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Background: Upper limb (UL) motor impairment following stroke is a leading cause of functional limitations in activities of daily living. Robot-assisted therapy supports rehabilitation, but how its efficacy and the underlying neural mechanisms depend on the time after stroke is yet to be assessed., Aim: We investigated the response to an intensive protocol of robot-assisted rehabilitation in sub-acute and chronic stroke patients, by analyzing the underlying changes in clinical scores, electroencephalography (EEG) and end-effector kinematics. We aimed at identifying neural correlates of the participants' upper limb motor function recovery, following an intensive 2-week rehabilitation protocol., Design: Prospective cohort study., Setting: Inpatients and outpatients from the Neurorehabilitation Unit of Pisa University Hospital, Italy., Population: Sub-acute and chronic stroke survivors., Methods: Thirty-one stroke survivors (14 sub-acute, 17 chronic) with mild-to-moderate UL paresis were enrolled. All participants underwent ten rehabilitative sessions of task-oriented exercises with a planar end-effector robotic device. All patients were evaluated with the Fugl-Meyer Assessment Scale and the Wolf Motor Function Test, at recruitment (T0), end-of-treatment (T1), and one-month follow-up (T2). Along with clinical scales, kinematic parameters and quantitative EEG were collected for each patient. Kinematics metrics were related to velocity, acceleration and smoothness of the movement. Relative power in four frequency bands was extracted from the EEG signals. The evolution over time of kinematic and EEG features was analyzed, in correlation with motor recovery., Results: Both groups displayed significant gains in motility after treatment. Sub-acute patients displayed more pronounced clinical improvements, significant changes in kinematic parameters, and a larger increase in Beta-band in the motor area of the affected hemisphere. In both groups these improvements were associated to a decrease in the Delta-band of both hemispheres. Improvements were retained at T2., Conclusions: The intensive two-week rehabilitation protocol was effective in both chronic and sub-acute patients, and improvements in the two groups shared similar dynamics. However, stronger cortical and behavioral changes were observed in sub-acute patients suggesting different reorganizational patterns., Clinical Rehabilitation Impact: This study paves the way to personalized approaches to UL motor rehabilitation after stroke, as highlighted by different neurophysiological modifications following recovery in subacute and chronic stroke patients.

Neurological disorders, including stroke, spinal cord injuries, multiple sclerosis, and Parkinson's disease, generally lead to diminished upper extremity (UE) function, impacting individuals' independence and quality of life. Traditional assessments predominantly focus on standardized clinical tasks, offering limited insights into real-life UE performance. In this context, this review focuses on wearable technologies as a promising solution to monitor UE function in neurologically impaired individuals during daily life activities. Our primary objective is to categorize the different sensors, review the data collection and understand the employed data processing approaches. After screening over 1500 papers and including 21 studies, what comes to light is that the majority of them involved stroke survivors, and predominantly employed accelerometers or inertial measurement units to collect kinematics. Most analyses in these studies were performed offline, focusing on activity duration and frequency as key metrics. Although wearable technology shows potential in monitoring UE function in real-life scenarios, it also appears that a solution combining non-intrusiveness, lightweight design, detailed hand and finger movement capture, contextual information, extended recording duration, ease of use, and privacy protection remains an elusive goal. These are critical characteristics for a monitoring solution and researchers in the field should try to integrate the most in future developments. Last but not least, it stands out a growing necessity for a multimodal approach in capturing comprehensive data on UE function during real-life activities to enhance the personalization of rehabilitation strategies and ultimately improve outcomes for these individuals.