Vitor Mendes Pereira, MD, performs the first telerobotic procedure of its kind on a stroke patient 120 miles away. Fred Moll, chairman of XCath Robotics, looks on. Image courtesy of XCath Robotics.
Showing posts with label robotic assisted therapy. Show all posts
Showing posts with label robotic assisted therapy. Show all posts
Wednesday, September 16, 2026
China’s self-powered neural device helps stroke survivors walk naturally
Did your doctor or hospital do anything with any of these? Why expect anything from this newest one? Over a decade and your doctors/hospital did nothing, I would call that complete incompetency.
A neuromechanics-based powered ankle exoskeleton to assist walking post-stroke: a feasibility study April, 2015
Feinstein Institute study finds robotic ankle rehabilitation helps post stroke recovery August, 2017
Japanese robo boot could help stroke sufferers walk again October, 2013
Clinical application of a modular ankle robot for stroke rehabilitation July, 2013
Ankle robots help participants retrain gait in study at the Maryland VA June, 2013
The latest here:
China’s self-powered neural device helps stroke survivors walk naturally
Prosthesis developed by mainland China and Hong Kong team uses electrical current to flex the wearer’s ankle while walking
Chinese team’s wearable dopamine patch could be used to track depression
Chinese robot helps children with nerve disorder stand up for the first time
Could China build an ‘army of centaurs’ with this non-invasive cyborg tech?
New device helps stroke survivors walk more naturally
Scientists have developed a lightweight, battery-free device that could help improve the mobility of people with difficulty walking, such as stroke survivors. Developed by researchers in Hong Kong and mainland China, the neural prosthesis uses energy generated by the wearer’s own movements to electrically stimulate their muscles, helping to flex their ankle and restore their natural walking pattern. This could prevent falls for stroke survivors, elderly individuals, and others living with mobility impairments. The researchers behind the device also said it could even be used by athletes during training. “Rather than relying on external sensors or battery-powered control, the device operates automatically during walking through mechanically coupled energy harvesting and stimulation delivery,” the team said in a paper published in the peer-reviewed journal Nature Communications on September 2.Requiring just a few steps to power up, the device helped to increase stride length and walking speed in stroke survivors during both indoor treadmill trials and outdoor walking tests. These improvements were “immediate” and were achieved without the need for a complex set-up, according to the team led by researchers from the Hong Kong Polytechnic University This includes a 67.3 per cent increase in walking distance and a 43.5 per cent increase in walking speed during outdoor tests. “The system operates without external batteries, integrates into standard footwear and requires minimal donning time, supporting pragmatic use beyond the laboratory,” the researchers wrote in their paper. China’s self-powered neural device helps stroke survivors walk naturally Corresponding author Yang Zhengbao, an associate professor at HKUST, said on September 10 that the device had several advantages over existing therapies, including the fact that it took advantage of the “natural intelligence” of human walking patterns. The team said in the paper that while the device was not a replacement for all existing assistive devices, the benefits of supporting natural gait patterns rather than replacing or restricting them offered a distinct strategy for rehabilitation. Strokes are one of the leading causes of death and long-term disability worldwide, with one in four adults over the age of 25 predicted to experience one in their lifetime. Stroke survivors can face numerous complications, including brain injury, memory loss, speech impairments and motor issues. Foot drop, or the inability to flex the ankle and lift the front of the foot, is a common impairment that reduces the efficiency of walking, increases the risk of falling and limits quality of life, according to the team. Conventionally, rigid braces on the lower leg have been prescribed to help correct post-stroke foot drop. However, they work mainly by constraining the ankle joint rather than restoring flexion. This not only makes it difficult to walk naturally, but can also cause muscle atrophy with prolonged use. The field of robotic exoskeletons has been advancing rapidly. However, these devices can be challenging to use as mobility aids in real life due to their complexity, size and need for calibration. “Here, we addressed this translational gap with a discreet, daily-life-oriented self-powered neuroprosthesis designed to assist ankle dorsiflexion and thereby