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Stroke is a major cause of death and disability among adults in China, and an efficient rehabilitation strategy has been an urgent demand for post-stroke rehabilitation. The non-invasive brain stimulation (NBS) can modulate the excitability of the cerebral cortex and provide after-effects apart from immediate effects to regain extremity motor functions, whereas robotic therapy provides high-intensity and long-duration repetitive movements to stimulate the cerebral cortex backward. The combined strategy of the two techniques is widely regarded as a promising application for stroke patients with dyskinesia. Transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (TES) are important methods of NBS. Their recovery principles, stimulation parameters, and clinical applications have been summarized. The combined treatments of rTMS/tDCS and robotic therapy are analyzed and discussed to overcome the application barriers of the two techniques. The future development trend and the key technical problems are expounded for the clinical applications. [ABSTRACT FROM AUTHOR]

Abstract Stroke is a major cause of death and disability among adults in China, and an efficient rehabilitation strategy has been an urgent demand for post-stroke rehabilitation. The non-invasive brain stimulation (NBS) can modulate the excitability of the cerebral cortex and provide after-effects apart from immediate effects to regain extremity motor functions, whereas robotic therapy provides high-intensity and long-duration repetitive movements to stimulate the cerebral cortex backward. The combined strategy of the two techniques is widely regarded as a promising application for stroke patients with dyskinesia. Transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (TES) are important methods of NBS. Their recovery principles, stimulation parameters, and clinical applications have been summarized. The combined treatments of rTMS/tDCS and robotic therapy are analyzed and discussed to overcome the application barriers of the two techniques. The future development trend and the key technical problems are expounded for the clinical applications.

(1) Background: The influence of robotic therapy on patients with sub-acute cervical spinal cord injury (SCI) for improving their activities of daily living (ADL) performance is unclear; (2) Methods: 31 subjects with cervical SCI completed the training randomly assigned to an intervention or control group during 40 sessions. All the subjects received, in each session, 30 min of upper-extremity conventional therapy. In addition, the subjects within the control group received another 30 min of conventional therapy, whereas subjects within the intervention group received 30 min of robotic therapy with Armeo Spring (Hocoma AG, Volketswil, Switzerland). Therefore, the ADL of drinking was trained by using the exoskeleton. Feasibility and efficacy measurements as clinical scales and kinematic indices, and usability questionnaires, were used as assessment at baseline and at the ending of the study (week 10); (3) Results: The intervention group significantly improved with regards to the feeding and grooming items of the Spinal Cord Independence Measure scale. The improvement in the movement smoothness related to the activity of drinking was greater in the intervention group than in the control (p = 0.034); (4) Conclusions: The findings of this study reveal that patients with cervical SCI improve their performance in ADL with robotic therapy. [ABSTRACT FROM AUTHOR]

Knee rehabilitation therapy after trauma or neuromotor diseases is fundamental to restore the joint functions as best as possible, exoskeleton robots being an important resource in this context, since they optimize therapy by applying tailored forces to assist or resist movements, contributing to improved patient outcomes and treatment efficiency. One of the points that must be taken into account when using robots in rehabilitation is their interaction with the patient, which must be safe for both and guarantee the effectiveness of the treatment. Therefore, the objective of this study was to assess the interaction between humans and an exoskeleton during the execution of knee flexion–extension movements under various configurations of robot assistance and resistance. The evaluation encompassed considerations of myoelectric activity, muscle recruitment, robot torque, and performed movement. To achieve this, an experimental protocol was implemented, involving an individual wearing the exoskeleton and executing knee flexion–extension motions while seated, with the robot configured in five distinct modes: passive (P), assistance on flexion (FA), assistance on extension (EA), assistance on flexion and extension (CA), and resistance on flexion and extension (CR). Results revealed distinctive patterns of movement and muscle recruitment for each mode, highlighting the complex interplay between human and robot; for example, the largest RMS tracking errors were for the EA mode (13.72 degrees) while the smallest for the CR mode (4.47 degrees), a non-obvious result; in addition, myoelectric activity was demonstrated to be greater for the completely assisted mode than without the robot (the maximum activation levels for the vastus medialis and vastus lateralis muscles were more than double those when the user had assistance from the robot). Tracking errors, muscle activations, and torque values varied across modes, emphasizing the need for careful consideration in configuring exoskeleton assistance and resistance to ensure effective and safe rehabilitation. Understanding these human–robot interactions is essential for developing precise rehabilitation programs, optimizing treatment effectiveness, and enhancing patient safety. [ABSTRACT FROM AUTHOR]

Background: Prolonged hospitalization in severe COVID-19 cases can lead to substantial muscle loss and functional deterioration. While rehabilitation is essential, conventional approaches face capacity challenges. Therefore, evaluating the effectiveness of robotic-assisted rehabilitation for patients with post-COVID-19 fatigue syndrome to enhance both motor function and overall recovery holds paramount significance. Our objective is to assess the effectiveness of rehabilitation in post-COVID-19 patients with upper extremity impairment through the utilization of a hand exoskeleton-based robotic system. Methods: A total of 13 participants experiencing acute or limited functional or strength impairment in an upper extremity due to COVID-19 were enrolled in the study. A structured intervention consisted of 45 min therapy sessions, conducted four times per week over a six-week period, utilizing a hand exoskeleton. The research employed standardized health assessments, motion analysis, and semi-structured interviews for pre-intervention and follow-up evaluations. Paired sample t-tests were employed to statistically analyze the outcomes. Results: The outcomes showed a reduction in overall dependence levels across participants, positive changes in various quality of life-related measurements, and an average increase of 60.4 ± 25.7% and 28.7 ± 11.2% for passive and active flexion, respectively. Conclusions: Our data suggest that hand exoskeleton-based robotic systems hold promise to optimize the rehabilitation outcomes following severe COVID-19. Trial registration: ID NCT06137716 at ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Medical robotics nowadays can prevent, treat, or alleviate numerous severe conditions, including the dire consequences of stroke. Our objective was to determine the effect of employing a robotic soft exoskeleton in therapy on the development of the early mobilization, gait, and coordination in stroke patients. The ReStore™ Soft Exo-Suit, a wearable exosuit developed by a leading company with exoskeleton technology, was utilized. It is a powered, lightweight device intended for use in stroke rehabilitation for people with lower limb disability. We performed a randomized clinical intervention, using a before–after trial design in a university hospital setting. A total of 48 patients with a history of stroke were included, of whom 39 were randomized and 30 completed the study. Interventions: Barthel Index and modified Rankin scale (mRS) patients were randomly assigned to a non-physical intervention control (n = 9 of 39 completed, 30 withdrew before baseline testing), or to a high-intensity agility program (15 sessions, 5 weeks, n = 30 completed). The main focus of assessment was on the Modified Rankin Scale. Additionally, we evaluated secondary factors including daily life functionality, five dimensions of health-related quality of life, the Beck depression inventory, the 6 min walk test (6MWT), the Berg Balance Scale (BBS), and static balance (center of pressure). The Robot-Assisted Gait Therapy (ROB/RAGT) program led to significant improvements across various measures, including a 37% improvement in Barthel Index scores, a 56% increase in 10 m walking speed, and a 68% improvement in 6 min walking distance, as well as notable enhancements in balance and stability. Additionally, the intervention group demonstrated significant gains in all these aspects compared to the control group. In conclusion, the use of robotic therapy can be beneficial in stroke rehabilitation. These devices support the restoration and improvement of movement in various ways and contribute to restoring balance and stability. [ABSTRACT FROM AUTHOR]

