groups at follow-up . Significant correlations were found at discharge between FMA gains and the dose and intensity of RA . Intensity also correlated with FMA gain at 6 months . The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months . As used during acute rehabilitation , motor-control changes at follow-up were no less with MIME than with additional conventional therapy . Intensity of training with MIME was positively correlated with motor-control gains Background and purpose There is little evidence available on the use of robot-assisted therapy in subacute stroke patients . A r and omized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset . Methods Fifty-three subacute stroke patients at their first-ever stroke were enrolled 30 ± 7 days after the acute event and r and omized into two groups , both exposed to st and ard therapy . Additional 30 sessions of robot-assisted therapy were provided to the Experimental Group . Additional 30 sessions of usual therapy were provided to the Control Group . The following impairment evaluations were performed at the beginning ( T0 ) , after 15 sessions ( T1 ) , and at the end of the treatment ( T2 ) : Fugl-Meyer Assessment Scale ( FM ) , Modified Ashworth Scale-Shoulder ( MAS-S ) , Modified Ashworth Scale-Elbow ( MAS-E ) , Total Passive Range of Motion-Shoulder/Elbow ( pROM ) , and Motricity Index ( MI ) . Results Evidence of significant improvements in MAS-S ( p = 0.004 ) , MAS-E ( p = 0.018 ) and pROM ( p < 0.0001 ) was found in the Experimental Group . Significant improvement was demonstrated in both Experimental and Control Group in FM ( EG : p < 0.0001 , CG : p < 0.0001 ) and MI ( EG : p < 0.0001 , CG : p < 0.0001 ) , with an higher improvement in the Experimental Group . Conclusions Robot-assisted upper limb rehabilitation treatment can contribute to increasing motor recovery in subacute stroke patients . Focusing on the early phase of stroke recovery has a high potential impact in clinical practice Article abstract In an attempt to improve motor recovery of the upper limb after stroke , we added a robot ( MIT-Manus ) experience that provided additional goal -directed sensorimotor activity to st and ard rehabilitation treatments . The first trial produced a significant decrease in motor impairment in the upper limb for the treated group . In re-evaluating 12 of those 20 patients , nearly 3 years later , robot-trained patients showed further significant decreases in impairment measures of the affected limb . The groups were comparable at the start of the study In the last few years , not many studies on the use of robot-assisted therapy to recover h and function in acute stroke patients have been carried out . This r and omized-controlled observer trial is aim ed at evaluating the effects of intensive robot-assisted h and therapy compared with intensive occupational therapy in the early recovery phases after stroke with a 3-month follow-up . Twenty acute stroke patients at their first-ever stroke were enrolled and r and omized into two groups . The experimental treatment was performed using the Amadeo Robotic System . Control treatment , instead , was carried out using occupational therapy executed by a trained physiotherapist . All participants received 20 sessions of treatment for 4 consecutive weeks ( 5 days/week ) . The following clinical scales , Fugl-Meyer Scale ( FM ) , Medical Research Council Scale for Muscle Strength ( h and flexor and extensor muscles ) ( MRC ) , Motricity Index ( MI ) and modified Ashworth Scale for wrist and h and muscles ( MAS ) , were performed at baseline ( T0 ) , after 20 sessions ( end of treatment ) ( T1 ) and at the 3-month follow-up ( T2 ) . The Barthel Index was assessed only at T0 and T1 . Evidence of a significant improvement was shown by the Friedman test for the FM [ experimental group ( EG ) : P=0.0039 , control group ( CG ) : P<0.0001 ] , Box and Block Test ( EG : P=0.0185 , CG : P=0.0086 ) , MI ( EG : P<0.0001 , CG : P=0.0303 ) and MRC ( EG : P<0.0001 , CG : P=0.001 ) scales . These results provide further support to the generalized therapeutic impact of intensive robot-assisted treatment on h and recovery functions in individuals with acute stroke . The robotic rehabilitation treatment may contribute toward the recovery of h and motor function in acute stroke patients . The positive results obtained through the safe and reliable robotic rehabilitation treatment reinforce the recommendation to extend it to a larger clinical practice Objective : To compare the outcome of robot-assisted therapy with dose-matched active control therapy by using accelerometers to study functional recovery in chronic stroke patients . Design : Prospect i ve , r and omized , controlled trial . Setting : Stroke units in three medical centres . Subjects : Twenty patients post stroke for a mean of 22 months . Intervention : Robot-assisted therapy ( n = 10 ) or dose-matched active control therapy ( n = 10 ) . All patients received either of these two therapies for 90–105 minutes each day , 5 days per week , for four weeks . Main measures : Outcome measures included arm activity ratio ( the ratio of mean activity between the impaired and unimpaired arm ) and scores on the Fugl-Meyer Assessment Scale , Functional Independence Measure , Motor Activity Log and ABILH AND question naire . Results : The robot-assisted therapy group significantly increased motor function , hemiplegic arm activity and bilateral arm coordination ( Fugl-Meyer Assessment Scale : 51.20 ± 8.82 , P = 0.002 ; mean arm activity ratio : 0.76 ± 0.10 , P = 0.026 ; ABILH AND question naire : 1.24 ± 0.28 , P = 0.043 ) compared with the dose-matched active control group ( Fugl-Meyer Assessment Scale : 40.90 ± 13.14 ; mean arm movement ratio : 0.69 ± 0.11 ; ABILH AND question naire : 0.95 ± 0.43 ) . Conclusions : Symmetrical and bilateral robotic practice , combined with functional task training , can significantly improve motor function , arm activity , and self-perceived bilateral arm ability in patients late after stroke OBJECTIVES To evaluate the use of an electromechanical device , comprising an exoskeleton , a static orthosis , and a glove , for functional rehabilitation of the elbow and h and in patients with hemiparesis , and to compare it with physical therapy rehabilitation . DESIGN Pretest-posttest design . SETTING Rehabilitation laboratory . PARTICIPANTS Volunteer sample of persons ( N=12 ) with persistent hemiparesis from a single , unilateral stroke within the past 3 to 36 months . INTERVENTIONS The volunteers were r and omly divided into 2 groups . One group was treated with a conventional program of physiotherapy , and another group participated in a training program in which an electromechanical orthosis was used . All volunteers received 24 sessions , held 3 times a week for 8 weeks . MAIN OUTCOME MEASURES Modified Ashworth Scale ( MAS ) , Fugl-Meyer Assessment ( FMA ) , and electromyogram ( EMG ) amplitude . RESULTS No statistical difference was found in the initial and final values of the MAS . Both groups showed a significant increase for the total scores of the FMA . However , only the group treated with the orthosis showed an increase in FMA scores related to the wrist and h and joint . The EMG analysis showed increased EMG amplitudes for all muscles in the group treated with the orthosis , whereas the group treated with physiotherapy showed gains in electromyographic activity only in the extensor digitorum communis . Intergroup comparison showed that the initial FMA scores of the wrist/h and were higher in the group treated with physiotherapy . However , after training , the scores in the group that used the orthosis were equivalent to those of the physiotherapy group . CONCLUSIONS The results suggest that this device can be an auxiliary tool to help the conventional rehabilitation program of motor function of the affected upper extremity Background and Objectives . Robot-assisted therapy ( RT ) is a current promising intervention in stroke rehabilitation , but more research is warranted for examining its efficacy and the dose – benefit relation . The authors investigated the effects of higher intensity versus lower intensity RT on movements of forearm pronation – supination and wrist flexion – extension relative to conventional rehabilitation ( CR ) in patients poststroke for a mean of 21 months . Methods . In this pilot study , 18 patients with initial mean Fugl-Meyer Assessment ( FMA ) of 37 to 44 for the upper extremity were r and omized to higher intensity RT , lower intensity RT , or CR intervention for 4 weeks . The dose of the higher intensity RT was twice the number of repetitions in the lower intensity RT . Outcome measures at pretreatment and posttreatment were administered to patients to evaluate beneficial and adverse effects of interventions . Primary outcomes were the FMA and Medical Research Council scale . Results . There were significant differences in motor function ( P = .04 ) and daily performance ( P = .03 ) among the 3 groups . The higher intensity RT group showed better improvement in motor function , muscle strength , performance of daily activities , and bimanual ability than the other 2 groups . The intensive RT intervention did not induce higher levels of an oxidative DNA biomarker . Conclusions . Higher intensity of RT that assists forearm and wrist movements may lead to greater improvement in motor ability and functional performance in stroke patients . A sample size of only 20 to 25 in each arm of a larger r and omized controlled trial is needed to confirm the findings for similar subjects Survivors post stroke commonly have upper limb impairments . Patients can drive neural reorganization , brain recovery and return of function with task specific repetitive training ( TSRT ) .  