reduce foot drop during walking,” the researchers said. Pan Qiqi, a former postdoctoral fellow at Yang’s lab who is now a professor at the Huazhong University of Science and Technology, said that the design of the device was inspired by natural gait patterns. No gym needed? Scientists in China develop self-exercising muscle grafts Humans typically walk in an alternating pattern. First comes the stance phase, when the leg is on the ground, followed by the swing phase, when the leg is lifted and moves forward. “This natural gait pattern aligns well with the needs of stroke patients, who typically have one healthy leg capable of normal walking while the other requires assistance,” said Pan, a lead author of the paper.The team’s device harvests mechanical energy from the movement of the less affected limb using a component embedded in the wearer’s shoe. This harvested energy then powers a lightweight neurostimulator secured around the calf of the weaker limb, which uses electrical current to help the wearer’s muscles contract. Pan said that unlike exoskeletons – which typically substitute or assist lost motor function rather than rehabilitate it – the team’s solution “actively stimulates the user’s muscles to facilitate the movement”. The paper said that while foot drop was not completely eliminated during outdoor trials, the device still significantly improved wearers’ gait. The researchers noted that their prototype still required optimisation, including more precise control of the stimulation to broaden its applicability for different patients. Pan said that study participants were “very eager to get appropriate rehabilitation products”. “Stroke patients often prioritise socialisation and community engagement. We therefore aimed to develop a wearable device that integrates seamlessly into their natural gait, encouraging them to socialise and engage with others.” He added that existing exoskeletons and functional electrical stimulation devices were complex and expensive, so he hoped their device could be “low-cost, easy to use and lightweight”. Yang said that further reducing the complexity of the design could help cut costs, which could allow people in low-income countries to benefit from the device. Very few companies want to develop products for this population, according to Yang, who encouraged more researchers and companies to create designs that could improve their quality of life. He said they had shown the device to a colleague who worked with elite Hong Kong athletes and they were interested in using the device for training purposes. The team is working on similar products for the knee and hip using different approaches, which Yang said could “generate positive impacts for the world”. The researchers are also hoping to incorporate the energy harvesting system into pacemakers, which could help reduce the devices’ size, much of which comes from the battery.FDA sees promise in remote robotic-assisted stroke device
Ask your competent? doctor EXACTLY WHAT FOLLOWON REHAB GETS YOU 100% RECOVERED!
Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!
FDA sees promise in remote robotic-assisted stroke device
XCath Robotics has received the FDA's breakthrough device designation for its Iris surgical robotic system that performs remote robotic-assisted mechanical thrombectomy in acute ischemic stroke patients.
This represents a significant step forward for the Houston-based medtech company. The FDA's breakthrough devices drogram helps support the development of medical devices that have the potential to provide more effective treatment for patients with life-threatening or irreversibly debilitating conditions. This provides XCath Robotics with more opportunities to interact with FDA experts and receive support as the company works toward U.S. regulatory approval for the Iris system.
Back in March, the Iris system was used to complete the world’s first telerobotic stroke thrombectomy. Neurosurgeon Vitor Mendes Pereira, MD, chair of advanced neurovascular interventions at the University of Toronto, used the system to perform the historic procedure in Santiago, Panama, while the patient was 120 miles away in Panama City.
XCath Robotics said the Iris technology could open the door to breaking down the geographic barriers to specialist stroke care. Mechanical thrombectomy is widely regarded as the gold standard treatment for patients suffering a large vessel occlusion (LVO) stroke, which is the deadliest and most disabling type of ischemic stroke. However, access to the procedure remains limited outside of major cities, both in the U.S. and internationally.
The global median rate of access to mechanical thrombectomy is only about 2.79%. LVO strokes, similar to heart attacks, have a limited window for treatment before irreversible damage is caused as brain tissues dies. About 77% of patients either die or are left with severe disability.
