Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review

Abstract

BACKGROUND: Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE: To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS: The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS: Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION: Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.

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“…Approximately 70–80% of stroke survivors have limb motor impairments, especially upper limb impairment, which directly impacts the quality of life (QOL) and social reintegration [ 3 ]. There is an important effort worldwide to establish therapeutic strategies and novel technologies to improve upper limb function after stroke, such as functional electrical stimulation (FES) [ 4 ], robotic-assisted therapy (RAT) [ 5 ], and task-oriented therapy (TOT) [ 6 ]. Unfortunately, six months after stroke, approximately 65% of patients still cannot incorporate the affected arm and hand into their daily activities [ 7 , 8 ].…”

Synergy-based functional electrical stimulation and robotic-assisted for retraining reach-to-grasp in stroke: a study protocol for randomised controlled trial

“…70-80% of stroke survivors have limb motor impairments, especially for upper limb, which directly impact quality of life (QOL) and social reintegration [3]. There is an important effort worldwide to establish therapeutic strategies and novel technologies to improve the upper limb function after stroke, such as functional electrical stimulation (FES) [4], robotic-assisted therapies (RAT) [5], task-oriented therapies (TOT) [6], and etc. Unfortunately, six months after stroke, about 65% of the patients still cannot incorporate the affected arm and hand into their daily activities [7,8].…”