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Background: Robot-assisted rehabilitation is considered beneficial for functional recovery in patients with stroke, but the therapeutic effect remains inconclusive. The present study investigated the therapeutic effects of gait training assisted by a user-initiated powered exoskeletal robot (UIPER) in patients in the early stage after stroke. We also characterized patients' improvement by analyzing chronological changes in clinical measurements together with gait parameters obtained from internal sensors in the exoskeletal robot. Methods: In this pilot case-controlled study, 17 and 81 patients with stroke onset durations of < 3 months were included in the robot-assisted combined with conventional treatment (RT + CT) group and conventional treatment only (CT) group, respectively. The UIPER, which provides knee flexion and extension support and has hip and knee sensors, was applied to guide gait performance in the RT + CT group. The patients in the RT + CT group received robot-assisted gait training for 40 min/ session, 1 session a day, and 2–3 sessions a week (6 sessions in total). The primary outcome was the proportion of patients reaching the minimum clinically important difference (MCID) in the 5-meter walking speed (5MWS) assessment, and the secondary outcomes were the MCID for the six-minute walking test, the Berg Balance Scale, the Barthel Index, the Fugl-Meyer assessment, and the timed up and go test before, during, and after the interventions. Gait parameters of the hip and knee were evaluated at baseline, midterm, and final sessions. Results: Gait function improved in both groups after the intervention (both P < 0.05). The primary outcome showed that a greater proportion of patients reached the MCID for the 5MWS in the RT + CT group than in the CT group (70.6 vs. 43.2%, P = 0.040; = 0.208). Similarly, in terms of the secondary outcomes, more patients in the RT + CT group reached the MCID for the Barthel index as compared with the CT group (41.2 vs. 17.3%, P = 0.047, = 0.220). Gait analysis revealed improvements in gait in the RT + CT group, as indicated by increases in the perimeter and area of the hip–knee cyclogram, as well as the range of motion in the hip joint. Conclusions: Gait training assisted by UIPER facilitates the recovery of walking speed and activities of daily living in patients with stroke, and these improvements may be related to improvements in gait parameters. Randomized controlled studies with larger sample sizes are needed to confirm these findings. Trial registration: This trial was approved by the Institutional Review Board of Chang Gung Medical Foundation (No. 202200822B0). [ABSTRACT FROM AUTHOR]

Abstract Background Robot-assisted rehabilitation is considered beneficial for functional recovery in patients with stroke, but the therapeutic effect remains inconclusive. The present study investigated the therapeutic effects of gait training assisted by a user-initiated powered exoskeletal robot (UIPER) in patients in the early stage after stroke. We also characterized patients’ improvement by analyzing chronological changes in clinical measurements together with gait parameters obtained from internal sensors in the exoskeletal robot. Methods In this pilot case-controlled study, 17 and 81 patients with stroke onset durations of

Aim: This work aimed to update and summarize the existing evidence on the effectiveness of robot-assisted training (RAT) in adults with Parkinson’s disease (PD). Methods: We conducted a systematic review with meta-analysis, reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42022371124). Seven databases and two trial registries were searched for randomized-controlled trials (RCTs) addressing RAT alone or in addition to other treatments in adults with PD up to January 2024. Primary outcomes were disease-specific motor impairment, balance, mobility, freezing of gait, falls, number of people who fell at least once, and adverse events. Meta-analysis using a random‐effects model was performed. Risk of bias (RoB) and certainty of the evidence for the primary outcomes were assessed using the Cochrane RoB Tool and the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively. Results: Fifteen RCTs (629 randomized adults with PD) were included. Our results show that the evidence is very uncertain about the effectiveness of any kind of RAT, either focused on gait, balance or upper limb impairment, compared to any comparator (treadmill training, overground gait training, exercises without the exoskeleton, conventional physical therapy, balance training, and no treatment), mainly because of RoB, inconsistency in individual studies results, and very limited number (less than 200) of participants considered in each comparison. Conclusion: In light of the aforementioned very low certainty evidence, clinical considerations should be drawn very carefully. High-quality studies are thus highly needed to investigate potential benefits, risks, and cost/benefit ratio of RAT in adults with PD. [ABSTRACT FROM AUTHOR]

• Hand motor interventions improve cognition post-stroke according to meta-analysis. • Robot-assisted and strength training are probably the most effective approaches. • Virtual reality and conventional rehabilitation were less effective. • There is limited evidence on their effects on specific cognitive domains. To synthetize the evidence on the effects of hand rehabilitation (RHB) interventions on cognition post-stroke and compare their efficacy. PubMed, Embase, Cochrane, Scopus, Web of Science, and CINAHL were searched from inception to November 2022. Randomized controlled trials conducted in adults with stroke where the effects of hand motor interventions on any cognitive domains were assessed. Data were extracted by 2 independent reviewers. A Bayesian Network Meta-analysis (NMA) was applied for measures with enough studies and comparisons. Risk of bias was assessed with the Cochrane Risk of Bias tool. Fifteen studies were included in qualitative synthesis, and 11 in NMA. Virtual reality (VR) (n=7), robot-assisted (n=5), or handgrip strength (n=3) training were the experimental interventions and conventional RHB (n=14) control intervention. Two separate NMA were performed with MoCA (n=480 participants) and MMSE (n=350 participants) as outcome measures. Both coincided that the most probable best interventions were robot-assisted and strength training, according to SUCRA and rankogram, followed by conventional RHB and VR training. No significant differences between any of the treatments were found in the MoCA network, but in the MMSE, robot-assisted and strength training were significantly better than conventional RHB and VR. No significant differences between robot-assisted and strength training were found nor between conventional RHB and VR. Motor interventions can improve MoCA/MMSE scores post-stroke. Most probable best interventions were robot-assisted and strength training. Limited literature assessing domain-specific cognitive effects was found. [ABSTRACT FROM AUTHOR]

Abstract Introduction About 17–80% stroke survivors experience the deficit of upper limb function, which strongly influences their independence and quality of life. Robot-assisted training and functional electrical stimulation are commonly used interventions in the rehabilitation of hemiplegia upper extremities, while the effect of their combination remains unclear. The aim of this trial is to explore the effect of robot-assisted upper limb training combined with functional electrical stimulation, in terms of neuromuscular rehabilitation, compared with robot-assisted upper limb training alone. Methods Individuals (n = 60) with the first onset of stroke (more than 1 week and less than 1 year after stroke onset) will be considered in the recruitment of this single-blinded, three-arm randomized controlled trial. Participants will be allocated into three groups (robot-assisted training combined with functional electrical stimulation group, robot-assisted training group, and conventional rehabilitation therapies group) with a ratio of 1:1:1. All interventions will be executed for 45 min per session, one session per day, 5 sessions per week for 6 weeks. The neuromuscular function of the upper limb (Fugl-Meyer Assessment of upper extremity), ability of daily life (modified Barthel Index), pain (visual analogue scale), and quality of life (EQ-5D-5L) will be assessed at the baseline, at the end of this trial and after 3 months follow-up. Two-way repeated measures analysis of variance will be used to compare the outcomes if the data are normally distributed. Simple effects tests will be used for the further exploration of interaction effects by time and group. Scheirer-Ray-Hare test will be used if the data are not satisfied with normal distribution. Discussion We expect this three-arm randomized controlled trial to explore the effectiveness of robot-assisted training combined with functional electrical stimulation in improving post-stroke upper limb function compared with robot-assisted training alone. Trial registration Effect of upper limb robot on improving upper limb function after stroke, identifier: ChiCTR2300073279. Registered on 5 July 2023.