The U.S. government has recently shown interest in expanding access to robotic stroke thrombectomy. This includes funding through the Advanced Research Projects Agency for Health (ARPA-H) to accelerate the development of an autonomous, remote endovascular robotic system that perform mechanical thrombectomy on stroke patients. Siemens Healthineers was awarded $31.1 million to accelerate the development of an autonomous, remote endovascular robotic system that can perform thrombectomy on stroke patients. Philips Healthcare was also awarded $33.7 million to develop an autonomous robotic system with partners Johns Hopkins University, Boston University and Weill Cornell Medicine.
Sunday, May 10, 2026
Hands-free control of an assistive robotic arm for high-level paralysis
Can your competent? doctor figure out how to repurpose this for upper limb hemiparesis?
Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!
My doctor knew nothing and did nothing to get my left arm recovered; starting with complete failure to cure spasticity! 20 years later, left arm/hand are still completely worthless.
Hands-free control of an assistive robotic arm for high-level paralysis
Abstract
Background
Recent advancements in assistive robotic arms have enabled many people with tetraplegia to perform activities of daily living more independently. Because these systems typically require hand use, they are not a ready option for many individuals with high-level (C4 and above) tetraplegia. Such individuals, however, might be able to use signals that arise from the head and neck to control assistive devices. Therefore, the goal of the study was to evaluate the utility of several signals arising from the head and neck to control a robotic arm during 3D center-out reaching to multiple targets ~ 25–50 cm from the start location.
Methods
Ten non-disabled human subjects were tested using five non-invasive, hands-free modalities (head position, head velocity, facial electromyography, tongue, and voice) to control a robot arm. For comparison, subjects also used joystick position and joystick velocity methods to control reaching movements of the robotic arm. A one-way repeated measures ANOVA was carried out on key performance indicators including movement time, path efficiency, throughput, and perceived workload.
Results
The hands-free control modalities of head position, facial EMG, tongue, and voice had average (± SD) movement times (5.8 ± 1.6, 8.2 ± 3.7, 6.3 ± 2.0, and 10.0 ± 3.7 s, respectively). With the exception of voice, none of these times were significantly different than that of the benchmark hand position control of a joystick (6.3 ± 2.3 s). Furthermore, no significant differences were revealed in perceived workload across control modalities.
Conclusions
These results indicate, therefore, that various non-invasive, hands-free methods could be used effectively by people with high-level tetraplegia to operate assistive robotic arms.
Sunday, August 24, 2025
Chandler teen creates robotic arm device aimed to help stroke patients
So a teenager is doing more than our fucking failures of stroke associations!
2:25 video at link
Chandler teen creates robotic arm device aimed to help stroke patients
CHANDLER, Ariz. — A Chandler teen just received a $50,000 scholarship for engineering innovation in stroke rehabilitation.
Brad Wu created a robotic arm device that could help stroke patients regain movement.
“It is one of the greatest honors that I have, that any high schooler can have,” said 17-year-old Brad Wu, a senior at Arizona College Prep High School in Chandler.
Wednesday, August 20, 2025
Effects of Treatment Intensity in Upper Limb Robot-Assisted Therapy for Chronic Stroke: A Pilot Randomized Controlled Trial
Any type of robotic therapy is almost assuredly only going to be available in higher income countries, so this fails the 'Leave no survivor behind' idea!
Survivors in charge wouldn't make errors like this!
Effects of Treatment Intensity in Upper Limb Robot-Assisted Therapy for Chronic Stroke: A Pilot Randomized Controlled Trial
Yu-wei Hsieh MS Ching-yi Wu ScD, Chia-yi Lee MS, https://doi.org/10.1177/1545968310394Abstract
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. In this pilot study, 18 patients with initial mean Fugl-Meyer Assessment (FMA) of 37 to 44 for the upper extremity were randomized 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 randomized controlled trial is needed to confirm the findings for similar subjects.