Fifteen community independent stroke survivors ( 25 - 75 years , > 6 months post stroke , Upper Limb Fugl Meyer [ ULFM ] scores 16 - 39 ) participated in this r and omized feasibility study to compare outcomes of upper limb TSRT guided by a robotic orthosis ( bilateral or unilateral ) or a physical therapist . After 6 weeks of training ( 18 h ) , across all subjects , there were significant improvements in depression , flexibility , strength , tone , pain and voluntary movement ( ULFM ) ( p < 0.05 ; effect sizes 0.49 - 3.53 ) . Each training group significantly improved ULFM scores and range of motion without significant group differences . Virtual or actual TSRT performed with a robotic orthosis or a physical therapist significantly reduced arm impairments around the shoulder and elbow without significant gains in fine motor h and control , activities of daily living or independence Investigators have demonstrated that a variety of intensive movement training protocol s for persistent upper limb paralysis in patients with chronic stroke ( 6 months or more after stroke ) improve motor outcome . This r and omized controlled study determined in patients with upper limb motor impairment after chronic stroke whether movement therapy delivered by a robot or by a therapist using an intensive training protocol was superior . Robotic training ( n = 11 ) and an intensive movement protocol ( n = 10 ) improved the impairment measures of motor outcome significantly and comparably ; there were no significant changes in disability measures . Motor gains were maintained at the 3-month evaluation after training . These data contribute to the growing awareness that persistent impairments in those with chronic stroke may not reflect exhausted capacity for improvement . These new protocol s , rendered by either therapist or robot , can be st and ardized , tested , and replicated , and potentially will contribute to rational activity-based programs This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence OBJECTIVE To compare response to upper-limb treatment using robotics plus motor learning ( ML ) versus functional electrical stimulation ( FES ) plus ML versus ML alone , according to a measure of complex functional everyday tasks for chronic , severely impaired stroke survivors . DESIGN Single-blind , r and omized trial . SETTING Medical center . PARTICIPANTS Enrolled subjects ( N=39 ) were > 1 year postsingle stroke ( attrition rate=10 % ; 35 completed the study ) . INTERVENTIONS All groups received treatment 5d/wk for 5h/d ( 60 sessions ) , with unique treatment as follows : ML alone ( n=11 ) ( 5h/d partial- and whole-task practice of complex functional tasks ) , robotics plus ML ( n=12 ) ( 3.5h/d of ML and 1.5h/d of shoulder/elbow robotics ) , and FES plus ML ( n=12 ) ( 3.5h/d of ML and 1.5h/d of FES wrist/h and coordination training ) . MAIN OUTCOME MEASURES Primary measure : Arm Motor Ability Test ( AMAT ) , with 13 complex functional tasks ; secondary measure : upper-limb Fugl-Meyer coordination scale ( FM ) . RESULTS There was no significant difference found in treatment response across groups ( AMAT : P≥.584 ; FM coordination : P≥.590 ) . All 3 treatment groups demonstrated clinical ly and statistically significant improvement in response to treatment ( AMAT and FM coordination : P≤.009 ) . A group treatment paradigm of 1:3 ( therapist/patient ) ratio proved feasible for provision of the intensive treatment . No adverse effects . CONCLUSIONS Severely impaired stroke survivors with persistent ( > 1y ) upper-extremity dysfunction can make clinical ly and statistically significant gains in coordination and functional task performance in response to robotics plus ML , FES plus ML , and ML alone in an intensive and long- duration intervention ; no group differences were found . Additional studies are warranted to determine the effectiveness of these methods in the clinical setting BACKGROUND Arm hemiparesis secondary to stroke is common and disabling . We aim ed to assess whether robotic training of an affected arm with ARMin -- an exoskeleton robot that allows task-specific training in three dimensions-reduces motor impairment more effectively than does conventional therapy . METHODS In a prospect i ve , multicentre , parallel-group r and omised trial , we enrolled patients who had had motor impairment for more than 6 months and moderate-to-severe arm paresis after a cerebrovascular accident who met our eligibility criteria from four centres in Switzerl and . Eligible patients were r and omly assigned ( 1:1 ) to receive robotic or conventional therapy using a centre-stratified r and omisation procedure . For both groups , therapy was given for at least 45 min three times a week for 8 weeks ( total 24 sessions ) . The primary outcome was change in score on the arm ( upper extremity ) section of the Fugl-Meyer assessment ( FMA-UE ) . Assessors tested patients immediately before therapy , after 4 weeks of therapy , at the end of therapy , and 16 weeks and 34 weeks after start of therapy . Assessors were masked to treatment allocation , but patients , therapists , and data analysts were unmasked . Analyses were by modified intention to treat . This study is registered with Clinical Trials.gov , number NCT00719433 . FINDINGS Between May 4 , 2009 , and Sept 3 , 2012 , 143 individuals were tested for eligibility , of whom 77 were eligible and agreed to participate . 