Introduction: About 17–80% stroke survivors experience the deficit of upper limb function, which strongly influences their independence and quality of life. Robot-assisted training and functional electrical stimulation are commonly used interventions in the rehabilitation of hemiplegia upper extremities, while the effect of their combination remains unclear. The aim of this trial is to explore the effect of robot-assisted upper limb training combined with functional electrical stimulation, in terms of neuromuscular rehabilitation, compared with robot-assisted upper limb training alone. Methods: Individuals (n = 60) with the first onset of stroke (more than 1 week and less than 1 year after stroke onset) will be considered in the recruitment of this single-blinded, three-arm randomized controlled trial. Participants will be allocated into three groups (robot-assisted training combined with functional electrical stimulation group, robot-assisted training group, and conventional rehabilitation therapies group) with a ratio of 1:1:1. All interventions will be executed for 45 min per session, one session per day, 5 sessions per week for 6 weeks. The neuromuscular function of the upper limb (Fugl-Meyer Assessment of upper extremity), ability of daily life (modified Barthel Index), pain (visual analogue scale), and quality of life (EQ-5D-5L) will be assessed at the baseline, at the end of this trial and after 3 months follow-up. Two-way repeated measures analysis of variance will be used to compare the outcomes if the data are normally distributed. Simple effects tests will be used for the further exploration of interaction effects by time and group. Scheirer-Ray-Hare test will be used if the data are not satisfied with normal distribution. Discussion: We expect this three-arm randomized controlled trial to explore the effectiveness of robot-assisted training combined with functional electrical stimulation in improving post-stroke upper limb function compared with robot-assisted training alone. Trial registration: Effect of upper limb robot on improving upper limb function after stroke, identifier: ChiCTR2300073279. Registered on 5 July 2023. [ABSTRACT FROM AUTHOR]

Extended reality (XR) technology combines physical reality with computer synthetic virtuality to deliver immersive experience to users. Virtual reality (VR) and augmented reality (AR) are two subdomains within XR with different immersion levels. Both of these have the potential to be combined with robot-assisted training protocols to maximize postural control improvement. In this study, we conducted a randomized control experiment with sixty-three healthy subjects to compare the effectiveness of robot-assisted posture training combined with VR or AR against robotic training alone. A robotic Trunk Support Trainer (TruST) was employed to deliver assistive force at the trunk as subjects moved beyond the stability limits during training. Our results showed that both VR and AR significantly enhanced the training outcomes of the TruST intervention. However, the VR group experienced higher simulator sickness compared to the AR group, suggesting that AR is better suited for sitting posture training in conjunction with TruST intervention. Our findings highlight the added value of XR to robot-assisted training and provide novel insights into the differences between AR and VR when integrated into a robotic training protocol. In addition, we developed a custom XR application that suited well for TruST intervention requirements. Our approach can be extended to other studies to develop novel XR-enhanced robotic training platforms.

In recent years, robot-assisted training has been shown to significantly improve motor function and proprioception in people with functional disabilities, but the efficiency of proprioceptive acuity was unclear. To characterize the efficiency of joint proprioceptive acuity improvement in space, we designed a robot-assisted ipsilateral joint position matching experiment using the wrist as the study object. We conducted 2-way repeated measures ANOVA on error data before and after training in 12 healthy subjects and mapped the distribution of wrist proprioceptive learning ability in different workspaces. The results showed significant differences in the proprioceptive acuity of the wrist joint in different workspaces and movement directions before and after training in 12 subjects ( $\text{p} < 0.01$ ), and the proprioceptive acuity of the wrist after training was significantly higher than before training. In addition, the learning ability of wrist proprioceptive acuity showed significant differences in different workspaces and movement directions (Flexion and Extension in habit workspace (HW) ( ${P}={0}.{037}$ ); Flexion and Extension in maximum workspace (MW) ( ${P}={0}.{016}$ ); Flexion in HW and MW ( ${P}={0}.{043}$ )). Robot-assisted training is beneficial for improving the proprioceptive acuity of the wrist. The learning ability of proprioceptive acuity of joints in different movement directions is independently distributed and influenced by usage habits, which accelerate the improvement of proprioceptive acuity. This research hopes to clinically guide the development of highly effective rehabilitation programs to achieve better recovery and help build patient confidence.

Abdominal palpation is one of the basic but important physical examination methods used by physicians. Visual, auditory, and haptic feedback from the patients are known to be the main sources of feedback they use in the diagnosis. However, learning to interpret this feedback and making accurate diagnosis require several years of training. Many abdominal palpation training simulators have been proposed to date, but very limited attempts have been reported in integrating vocal pain expressions into physical abdominal palpation simulators. Here, we present a vocal pain expression augmentation for a robopatient. The proposed robopatient is capable of providing real-time facial and vocal pain expressions based on the exerted palpation force and position on the abdominal phantom of the robopatient. A pilot study is conducted to test the proposed system, and we show the potential of integrating vocal pain expressions to the robopatient. The platform has also been tested by two clinical experts with prior experience in abdominal palpation. Their evaluations on functionality and suggestions for improvements are presented. We highlight the advantages of the proposed robopatient with real-time vocal and facial pain expressions as a controllable simulator platform for abdominal palpation training studies. Finally, we discuss the limitations of the proposed approach and suggest several future directions for improvements.

After equinus corrective surgery, repetitive exercises for ankle dorsiflexion and plantar flexion are crucial during rehabilitation. The single-joint Hybrid Assistive Limb (HAL-SJ) is an advanced exoskeletal robotic device with a control system that uses bioelectrical signals to assist joint motion in real time and demonstrates joint torque assistance with the wearer’s voluntary movement. We present two cases of robot-assisted ankle rehabilitation after equinus surgery using the HAL-SJ in children. Case 1 was an 8-year-old boy, whereas case 2 was a 6-year-old boy. When they were allowed to walk without braces, training with the HAL-SJ was performed postoperatively for 20 min per session a total of eight times (2–4 sessions per week). Assessments were performed before and after HAL-SJ training. During gait analysis, case 1 had improved joint angles during the stance phase on the operated side; however, case 2 had improved joint angles during the stance and swing phases. The co-activation index values of the medial gastrocnemius and tibialis anterior muscles, which were high before training, decreased after training and approached the standard value. The HAL-SJ may provide systematic feedback regarding voluntary ankle dorsiflexion and plantar flexion and is considered to have motor learning effects.