(1) Background: The influence of robotic therapy on patients with sub-acute cervical spinal cord injury (SCI) for improving their activities of daily living (ADL) performance is unclear; (2) Methods: 31 subjects with cervical SCI completed the training randomly assigned to an intervention or control group during 40 sessions. All the subjects received, in each session, 30 min of upper-extremity conventional therapy. In addition, the subjects within the control group received another 30 min of conventional therapy, whereas subjects within the intervention group received 30 min of robotic therapy with Armeo Spring (Hocoma AG, Volketswil, Switzerland). Therefore, the ADL of drinking was trained by using the exoskeleton. Feasibility and efficacy measurements as clinical scales and kinematic indices, and usability questionnaires, were used as assessment at baseline and at the ending of the study (week 10); (3) Results: The intervention group significantly improved with regards to the feeding and grooming items of the Spinal Cord Independence Measure scale. The improvement in the movement smoothness related to the activity of drinking was greater in the intervention group than in the control (p = 0.034); (4) Conclusions: The findings of this study reveal that patients with cervical SCI improve their performance in ADL with robotic therapy.

Abstract Background Robotic therapy and serious gaming support motor learning in neurorehabilitation. Traditional monitor-based gaming outputs cannot adequately represent the third dimension, whereas virtual reality headsets lack the connection to the real world. The use of Augmented Reality (AR) techniques could potentially overcome these issues. The objective of this study was thus to evaluate the usability, feasibility and functionality of a novel arm rehabilitation device for neurorehabilitation (RobExReha system) based on a robotic arm (LBR iiwa, KUKA AG) and serious gaming using the AR headset HoloLens (Microsoft Inc.). Methods The RobExReha system was tested with eleven adult inpatients (mean age: 64.4 ± 11.2 years; diagnoses: 8 stroke, 2 spinal cord injury, 1 Guillain-Barré-Syndrome) who had paretic impairments in their upper limb. Five therapists administered and evaluated the system. Data was compared with a Reference Group (eleven inpatients; mean age: 64.3 ± 9.1 years; diagnoses: 10 stroke, 1 spinal cord injury) who trained with commercially available robotic therapy devices (ArmeoPower or ArmeoSpring, Hocoma AG). Patients used standardized questionnaires for evaluating usability and comfort (Quebec User Evaluation of Satisfaction with assistive technology [QUEST]), workload (Raw Task Load Index [RTLX]) and a questionnaire for rating visual perception of the gaming scenario. Therapists used the QUEST, the System Usability Scale and the short version of the User Experience Questionnaire. Results Therapy with the RobExReha system was safe and feasible for patients and therapists, with no serious adverse events being reported. Patients and therapists were generally satisfied with usability. The patients’ usability ratings were significantly higher in the Reference Group for two items of the QUEST: reliability and ease of use. Workload (RTLX) ratings did not differ significantly between the groups. Nearly all patients using the RobExReha system perceived the gaming scenario in AR as functioning adequately despite eight patients having impairments in stereoscopic vision. The therapists valued the system’s approach as interesting and inventive. Conclusions We demonstrated the clinical feasibility of combining a novel robotic upper limb robot with an AR-serious game in a neurorehabilitation setting. To ensure high usability in future applications, a reliable and easy-to-use system that can be used for task-oriented training should be implemented. Trial registration Ethical approval was obtained and the trial was registered at the German Clinical Trials Register (DRKS00022136).

Introduction: Obstructive sleep apnea in spinal cord injured (SCI) patients is an important but underestimated clinical problem. Spinal cord injury weakens the muscles responsible for breathing, resulting in a reduction in lung capacity. Training of respiratory muscles may present an effective method of increasing respiratory muscle strength and lung volume. Aim: The aim of study was to evaluate the effectiveness of robot-assisted gait training (RAGT) in 34 patients with SCI in sleep-disordered breathing (SDB) reduction. Material and methods: We conducted a control trail to compare RAGT (exoskeleton EKSO-GT or Locomat Pro) with conventional gait training using conventional physiotherapy with dynamic parapodium. We included patients with SCI (above T8 level of injury) recruited between 3 months and 2 years post injury. Polysomnographic studies were performed before and after the completion of the 7-week rehabilitation program. Patients were divided into 2 groups above and up 40 years old. Results and discussion: The comparison of all polysomnographic parameters before and after rehabilitation with RAGT revealed the decline in all polysomnographic parameters (the apnea-hypopnea index – AHI; score reached statistically significant value – P < 0.02). In comparison in patients aged up to 40 years with conventional gait rehabilitation the number of apnoea’s and shortness of breath during sleep even increased: the AHI index increased after rehabilitation from 1.7 to 3.2 values. Conclusions: RAGT therapy should be considered as a therapeutic option for SDB reduction in patients after SCI. Additionally, the study identified the need to conduct further studies on larger groups of patients. [ABSTRACT FROM AUTHOR]

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. The incidence of the stone formation in the calyceal diverticula is up to 50%. The most effective diagnostic method is the computed tomography urogram. Treatment options for symptomatic patients include shock -wave lithotripsy, ureteroscopic or percutaneous methods, and laparoscopic surgery. The treatment option should be selected based on the basis of the diverticulum location and stone burden. This paper reports an interesting case of a 19-year-old boy with a stone burden of 1.663 mm3 in the calyceal diverticula of the right kidney. The patient underwent a robot-assisted procedure using the daVinci© Xi system.

