Background Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing. Objective To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke. Methods A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council. Results All outcomes but SSQoL significantly improved over time in both groups ( P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points ( P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8). Conclusions Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.

Aquatic exercises have been demonstrated to benefit the facilitation of motor recovery and the enhancement of well-being in middle-aged adults and the elderly. Personalization, immersiveness, and biofeedback are key for amplifying and accelerating any rehabilitation process in neurological and orthopedic patients. However, a therapist can neither properly visualize nor monitor rehabilitation exercises executed under water, nor can he/she measure them. Therefore, the present study aims to provide adaptive biofeedback during aquatic exercises in order to enhance the training's effectiveness. A wearable biofeedback suit equipped with wearable underwater-resistant sensor nodes has been designed, produced, and tested. A dedicated algorithm for quantitatively extracting joint angles has been developed and validated against the optical tracking system. Multiple biofeedback modalities are proposed based on visual feedback: amplitude control with set target angles; velocityamplitude control with set target angles and angular velocity; and velocity tutor with set target angles, a frequency value, and a rest period. Joint angles estimated using the sensor network are compared to those estimated using an optical tracking system with the root-mean-squared angle error between the two systems ranging from 4.0° to 6.3° and a significant correlation coefficient that is always greater than 0.99. Pilot tests during aquatic exercises executed in a thermal environment demonstrate the feasibility and usability of the complete system in the final working environment. The relevant angles are correctly calculated and monitored online during the exercises, and the tested subjects understand the implemented biofeedback modalities easily and follow them well as the SUS evaluation indicates. 0018-9456 (c)

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Objective: To investigate the effects of cycling with functional electrical stimulation on walking, muscle power and tone, balance and activities of daily living in subacute stroke survivors. Data Sources: Ten electronic databases were searched from inception to February 2020. Review methods: Inclusion criteria were: subacute stroke survivors (<6 months since stroke), an experimental group performing any type of cycling training with electrical stimulation, alone or in addition to usual care, and a control group performing usual care alone. Two reviewers assessed eligibility, extracted data and analyzed the risks of bias. Standardized Mean Difference (SMD) or Mean Difference (MD) with 95% Confidence Intervals (CI) were estimated using fixed- or random-effects models to evaluate the training effect. Results: Seven randomized controlled trials recruiting a total of 273 stroke survivors were included in the meta-analyses. There was a statistically significant, but not clinically relevant, effect of cycling with electrical stimulation compared to usual care on walking (six studies, SMD [95% CI] = 0.40 [0.13, 0.67]; P = 0.004), capability to maintain a sitting position (three studies, MD [95% CI] = 7.92 [1.01, 14.82]; P = 0.02) and work produced by the paretic leg during pedaling (2 studies, MD [95% CI] = 8.13 [1.03, 15.25]; P = 0.02). No significant between-group differences were found for muscular power, tone, standing balance, and activities of daily living. Conclusions: Cycling training with functional electrical stimulation cannot be recommended in terms of being better than usual care in subacute stroke survivors. Further investigations are required to confirm these results, to determine the optimal training parameters and to evaluate long-term effects.

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