Rehabilitation interventions are crucial in promoting neuroplasticity after spinal cord injury (SCI). We provided rehabilitation with a single-joint hybrid assistive limb (HAL-SJ) ankle joint unit (HAL-T) in a patient with incomplete SCI. The patient had incomplete paraplegia and SCI (neurological injury height: L1, ASIA Impairment Scale: C, ASIA motor score (R/L) L4:0/0, S1:1/0) following a rupture fracture of the first lumbar vertebra. The HAL-T consisted of a combination of ankle plantar dorsiflexion exercises in the sitting position, knee flexion, and extension exercises in the standing position, and stepping exercises in the standing position with HAL assistance. The plantar dorsiflexion angles of the left and right ankle joints and electromyograms of the tibialis anterior and gastrocnemius muscles were measured and compared using a three-dimensional motion analyzer and surface electromyography before and after HAL-T intervention. Phasic electromyographic activity was developed in the left tibialis anterior muscle during plantar dorsiflexion of the ankle joint after the intervention. No changes were observed in the left and right ankle joint angles. We experienced a case in which intervention using HAL-SJ induced muscle potentials in a patient with a spinal cord injury who was unable to perform voluntary ankle movements due to severe motor–sensory dysfunction. [ABSTRACT FROM AUTHOR]

• Spinal and bulbar muscular atrophy patients benefit from the Hybrid Assistive Limb. • Long-term Hybrid Assistive Limb treatment showed good outcomes. • The mean walking distance in the 2-minute walk test significantly improved. • Exercise training can be continued without deterioration of the quality of life. • Maintaining long-term gait function can be supported with exercise training. Spinal and bulbar muscular atrophy (SBMA) progressively impairs gait function, resulting in the need for patients to use a wheelchair approximately 20 years after onset. No reports have investigated the effects of long-term exercise training using the Hybrid Assisted Limb (HAL) in patients with multiple SBMA. This study investigated the effects of long-term exercise training using HAL in patients with SBMA and its effects on the quality of life (QoL). Six courses of HAL treatment were administered to three males with SBMA, and leuprorelin was administered to each patient. Each course had a 4–5 week duration, during which the treatment was performed nine times, with a rest period of at least 2 months between each course. A 2-minute walk test (2MWT) and a 10-m walk test (10MWT) were performed to measure gait ability, and a blood test to measure the serum creatine kinase (CK) and creatinine (CRE) levels was performed before and after each course of treatment. We evaluated QoL using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). The average 2MWT distance improved over 2 years (p = 0.038), and the 10MWT showed neither improvement nor decline. No increase or decrease in serum CK or CRE levels was observed. There were no significant changes in the SF-36 physical, mental, or social summary scores. In combination with leuprorelin therapy, robot-assisted training using HAL maintained gait ability and QoL in patients with SBMA for 2 years. [ABSTRACT FROM AUTHOR]

Background: Robotic rehabilitation therapy has grown rapidly during the last two decades allowing researchers and clinicians to deliver high-intensity training to persons with sensorimotor disorders caused by neurological injuries and diseases. Methods: This case series reports the effect of robot-assisted, impairment-oriented training for persons recovering from stroke on impairment of the paretic ankle as well as on the kinematic and spatiotemporal parameters of gait. Five persons with chronic stroke (>6 months post-stroke) participated in a 10-week training protocol, receiving three, 30-min sessions per week of a robot-assisted therapy. The robot-assisted intervention cyclically induced dorsiflexion and plantarflexion to the ankle at 5 degrees/s through ±15 degrees while the participants assisted with the imposed movement. Concurrently, participants received visual feedback of their active, assistive torque as well as targeted mechanical vibration of the ankle tendons when lengthened by the applied motion. Walking speed, cadence, step length of the non-paretic leg, percentage of paretic single limb support during the gait cycle, and ankle strength were assessed just before training began (baseline), after the last training session (post-training), and 3 months post-training (follow-up). Discussion: Robot-assisted training that provided assisted movement, biofeedback, and proprioceptive stimulation reduced ankle impairment and improved kinematic and spatiotemporal gait parameters, suggesting that impairment-oriented therapy applied to the paretic ankle may provide a valuable adjunct to locomotor therapies in persons with chronic gait disorders due to stroke. [ABSTRACT FROM AUTHOR]

Bi-manual therapy (BT), mirror therapy (MT), and robot-assisted rehabilitation have been conducted in hand training in a wide range of stages in stroke patients; however, the mechanisms of action during training remain unclear. In the present study, participants performed hand tasks under different intervention conditions to study bilateral sensorimotor cortical communication, and EEG was recorded. A multifactorial design of the experiment was used with the factors of manipulating objects (O), robot-assisted bimanual training (RT), and MT. The sum of spectral coherence was applied to analyze the C3 and C4 signals to measure the level of bilateral corticocortical communication. We included stroke patients with onset <6 months (n = 6), between 6 months and 1 year (n = 14), and onset >1 year (n = 20), and their Brunnstrom recovery stage ranged from 2 to 4. The results showed that stroke duration might influence the effects of hand rehabilitation in bilateral cortical corticocortical communication with significant main effects under different conditions in the alpha and beta bands. Therefore, stroke duration may influence the effects of hand rehabilitation on interhemispheric coherence. [ABSTRACT FROM AUTHOR]