Knee rehabilitation therapy after trauma or neuromotor diseases is fundamental to restore the joint functions as best as possible, exoskeleton robots being an important resource in this context, since they optimize therapy by applying tailored forces to assist or resist movements, contributing to improved patient outcomes and treatment efficiency. One of the points that must be taken into account when using robots in rehabilitation is their interaction with the patient, which must be safe for both and guarantee the effectiveness of the treatment. Therefore, the objective of this study was to assess the interaction between humans and an exoskeleton during the execution of knee flexion–extension movements under various configurations of robot assistance and resistance. The evaluation encompassed considerations of myoelectric activity, muscle recruitment, robot torque, and performed movement. To achieve this, an experimental protocol was implemented, involving an individual wearing the exoskeleton and executing knee flexion–extension motions while seated, with the robot configured in five distinct modes: passive (P), assistance on flexion (FA), assistance on extension (EA), assistance on flexion and extension (CA), and resistance on flexion and extension (CR). Results revealed distinctive patterns of movement and muscle recruitment for each mode, highlighting the complex interplay between human and robot; for example, the largest RMS tracking errors were for the EA mode (13.72 degrees) while the smallest for the CR mode (4.47 degrees), a non-obvious result; in addition, myoelectric activity was demonstrated to be greater for the completely assisted mode than without the robot (the maximum activation levels for the vastus medialis and vastus lateralis muscles were more than double those when the user had assistance from the robot). Tracking errors, muscle activations, and torque values varied across modes, emphasizing the need for careful consideration in configuring exoskeleton assistance and resistance to ensure effective and safe rehabilitation. Understanding these human–robot interactions is essential for developing precise rehabilitation programs, optimizing treatment effectiveness, and enhancing patient safety.

Background: Robotic therapy and serious gaming support motor learning in neurorehabilitation. Traditional monitor-based gaming outputs cannot adequately represent the third dimension, whereas virtual reality headsets lack the connection to the real world. The use of Augmented Reality (AR) techniques could potentially overcome these issues. The objective of this study was thus to evaluate the usability, feasibility and functionality of a novel arm rehabilitation device for neurorehabilitation (RobExReha system) based on a robotic arm (LBR iiwa, KUKA AG) and serious gaming using the AR headset HoloLens (Microsoft Inc.). Methods: The RobExReha system was tested with eleven adult inpatients (mean age: 64.4 ± 11.2 years; diagnoses: 8 stroke, 2 spinal cord injury, 1 Guillain-Barré-Syndrome) who had paretic impairments in their upper limb. Five therapists administered and evaluated the system. Data was compared with a Reference Group (eleven inpatients; mean age: 64.3 ± 9.1 years; diagnoses: 10 stroke, 1 spinal cord injury) who trained with commercially available robotic therapy devices (ArmeoPower or ArmeoSpring, Hocoma AG). Patients used standardized questionnaires for evaluating usability and comfort (Quebec User Evaluation of Satisfaction with assistive technology [QUEST]), workload (Raw Task Load Index [RTLX]) and a questionnaire for rating visual perception of the gaming scenario. Therapists used the QUEST, the System Usability Scale and the short version of the User Experience Questionnaire. Results: Therapy with the RobExReha system was safe and feasible for patients and therapists, with no serious adverse events being reported. Patients and therapists were generally satisfied with usability. The patients' usability ratings were significantly higher in the Reference Group for two items of the QUEST: reliability and ease of use. Workload (RTLX) ratings did not differ significantly between the groups. Nearly all patients using the RobExReha system perceived the gaming scenario in AR as functioning adequately despite eight patients having impairments in stereoscopic vision. The therapists valued the system's approach as interesting and inventive. Conclusions: We demonstrated the clinical feasibility of combining a novel robotic upper limb robot with an AR-serious game in a neurorehabilitation setting. To ensure high usability in future applications, a reliable and easy-to-use system that can be used for task-oriented training should be implemented. Trial registration: Ethical approval was obtained and the trial was registered at the German Clinical Trials Register (DRKS00022136). [ABSTRACT FROM AUTHOR]

Abstract Background Stroke is a devastating condition, which not only affects patients’ activity, but also is a primary reason for the psychosocial impact on them, their caregivers, and the healthcare system. Transcranial direct current stimulation (tDCS) modulates cortical activity, encouraging neuro-modulation and motor recovery in stroke rehabilitation. Robotic therapy (RT) provides repetitive, high-intensity, interactive, task-specific intervention and can measure changes while providing feedback to people with stroke. Objectives This study aimed to evaluate and summarize the scientific literature systematically to investigate the combined effect of tDCS and RT in patients with stroke. Methods Four databases (MEDLINE, Web of Science, ScienceDirect, & PEDro) were searched for clinical trials investigating the effect of RT and tDCS in stroke patients with upper limb impairment. PEDro scale was used for the quality assessment of included studies. Results The search yielded 208 articles. A total of 213 patients with stroke who had upper limb impairment were studied. In the majority of the trials, RT combined with tDCS lead to positive improvement in various measures of upper limb function and spasticity. Conclusions RT along with tDCS is an effective mode of rehabilitation, although no additional effects of tDCS plus RT in comparison with RT alone were reported. Large, robust studies are needed, so that health care providers and researchers can make better decisions about merging tDCS and RT in stroke rehabilitation settings in the future.

The improvement of walking ability is a primary goal for spinal cord injury (SCI) patients. Robotic-assisted gait training (RAGT) is an innovative method for its improvement. This study evaluates the influence of RAGT vs. dynamic parapodium training (DPT) in improving gait motor functions in SCI patients. In this single-centre, single-blinded study, we enrolled 105 (39 and 64 with complete and incomplete SCI, respectively) patients. The investigated subjects received gait training with RAGT (experimental S1-group) and DPT (control S0-group), with six training sessions per week over seven weeks. The American Spinal Cord Injury Association Impairment Scale Motor Score (MS), Spinal Cord Independence Measure, version-III (SCIM-III), Walking Index for Spinal Cord Injury, version-II (WISCI-II), and Barthel Index (BI) were assessed in each patient before and after sessions. Patients with incomplete SCI assigned to the S1 rehabilitation group achieved more significant improvement in MS [2.58 (SE 1.21, p < 0.05)] and WISCI-II [3.07 (SE 1.02, p < 0.01])] scores in comparison with patients assigned to the S0 group. Despite the described improvement in the MS motor score, no progression between grades of AIS (A to B to C to D) was observed. A nonsignificant improvement between the groups for SCIM-III and BI was found. RAGT significantly improved gait functional parameters in SCI patients in comparison with conventional gait training with DPT. RAGT is a valid treatment option in SCI patients in the subacute phase. DPT should not be recommended for patients with incomplete SCI (AIS-C); in those patients, RAGT rehabilitation programs should be taken into consideration. [ABSTRACT FROM AUTHOR]

