Efficacy of radial shock wave therapy for ankle spasticity in patients with stroke within 3 months of onset: a prospective quasi-experimental study

So, still a failure; no cure for spasticity. The goal is to cure spasticity, not just reduce it.

When you are the 1 in 4 per WHO that has a stroke with spasticity, you'll want your spasticity cured. You better start solving that now.

Since you are using a subjective measurement scale(Modified Ashworth Scale) nothing here inspires any sort of confidence. In fact I would assume that the participants are using the Hawthorne effect to please the researchers. 

Efficacy of radial shock wave therapy for ankle spasticity in patients with stroke within 3 months of onset: a prospective quasi-experimental study

• Yuichi Hiramatsu,
• Hajime Yagura,
• Hiroaki Fujimoto,
• Megumi Hatakenaka,
• Teiji Kawano,
• Shota Segawa,
• Makiko Rai,
• Ryutaro Hayashi,
• Akihiko Nakae,
• Haruka Asano,
• Takuya Ogawa &
• Ichiro Miyai 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Background

Extracorporeal shock wave therapy (ESWT) is widely used to reduce poststroke spasticity (PSS). However, limited evidence exists regarding its efficacy in patients with stroke within 3 months of onset. Therefore, this study aimed to investigate the association between ESWT administered 1 to 3 months after stroke and changes in spasticity and joint mobility in patients with PSS.

Methods

Prospective quasi-experimental study. Fifty-two patients with PSS affecting the ankle joint were enrolled from March 2023 to March 2025, and allocated into three groups based on the time elapsed from stroke onset: 1, 2, or 3 months. All patients underwent radial ESWT to the gastrocnemius and soleus muscles once weekly for 3 consecutive weeks. Spasticity and joint mobility were evaluated using the Modified Ashworth Scale (MAS) and passive range of motion (PROM) measurements before and after each session, and at 1 and 5 weeks post-treatment.

Results

Except for the MAS score obtained after the first session, significant immediate reductions in the MAS scores and PROM measurements were observed after all shock wave therapy sessions. Compared to baseline, cumulative changes were greatest after the third session, with a mean reduction of 0.6 points in the MAS score and a 6.4° increase in the PROM. These changes were maintained for 5 weeks. No serious adverse events related to shock wave therapy were reported.

Conclusions

ESWT during the early subacute stage was associated with improvements(NOT GOOD ENOUGH!) in spasticity and joint mobility in patients with PSS. Repeated sessions showed greater cumulative changes compared with a single session.

Trial registration UMIN-CTR000050477.

Effects of Segmental Muscle Vibration on Flexor and Extensor Groups of the Upper Limb in Enhancing Functional Recovery After Stroke: A Randomized Trial

Didn't your competent? doctor create a protocol on vibration years ago? Oh, you DON'T have a functioning stroke doctor, do you? Which means your board of directors is completely incompetent also! I'd fire everyone and reconstitute the hospital! I take no prisoners in getting stroke solved and will run over supposedly smart people in the process!

focal muscle vibration (9 posts to May 2020)

vibration (37 posts to February 2011)

Whole Body Vibration Therapy (7 posts to January 2016)

Effects of Segmental Muscle Vibration on Flexor and Extensor Groups of the Upper Limb in Enhancing Functional Recovery After Stroke: A Randomized Trial

Author links open overlay panel, , , , , 

https://doi.org/10.1016/j.jbmt.2025.07.019Get rights and content

Highlights

• •
  This randomized controlled trial evaluated the differential effects of segmental vibration therapy significantly improved upper limb function, reduced spasticity, and enhanced motor recovery in post-stroke patients over six weeks.
• •
  Flexor-targeted SVT showed consistent improvements in functional ability and spasticity reduction.
• •
  Extensor-targeted SVT) demonstrated greater gains in motor recovery, suggesting potential benefits for targeting extensor pathways.
• •
  SVT may be a valuable adjunct to neurorehabilitation, with muscle-specific and phase-oriented approaches enhancing therapeutic outcomes.

Abstract

Background

Upper limb motor impairment is a common sequela of stroke, often leading to long-term functional limitations. Segmental vibration therapy (SVT) has been proposed to facilitate sensorimotor recovery by enhancing proprioceptive input and cortical excitability. However, its differential effects on upper limb flexor and extensor muscle groups remain underexplored.

