End-effector or exoskeleton in finger-hand stroke rehabilitation: Which is the best choice?

Had to look up end effector devices and still don't understand.

End-effector or exoskeleton in finger-hand stroke rehabilitation: Which is the best choice?

L. Moggio1 , N. Marotta1 , A. Demeco1 , C. Marinaro1 , A. Petraroli1 , I. Pino1 , R.C. Meliado’2 , L. Fratto2 , A. Ammendolia1,2 1 Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy, 2 A.O.U. Mater Domini, Catanzaro, Italy 

 

Background and Aims: 

 

A new proposal for treating stroke outcomes is robot-assisted therapy. Gassert and Dietz classified upper limb rehabilitation robots into end effectors (EE) and exoskeletons (EXO). This study aimed to compare the relative effects of EE and EXO devices in motor recovery and disability and its impact on the quality of life of patients with finger-hand motor impairment post-stroke. 

 

Methods: 

 

We conducted a search to select randomized controlled trials (RCTs) on PubMed, Embase, MEDLINE, the Cochrane library. We considered as outcomes: motility index (MI), quick version of the arm, shoulder and hand disability questionnaire (QuickDASH) and evaluation Fugl-Meyer for the upper extremity (FMAUE). To compare efficacy, we performed a network meta-analysis and a surface under cumulative ranking analysis (SUCRA). 

 

Results: 

 

Five RTCs and 149 subjects were included. A significant decrease in QuickDASH (p <0.05) was observed in the EXO group (ES: -6.71; CI: -9.17, -4.25). FMAUE showed a significant increase (p <0.05) in the EE group (ES: 3; CI: 1.97, 4.04). The SUCRA analysis of MI demonstrated that robotic rehabilitation is more likely to be the best alternative for motor recovery (97.3% EXO probability; 48.3% EE; 4.4% control). 

 

Conclusions: 

 

EXO devices appear to be a better option than EE devices in the treatment of finger-hand motor disability associated with traditional rehabilitation, with important implications in hand motor recovery and reduction of disability. More research is needed focusing on direct comparison of the two devices.