Medical robotics nowadays can prevent, treat, or alleviate numerous severe conditions, including the dire consequences of stroke. Our objective was to determine the effect of employing a robotic soft exoskeleton in therapy on the development of the early mobilization, gait, and coordination in stroke patients. The ReStore™ Soft Exo-Suit, a wearable exosuit developed by a leading company with exoskeleton technology, was utilized. It is a powered, lightweight device intended for use in stroke rehabilitation for people with lower limb disability. We performed a randomized clinical intervention, using a before–after trial design in a university hospital setting. A total of 48 patients with a history of stroke were included, of whom 39 were randomized and 30 completed the study. Interventions: Barthel Index and modified Rankin scale (mRS) patients were randomly assigned to a non-physical intervention control (n = 9 of 39 completed, 30 withdrew before baseline testing), or to a high-intensity agility program (15 sessions, 5 weeks, n = 30 completed). The main focus of assessment was on the Modified Rankin Scale. Additionally, we evaluated secondary factors including daily life functionality, five dimensions of health-related quality of life, the Beck depression inventory, the 6 min walk test (6MWT), the Berg Balance Scale (BBS), and static balance (center of pressure). The Robot-Assisted Gait Therapy (ROB/RAGT) program led to significant improvements across various measures, including a 37% improvement in Barthel Index scores, a 56% increase in 10 m walking speed, and a 68% improvement in 6 min walking distance, as well as notable enhancements in balance and stability. Additionally, the intervention group demonstrated significant gains in all these aspects compared to the control group. In conclusion, the use of robotic therapy can be beneficial in stroke rehabilitation. These devices support the restoration and improvement of movement in various ways and contribute to restoring balance and stability.

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. The incidence of the stone formation in the calyceal diverticula is up to 50%. The most effective diagnostic method is the computed tomography urogram. Treatment options for symptomatic patients include shock -wave lithotripsy, ureteroscopic or percutaneous methods, and laparoscopic surgery. The treatment option should be selected based on the basis of the diverticulum location and stone burden. This paper reports an interesting case of a 19-year-old boy with a stone burden of 1.663 mm3 in the calyceal diverticula of the right kidney. The patient underwent a robot-assisted procedure using the daVinci© Xi system. [ABSTRACT FROM AUTHOR]

Introduction: Total Knee Replacement (TKR) surgery rehabilitation presents significant challenges, necessitating effective interventions to restore function and mobility. Robotic devices have emerged as promising tools for enhancing knee rehabilitation outcomes. RoboticAssisted Rehabilitation (RAR) systems offer unique capabilities that may address some of the challenges associated with traditional methods, robotic devices can facilitate early mobilisation and functional training, potentially leading to faster recovery, improved joint function, and enhanced patient satisfaction. Aim: To provide a comprehensive overview of the current state of research on the use of robotic devices in knee rehabilitation. Materials and Methods: A thorough search of databases, including PubMed, Google Scholar, Science Direct, and Medical Literature Analysis and Retrieval System Online (MEDLINE) was conducted by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the terms” rehabilitation”,” robot”, and “total knee replacement”. This approach yielded 37 articles of which six full-text available articles, from 2014 and 2024 were included in the present review. Studies were selected based on predefined inclusion criteria. Pertinent reference lists were examined. Results: The review identified various types of robotic devices utilised in knee rehabilitation, including exoskeletons, roboticassisted therapy systems, and rehabilitation platforms. Comparative effectiveness studies indicated potential benefits of robotic-assisted rehabilitation in improving range of motion, muscle strength, functional performance and patient satisfaction. Conclusion: It can be concluded that RAR may be an effective treatment in TKR patients. Future research should focus on personalised rehabilitation protocols, longitudinal outcomes assessment and innovative technologies to optimise patient care and rehabilitation efficacy in knee injuries and surgeries. [ABSTRACT FROM AUTHOR]

The aim of the present study is to present a case report with hemiplegia where, in addition to all kinesitherapists and a physical plan, the rehabilitation included robotic therapy of the lower limbs, where a robot-assisted exoskeleton (locomat) was used. Materials and methods: The robotic therapy together with the comprehensive rehabilitation treatment is carried out within twenty days with a rest on the 10th day of one week to show the patient's progress between the two treatments of 10 days each and to determine how much the robotic therapy has effect on motor neurorehabilitation in hemiplegic patients. In order to determine the independence and mobility of the patient at the beginning, on the 10th day and on the 20th day, the Barthel index test and the Fugl-Meyer assessment test were performed. Results: According to the analysis and processing of the results obtained from the robot-assisted exoskeleton itself and after their statistical processing, they show a significant improvement in the results in the second period of rehabilitation compared to the first rehabilitation, which means that the patient took a significant part in the movement itself with the robot-assisted exoskeleton and a significant patient improvement in terms of walking distance, meters walked, treadmill speed, driving force and body weight support. The overall result also results in an improvement in coordination and the establishment of a straight pattern of walking, which only hinders further rehabilitation. The results of the Bartel index test shows the progress of the patient and the improvement of his mobility, while the Fugl-Meyer assessment test shows the improvement of motor function and sensitivity. Conclusion: Robotic therapy, although it is still being developed and despite its inaccessibility in terms of the price of treatments, shows a significant improvement in motor function and in motor neurorehabilitation in patients with hemiplegia. [ABSTRACT FROM AUTHOR]

Background: Stroke is a devastating condition, which not only affects patients' activity, but also is a primary reason for the psychosocial impact on them, their caregivers, and the healthcare system. Transcranial direct current stimulation (tDCS) modulates cortical activity, encouraging neuro-modulation and motor recovery in stroke rehabilitation. Robotic therapy (RT) provides repetitive, high-intensity, interactive, task-specific intervention and can measure changes while providing feedback to people with stroke. Objectives: This study aimed to evaluate and summarize the scientific literature systematically to investigate the combined effect of tDCS and RT in patients with stroke. Methods: Four databases (MEDLINE, Web of Science, ScienceDirect, & PEDro) were searched for clinical trials investigating the effect of RT and tDCS in stroke patients with upper limb impairment. PEDro scale was used for the quality assessment of included studies. Results: The search yielded 208 articles. A total of 213 patients with stroke who had upper limb impairment were studied. In the majority of the trials, RT combined with tDCS lead to positive improvement in various measures of upper limb function and spasticity. Conclusions: RT along with tDCS is an effective mode of rehabilitation, although no additional effects of tDCS plus RT in comparison with RT alone were reported. Large, robust studies are needed, so that health care providers and researchers can make better decisions about merging tDCS and RT in stroke rehabilitation settings in the future. [ABSTRACT FROM AUTHOR]

Abstract Background The sequence of establishing a proximal stability or function before facilitation of the distal body part has long been recognized in stroke rehabilitation practice but lacks scientific evidence. This study plans to examine the effects of proximal priority robotic priming and impairment-oriented training (PRI) and distal priority robotic priming and impairment-oriented training (DRI). Methods This single-blind, randomized, comparative efficacy study will involve 40 participants with chronic stroke. Participants will be randomized into the PRI or DRI groups and receive 18 intervention sessions (90 min/day, 3 days/weeks for 6 weeks). The Fugl-Meyer Assessment Upper Extremity subscale, Medical Research Council Scale, Revised Nottingham Sensory Assessment, and Wolf Motor Function Test will be administered at baseline, after treatment, and at the 3-month follow-up. Two-way repeated-measures analysis of variance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after PRI and DRI. Discussion Through manipulating the sequence of applying wrist and forearm robots in therapy, this study will attempt to examine empirically the priming effect of proximal or distal priority robotic therapy in upper extremity impairment-oriented training for people with stroke. The findings will provide directions for further studies and empirical implications for clinical practice in upper extremity rehabilitation after stroke. Trial Registration ClinicalTrials.gov NCT04446273. Registered on June 23, 2020.