Introduction
Stroke remains a leading cause of permanent disability and is a large source of disease burden worldwide. 2 Robot-assisted therapy (RT) for upper extremity (UE) motor function has emerged as a possible adjunct for stroke rehabilitation, although not yet convincingly shown to be better than the same intensity of conventional focused UE therapy.RT incorporates some therapeutic elements for success in stroke motor rehabilitation into its design: intensive, repetitiveness, feedback, and bilateral training.9 Along with these advantages, patients can be trained much more often, which has been shown to lead to better outcomes and have potential to enhance motor learning (eg, the Assisted Rehabilitation and Measurement Guide). 11 Previous RT studies showed significant, if modest, improvement in UE motor function, strength, and motor control parameters in stroke patients after interventions.5,6,8 Systematic reviews found that RT significantly improved arm motor function for stroke patients but did not significantly improve daily functions.12,13 Robotics can also provide quantitative control and measurement of therapy (eg, velocity, kinematics, resistance, and range of motion), allowing for research into the treatment dosage of rehabilitation.14 Despite growing empirical evidence for the use of RT in stroke rehabilitation, rigorous research is needed to answer more specific questions that will maximize the benefits from the treatment.15 For example, what is the optimal intensity of RT? What are the relative beneficial and adverse effects of RT compared with other treatments?Dosage in stroke rehabilitation trials usually uses the duration-based measure of therapy and provides the information regarding the amount of minutes or days per week of therapy provided.16 Most RT trials have offered the treatment in sessions lasting 30 minutes to 1.5 hours, with 3 to 5 sessions per week for 3 to 8 weeks.5,6,8,9 In the EXCITE trial for constraint-induced therapy, the training involved forcing the patient to use the affected arm for up to 6 hours daily for 10 weekdays, and the less-affected hand was placed in a mitt for a goal of 90% of the patient’s waking hours for 14 days during a 2-week period.17 In addition, one study found that in a standard rehabilitation session, the average of repetitions of the functional UE practice was 32.16 According to recent research, performing about 300 repetitions of task-specific UE training per session was feasible in stroke rehabilitation.18 Although greater duration or intensity of rehabilitation resulted in more functional improvement,19-21 current data do not allow for a prescription of how much treatment is enough to induce improvements and not harm the patient. Thus, the definition of treatment intensity as the number of movement repetitions per unit of time22 was adopted in this study and was investigated to inform the optimal dosage for further stroke rehabilitation.
Moreover, it is important to select the appropriate intensity of exercise or treatment, because exercise that is too intensive can be hazardous.23 The study found that high-intensity exercise (ie, 75% maximum oxygen consumption reached) increased oxidative stress in healthy men.23 During prolonged heavy exercise, antioxidant systems may be overwhelmed by excessive reactive oxygen species, leading to cell and tissue damage.24 Stroke patients commonly showed activity intolerance and significantly lower maximal workloads than controls during exercise.25 For healthy people, the RT protocols proposed in this study seem not to have been so stressful or reach the effort level of the previous study where increased oxidative stress was found.23 For stroke patients, however, the same intensity or amount of training may have different impacts from healthy people. In addition, the oxidative stress level has been reported to be higher in acute stroke patients than in control subjects, but the effects of training on oxidative damage have not been addressed in these studies.26,27 To date, the threshold level of training intensity that may cause oxidative stress in stroke patients remains unclear and warrants scrutiny. To address this gap in dose–response relations in stroke motor rehabilitation, this study investigated the effects of intensive RT on the 8-hydroxy-2′-deoxyguanosine (8-OHdG) level, an oxidative DNA biomarker, in stroke patients. Our goals in this study were to (a) investigate the treatment effects of RT on different outcomes relative to conventional rehabilitation (CR) in patients with stroke, (b) test the dose–response relations by using 2 groups receiving higher intensity and lower intensity RT, and (c) examine the effects of RT training on 8-OHdG, a biomarker of oxidative stress.