Objective

The objective of this study was to determine the effects of segmental vibration on flexors and extensor muscle groups for upper limb functional ability, recovery, and spasticity in post-stroke patients.

Methodology

This two-arm, parallel-design, double-blinded randomized clinical trial was conducted at Zohra Institute of Health Sciences. A total of 62 patients were recruited using a non-probability convenience sampling technique and randomized into two groups through an online randomization tool. Group A received low-frequency segmental muscle vibration (41 Hz) applied over the flexor muscles of the upper limb, along with routine physical therapy. Group B received the same vibration frequency applied to the extensor muscles of the upper limb, in addition to routine physical therapy. Stroke patients with spasticity graded 1–3 on the Modified Ashworth Scale and who were 3–6 months post-stroke were included in the study. The intervention lasted for six weeks, comprising 18 sessions (three sessions per week). The Wolf Motor Function Test (WMFT) was used to assess upper extremity functional ability, while the Fugl-Meyer Assessment (FMA) evaluated motor function. Muscle spasticity was measured using the Modified Ashworth Scale (MAS), and motor recovery stages were assessed via the Brunnstrom scale. Data analysis was performed using SPSS version 26. An independent t-test was used for between-group comparisons, and a paired t-test was applied for within-group analysis.

Results

Post-intervention, WMFT scores improved in Group A (60.93 ± 6.12) compared to Group B (58.45 ± 7.66), though the difference was not statistically significant (p = 0.207). MAS scores decreased in Group A (0.56 ± 0.58) versus Group B (0.72 ± 0.74; p = 0.151). BSMR scores improved in both Group A (4.94 ± 1.19) and Group B (5.25 ± 1.23; p = 0.148). FMA scores increased in Group A (57.41 ± 3.97) compared to Group B (53.61 ± 4.89; p = 0.151). However, none of the between-group differences reached statistical significance.

Conclusion

The findings of this study suggest that segmental vibration therapy applied to both flexor and extensor muscles effectively improves upper limb function in post-stroke patients. However, no statistically significant difference was observed between the effects of vibration therapy on the two muscle groups.

Trial Registration

The trial registration number for this study is NCT05356481. The trial started on May 2, 2022, and was completed on June 30, 2023.

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High Repetition Activity in Stroke Rehabilitation

 You really do know ABSOLUTELY NOTHING ABOUT STROKE RECOVERY, DO YOU? Nothing about motivation or why you don't want to do high intensity training!

My conclusion is you don't understand ONE GODDAMN THING ABOUT SURVIVOR MOTIVATION/ENGAGEMENT, DO YOU? You create EXACT 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE!

Your competent? doctor WILL 100% GUARANTEE that HIT(High intensity training) will not cause a stroke? By verifying that your aneurysms will not blow out? Not just pooh poohing your question?

Do you really want to do high intensity training?

Because Andrew Marr blames high-intensity training for his stroke. 

Can too much exercise cause a stroke?

The latest here:

High Repetition Activity in Stroke Rehabilitation

Author links open overlay panel

https://doi.org/10.1016/j.apmr.2025.01.230

Get rights and content

Objectives

To investigate the effect of a high-repetition active motion home program in stroke rehabilitation.

Design

Institutional review board–approved case series with ten stroke survivor participants, at least 3 months poststroke. The in-clinic visits included pre and postintervention tests, training of device use, and a 2-week home-based intervention.

Setting

Outpatient therapy services clinic for testing and training and home setting for intervention.

Participants

All participants provided written informed consent per the institutional review board. Inclusion and exclusion criteria was used for selection of ten observational stroke survivor participants, at least 3 months poststroke. Referral was from Johns Hopkins physicians and outpatient therapy clinicians.

Interventions

Pre and postintervention arm function were measured in-clinic using the Action Research Arm Test (ARAT) and spasticity using the Modified Ashworth Scale (MAS). Participants completed a preintervention and postintervention survey on the ease of use of the device. Participants were trained in the use of the device and given a structured home-based 6 x week program including a recommended 600 reps. per day of active arm motion using the device, self-stretches, and functional use of the affected arm.

Main Outcome Measures

Arm function test using ARAT, spasticity using MAS, a preintervention and postintervention ease of device use survey, 3 postintervention open-ended questions about challenges in use of the device, adherence to the prescribed program, and motivation to use the affected arm in daily activities.