Aim: This work aimed to update and summarize the existing evidence on the effectiveness of robot-assisted training (RAT) in adults with Parkinson's disease (PD)., Methods: We conducted a systematic review with meta-analysis, reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42022371124). Seven databases and two trial registries were searched for randomized-controlled trials (RCTs) addressing RAT alone or in addition to other treatments in adults with PD up to January 2024. Primary outcomes were disease-specific motor impairment, balance, mobility, freezing of gait, falls, number of people who fell at least once, and adverse events. Meta-analysis using a random-effects model was performed. Risk of bias (RoB) and certainty of the evidence for the primary outcomes were assessed using the Cochrane RoB Tool and the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively., Results: Fifteen RCTs (629 randomized adults with PD) were included. Our results show that the evidence is very uncertain about the effectiveness of any kind of RAT, either focused on gait, balance or upper limb impairment, compared to any comparator (treadmill training, overground gait training, exercises without the exoskeleton, conventional physical therapy, balance training, and no treatment), mainly because of RoB, inconsistency in individual studies results, and very limited number (less than 200) of participants considered in each comparison., Conclusion: In light of the aforementioned very low certainty evidence, clinical considerations should be drawn very carefully. High-quality studies are thus highly needed to investigate potential benefits, risks, and cost/benefit ratio of RAT in adults with PD., Competing Interests: Declarations. Conflicts of interest: The authors declare that they have no conflict of interests to declare., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Abstract Background Prior studies have established that senses of the limb position in space (proprioception and kinaesthesia) are important for motor control and learning. Although nearly one-half of stroke patients have impairment in the ability to sense their movements, somatosensory retraining focusing on proprioception and kinaesthesia is often overlooked. Interventions that simultaneously target motor and somatosensory components are thought to be useful for relearning somatosensory functions while increasing mobility of the affected limb. For over a decade, robotic technology has been incorporated in stroke rehabilitation for more controlled therapy intensity, duration, and frequency. This pilot randomised controlled trial introduces a compact robotic-based upper-limb reaching task that retrains proprioception and kinaesthesia concurrently. Methods Thirty first-ever chronic stroke survivors (> 6-month post-stroke) will be randomly assigned to either a treatment or a control group. Over a 5-week period, the treatment group will receive 15 training sessions for about an hour per session. Robot-generated haptic guidance will be provided along the movement path as somatosensory cues while moving. Audio-visual feedback will appear following every successful movement as a reward. For the same duration, the control group will complete similar robotic training but without the vision occluded and robot-generated cues. Baseline, post-day 1, and post-day 30 assessments will be performed, where the last two sessions will be conducted after the last training session. Robotic-based performance indices and clinical assessments of upper limb functions after stroke will be used to acquire primary and secondary outcome measures respectively. This work will provide insights into the feasibility of such robot-assisted training clinically. Discussion The current work presents a study protocol to retrain upper-limb somatosensory and motor functions using robot-based rehabilitation for community-dwelling stroke survivors. The training promotes active use of the affected arm while at the same time enhances somatosensory input through augmented feedback. The outcomes of this study will provide preliminary data and help inform the clinicians on the feasibility and practicality of the proposed exercise. Trial registration ClinicalTrials.gov NCT04490655 . Registered 29 July 2020.

Task-specific training constitutes a core element for evidence-based rehabilitation strategies targeted at improving upper extremity activity after stroke. Its combination with additional treatment strategies and neurotechnology-based solutions could further improve patients' outcomes. Here, we studied the effect of gamified robot-assisted upper limb motor training on motor performance, skill learning, and transfer with respect to a non-gamified control condition with a group of chronic stroke survivors. The results suggest that a gamified training strategy results in more controlled motor performance during the training phase, which is characterized by a higher accuracy (lower deviance), higher smoothness (lower jerk), but slower speed. The responder analyses indicated that mildly impaired patients benefited most from the gamification approach. In conclusion, gamified robot-assisted motor training, which is personalized to the individual capabilities of a patient, constitutes a promising investigational strategy for further improving motor performance after a stroke.

After equinus corrective surgery, repetitive exercises for ankle dorsiflexion and plantar flexion are crucial during rehabilitation. The single-joint Hybrid Assistive Limb (HAL-SJ) is an advanced exoskeletal robotic device with a control system that uses bioelectrical signals to assist joint motion in real time and demonstrates joint torque assistance with the wearer's voluntary movement. We present two cases of robot-assisted ankle rehabilitation after equinus surgery using the HAL-SJ in children. Case 1 was an 8-year-old boy, whereas case 2 was a 6-year-old boy. When they were allowed to walk without braces, training with the HAL-SJ was performed postoperatively for 20 min per session a total of eight times (2–4 sessions per week). Assessments were performed before and after HAL-SJ training. During gait analysis, case 1 had improved joint angles during the stance phase on the operated side; however, case 2 had improved joint angles during the stance and swing phases. The co-activation index values of the medial gastrocnemius and tibialis anterior muscles, which were high before training, decreased after training and approached the standard value. The HAL-SJ may provide systematic feedback regarding voluntary ankle dorsiflexion and plantar flexion and is considered to have motor learning effects. [ABSTRACT FROM AUTHOR]

• In contrast to these AAN control strategies that require a timed trajectory, the proposed force-field-based AAN controller in this paper provides the user with motion timing freedom. • The proposed controller in the work adopts a time-varying force field assistance factor based on the subject's motor performance, which generates less intervention when the user can perform the task and provides sufficient assistance when the motion performance deteriorates. • The parameters of the controller can be individually tuned to satisfy different training requirements. Robot-assisted training with an assist-as-needed (AAN) control strategy has been used in clinical investigations to effectively enhance the subject's active effort and promote the rehabilitation of individuals with upper-limb motor impairment. In this paper, a force field-based AAN control scheme is proposed for robot-assisted upper limb rehabilitation training and then implemented in a robot-assisted rehabilitation training system (RaRTS). A spatial varying assistance force field is constructed around the predetermined trajectory in this scheme, and then a varying force field coefficient based on the subject's motor performance is adopted to deliver the AAN features with temporal freedom. The normal force field, tangential force field, and viscous force field are the three components of the constructed spatial varying assistance force field. Furthermore, the proposed scheme contains three training modes that are switched according to the subject's trajectory tracking error. Finally, task-oriented continuous training experiments with different force field factors are conducted on able-bodied subjects to evaluate and validate the performance and feasibility of the proposed scheme. Preliminary experimental results and statistics analysis suggest that the subjects were able to keep much closer to the predetermined trajectory through an appropriate selection of force-field assistance factors. Furthermore, the robot would apply an assistance force as needed as the motor performance deteriorate, which could prevent the subject from losing confidence due to poor performance. [ABSTRACT FROM AUTHOR]

Effects of the combined task-oriented trainings with botulinum toxin A (BoNT-A) injection on improving motor functions and reducing spasticity remains unclear. This study aims to investigate effects of 3 task-oriented trainings (robot-assisted therapy (RT), mirror therapy (MT), and active control treatment (AC)) in patients with stroke after BoNT-A injection. Thirty-seven patients with chronic spastic hemiplegic stroke were randomly assigned to receive RT, MT, or AC following BoNT-A injection over spastic upper extremity muscles. Each session of RT, MT, and AC was 75 min, 3 times weekly, for 8 weeks. Outcome measures were assessed at pretreatment, post-treatment, and 3-month follow-up, involving the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), including amount of use (AOU) and quality of movement (QOM), and arm activity level. All 3 combined treatments improved FMA, MAS, and MAL. The AC induced a greater effect on QOM in MAL at the 3-month follow-up than RT or MT. All 3 combined trainings induced minimal effect on arm activity level. Our findings suggest that for patients with stroke who received BoNT-A injection over spastic UE muscles, the RT, MT, or AC UE training that followed was effective in improving motor functions, reducing spasticity, and enhancing daily function. [ABSTRACT FROM AUTHOR]