More at link.
Tuesday, August 19, 2025
Effects of Robot Assisted Therapy as an Adjunct to Conventional Therapy in Upper Limb Motor Recovery after Stroke
With NO KNOWLEDGE OF EXACTLY HOW NEUROPLASTICITY WORKS, this is useless!
We don't SPECIFICALLY know why a neuron gives up its' current job and takes on a neighbors. Thus nothing on neuroplasticity is scientifically repeatable on demand. So, DEMAND your doctor give you EXACT PROTOCOLS to use. Don't allow your doctor to give you generalities or guidelines.
Effects of Robot Assisted Therapy as an Adjunct to Conventional Therapy in Upper Limb Motor Recovery after Stroke
Dr Sucheta Saha, Dr Nonica Laisram, Dr Ajay Gupta
Department of Physical Medicine & Rehabilitation, Vardhman Mahavir Medical College & Safdarjang
Hospital. Ring Road, Ansari Nagar East, New Delhi-110029
Corresponding Author
Dr Sucheta Saha
B-161, Flat no. 202, First floor, Gujjar Dairy, Gautam Nagar
New Delhi- 110049
Email: dr.sucheta.saha@gmail.com, Telephone no.-9136172451
ABSTRACT
The recovery of upper extremity (UE) function after stroke is slower and less complete than return of
mobility. Neuroplasticity is the key mechanism underlying improvement in functional outcome after stroke.
Robotic devices can stimulate neuroplasticity by providing high-intensity, repetitive, task-specific training.
Aim of this prospective randomized controlled study was to evaluate the efficacy of Robot-assisted therapy as
an adjunct to conventional rehabilitation program in management of UE weakness in stroke patients in terms
of motor recovery & functional outcome.
Sixty four patients, having stroke duration less than two years, included in the study (n=64) and divided in
two groups. Thirty two subjects in control group received conventional rehabilitation program & thirty two
in study group additionally received Robot-assisted therapy using over four weeks. Assessment was done pre
treatment, at 1 month & at 4 months. The outcome measures were: Fugl-Meyer Assessment(FMA) score for
upper extremity & Motor Activity Log scale(MAL) comprising of Amount of Use(AOU) score and Quality of
Use (QOU) score.
Chi-Square test and paired t test were used. Results were considered significant at 5% that is P value<0.05.
The study group exhibited greater motor recovery than the control group on the FMA scores at 1month and
4months. The mean AOU and QOS scores of MAL in the study group were also better than that of control
group at 1month and 4months.
So it can be concluded that Robot-assisted therapy can be used as a complement to conventional therapy for
improving UE function in stroke.
Keywords: Stroke, Rehabilitation, Robotics, Upper extremity.
Thursday, July 17, 2025
Upper limb robotic rehabilitation following stroke: a systematic review and meta-analysis investigating efficacy and the influence of device features and program parameters
It barely works! WHO is going to do the research that gets survivors recovered? ANYONE? Since there is NO stroke leadership, NOTHING WILL GET DONE! Better not have a stroke, because your fucking failures of stroke associations have completely failed at getting stroke solved!
Upper limb robotic rehabilitation following stroke: a systematic review and meta-analysis investigating efficacy and the influence of device features and program parameters
Journal of NeuroEngineering and Rehabilitation 22, Article number: 164 (2025)
Abstract
Background
Following stroke, upper limb impairment is common and frequently limits ability to perform everyday activities. Due to limited resources, current therapy levels are insufficient to optimise functional improvement. Robotic devices have potential to augment upper limb stroke rehabilitation, but knowledge regarding the optimal device features and intervention parameters is limited. This systematic review and meta-analysis aimed to determine the efficacy of upper limb robotic rehabilitation compared with conventional rehabilitation, and to critically explore the device features and programme parameters that influence rehabilitation outcomes.