The improvement of walking ability is a primary goal for spinal cord injury (SCI) patients. Robotic-assisted gait training (RAGT) is an innovative method for its improvement. This study evaluates the influence of RAGT vs. dynamic parapodium training (DPT) in improving gait motor functions in SCI patients. In this single-centre, single-blinded study, we enrolled 105 (39 and 64 with complete and incomplete SCI, respectively) patients. The investigated subjects received gait training with RAGT (experimental S1-group) and DPT (control S0-group), with six training sessions per week over seven weeks. The American Spinal Cord Injury Association Impairment Scale Motor Score (MS), Spinal Cord Independence Measure, version-III (SCIM-III), Walking Index for Spinal Cord Injury, version-II (WISCI-II), and Barthel Index (BI) were assessed in each patient before and after sessions. Patients with incomplete SCI assigned to the S1 rehabilitation group achieved more significant improvement in MS [2.58 (SE 1.21, p < 0.05)] and WISCI-II [3.07 (SE 1.02, p < 0.01])] scores in comparison with patients assigned to the S0 group. Despite the described improvement in the MS motor score, no progression between grades of AIS (A to B to C to D) was observed. A nonsignificant improvement between the groups for SCIM-III and BI was found. RAGT significantly improved gait functional parameters in SCI patients in comparison with conventional gait training with DPT. RAGT is a valid treatment option in SCI patients in the subacute phase. DPT should not be recommended for patients with incomplete SCI (AIS-C); in those patients, RAGT rehabilitation programs should be taken into consideration.

Multiple sclerosis (MS) is a neurodegenerative disease that produces alterations in balance and gait in most patients. Robot-assisted gait training devices have been proposed as a complementary approach to conventional rehabilitation treatment as a means of improving these alterations. The aim of this study was to investigate the available scientific evidence on the benefits of the use of robotics in the physiotherapy treatment in people with MS. A systematic review of randomized controlled trials was performed. Studies from the last five years on walking in adults with MS were included. The PEDro scale was used to assess the methodological quality of the included studies, and the Jadad scale was used to assess the level of evidence and the degree of recommendation. Seventeen studies met the eligibility criteria. For the improvement of gait speed, robotic devices do not appear to be superior, compared to the rest of the interventions evaluated. The methodological quality of the studies was moderate–low. For this reason, robot-assisted gait training is considered just as effective as conventional rehabilitation training for improving gait in people with MS. [ABSTRACT FROM AUTHOR]

Objective: This study aims to find out whether including robotic therapy in addition to a conventional rehabilitation program affects the quality of life, motor function, cognition, and emotional status of hemiplegic patients. Design: Thirty-seven stroke patients recruited between April 2016 and April 2019 were included in the study. The patients were randomized into 2 groups (Robotic rehabilitation group-RR n:17, Control group n:20), RR was arranged to be 30–45 min, 5 days per week for 4 weeks. All patients were assessed at the beginning of therapy and the end of 4th week with Brunnstrom stages of motor recovery, Fugl-Meyer Assessment (FMA), handgrip strength, Purdue peg test, Minnesota manual dexterity test, Modified Ashworth Scale (MAS), Functional Independence Measure (FIM), Stroke Specific Quality of Life Scale (SS-QOL), Nottingham Extended Activities of Daily Living (NEADL) Scale, Montreal Cognitive Assessment (MoCA) and Center for Epidemiological Studies Depression Scale (CES- D). Results: Improvements in motor function scores, spasticity, general functioning, activities of daily living, cognitive assessment were better in the robotic group when compared to the control group but this difference was not statistically significant (p > 0.05). Improvement in the CES-D in the RR-group was better in comparison to the control group (p = 0.018). Conclusion: Improvements in motor functions were observed after the treatment in both groups. Although RR group improved better in numbers, none of the outcomes except the CES-D scale were significant. Robotic rehabilitation provides a favorable alternative bringing slight benefits, and also is advantageous in terms of work power and psychological recovery, making its addition to conventional neurological rehabilitation effective and useful in patient management after stroke. Trial registration: ClinicalTrials.gov Identifier: NCT04393480 [ABSTRACT FROM AUTHOR]

Abstract Backgrounds Exoskeletons development arises with a leading role in neurorehabilitation technologies; however, very few prototypes for upper limbs have been tested, contrasted and duly certified in terms of their effectiveness in clinical environments in order to incorporate into the health system. The purpose of this pilot study was to determine if robotic therapy of Hemiplegic Shoulder Pain (HSP) could lead to functional improvement in terms of diminishing of pain, spasticity, subluxation, the increasing of tone and muscle strength, and the satisfaction degree. Methods An experimental study was conducted in 16 patients with painful shoulder post- ischemic stroke in two experimental groups: conventional and robotic therapy. At different stages of its evolution, the robotic therapy effectiveness applied with anti-gravitational movements was evaluated. Clinical trial was developed at the Physical Medicine and Rehabilitation Department of the Surgical Clinical Hospital “Dr. Juan Bruno Zayas Alfonso” in Santiago de Cuba, from September 2016 - March 2018. Among other variables: the presence of humeral scapular subluxation (HSS), pain, spasticity, mobility, tone and muscle strength, and the satisfaction degree were recorded. Results with 95% reliability were compared between admission and third months of treatment. The Mann-Whitney U-Test, Chi-Square and Fisher’s Exact Tests were used as comparison criteria. Results Robotic therapy positively influenced in the decrease and annulment of pain and the spasticity degree, reaching a range increase of joint movement and the improvement of muscle tone.