Results

The average number of repetitions achieved by each participant per day was 899.5±423. The ARAT score for arm function increased by (mean±SD) 7.1±3.9 and the MAS score for spasticity reduced by 1.0±0.6. Subjectively, there was increased reported actual the ease of use of the device postintervention compared with that anticipated preintervention; 90% of the participants reported little difficulty completing the program despite stroke- and device-related challenges and expressed increased motivation to use the arm.

Conclusions

A structured home program using high-repetition gaming devices may mitigate barriers to motivation, adherence, accessibility, and participation for stroke survivors. This study demonstrates the effect of a high-repetition active motion program at home in moderately impaired stroke survivors(So you are willing to let other survivors languish because you INCOMPETENTLY did not plan on getting them recovered?) with measurable clinically important differences in arm function and spasticity scores in a short time frame. Key ingredients include a gaming device designed for moderately impaired stroke survivors, detailed instructions on using the device, stretching, and arm use for daily activities provided by an occupational therapist.

Disclosures

none.

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A systematic review of upper extremity outcome measures assessed in randomized controlled trials of post stroke upper extremity rehabilitation over time

 Yep, the standard outcome measure for all stroke interventions should be 100% recovery. Not this tyranny of low expectations your stroke medical 'professionals' are pushing on you because they are completely failing at their only job; 100% recovery for all!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? Your patients need an explanation of why you aren't working on 100% recovery protocols.

Why isn't your doctor solving stroke?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem?

A systematic review of upper extremity outcome measures assessed in randomized controlled trials of post stroke upper extremity rehabilitation over time

Robert Teasell

,

Sarvenaz Mehrabi

,

Marcus Saikaley

,

Catherine George

,

Sean P. Dukelow

,

Amber Harnett

& show all

Received 05 Jan 2024, Accepted 17 Aug 2024, Published online: 11 Sep 2024

• Cite this article
• https://doi.org/10.1080/10749357.2024.2395723
• CrossMark

ABSTRACT

Background

The heterogeneity in outcome measures of post stroke rehabilitation trials suggests the need for consensus approach in stroke recovery measurement. To reach this aim, it is important to understand the past and current use of outcome measures in randomized control trials (RCTs) of stroke rehabilitation.

Objective

To systematically review RCTs of post stroke UE rehabilitation interventions to understand the use of UE outcome measures in research and their changes over time.

Methods

CINAHL, Embase, PubMed, Scopus and Web of Science were searched from 1960 to 1 April 2021. Studies were eligible for inclusion if they (1) were RCTs or crossovers published in English (2) ≥50% of participants were affected by stroke, 3) included adults ≥ 18 years old, and (4) applied an intervention to the hemiparetic UE as the primary objective of the study.

Results

1,276 RCTs met inclusion criteria, and 112 different outcome measures were identified. Outcome measures were classified according to the International Classification of Functioning, Disability and Health (ICF) framework. Outcome measures most frequently assessed body function and structure (n = 1,692), followed by activities (n = 1,572) and participation (n = 162). The most used outcome measures were the Fugl-Meyer Assessment (n = 619), the modified Ashworth Scale (n = 255), Action Research Arm Test (n = 211), Wolf Motor Function Test (n = 184), and Box and Block Test (n = 178).

Using Fugl-Meyer for anything in stroke is the height of stupidity, nothing objective in it, so nothing is repeatable.

Since you are using subjective measurement scales(Fugl-Meter and Modified Ashworth Scale) nothing here inspires any sort of confidence. In fact I would assume that the participants are using the Hawthorne effect to please the researchers.

 

 

Conclusions

Understanding the breadth of outcome measures that have been used over time emphasizes the need for proposed standardization of outcome measures but also the need to adjust and expand consensus recommendations based on past and ongoing research trends.

A Case Series Clinical Trial of a Novel Approach Using Augmented Reality That Inspires Self-body Cognition in Patients With Stroke: Effects on Motor Function and Resting-State Brain Functional Connectivity

Since you are using subjective measurement scales(Fugl-Meter and Modified Ashworth Scale) nothing here inspires any sort of confidence. In fact I would assume that the participants are using the Hawthorne effect to please the researchers.

