Robotic approaches for the rehabilitation of upper limb recovery after stroke: a systematic review and meta-analysis

Abstract

This systematic review with a meta-analysis of studies was carried out to evaluate the effectiveness of robotic training (RT) and conventional training (CT) in improving the motor recovery of paretic upper limbs in stroke patients. Numerous electronic databases were searched from January 2000 to May 2016. Finally, 13 randomized-controlled trials fulfilled the inclusion criteria and were included in the three meta-analyses. The first meta-analysis carried out for those studies using RT for stroke patients indicated a significant improvement in the RT groups. The second meta-analysis suggested that the upper limb function (measured by Fugl-Meyer test) was significantly improved when RT was used with CT compared with CT alone. The third meta-analysis noted a significant difference in motor recovery between the CT-only and RT groups (RT only or RT combined with CT) in the chronic stages of stroke, but not in the acute or subacute stages. However, the RT group also showed a higher Fugl-Meyer score in patients at both the acute and the subacute stage. RT appeared to have positive outcomes to enhance motor recovery of the paralyzed upper limb. Robotic devices were believed to provide more assistance to patients to help support the weight of the upper limb; thus, active movement training can begin in the early rehabilitation stage. These novel devices may also help those chronic patients to achieve better rehabilitation goals. As a summary, RT could be used in addition to CT to help both therapists and patients in the management of the paralyzed upper limb.

Exoskeleton and End‐Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review

“…Recently, Zhang et al [40] evaluated the effectiveness of robotic training and conventional training in improving the motor recovery of paretic upper limbs in stroke patients. They found significant differences in motor recovery between the conventional and robotic groups in chronic stroke patients but not in the acute/subacute stage.…”

Upper-Limb Exoskeletons for Stroke Rehabilitation

“…The effects of robotic devices on rehabilitative outcomes after stroke have been strongly investigated through randomized controlled trials (RCT) and, in the latest years, through systematic reviews and meta-analysis [29,19,28]. Robotic training can be used in addition to usual care to help both therapists and patients in the management of the paralyzed upper-limb and to achieve better rehabilitation outcomes [29].…”

“…The effects of robotic devices on rehabilitative outcomes after stroke have been strongly investigated through randomized controlled trials (RCT) and, in the latest years, through systematic reviews and meta-analysis [29,19,28]. Robotic training can be used in addition to usual care to help both therapists and patients in the management of the paralyzed upper-limb and to achieve better rehabilitation outcomes [29]. A recent Cochrane review, including 34 trials (1160 participants), demonstrated that stroke patients who receive electromechanical and robot-assisted arm and hand training after stroke might improve their ADL, arm and hand function and strength [19].…”

Effectiveness of interventions to improve hand motor function in individuals with moderate to severe stroke: a systematic review protocol

“…According to our knowledge of the literature, ample summary of the efficacy of various interventions for upper limb function rehabilitation in stroke patients can be found in published systematic reviews. Most of these reviews evaluate the efficacy of a single category of therapeutic technique, such as CIMT,25–29 robot-assisted therapy,30–35 bilateral training,36 37 task-oriented training,38 exercise therapy,39 functional electrical stimulation (FES),40 41 orthotics,42 43 mental practice,44 45 mirror therapy,46 47 action observation,48 non-invasive cerebral stimulation,49–52 brain-computer interface,53 54 virtual reality,42 home‐based therapy programmes55 and so on. There are also some comprehensive systematic reviews on general function treatment of upper limb after stroke56–58 or other specific problems, such as motor dysfunction,59 60 sensory impairment,61 spasticity,62 63 decreased quality of life,64 and shoulder pain and subluxation 65–67.…”