Methods
Six electronic databases were searched for RCTs that compared dose-matched robotic versus conventional rehabilitation following stroke, and measured activity level changes in upper limb outcomes. The efficacy of robotic compared with conventional rehabilitation was evaluated using random-effects (I2 ≥ 50%) or fixed-effect (I2 < 50%) models. A systematic categorization of robotic device features and intervention parameters was conducted to facilitate subgroup analyses and meta-regression, enabling exploration of how these factors influence rehabilitation outcomes.
Results
The review included 54 studies, involving 2744 participants. Meta-analysis demonstrated that robotic rehabilitation had a small, statistically significant positive effect on upper limb capacity compared with conventional rehabilitation (SMD 0.14, 95% CI [0.02, 0.26]), however these gains were not maintained at follow-up (SMD 0.05, 95% CI [− 0.13, 0.24]). No significant differences were found between robotic and conventional rehabilitation for ADL outcomes either post-treatment (SMD 0.04, 95% CI [– 0.05, 0.13]) or at follow-up (SMD 0.05, 95% CI [− 0.13, 0.24]). Subgroup analyses provided crucial insights into the factors influencing robotic rehabilitation efficacy, revealing significant effects of device assistance (p = 0.0046), joints mobilized (p = 0.0133), degrees of freedom (p = 0.012), device laterality (p = 0.0048), and the number of devices used (p = 0.0001).
Conclusions
The results suggest that robotic rehabilitation does not result in clinically meaningful improvement in either upper limb capacity or ADL performance. However, this study’s novel subgroup analyses highlight specific device features and intervention parameters that significantly influence efficacy. These findings provide critical guidance for the design, implementation, and future research of robotic rehabilitation.
Introduction
Stroke is the third leading cause of adult disability worldwide, with 101 million people living with long-term effects [1]. Amongst people who have had a stroke, around 80% experience upper limb impairment, with 65% still experiencing deficits six months post stroke [2, 3]. This impairment significantly affects individuals’ wellbeing and quality of life by limiting their ability to engage in daily activities [4]. Following a stroke some spontaneous motor recovery occurs, but further improvements usually rely on engagement in rehabilitation delivered by a specialised multidisciplinary team [5, 6]. Effective rehabilitation programmes emphasise high doses of therapy incorporating repetition, challenge, and task-specific practice to promote upper limb recovery [7,8,9]. However, the amount of rehabilitation currently being delivered is often insufficient to elicit optimal functional change, due to limited resourcing of rehabilitation services, shortages of clinicians and high caseloads [10]. Delivering optimum doses of rehabilitation therefore continues to be challenging for stroke services, necessitating a need for enhancing rehabilitation approaches.
The implementation of robotic devices offers a potential solution to address this shortfall by facilitating upper limb movements akin to conventional rehabilitation [11]. Robotic rehabilitation could improve functional outcomes for people recovering from stroke by enabling greater repetitions of upper limb movement, task specific practice and grading of the challenge level [12,13,14]. Rehabilitation robotics are classified according to their placement and the application of force to the upper limb, where exoskeleton devices have an external structural mechanism with the robot axes aligned with the anatomical axes of the wearer [15], whereas end-effector devices are attached to the wearer’s distal upper limb and generate forces at the interface [16].
In this dynamically evolving field, upper limb stroke rehabilitation robotics have been evaluated through randomised control trials (RCTs) to gauge efficacy compared to conventional rehabilitation. Previous systematic reviews have investigated the overall effectiveness of rehabilitation robotics for upper limb rehabilitation following stroke [17,18,19], primarily focusing on ‘body functions and structures’ and ‘activity’ level outcomes according to the International Classification of Functioning, Disability, and Health (ICF) [20]. ‘Body functions and structures’ are defined as the anatomical parts and physiological functions of body systems [20] and include measures of muscle strength and motor control. Systematic reviews evaluating ‘body functions and structures’ level outcomes have shown robotic rehabilitation may lead to significant improvement in hemiparetic upper limb muscle strength [17, 19] and motor control [17] compared with conventional rehabilitation in dose-matched [17] and non-dose matched trials [19]. Whereas Norouzi-Gheidari et al. [18] found comparable improvements in motor control and strength outcomes when robotic and conventional rehabilitation was dose-matched. However, additional sessions of robotic rehabilitation yielded better motor control outcomes compared with conventional rehabilitation alone [18], suggesting increased rehabilitation dosage may enhance ‘body function and structures’ outcomes.