A Case Series Clinical Trial of a Novel Approach Using Augmented Reality That Inspires Self-body Cognition in Patients With Stroke: Effects on Motor Function and Resting-State Brain Functional Connectivity

Fuminari Kaneko^1,2*, Keiichiro Shindo^1,2, Masaki Yoneta^1,2,3, Megumi Okawada^1,2,3, Kazuto Akaboshi^1,2,3 and Meigen Liu¹

• ¹Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
• ²Department of Rehabilitation, Shonan Keiiku Hospital, Fujisawa, Japan
• ³Hokuto Social Medical Corporation, Obihiro, Japan

Barring a few studies, there are not enough established treatments to improve upper limb motor function in patients with severe impairments due to chronic stroke. This study aimed to clarify the effect of the kinesthetic perceptional illusion induced by visual stimulation (KINVIS) on upper limb motor function and the relationship between motor function and resting-state brain networks. Eleven patients with severe paralysis of upper limb motor function in the chronic phase (seven men and four women; age: 54.7 ± 10.8 years; 44.0 ± 29.0 months post-stroke) participated in the study. Patients underwent an intervention consisting of therapy using KINVIS and conventional therapeutic exercise (TherEX) for 10 days. Our originally developed KiNvis™ system was applied to induce KINVIS while watching the movement of the artificial hand. Clinical outcomes were examined to evaluate motor functions and resting-state brain functional connectivity (rsFC) by analyzing blood-oxygen-level-dependent (BOLD) signals measured using functional magnetic resonance imaging (fMRI). The outcomes of motor function (Fugle-Meyer Assessment, FMA) and spasticity (Modified Ashworth Scale, MAS) significantly improved after the intervention. The improvement in MAS scores for the fingers and the wrist flexors reached a minimum of clinically important differences. Before the intervention, strong and significant negative correlations between the motor functions and rsFC of the inferior parietal lobule (IPL) and premotor cortex (PMd) in the unaffected hemisphere was demonstrated. These strong correlations were disappeared after the intervention. A negative and strong correlation between the motor function and rsFC of the bilateral inferior parietal sulcus (IPS) significantly changed to strong and positive correlation after the intervention. These results may suggest that the combination approach of KINVIS therapy and TherEX improved motor functions and decreased spasticity in the paralyzed upper extremity after stroke in the chronic phase, possibly indicating the contribution of embodied-visual stimulation. The rsFC for the interhemispheric IPS and intrahemispheric IPL and PMd may be a possible regulatory factor for improving motor function and spasticity.
Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01274117.

Effects of Transcranial Direct Current Stimulation (tDCS) Combined with Wrist Robot-assisted Rehabilitation on Motor Recovery in Subacute Stroke Patients: A Randomized Controlled Trial

There seems to be no objective diagnosis of damage so this will never be repeatable and usable in creating a stroke rehab protocol. 

The Fugl-Meyer upper extremity scale has no objective distinction for changes in ability and thus would be useless as a measurement tool.

The Modified Ashworth Scale is way too subjective to be of any use in knowing if improvements are occurring.  

 

Effects of Transcranial Direct Current Stimulation (tDCS) Combined with Wrist Robot-assisted Rehabilitation on Motor Recovery in Subacute Stroke Patients: A Randomized Controlled Trial

Mazzoleni S, Tran VD, Dario P, Posteraro F.

Abstract

Both transcranial direct current stimulation (tDCS) and wrist robot-assisted training have demonstrated to be promising approaches for stroke rehabilitation. However, the effects of the combination of the two treatments in subacute stroke patients are not yet clear. To investigate the effectiveness of combining tDCS and wrist robot-assisted rehabilitation in subacute stroke patients in comparison with the wrist robotic training only, a single-blind, randomized, sham-controlled trial was performed with 40 subacute stroke patients (25 ± 7 days from stroke onset time). Patients were randomly assigned to experimental group (EG, n = 20) where patients receive real tDCS (2mA, 20 minutes, the anodal electrode on the primary motor cortex -M1 -area of the affected hemisphere(C3/C4 in the 10-20 EEG system and the cathodal electrode on the contralateral orbit bone) or control group (CG, n = 20) where patients receive sham tDCS (5 seconds) during wrist robotic rehabilitation training. The effects of the treatment were evaluated by means of the upper extremity, shoulder-elbow and wrist subsections of the Fugl-Meyer Assessment Scale, Modified Ashworth Scale, Motricity Index and Box & Block test together with kinematic parameters. One out of 20 patients in the CG did not complete the treatment. All the clinical outcome measures except the Modified Ashworth Scale showed a significant increase after the treatment in both groups. However, no significant difference in the average changes after treatment between groups was observed. The movement velocity and smoothness showed significant increases after the training, even though no significant difference between groups was observed. The combination of wrist robot-assisted training and tDCS did not show additional effects in comparison with wrist robot-assisted training only in subacute stroke patients. The negative results found in this study are specific for the specific intervention. The timing of delivering the tDCS and the robot-assisted therapy has to be deeply investigated to enhance the effectiveness of the training.