During the last ten years the use of robotic-assisted rehabilitation has increased significantly. Compared with traditional care, robotic rehabilitation has several potential advantages. Platform-based robotic rehabilitation can help patients recover from musculoskeletal and neurological conditions. Evidence on how platform-based robotic technologies can positively impact on disability recovery is still lacking, and it is unclear which intervention is most effective in individual cases. This systematic review aims to evaluate the effectiveness of platform-based robotic rehabilitation for individuals with musculoskeletal or neurological injuries. Thirty-eight studies met the inclusion criteria and evaluated the efficacy of platform-based rehabilitation robots. Our findings showed that rehabilitation with platform-based robots produced some encouraging results. Among the platform-based robots studied, the VR-based Rutgers Ankle and the Hunova were found to be the most effective robots for the rehabilitation of patients with neurological conditions (stroke, spinal cord injury, Parkinson's disease) and various musculoskeletal ankle injuries. Our results were drawn mainly from studies with low-level evidence, and we think that our conclusions should be taken with caution to some extent and that further studies are needed to better evaluate the effectiveness of platform-based robotic rehabilitation devices. [ABSTRACT FROM AUTHOR]

Background: Prior studies have established that senses of the limb position in space (proprioception and kinaesthesia) are important for motor control and learning. Although nearly one-half of stroke patients have impairment in the ability to sense their movements, somatosensory retraining focusing on proprioception and kinaesthesia is often overlooked. Interventions that simultaneously target motor and somatosensory components are thought to be useful for relearning somatosensory functions while increasing mobility of the affected limb. For over a decade, robotic technology has been incorporated in stroke rehabilitation for more controlled therapy intensity, duration, and frequency. This pilot randomised controlled trial introduces a compact robotic-based upper-limb reaching task that retrains proprioception and kinaesthesia concurrently. Methods: Thirty first-ever chronic stroke survivors (> 6-month post-stroke) will be randomly assigned to either a treatment or a control group. Over a 5-week period, the treatment group will receive 15 training sessions for about an hour per session. Robot-generated haptic guidance will be provided along the movement path as somatosensory cues while moving. Audio-visual feedback will appear following every successful movement as a reward. For the same duration, the control group will complete similar robotic training but without the vision occluded and robot-generated cues. Baseline, post-day 1, and post-day 30 assessments will be performed, where the last two sessions will be conducted after the last training session. Robotic-based performance indices and clinical assessments of upper limb functions after stroke will be used to acquire primary and secondary outcome measures respectively. This work will provide insights into the feasibility of such robot-assisted training clinically. Discussion: The current work presents a study protocol to retrain upper-limb somatosensory and motor functions using robot-based rehabilitation for community-dwelling stroke survivors. The training promotes active use of the affected arm while at the same time enhances somatosensory input through augmented feedback. The outcomes of this study will provide preliminary data and help inform the clinicians on the feasibility and practicality of the proposed exercise. Trial registration: ClinicalTrials.gov NCT04490655. Registered 29 July 2020. [ABSTRACT FROM AUTHOR]

The use of robots has attracted researchers to design numerous haptic training methods to support motor learning. However, investigations of new methods yielded inconclusive results regarding their effectiveness to enhance learning due to the diversity of tasks, haptic designs, participants’ skill level, and study protocols. In this review, we developed a taxonomy to identify generalizable findings out of publications on haptic training. In the taxonomy, we grouped the results of studies on healthy learners based on participants’ skill level and tasks’ characteristics. Our inspection of included studies revealed that: i) Performance-enhancing haptic methods were beneficial for novices, ii) Training with haptics was as effective as training with other feedback modalities, and iii) Performance-enhancing and performance-degrading haptic methods were useful for the learning of temporal and spatial aspects, respectively. We also observed that these findings are in line with results from robot-aided neurorehabilitation studies on patients. Our review suggests that haptic training can be effective to foster learning, especially when the information cannot be provided with other feedback modalities. We believe the findings from the taxonomy constitute a general guide, which can assist researchers when designing studies to investigate the effectiveness of haptics on learning different tasks. [ABSTRACT FROM AUTHOR]

Bi-manual therapy (BT), mirror therapy (MT), and robot-assisted rehabilitation have been conducted in hand training in a wide range of stages in stroke patients; however, the mechanisms of action during training remain unclear. In the present study, participants performed hand tasks under different intervention conditions to study bilateral sensorimotor cortical communication, and EEG was recorded. A multifactorial design of the experiment was used with the factors of manipulating objects (O), robot-assisted bimanual training (RT), and MT. The sum of spectral coherence was applied to analyze the C3 and C4 signals to measure the level of bilateral corticocortical communication. We included stroke patients with onset 1 year (n = 20), and their Brunnstrom recovery stage ranged from 2 to 4. The results showed that stroke duration might influence the effects of hand rehabilitation in bilateral cortical corticocortical communication with significant main effects under different conditions in the alpha and beta bands. Therefore, stroke duration may influence the effects of hand rehabilitation on interhemispheric coherence.

Purpose: Robot-assisted training has been widely used in neurorehabilitation, but its effect on facilitating recovery after stroke remains controversial. One possible reason might be lacking consideration of the role of embodiment in robotic systems. Mirror visual feedback is an ideal method to approach embodiment. Thus, we hypothesized that mirror visual feedback priming with subsequent robot-assisted training might provide additional treatment benefits in rehabilitation.Method: This is a prospective, assessor-blinded, randomized, controlled study. Forty subacute stroke patients were randomly assigned into an experimental group (N = 20) or a control group (N = 20). They received either mirror visual feedback or sham-mirror visual feedback prior to robot-assisted training for 1.5 h/day, 5 days/week for 4 weeks. Before and after intervention, the Fugl-Meyer Assessment Upper Limb subscale, the Functional Independence Measure, the modified Barthel Index, and grip strength were measured. Scores of four specified games were recorded pre and post one-time mirror visual feedback priming before intervention in the experimental group.Results: All measurements improved significantly in both groups following interventions. Moreover, the Fugl-Meyer Assessment Upper Limb subscale, self-care subscale of the Functional Independence Measure, and the grip strength were improved significantly in the experimental group after a 4-week intervention, compared with the control group. Significantly higher scores of two games were revealed after one-time priming.Conclusions: Mirror visual feedback prior to robot-assisted training could prompt motor recovery, increase ability of self-care, and potentially enhance grip strength in stroke patients, compared to control treatment. Moreover, mirror visual feedback priming might have the capability to improve the patient's performance and engagement during robot-assisted training, which could prompt the design and development of robotic systems.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: ChiCTR1900023356.

