Effectiveness of robot-assisted arm therapy in stroke rehabilitation: An overview of systematic reviews

Abstract

BACKGROUND: Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs). OBJECTIVE: The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments. METHODS: The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality of the included SRs was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction. RESULTS: 18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity. CONCLUSION: RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results.

Effects of Upper Limb Robot-Assisted Rehabilitation Compared with Conventional Therapy in Patients with Stroke: Preliminary Results on a Daily Task Assessed Using Motion Analysis

“…Numerous studies have been published on the topic of upper limb RAT for post-stroke patients, showing promising results for improving arm function, arm muscle strength, and the activities of daily living [ 11 , 12 ]. According to a very recent synthesis of the available systematic reviews [ 13 ], RAT had beneficial impacts on motor function and muscular strength, while there was no consensus on muscle tone effects, and just one systematic review reported a good impact of RAT on daily living activities. Therefore, RAT may be a beneficial choice for improving upper limb motor function and muscular strength.…”

Robotically driven Error Augmentation training enhances post‐stroke arm motor recovery

“…In addition, executing assisted movements may not provide the appropriate proprioceptive feedback or afferent messages from muscles as compared to fully active movement. [15][16][17][18] Error Augmentation (EA) training was developed to overcome these drawbacks. During normal adaptation, the proprioceptive, cutaneous, and visual feedback perceived during movement execution are utilized to calibrate the motor output on the next trial.…”

“…However, this type of therapy may not maximally motivate the patients to make a sufficient effort to promote motor plasticity. In addition, executing assisted movements may not provide the appropriate proprioceptive feedback or afferent messages from muscles as compared to fully active movement 15–18 …”

Post-Stroke Rehabilitation: Challenges and New Perspectives

“…In the light of this scenario, with the aim of evaluating the efficacy of a specific therapy for the motor and cognitive recovery of patients with neurological disease, the aggregation of numerical data (as done in systematic reviews) is not always useful to deduce the dilemma. An example of this is a recent review of systematic reviews of robotics which showed that in the face of primary studies of excellent quality, most of the systematic reviews lack sufficient methodological quality with few exceptions [ 9 ].…”