PMID:

31170077

DOI:

10.1109/TNSRE.2019.2920576

Distal versus proximal-an investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: a randomized controlled trial

Nothing here even suggests they have an objective starting point. Thus none of this is repeatable research and you can't make any conclusions from this.

The Fugl-Meyer upper extremity scale has no objective distinction for changes in ability and thus would be useless as a measurement tool. 

Using the Action Research Arm Test for validation is not useful, it is subjective.

The Modified Ashworth Scale is way too subjective to be of any use in knowing if improvements are occurring.  

 

Distal versus proximal-an investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: a randomized controlled trial

• Qiuyang QIAN,
• Chingyi Nam,
• Ziqi Guo,
• Yanhuan Huang,
• Xiaoling HuEmail authorView ORCID ID profile,
• Stephanie C. Ng,
• Yongping Zheng and
• Waisang Poon

Journal of NeuroEngineering and Rehabilitation201916:64

https://doi.org/10.1186/s12984-019-0537-5

©  The Author(s). 2019

• Received: 21 September 2018
• Accepted: 16 May 2019
• Published: 3 June 2019

Abstract

Background

Different mechanical supporting strategies to the joints in the upper extremity (UE) may lead to varied rehabilitative effects after stroke. This study compared the rehabilitation effectiveness achieved by electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robotic systems when supporting to the distal fingers and to the proximal (wrist-elbow) joints.

Methods

Thirty subjects with chronic stroke were randomly assigned to receive motor trainings with NMES-robotic support to the finger joints (hand group, n = 15) and with support to the wrist-elbow joints (sleeve group, n = 15). The training effects were evaluated by the clinical scores of Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Modified Ashworth Scale (MAS) before and after the trainings, as well as 3 months later. The cross-session EMG monitoring of EMG activation level and co-contraction index (CI) were also applied to investigate the recovery progress of muscle activations and muscle coordination patterns through the training sessions.

Results

Significant improvements (P < 0.05) in FMA full score, FMA shoulder/elbow (FMA-SE) and ARAT scores were found in both groups, whereas significant improvements (P < 0.05) in FMA wrist/hand (FMA-WH) and MAS scores were only observed in the hand group. Significant decrease of EMG activation levels (P < 0.05) of UE flexors was observed in both groups. Significant decrease in CI values (P < 0.05) was observed in both groups in the muscle pairs of biceps brachii and triceps brachii (BIC&TRI) and the wrist-finger flexors (flexor carpi radialis-flexor digitorum) and TRI (FCR-FD&TRI). The EMG activation levels and CIs of the hand group exhibited faster reductions across the training sessions than the sleeve group (P < 0.05).

Conclusions

Robotic supports to either the distal fingers or the proximal elbow-wrist could achieve motor improvements in UE. The robotic support directly to the distal fingers was more effective than to the proximal parts in improving finger motor functions and in releasing muscle spasticity in the whole UE.

Clinical trial registration

ClinicalTrials.gov, identifier NCT02117089; date of registration: April 10, 2014. https://clinicaltrials.gov/ct2/show/NCT02117089

The Effect of Repeated Botulinum Toxin A Therapy Combined with Intensive Rehabilitation on Lower Limb Spasticity in Post-Stroke Patients

Looking back at my use of Botox, I really saw no benefit. None of the antagonist muscles to the spastics ones were ever able to overpower the spastic muscles post treatment. 