Purpose: Robot-assisted training has been widely used in neurorehabilitation, but its effect on facilitating recovery after stroke remains controversial. One possible reason might be lacking consideration of the role of embodiment in robotic systems. Mirror visual feedback is an ideal method to approach embodiment. Thus, we hypothesized that mirror visual feedback priming with subsequent robot-assisted training might provide additional treatment benefits in rehabilitation. Method: This is a prospective, assessor-blinded, randomized, controlled study. Forty subacute stroke patients were randomly assigned into an experimental group (N = 20) or a control group (N = 20). They received either mirror visual feedback or sham-mirror visual feedback prior to robot-assisted training for 1.5 h/day, 5 days/week for 4 weeks. Before and after intervention, the Fugl-Meyer Assessment Upper Limb subscale, the Functional Independence Measure, the modified Barthel Index, and grip strength were measured. Scores of four specified games were recorded pre and post one-time mirror visual feedback priming before intervention in the experimental group. Results: All measurements improved significantly in both groups following interventions. Moreover, the Fugl-Meyer Assessment Upper Limb subscale, self-care subscale of the Functional Independence Measure, and the grip strength were improved significantly in the experimental group after a 4-week intervention, compared with the control group. Significantly higher scores of two games were revealed after one-time priming. Conclusions: Mirror visual feedback prior to robot-assisted training could prompt motor recovery, increase ability of self-care, and potentially enhance grip strength in stroke patients, compared to control treatment. Moreover, mirror visual feedback priming might have the capability to improve the patient's performance and engagement during robot-assisted training, which could prompt the design and development of robotic systems. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: ChiCTR1900023356. [ABSTRACT FROM AUTHOR]

Effects of the combined task-oriented trainings with botulinum toxin A (BoNT-A) injection on improving motor functions and reducing spasticity remains unclear. This study aims to investigate effects of 3 task-oriented trainings (robot-assisted therapy (RT), mirror therapy (MT), and active control treatment (AC)) in patients with stroke after BoNT-A injection. Thirty-seven patients with chronic spastic hemiplegic stroke were randomly assigned to receive RT, MT, or AC following BoNT-A injection over spastic upper extremity muscles. Each session of RT, MT, and AC was 75 min, 3 times weekly, for 8 weeks. Outcome measures were assessed at pretreatment, post-treatment, and 3-month follow-up, involving the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), including amount of use (AOU) and quality of movement (QOM), and arm activity level. All 3 combined treatments improved FMA, MAS, and MAL. The AC induced a greater effect on QOM in MAL at the 3-month follow-up than RT or MT. All 3 combined trainings induced minimal effect on arm activity level. Our findings suggest that for patients with stroke who received BoNT-A injection over spastic UE muscles, the RT, MT, or AC UE training that followed was effective in improving motor functions, reducing spasticity, and enhancing daily function.

Background: Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. Objective: The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. Design: This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. Setting: The trial was set in four NHS trial centres. Participants: Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. Interventions: Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. Main outcome measures: The primary outcome was upper limb functional recovery ‘success’ (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. Results: A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery ‘success’ was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. Conclusions: Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. Future work: Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. Limitations: Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. Trial registration: Current Controlled Trials ISRCTN69371850. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.

During the last ten years the use of robotic-assisted rehabilitation has increased significantly. Compared with traditional care, robotic rehabilitation has several potential advantages. Platform-based robotic rehabilitation can help patients recover from musculoskeletal and neurological conditions. Evidence on how platform-based robotic technologies can positively impact on disability recovery is still lacking, and it is unclear which intervention is most effective in individual cases. This systematic review aims to evaluate the effectiveness of platform-based robotic rehabilitation for individuals with musculoskeletal or neurological injuries. Thirty-eight studies met the inclusion criteria and evaluated the efficacy of platform-based rehabilitation robots. Our findings showed that rehabilitation with platform-based robots produced some encouraging results. Among the platform-based robots studied, the VR-based Rutgers Ankle and the Hunova were found to be the most effective robots for the rehabilitation of patients with neurological conditions (stroke, spinal cord injury, Parkinson’s disease) and various musculoskeletal ankle injuries. Our results were drawn mainly from studies with low-level evidence, and we think that our conclusions should be taken with caution to some extent and that further studies are needed to better evaluate the effectiveness of platform-based robotic rehabilitation devices.

Objective:To systematically review the effect of robot-assisted training on lower extremities function of stroke patients in the early stage of rehabilitation.Methods:We electronically searched databases including PubMed, EMbase, Clinicaltrials.gov, EBSCO, CNKI, and WanFang to collect randomized controlled trials (RCTs) about robot-assisted training for improvement of lower extremities motor and balance function of patients in early stage of stroke (durationPP

In rowing, rowers need outdoor and indoor training to develop a proficient technique. Although numerous indoor rowing machines have been proposed, none of the devices can realistically render the haptic, visual, and auditory characteristics of an actual rowing scenario. In our laboratory, we developed a simulator to support rowing training indoors. However, rendered forces with the initial rowing model, which was based on a simplified fluid dynamic model that approximated the drag/lift forces, were not perceived realistic enough for indoor training by expert rowers. Therefore, we implemented a new model for the blade–water interaction forces, which incorporates the three-dimensional rotation of the oar and continuously adjusts drag/lift coefficients. Ten expert rowers were asked to evaluate both models for various rowing aspects. In addition, the effect of individualization of model parameters on the perceived realism of rowing forces was elaborated. Based on the answers of the experts, we concluded that the new model rendered realistically resistive forces and ensured a smooth transition of forces within a rowing cycle. Additionally, we found that individualization of parameters significantly improved the perceived realism of the simulator. Equipped with a configurable rowing model, our simulator provides a realistic indoor training platform for rowers. [ABSTRACT FROM AUTHOR]

Although robot-assisted training is present in various fields such as sports engineering and rehabilitation, provision of training strategies that optimally support individual motor learning remains as a challenge. Literature has shown that guidance strategies are useful for beginners, while skilled trainees should benefit from challenging conditions. The Challenge Point Theory also supports this in a way that learning is dependent on the available information, which serves as a challenge to the learner. So, learning can be fostered when the optimal amount of information is given according to the trainee's skill. Even though the framework explains the importance of difficulty modulation, there are no practical guidelines for complex dynamic tasks on how to match the difficulty to the trainee's skill progress. Therefore, the goal of this study was to determine the impact on learning of a complex motor task by a modulated task difficulty scheme during the training sessions, without distorting the nature of task. In this 3-day protocol study, we compared two groups of naïve participants for learning a sweep rowing task in a highly sophisticated rowing simulator. During trainings, groups received concurrent visual feedback displaying the requested oar movement. Control group performed the task under constant difficulty in the training sessions. Experimental group's task difficulty was modulated by changing the virtual water density that generated different heaviness of the simulated water-oar interaction, which yielded practice variability. Learning was assessed in terms of spatial and velocity magnitude errors and the variability for these metrics. Results of final day tests revealed that both groups reduced their error and variability for the chosen metrics. Notably, in addition to the provision of a very well established visual feedback and knowledge of results, experimental group's variable training protocol with modulated difficulty showed a potential to be advantageous for the spatial consistency and velocity accuracy. The outcomes of training and test runs indicate that we could successfully alter the performance of the trainees by changing the density value of the virtual water. Therefore, a follow-up study is necessary to investigate how to match different density values to the skill and performance improvement of the participants.