Abstract Background Clinical practice typically emphasizes active involvement during therapy. However, traditional approaches can offer only general guidance on the form of involvement that would be most helpful to recovery. Beyond assisting movement, robots allow comprehensive methods for measuring practice behaviors, including the energetic input of the learner. Using data from our previous study of robot-assisted therapy, we examined how separate components of mechanical work contribute to predicting training outcomes. Methods Stroke survivors (n = 11) completed six sessions in two-weeks of upper extremity motor exploration (self-directed movement practice) training with customized forces, while a control group (n = 11) trained without assistance. We employed multiple regression analysis to predict patient outcomes with computed mechanical work as independent variables, including separate features for elbow versus shoulder joints, positive (concentric) and negative (eccentric), flexion and extension. Results Our analysis showed that increases in total mechanical work during therapy were positively correlated with our final outcome metric, velocity range. Further analysis revealed that greater amounts of negative work at the shoulder and positive work at the elbow as the most important predictors of recovery (using cross-validated regression, R2 = 52%). However, the work features were likely mutually correlated, suggesting a prediction model that first removed shared variance (using PCA, R2 = 65–85%). Conclusions These results support robotic training for stroke survivors that increases energetic activity in eccentric shoulder and concentric elbow actions. Trial registration ClinicalTrials.gov , Identifier: NCT02570256 . Registered 7 October 2015 – Retrospectively registered,

This research article presents a preliminary longitudinal study to check the improvement in multi-human communication of children with Autism Spectrum Disorder (ASD) using a standardized multi-robot therapy. The research is based on a 3 step framework: 1) Human-Human Interaction, Stage-1 (HHI-S1), 2) Human-Robot Interaction, Stage-2 (HRI-S2), and 3) Human-Human Interaction, Stage-3 (HHI-S3). All three stages of the therapy consist of two command sets: 1) Controls commands and 2) Evaluation commands (auditory commands, visual commands, and combination of both). The concept of multiple robots is introduced to help multi-human communication and discourage isolation in ASD children. The joint attention of an ASD child is improved by the robotic therapy in stage 2 considering it as a key parameter for a multi-human communication scenario. The improvement in joint attention results in better command following in a triad multi-human communication scenario in stage 3 as compared to stage 1. The proposed intervention has been tested on 8 ASD subjects with 10 sessions over a period of two and a half months (10 weeks). Each session of human-human interaction (stage 1 and 3) consisted of 14 cues whereas 18 cues were presented by each robot for human-robot interaction (stage 2). The results indicate an overall 86% improvement in the social communication skills of ASD children in case of a multi-human scenario. Validation of results and effectiveness of the therapy has been further accomplished through the use of the Childhood Autism Rating Scale (CARS) score.

Recent research has shown reliability in robotic therapies for improvement in core impairments of autism. To improve the efficiency of communication using robots, this study evaluates the effectiveness of three different stimuli in a robotic intervention for children with autism spectrum disorder. Three different reinforcement stimuli presented in least-to-most (LTM) order introduced in this therapy using NAO robot are: visual (color variation), auditory and motion cues. The therapy was tested on 12 ASD children, 4 out of 12 children fall under mild category whereas 8 fall under the minimal category of autism. The experimentation was conducted for 2 months. Total 8 experiments were conducted with 1 trial per week. Total 12 cues were given per trial, 4 cues corresponding to each category. In total 96 cues were given per subject, 32 cues from each category. The results indicate a general trend for linking a particular autism category with the most effective stimulus for that category. It can be concluded that visual cue (color variation) is the most effective reinforcement stimulus for children with minimal autism as 8 out of 8 i.e., 100% were more responsive to visual cues whereas for children with mild autism category, 3 out of 4 i.e., 75% are more receptive towards the motion stimulus. The parameters used for assessment were joint attention and the time eye contact is maintained. Single factor ANOVA was used for the statistical analysis of results with alpha is 0.05 and p-value 0.0342, F value is 3.7456 and F critical value is 3.2834. The test was performed on 96 (8×12) trails in total, therefore ensuring the significance and reliability of our results.

Implanted vagus nerve stimulation (VNS) delivered concurrently with upper limb rehabilitation has been shown to improve arm function after stroke. Transcutaneous auricular VNS (taVNS) offers a non-invasive alternative to implanted VNS and may provide similar therapeutic benefit. There is much discussion about the optimal approach for combining VNS and physical therapy, as such we sought to determine whether taVNS administered during robotic training, specifically delivered during the premotor planning stage for arm extension movements, would confer additional motor improvement in patients with chronic stroke. Thirty-six patients with chronic, moderate-severe upper limb hemiparesis (>6 months; mean Upper Extremity Fugl-Meyer score = 25 ± 2, range 13–48), were randomized to receive 9 sessions (1 h in length, 3x/week for 3 weeks) of active (N = 18) or sham (N = 18) taVNS (500 ms bursts, frequency 30 Hz, pulse width 0.3 ms, max intensity 5 mA, ∼250 stimulated movements per session) delivered during robotic training. taVNS was triggered by the onset of a visual cue prior to center-out arm extension movements. Clinical assessments and surface electromyography (sEMG) measures of the biceps and triceps brachii were collected during separate test sessions. Significant motor improvements were measured for both the active and sham taVNS groups, and these improvements were robust at 3 month follow-up. Compared to the sham group, the active taVNS group showed a significant reduction in spasticity of the wrist and hand at discharge (Modified Tardieu Scale; taVNS = –8.94% vs. sham = + 2.97%, p < 0.05). The EMG results also demonstrated significantly increased variance for the bicep peak sEMG amplitude during extension for the active taVNS group compared to the sham group at discharge (active = 26.29% MVC ± 3.89, sham = 10.63% MVC ± 3.10, mean absolute change admission to discharge, p < 0.01), and at 3-month follow-up, the bicep peak sEMG amplitude was significantly reduced in the active taVNS group (P < 0.05). Thus, robot training improved the motor capacity of both groups, and taVNS, decreased spasticity. taVNS administered during premotor planning of movement may play a role in improving coordinated activation of the agonist-antagonist upper arm muscle groups by mitigating spasticity and increasing motor control following stroke. Clinical Trial Registration: www.ClinicalTrials.gov, identifier (NCT03592745). [ABSTRACT FROM AUTHOR]

As the number of stroke survivors is continuously growing, with an important number suffering from consequent functional deficits, the rehabilitation field is facing more complex demands. Technological progress gives us the opportunity to remotely assist patients while they exercise at home through telerehabilitation (TR), addressing the problems of limited medical resources and staff, difficult transportation, or living a long distance from rehabilitation centers. In addition, TR is a way to provide continuity in long-term post-stroke recovery during the COVID-19 pandemic, which limits traveling and human interaction. While the implementation of TR is increasing, the biggest challenges are to raise patients' acceptability of the new method and their motivation and engagement during the program. In this review, we aimed to find methods to address these challenges by identifying the patients who benefit the most from this therapy and efficiently organizing the space and technology used for telerehabilitation. User-friendly technologies and devices along with therapists' constant support and feedback are some of the most important aspects that make TR an efficient intervention and an alternative to conventional therapy. [ABSTRACT FROM AUTHOR]