The Effect of Repeated Botulinum Toxin A Therapy Combined with Intensive Rehabilitation on Lower Limb Spasticity in Post-Stroke Patients

Takatoshi Hara 1,2,*, Masahiro Abo 1, Hiroyoshi Hara 2, Nobuyuki Sasaki 1, Naoki Yamada 1, Masachika Niimi 1 and Yusuke Shimamoto 2 1 Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan; abo@jikei.ac.jp (M.A.); nobsasa1005@gmail.com (N.S.); mela012921@yahoo.co.jp (N.Y.); pomardon2010@gmail.com (M.N.) 2 Department of Rehabilitaion Medicine, Kikyogahara Hospital 1295, 3996461 Nagano, Japan; hhara448@orange.plala.or.jp (H.H.); shimamoto@keijin-kai.jp (Y.S.) * Correspondence: t_hara1019@jikei.ac.jp
Received: 15 August 2018; Accepted: 30 August 2018; Published: 31 August 2018

Abstract:

Objectives: This study is a retrospective investigation of the effects of repetitive botulinum toxin A therapy (BoNT-A) and intensive rehabilitation (IR) on lower limb spasticity in post-stroke patients. Methods: Thirty-five post-stroke patients was included in this study and received BoNT-A forthefirsttime. A 12-day in patient protocol was with 4 cycles of the treatment protocol. The severity of spasticity, motor function and brace status were evaluated.
Results: The modified Ashworth Scale (MAS) score of ankle dorsiflexors, range of motion, walking speed and balancing ability were significantly improved after cycle1. The improvement of spasticity and motor function was persistent through cycles 2–4. One-third of brace users were able to discontinue the use of a brace. All of these brace users showed a forward gait pattern prior to therapy.
Conclusions: Repeated BoNT-A combined with IR improved lower limb spasticity in post-stroke patients. Our results suggest that patients who show the forward gait pattern prior to therapy may be able to discontinue the use of their brace after therapy.

Translation of robot-assisted rehabilitation to clinical service: a comparison of the rehabilitation effectiveness of EMG-driven robot hand assisted upper limb training in practical clinical service and in clinical trial with laboratory configuration for chronic stroke

And just where the fuck is the protocol from this? Or are you too lazy to even do that much for survivors?  

Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'
Politeness will never solve anything in stroke.

Translation of robot-assisted rehabilitation to clinical service: a comparison of the rehabilitation effectiveness of EMG-driven robot hand assisted upper limb training in practical clinical service and in clinical trial with laboratory configuration for chronic stroke 

• Yanhuan Huang

,

Will Poyan Lai

,

Qiuyang Qian

,

Xiaoling HuEmail author,

Eric W. C. Tam

and

Yongping Zheng

201817

:91

https://doi.org/10.1186/s12938-018-0516-2

©  The Author(s) 2018

Received: 27 February 2018

Accepted: 12 June 2018

Published: 25 June 2018

Abstract

Background

Rehabilitation robots can provide intensive physical training after stroke. However, variations of the rehabilitation effects in translation from well-controlled research studies to clinical services have not been well evaluated yet. This study aims to compare the rehabilitation effects of the upper limb training by an electromyography (EMG)-driven robotic hand achieved in a well-controlled research environment and in a practical clinical service.

Methods

It was a non-randomized controlled trial, and thirty-two participants with chronic stroke were recruited either in the clinical service (n = 16, clinic group), or in the research setting (n = 16, lab group). Each participant received 20-session EMG-driven robotic hand assisted upper limb training. The training frequency (4 sessions/week) and the pace in a session were fixed for the lab group, while they were flexible (1–3 sessions/week) and adaptive for the clinic group. The training effects were evaluated before and after the treatment with clinical scores of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS).

Results

Significant improvements in the FMA full score, shoulder/elbow and wrist/hand (P < 0.001), ARAT (P < 0.001), and MAS elbow (P < 0.05) were observed after the training for both groups. Significant improvements in the FIM (P < 0.05), MAS wrist (P < 0.001) and MAS hand (P < 0.05) were only obtained after the training in the clinic group. Compared with the lab group, higher FIM improvement in the clinic group was observed (P < 0.05).

Conclusions

The functional improvements after the robotic hand training in the clinical service were comparable to the effectiveness achieved in the research setting, through flexible training schedules even with a lower training frequency every week. Higher independence in the daily living and a more effective release in muscle tones were achieved in the clinic group than the lab group.