Motor learning is assumed to be a partly error driven process. Motor learning studies on simple movements have shown that skilled subjects benefit from training with error amplification. Findings of studies with simple movements do not necessarily transfer to complex sport movements. The goal of this work was to determine the benefit of visual error amplification for non-naïve subjects in learning a fast rowing movement. We conducted a study comparing non-naïve subjects receiving a fading, visual feedback with visual error amplification against a control group receiving the same visual feedback without error amplification. Separate outcome metrics were applied for the domains of spatial and velocity magnitude errors. Besides error metrics, variability metrics were evaluated for both domains, such that they could be interpreted in quantitative relation to each other. The implemented error amplification did not cause group differences in any variable. Subjects with or without error amplification reached similar absolute levels in error and variability. Possible reasons remain speculative. For implementing error amplification to the training of complex movements design decisions must be made for which an informative basis is missing, e.g. the error amplification gains.

Robot-assisted training, where social robots can be used as motivational coaches, provides an interesting application area. This paper examines how feedback given by a robot agent influences the various facets of participant experience in robot-assisted training. Specifically, we investigated the effects of feedback type on robot acceptance, sense of safety and security, attitude towards robots and task performance. In the experiment, 23 older participants performed basic arm exercises with a social robot as a guide and received feedback. Different feedback conditions were administered, such as flattering, positive and negative feedback. Our results suggest that the robot with flattering and positive feedback was appreciated by older people in general, even if the feedback did not necessarily correspond to objective measures such as performance. Participants in these groups felt better about the interaction and the robot. [ABSTRACT FROM AUTHOR]

Featured Application: The present study examines the effectiveness of robot training in stroke patients with hemiplegic motor paralysis with or without complete sensory loss. Motor paralysis improvement through the use of robot training was observed in all patients examined. However, the effectiveness of robot training for patients with moderate or severe paralysis was reduced if the patient also had complete sensory loss. These results should be considered when determining the applicability and period of use of robot training. Sensory disorder is a factor preventing recovery from motor paralysis after stroke. Although several robot-assisted exercises for the hemiplegic upper limb of stroke patients have been proposed, few studies have examined improvement in function in stroke patients with sensory disorder using robot-assisted training. In this study, the efficacies of robot training for the hemiplegic upper limb of three stroke patients with complete sensory loss were compared with those of 19 patients without complete sensory loss. Robot training to assist reach motion was performed in 10 sessions over a 2-week period for 5 days per week at 1 h per day. Before and after the training, the total Fugl–Meyer Assessment score excluding coordination and tendon reflex (FMA-total) and the FMA shoulder and elbow score excluding tendon reflex (FMA-S/E) were evaluated. Reach and path errors (RE and PE) during the reach motion were also evaluated by the arm-training robot. In most cases, both the FMA-total and the FMA-S/E scores improved. Cases with complete sensory loss showed worse RE and PE scores. Our results suggest that motor paralysis is improved by robot training. However, improvement may be varied according to the presence or absence of somatic sensory feedback. [ABSTRACT FROM AUTHOR]

Motor learning is assumed to be a partly error driven process. Motor learning studies on simple movements have shown that skilled subjects benefit from training with error amplification. Findings of studies with simple movements do not necessarily transfer to complex sport movements. The goal of this work was to determine the benefit of visual error amplification for non-naïve subjects in learning a fast rowing movement. We conducted a study comparing non-naïve subjects receiving a fading, visual feedback with visual error amplification against a control group receiving the same visual feedback without error amplification. Separate outcome metrics were applied for the domains of spatial and velocity magnitude errors. Besides error metrics, variability metrics were evaluated for both domains, such that they could be interpreted in quantitative relation to each other. The implemented error amplification did not cause any beneficial effect. Subjects exposed to error amplification and control did not show different behavior or progress in both error and variability outcomes. Possible reasons remain speculative, e.g. the used error amplification gain could have been wrong. The feasibility of a beneficial error amplification for the training of complex movements remains questionable, since for many required design decisions an informative basis is missing. [ABSTRACT FROM AUTHOR]

In rowing, rowers need outdoor and indoor training to develop a proficient technique. Although numerous indoor rowing machines have been proposed, none of the devices can realistically render the haptic, visual, and auditory characteristics of an actual rowing scenario. In our laboratory, we developed a simulator to support rowing training indoors. However, rendered forces with the initial rowing model, which was based on a simplified fluid dynamic model that approximated the drag/lift forces, were not perceived realistic enough for indoor training by expert rowers. Therefore, we implemented a new model for the blade−water interaction forces, which incorporates the three-dimensional rotation of the oar and continuously adjusts drag/lift coefficients. Ten expert rowers were asked to evaluate both models for various rowing aspects. In addition, the effect of individualization of model parameters on the perceived realism of rowing forces was elaborated. Based on the answers of the experts, we concluded that the new model rendered realistically resistive forces and ensured a smooth transition of forces within a rowing cycle. Additionally, we found that individualization of parameters significantly improved the perceived realism of the simulator. Equipped with a configurable rowing model, our simulator provides a realistic indoor training platform for rowers.

Background: Robotic walking training improves probability to reach an autonomous walking in non-ambulant patients affected by subacute stroke. However, little information is available regarding the prognostic factors for identifying best responder patients. The purpose of the present study is therefore to investigate the clinical features of patients with subacute stroke that might benefit more from robotic walking therapy. Methods: One hundred subacute inpatients randomized in robotic or conventional gait training were assessed at baseline and after 4 weeks of training performed 5 times per week. Forward Binary Logistic Regression was performed using functional ambulation category (FAC) as dependent variable and as independent variables: trunk function (trunk control test), global ability (Barthel Index), age, sex, time from stroke and beginning of rehabilitation, side and type of stroke, and in the first analysis also type of treatment. Results: The parameters that have a significant effect on the FAC-score at discharge were a higher BI-score at admission, a higher TCT-score at admission, a short time from the ictus and a robotic therapy. The variance explained by these four factors was 78%. When the two groups were separately analysed for type of treatment, a higher BI-score and a short time from stroke resulted in good prognosis for conventional therapy, whereas only a high TCT-score improved efficacy of robotic training. Conclusion: Efficacy of robotic walking training was not associated with global ability at admission. Hence, more severely disabled patients may obtain greater benefit from robotic training, independently by other factors, except the need of a residual trunk control that was identified as a good prognostic factor for robotic walking training. [ABSTRACT FROM AUTHOR]

Robot-assisted training, where social robots can be used as motivational coaches, provides an interesting application area. This paper examines how feedback given by a robot agent influences the various facets of participant experience in robot-assisted training. Specifically, we investigated the effects of feedback type on robot acceptance, sense of safety and security, attitude towards robots and task performance. In the experiment, 23 older participants performed basic arm exercises with a social robot as a guide and received feedback. Different feedback conditions were administered, such as flattering, positive and negative feedback. Our results suggest that the robot with flattering and positive feedback was appreciated by older people in general, even if the feedback did not necessarily correspond to objective measures such as performance. Participants in these groups felt better about the interaction and the robot.