Implanted vagus nerve stimulation (VNS) delivered concurrently with upper limb rehabilitation has been shown to improve arm function after stroke. Transcutaneous auricular VNS (taVNS) offers a non-invasive alternative to implanted VNS and may provide similar therapeutic benefit. There is much discussion about the optimal approach for combining VNS and physical therapy, as such we sought to determine whether taVNS administered during robotic training, specifically delivered during the premotor planning stage for arm extension movements, would confer additional motor improvement in patients with chronic stroke. Thirty-six patients with chronic, moderate-severe upper limb hemiparesis (>6 months; mean Upper Extremity Fugl-Meyer score = 25 ± 2, range 13–48), were randomized to receive 9 sessions (1 h in length, 3x/week for 3 weeks) of active (N = 18) or sham (N = 18) taVNS (500 ms bursts, frequency 30 Hz, pulse width 0.3 ms, max intensity 5 mA, ∼250 stimulated movements per session) delivered during robotic training. taVNS was triggered by the onset of a visual cue prior to center-out arm extension movements. Clinical assessments and surface electromyography (sEMG) measures of the biceps and triceps brachii were collected during separate test sessions. Significant motor improvements were measured for both the active and sham taVNS groups, and these improvements were robust at 3 month follow-up. Compared to the sham group, the active taVNS group showed a significant reduction in spasticity of the wrist and hand at discharge (Modified Tardieu Scale; taVNS = –8.94% vs. sham = + 2.97%, p < 0.05). The EMG results also demonstrated significantly increased variance for the bicep peak sEMG amplitude during extension for the active taVNS group compared to the sham group at discharge (active = 26.29% MVC ± 3.89, sham = 10.63% MVC ± 3.10, mean absolute change admission to discharge, p < 0.01), and at 3-month follow-up, the bicep peak sEMG amplitude was significantly reduced in the active taVNS group (P < 0.05). Thus, robot training improved the motor capacity of both groups, and taVNS, decreased spasticity. taVNS administered during premotor planning of movement may play a role in improving coordinated activation of the agonist-antagonist upper arm muscle groups by mitigating spasticity and increasing motor control following stroke.Clinical Trial Registration:www.ClinicalTrials.gov, identifier (NCT03592745).

Background: The sequence of establishing a proximal stability or function before facilitation of the distal body part has long been recognized in stroke rehabilitation practice but lacks scientific evidence. This study plans to examine the effects of proximal priority robotic priming and impairment-oriented training (PRI) and distal priority robotic priming and impairment-oriented training (DRI).Methods: This single-blind, randomized, comparative efficacy study will involve 40 participants with chronic stroke. Participants will be randomized into the PRI or DRI groups and receive 18 intervention sessions (90 min/day, 3 days/weeks for 6 weeks). The Fugl-Meyer Assessment Upper Extremity subscale, Medical Research Council Scale, Revised Nottingham Sensory Assessment, and Wolf Motor Function Test will be administered at baseline, after treatment, and at the 3-month follow-up. Two-way repeated-measures analysis of variance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after PRI and DRI.Discussion: Through manipulating the sequence of applying wrist and forearm robots in therapy, this study will attempt to examine empirically the priming effect of proximal or distal priority robotic therapy in upper extremity impairment-oriented training for people with stroke. The findings will provide directions for further studies and empirical implications for clinical practice in upper extremity rehabilitation after stroke.Trial Registration: ClinicalTrials.gov NCT04446273. Registered on June 23, 2020. [ABSTRACT FROM AUTHOR]

Socially assistive robots may help the treatment of autism spectrum disorder(ASD), through games using dyadic interactions to train social skills. Existing systems are mainly based on simplified protocols which qualitatively evaluate subject performance. We propose a robotic coaching platform for training social, motor and cognitive capabilities, with two main contributions: (i) using triadic interactions(adult, robot and child), with robotic mirroring, and (ii) providing quantitative performance indicators. The key system features were accurately designed, including type of protocols, feedback systems and evaluation metrics, contemplating the requirements for applications with ASD children. We implemented two protocols, Robot-Master and Adult-Master, where children performed different gestures guided by the robot or the adult respectively, eventually receiving feedback about movement execution. In both, the robot mirrors the subject during the movement. To assess system functionalities, with a homogeneous group of subjects, tests were carried out with 28 healthy subjects; one preliminary acquisition was done with an ASD child. Data analysis was customized to design protocol-specific parameters for movement characterization. Our tests show that robotic mirroring execution depends on the complexity and standardization of movements, as well as on the robot technical features. The feedback system evaluated movement phases and successfully estimated the completion of the exercises. Future work includes improving platform flexibility and adaptability, and clinical trials with ASD children to test the impact of the robotic coach on reducing symptoms. We trust that the proposed quantitative performance indicators extend the current state-of-the-art towards clinical usage of robotic-based coaching systems. [ABSTRACT FROM AUTHOR]

Abstract Background There is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200–300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group. Methods Seven subjects received 8–1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated. Results The VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group. Conclusions An additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.

Purpose: Socially assistive robots are emerging as a method of supporting the rehabilitation of children with physical disabilities. To date there has been no in-depth analysis of parent and child perspectives regarding the use of socially assistive robots for pediatric rehabilitation. The purpose of this study was to capture the experiences of parents and children who participated in a rehabilitation session with a socially assistive rehabilitation robot. Methods: An interpretivist qualitative design was used. Semi-structured interviews of five parent-child pairs were undertaken to examine their experiences during a rehabilitation session with the NAO robot. Interviews were analyzed using inductive thematic analysis. Results: Five themes were identified: 1) affective influence, 2) independence, 3) preference for human interaction, 4) accessibility of therapy and 5) familiarity with technology. Conclusion: Based on parent and child perspectives, the NAO robot is an acceptable complement to rehabilitation therapies. Children and parents perceived the NAO robot to have therapeutic value through its potential to enhance engagement, promote child independence during rehabilitation exercises and its potential support a rehabilitation program when a human therapist is not accessible. Socially assistive robots are an acceptable tool to support the delivery of exercise programs in pediatric rehabilitation. Therapists need to consider how to provide a positive affective experience during rehabilitation sessions, the use of socially assistive robots may be one method of doing this. When using socially assistive robots to support rehabilitation the individual needs and preferences of the child and family should be considered. Socially assistive robots may have a role in supporting home exercises programs; future work is needed to determine the feasibility of this. [ABSTRACT FROM AUTHOR]