38 patients assigned to robotic therapy and 35 assigned to conventional therapy were included in analyses . Patients assigned to robotic therapy had significantly greater improvements in motor function in the affected arm over the course of the study as measured by FMA-UE than did those assigned to conventional therapy ( F=4.1 , p=0.041 ; mean difference in score 0.78 points , 95 % CI 0.03 - 1.53 ) . No serious adverse events related to the study occurred . INTERPRETATION Neurorehabilitation therapy including task-oriented training with an exoskeleton robot can enhance improvement of motor function in a chronically impaired paretic arm after stroke more effectively than conventional therapy . However , the absolute difference between effects of robotic and conventional therapy in our study was small and of weak significance , which leaves the clinical relevance in question . FUNDING Swiss National Science Foundation and Bangerter-Rhyner Stiftung Objective . To examine retrospectively the recovery of patients engaged in robotic research during a 6- to 7-week course of inpatient rehabilitation . Because timing of the Interim evaluation at 31/2 weeks was comparable to the present length of inpatient stroke rehabilitation , the authors assessed whether significant gains in motor abilities occurred after the time when most stroke patients today are discharged home . Methods . Fifty-six in patients with a single , unilateral stroke were r and omly assigned to a robot therapy or robot exposure group . Therapists blinded to group assignment administered the Fugl-Meyer , Motor Status Score , and MRC motor power test . Results . Significant improvements in upper-limb motor abilities occurred throughout a period approximately twice the present length of stay in inpatient rehabilitation . However , in the latter half of this period , patients who received conventional therapy showed little improvement , whereas patients who received robot training plus conventional therapy continued to improve . Conclusion . Further opportunities for recovery after stroke are possible by extending intensive therapy beyond present inpatient rehabilitation stays Objective We investigated the training effects of interlimb force coupling training on paretic upper extremity outcomes in patients with chronic stroke and analyzed the relationship between motor recovery of the paretic h and , arm and functional performances on paretic upper limb . Design A r and omized controlled trial with outcome assessment at baseline and after 4 weeks of intervention . Setting Taipei Veterans General Hospital , National Yang-Ming University . Participants Thirty-three subjects with chronic stroke were recruited and r and omly assigned to training ( n = 16 ) and control groups ( n = 17 ) . Interventions The computer-aided interlimb force coupling training task with visual feedback included different grip force generation methods on both h and s. Main Outcome Measures The Barthel Index ( BI ) , the upper extremity motor control Fugl-Meyer Assessment ( FMA-UE ) , the Motor Assessment Score ( MAS ) , and the Wolf Motor Function Test ( WMFT ) . All assessment s were executed by a blinded evaluator , and data management and statistical analysis were also conducted by a blinded research er . Results The training group demonstrated greater improvement on the FMA-UE ( p<.001 ) , WMFT ( p<.001 ) , MAS ( p = .004 ) and BI ( p = .037 ) than the control group after 4 weeks of intervention . In addition , a moderate correlation was found between the improvement of scores for h and scales of the FMA and other portions of the FMA UE ( r = .528 , p = .018 ) or MAS ( r = .596 , p = .015 ) in the training group . Conclusion Computer-aided interlimb force coupling training improves the motor recovery of a paretic h and , and facilitates motor control and enhances functional performance in the paretic upper extremity of people with chronic stroke . Trial Registration Clinical Trials.gov NCT02247674 Background Although bilateral arm training ( BAT ) has been widely studied , the comparative effects of therapist-based BAT ( TBAT ) versus robot-assisted BAT ( RBAT ) remains unknown . Objective This study compared the efficacy of TBAT , RBAT , and a control treatment ( CT ) on motor control , functional performance , and quality of life after chronic stroke . Design A r and omized , pretest-posttest , control group design was used . Methods Forty-two patients ( mean age=54.49 years , SD=9.69 ; mean length of time since stroke onset=17.62 months , SD=10.50 ) were r and omly assigned to TBAT , RBAT , and CT groups . Each group received treatment for 90 to 105 minutes per session , 5 sessions on weekdays , for 4 weeks . Outcome measures included kinematic analyses , the Fugl-Meyer Assessment ( FMA ) , the Motor Activity Log , and the Stroke Impact Scale ( SIS ) . Results Large and significant effects were found in the kinematic variables , distal part of upper-limb motor impairment , and certain aspects of quality of life in favor of TBAT or RBAT . Specifically , the TBAT group demonstrated significantly better temporal efficiency and smoothness , straighter trunk motion , and less trunk compensation compared with the CT and RBAT groups . The RBAT group had increased shoulder flexion compared with the CT and TBAT groups . On the FMA , the TBAT group showed higher distal part scores than the CT group . On the SIS , the RBAT group had better strength subscale , physical function domain , and total scores than the CT group . Limitations This study recruited patients with mild spasticity and without cognitive impairment . Conclusions Compared with CT , TBAT and RBAT exhibited differential effects on outcome measures . Therapist-based BAT may improve temporal efficiency , smoothness , trunk control , and motor impairment of the distal upper limb .  