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• The rehabilitation effects of the NMES robotic hand and robotic hand were compared. • Both training systems could significantly improve the motor function of upper limb. • The NMES robot was more effective than the pure robot. • NMES applied on distal muscle could benefit the recovery in the entire upper limb. To compare the rehabilitation effects of the electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) robotic hand and EMG-driven robotic hand for chronic stroke. This study was a randomized controlled trial with a 3-month follow-up. Thirty chronic stroke patients were randomly assigned to receive 20-session upper limb training with either EMG-driven NMES robotic hand (NMES group, n = 15) or EMG-driven robotic hand (pure group, n = 15). The training effects were evaluated before and after the training, as well as 3 months later, using the clinical scores of Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Action Research Arm Test (ARAT), and Functional Independence Measure (FIM). Session-by-session EMG parameters, including the normalized EMG activation level and co-contraction indexes (CIs) of the target muscles were applied to monitor the recovery progress in muscular coordination patterns. Both groups achieved significantly increased FMA and ARAT scores (p < 0.05), and the NMES group improved more (p < 0.05). A significant improvement in MAS was obtained in the NMES group (p < 0.05) but absence in the pure group. Meanwhile, better performance could be obtained in the NMES group in releasing the EMG activation levels and CIs than the pure group across the training sessions (p < 0.05). Both training systems were effective in improving the long-term distal motor functions in upper limb, where the NMES robot-assisted training achieved better voluntary motor recovery and muscle coordination and more release in muscle spasticity. This study indicated more effective distal rehabilitation using the NMES robot than the pure robot-assisted rehabilitation. ClinicalTrials.gov. NCT02117089; date of registration: April 10, 2014. [ABSTRACT FROM AUTHOR]