Understanding the reorganization of the central nervous system after stroke is an important endeavor in order to design new therapies in gait training for stroke patients. Current clinical evaluation scores and gait velocity are insufficient to describe the state of the nervous system, and one aspect where this is lacking is in the quantification of gait symmetry. Previous studies have pointed out that spatiotemporal gait asymmetries are commonly observed in stroke patients with hemiparesis. Such asymmetries are known to cause long-term complications like joint pain and deformation. Recent studies also indicate that spatiotemporal measures showed that gait symmetry worsens after discharge from therapy. This study shows that muscle synergy analysis can be used to quantify gait symmetry and compliment clinical measures. Surface EMG was collected from lower limb muscles of subacute post-stroke patients (with an onset of around 14 days) from two groups, one undergoing robotic-assisted therapy (known as HAL group) and the other undergoing conventional therapy (known as Control group). Muscle synergies from the paretic and non-paretic limb were extracted with Non-Negative Matrix Factorization (NNMF) and compared with each other to obtain a gait symmetry index over therapy sessions. Gait events were tracked with motion tracking (for the HAL group) or foot pressure sensors (for the conventional therapy group). Patients from both groups were assessed over a 3-weeks long gait training program. Results indicated that there were no differences in muscle synergy symmetry for both groups of patients. However, the timing of muscle synergies were observed to be symmetrical in the HAL group, but not for the Control group. Intergroup comparisons of symmetry in muscle synergies and their timings were not significantly different. This could be due to a large variability in recovery in the Control group. Finally, stance time ratio was not observed to improve in both groups after their respective therapies. Interestingly, FIM and FMA scores of both groups were observed to improve after their respective therapies. Analysis of muscle coordination could reveal mechanisms of gait symmetry which could otherwise be difficult to observe with clinical scores.

Multiple sclerosis (MS) is a neurodegenerative disease that produces alterations in balance and gait in most patients. Robot-assisted gait training devices have been proposed as a complementary approach to conventional rehabilitation treatment as a means of improving these alterations. The aim of this study was to investigate the available scientific evidence on the benefits of the use of robotics in the physiotherapy treatment in people with MS. A systematic review of randomized controlled trials was performed. Studies from the last five years on walking in adults with MS were included. The PEDro scale was used to assess the methodological quality of the included studies, and the Jadad scale was used to assess the level of evidence and the degree of recommendation. Seventeen studies met the eligibility criteria. For the improvement of gait speed, robotic devices do not appear to be superior, compared to the rest of the interventions evaluated. The methodological quality of the studies was moderate–low. For this reason, robot-assisted gait training is considered just as effective as conventional rehabilitation training for improving gait in people with MS.

Objective: This article aimed to analyze the response of the spastic muscle of the upper limbs of hemiparetic individuals, in relation to muscle performance and range of motion, after treatment with robotic therapy. Methodology: the sample consisted of 12 healthy volunteers (Control Group) and 15 post-stroke volunteers (Intervention Group). Both groups underwent an evaluation protocol that consisted in data collection based on the evaluation of fatigue and peripheral muscle strength: blood collection for the baseline measurement of blood lactate; torque measurement (Isokinetic Dynamometer); blood collection for the final measurement of blood lactate; and functional evaluation of the elbow flexion and extension movements with the aid of the kinematic camera. The Intervention Group performed 10 sessions of robotic therapy on the ArmeoSpring® exoskeleton, and after the treatment, the reevaluation was performed. Results: after the treatment, the Intervention Group presented increased range of motion, increased muscle torque and decreased lactate concentration after a maximal voluntary contraction. Conclusion: robotic therapy was a safe and effective tool to improve the performance of the paretic limb of the individuals who participated in this study. [ABSTRACT FROM AUTHOR]

Backgrounds: Exoskeletons development arises with a leading role in neurorehabilitation technologies; however, very few prototypes for upper limbs have been tested, contrasted and duly certified in terms of their effectiveness in clinical environments in order to incorporate into the health system. The purpose of this pilot study was to determine if robotic therapy of Hemiplegic Shoulder Pain (HSP) could lead to functional improvement in terms of diminishing of pain, spasticity, subluxation, the increasing of tone and muscle strength, and the satisfaction degree.Methods: An experimental study was conducted in 16 patients with painful shoulder post- ischemic stroke in two experimental groups: conventional and robotic therapy. At different stages of its evolution, the robotic therapy effectiveness applied with anti-gravitational movements was evaluated. Clinical trial was developed at the Physical Medicine and Rehabilitation Department of the Surgical Clinical Hospital "Dr. Juan Bruno Zayas Alfonso" in Santiago de Cuba, from September 2016 - March 2018. Among other variables: the presence of humeral scapular subluxation (HSS), pain, spasticity, mobility, tone and muscle strength, and the satisfaction degree were recorded. Results with 95% reliability were compared between admission and third months of treatment. The Mann-Whitney U-Test, Chi-Square and Fisher's Exact Tests were used as comparison criteria.Results: Robotic therapy positively influenced in the decrease and annulment of pain and the spasticity degree, reaching a range increase of joint movement and the improvement of muscle tone. [ABSTRACT FROM AUTHOR]

Background: Clinical practice typically emphasizes active involvement during therapy. However, traditional approaches can offer only general guidance on the form of involvement that would be most helpful to recovery. Beyond assisting movement, robots allow comprehensive methods for measuring practice behaviors, including the energetic input of the learner. Using data from our previous study of robot-assisted therapy, we examined how separate components of mechanical work contribute to predicting training outcomes.Methods: Stroke survivors (n = 11) completed six sessions in two-weeks of upper extremity motor exploration (self-directed movement practice) training with customized forces, while a control group (n = 11) trained without assistance. We employed multiple regression analysis to predict patient outcomes with computed mechanical work as independent variables, including separate features for elbow versus shoulder joints, positive (concentric) and negative (eccentric), flexion and extension.Results: Our analysis showed that increases in total mechanical work during therapy were positively correlated with our final outcome metric, velocity range. Further analysis revealed that greater amounts of negative work at the shoulder and positive work at the elbow as the most important predictors of recovery (using cross-validated regression, R2 = 52%). However, the work features were likely mutually correlated, suggesting a prediction model that first removed shared variance (using PCA, R2 = 65-85%).Conclusions: These results support robotic training for stroke survivors that increases energetic activity in eccentric shoulder and concentric elbow actions.Trial Registration: ClinicalTrials.gov, Identifier: NCT02570256. Registered 7 October 2015 - Retrospectively registered. [ABSTRACT FROM AUTHOR]