Though there is some evidence to suggest that robotic rehabilitation may improve upper limb outcomes at the ‘body function and structures’ level, these improvements do not necessarily transfer to improved performance at the ‘activities’ level [21]. ‘Activities’ are defined by the ICF as the execution of a task or action by an individual [20]. Measures in this domain evaluates upper limb capacity of performing tasks such as unscrewing a lid or picking up an object [22], or evaluates performance during activities of daily living (ADLs) such as toileting or dressing. While some systematic reviews show improvements in upper limb capacity and ADL performance among people with stroke receiving robotic rehabilitation compared to conventional rehabilitation [19], dose matching remains inconsistent across trials. In dose-matched trials, Veerbeek [17] found no significant differences in upper limb capacity and ADL outcomes, and Norouzi-Gheidari [18] found no significant differences in ADL outcomes comparing robotic therapy with conventional rehabilitation. Consequently, the evidence for robotic rehabilitation’s efficacy at the ‘activity’ level remains uncertain. Favourable outcomes in non-dose matched trials with increased sessions raise questions about whether improvements stem from the robotic treatment itself or simply from the additional volume of rehabilitation delivered.
Beyond dose-matching inconsistencies there are also considerable variations in how robotic rehabilitation interventions are implemented. Studies have employed a range of robotic devices, each with distinct design features, and have implemented them within variable rehabilitation programmes and clinical environments. This has resulted in uncertainty about the best parameters for delivery [23]. To maximise robotic rehabilitation, there is a need to report on, and investigate, the specific features of robotic devices themselves, and the ways the robotic rehabilitation is delivered, which may lead to improved rehabilitation outcomes [24]. Researchers have begun to respond to this need by carrying out RCTs exploring whether features such as gamification of robotic devices [25], level of assistance provided by the device [26], provision of feedback from the device [27], or age of the user [28] has an impact on the effectiveness of robotic rehabilitation. A recent systematic review suggested that device type may be an important feature, with Moggio and colleagues [29] demonstrating that exoskeleton devices were more effective than end-effector devices for improving finger-hand muscle strength [29]. In contrast, Veerbeek’s [17] systematic review reported that end-effector devices were more effective compared to exoskeleton devices for improving motor control outcomes for all upper limb joints [17]. Veerbeek [17] also explored subgroups based on the joint targeted by the device, reporting significantly larger improvements in upper limb muscle strength following robotic rehabilitation targeting the shoulder and elbow joints together compared with devices targeting the elbow, shoulder, wrist, hand, the whole arm, or combinations of these. Mehrholz et al. [30] conducted a network meta-analysis categorising robotic devices by key features and found no significant impact on outcomes based on laterality, device type, device placement, or glove-finger-based design [30]. This small body of emerging evidence suggests some device features may be more important in driving intervention efficacy.
This literature shows that there is uncertainty regarding the effectiveness of upper limb robotic rehabilitation on ‘activity’ level outcomes following stroke, and limited evidence about the robotic device features and programme parameters that impact these outcomes, where many variables remain unexplored. Clarifying best delivery could enhance device design and implementation [23]. Therefore, this systematic review and meta-analysis aimed to 1) determine the efficacy of upper limb robotic rehabilitation on ‘activity’ level outcomes of upper limb capacity and ADL, in comparison with conventional rehabilitation in dose-matched trials, and 2) analyse the robotic device features and programme parameters which may contribute to improved robotic rehabilitation outcomes.
More at link.
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