Robot-assisted BAT may improve shoulder flexion and quality of life Background . Individuals with chronic stroke often have long-lasting upper extremity impairments that impede function during activities of daily living . Rehabilitation robotics have shown promise in improving arm function , but current systems do not allow realistic training of activities of daily living . We have incorporated the ARMin III and H and SOME device into a novel robotic therapy modality that provides functional training of reach and grasp tasks . Objective . To compare the effects of equal doses of robotic and conventional therapy in individuals with chronic stroke . Methods . Subjects were r and omized to 12 hours of robotic or conventional therapy and then crossed over to the other therapy type after a 1-month washout period . Twelve moderate to severely impaired individuals with chronic stroke were enrolled , and 10 completed the study . Results . Across the 3-month study period , subjects showed significant improvements in the Fugl-Meyer ( P = .013 ) and Box and Blocks tests ( P = .028 ) . The robotic intervention produced significantly greater improvements in the Action Research Arm Test than conventional therapy ( P = .033 ) . Gains in the Box and Blocks test from conventional therapy were larger than from robotic therapy in subjects who received conventional therapy after robotic therapy ( P = .044 ) . Conclusions . Data suggest that robotic therapy can elicit improvements in arm function that are distinct from conventional therapy and supplements conventional methods to improve outcomes . Results from this pilot study should be confirmed in a larger study Objective : To compare the efficacy of a repetitive task-specific practice regimen integrating a portable , electromyography-controlled brace called the ‘ Myomo ’ versus usual care repetitive task-specific practice in subjects with chronic , moderate upper extremity impairment . Subjects : Sixteen subjects ( 7 males ; mean age 57.0 ± 11.02 years ; mean time post stroke 75.0 ± 87.63 months ; 5 left-sided strokes ) exhibiting chronic , stable , moderate upper extremity impairment . Interventions : Subjects were administered repetitive task-specific practice in which they participated in valued , functional tasks using their paretic upper extremities . Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration , occurring 3 days/week for eight weeks . One group participated in repetitive task-specific practice entirely while wearing the portable robotic , while the other performed the same activity regimen manually . Main outcome measures : The upper extremity Fugl-Meyer , Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention . Results : After intervention , groups exhibited nearly identical Fugl-Meyer score increases of ≈2.1 points ; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales , including a 12.5-point increase on the Stroke Impact Scale recovery subscale . Conclusions : Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment Background / Objective . The authors previously developed a passive instrumented arm orthosis ( Therapy Wilmington Robotic Exoskeleton [ T-WREX ] ) that enables individuals with hemiparesis to exercise the arm by playing computer games in a gravity-supported environment . The purpose of this study was to compare semiautonomous training with T-WREX and conventional semiautonomous exercises that used a tabletop for gravity support . Methods . Twenty-eight chronic stroke survivors with moderate/severe hemiparesis were r and omly assigned to experimental ( T-WREX ) or control ( tabletop exercise ) treatment . A blinded rater assessed arm movement before and after twenty-four 1-hour treatment sessions and at 6-month follow-up . Subjects also rated subjective treatment preferences after a single-session crossover treatment . Results . All subjects significantly improved ( P ≤ .05 ) upper extremity motor control ( Fugl-Meyer ) , active reaching range of motion ( ROM ) , and self-reported quality and amount of arm use ( Motor Activity Log ) . Improvements were sustained at 6 months . The T-WREX group maintained gains on the Fugl-Meyer significantly better than controls at 6 months ( improvement of 3.6 ± 3.9 vs 1.5 ± 2.7 points , mean ± SD ; P = .04 ) . Subjects also reported a preference for T-WREX training . Conclusion . Gravity-supported arm exercise , using the T-WREX or tabletop support , can improve arm movement ability after chronic severe hemiparesis with brief one-on-one assistance from a therapist ( approximately 4 minutes per session ) . The 3-dimensional weight support , instant visual movement feedback , and simple virtual reality software provided by T-WREX were associated with modest sustained gains at 6-month follow-up when compared with the conventional approach
Robot-Assisted Therapy ( RT ) is an innovative approach to neurological rehabilitation that uses intensive , repetitive , interactive , and individualized practice .
This systematic review aim ed to investigate the effectiveness of RT on the body function and structure of people with upper limb impairments ( PROSPERO registration : CRD42017054982 ) .