Sensory disorder is a factor preventing recovery from motor paralysis after stroke. Although several robot-assisted exercises for the hemiplegic upper limb of stroke patients have been proposed, few studies have examined improvement in function in stroke patients with sensory disorder using robot-assisted training. In this study, the efficacies of robot training for the hemiplegic upper limb of three stroke patients with complete sensory loss were compared with those of 19 patients without complete sensory loss. Robot training to assist reach motion was performed in 10 sessions over a 2-week period for 5 days per week at 1 h per day. Before and after the training, the total Fugl−Meyer Assessment score excluding coordination and tendon reflex (FMA-total) and the FMA shoulder and elbow score excluding tendon reflex (FMA-S/E) were evaluated. Reach and path errors (RE and PE) during the reach motion were also evaluated by the arm-training robot. In most cases, both the FMA-total and the FMA-S/E scores improved. Cases with complete sensory loss showed worse RE and PE scores. Our results suggest that motor paralysis is improved by robot training. However, improvement may be varied according to the presence or absence of somatic sensory feedback.

Limited evidence is available on optimal patient effort and degree of assistance to achieve preferable changes during robot-assisted training (RAT) for spinal cord injury (SCI) patients with spasticity. To investigate the relationship between patient effort and robotic assistance, we performed training using an electromyography-based robotic assistance device (HAL-SJ) in an SCI patient at multiple settings adjusted to patient effort. In this exploratory study, we report immediate change in muscle contraction patterns, patient effort, and spasticity in a 64-year-old man, diagnosed with cervical SCI and with American Spinal Injury Association Impairment Scale C level and C4 neurological level, who underwent RAT using HAL-SJ from post-injury day 403. Three patient effort conditions (comfortable, somewhat hard, and no-effort) by adjusting HAL-SJ’s assists were set for each training session. Degree of effort during flexion and extension exercise was assessed by visual analog scale, muscle contraction pattern by electromyography, modified Ashworth scale, and maximum elbow extension and flexion torques, immediately before and after each training session, without HAL-SJ. The amount of effort during training with the HAL-SJ at each session was evaluated. The degree of effort during training can be set to three effort conditions as we intended by adjusting HAL-SJ. In sessions other than the no-effort setting, spasticity improved, and the level of effort was reduced immediately after training. Spasticity did not decrease in the training session using HAL-SJ with the no-effort setting, but co-contraction further increased during extension after training. Extension torque was unchanged in all sessions, and flexion torque decreased in all sessions. When performing upper-limb training with HAL-SJ in this SCI patient, the level of assistance with some effort may reduce spasticity and too strong assistance may increase co-contraction. Sometimes, a patient’s effort may be seemingly unmeasurable; hence, the degree of patient effort should be further measured.

Background: Robotic-assisted gait training (RAGT) affords an opportunity to increase walking practice with mechanical assistance from robotic devices, rather than therapists, where the child may not be able to generate a sufficient or correct motion with enough repetitions to promote improvement. However the devices are expensive and clinicians and families need to understand if the approach is worthwhile for their children, and how it may be best delivered.Methods: The objective of this review was to identify and appraise the existing evidence for the effectiveness of RAGT for paediatric gait disorders, including modes of delivery and potential benefit. Six databases were searched from 1980 to October 2016, using relevant search terms. Any clinical trial that evaluated a clinical aspect of RAGT for children/adolescents with altered gait was selected for inclusion. Data were extracted following the PRISMA approach. Seventeen trials were identified, assessed for level of evidence and risk of bias, and appropriate data extracted for reporting.Results: Three randomized controlled trials were identified, with the remainder of lower level design. Most individual trials reported some positive benefits for RAGT with children with cerebral palsy (CP), on activity parameters such as standing ability, walking speed and distance. However a meta-analysis of the two eligible RCTs did not confirm this finding (p = 0.72). Training schedules were highly variable in duration and frequency and adverse events were either not reported or were minimal. There was a paucity of evidence for diagnoses other than CP.Conclusion: There is weak and inconsistent evidence regarding the use of RAGT for children with gait disorders. If clinicians (and their clients) choose to use RAGT, they should monitor individual progress closely with appropriate outcome measures including monitoring of adverse events. Further research is required using higher level trial design, increased numbers, in specific populations and with relevant outcome measures to both confirm effectiveness and clarify training schedules. [ABSTRACT FROM AUTHOR]

Objectives: Numbers of research have reported the usage of robot-assisted gait training for walking restoration post-stroke. However, no consistent conclusion has been reached yet about the efficacy of exoskeleton robot-assisted training (ERAT) on gait function of stroke survivors, especially during the chronic period. We conducted a systematic review to investigate the efficacy of ERAT on gait function for chronic stroke survivors., Design: This review followed the Participant, Intervention, Comparison and Outcome principle., Data Sources: PubMed, Cochrane Library, Web of Science, Embase and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched until December 2022., Eligibility Criteria: Only randomised controlled trials (RCTs) were included and these RCTs took patients who had a chronic stroke as participants, exoskeleton robot-assisted gait training as intervention, regular rehabilitation therapy as comparison and gait-related functional assessments as outcomes., Data Extraction and Synthesis: Data extraction and synthesis used the reporting checklist for systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias and methodological quality of included studies were evaluated by two independent investigators under the guidance of Cochrane risk of bias., Results: Out of 278 studies, a total of 10 studies (n=323, mean age 57.6 years, 63.2% males) were identified in this systematic review. According to the Cochrane risk of bias, the quality of these studies was assessed as low risk. Six studies reported favourable effects of ERAT on gait function involving gait performance, balance function and physical endurance, and the ERAT group was significantly superior when compared with the control group. In contrast, the other four trials showed equal or negative effects of ERAT considering different study designs. All the included studies did not claim any serious adverse events., Conclusion: ERAT could be an efficient intervention to improve gait function for individuals who had a chronic stroke. However, more rigorously designed trials are required to draw more solid evidence., Prospero Registration Number: CRD42023410796., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Abdominal palpation is one of the basic but important physical examination methods used by physicians. Visual, auditory, and haptic feedback from the patients are known to be the main sources of feedback they use in the diagnosis. However, learning to interpret this feedback and making accurate diagnosis require several years of training. Many abdominal palpation training simulators have been proposed to date, but very limited attempts have been reported in integrating vocal pain expressions into physical abdominal palpation simulators. Here, we present a vocal pain expression augmentation for a robopatient. The proposed robopatient is capable of providing real-time facial and vocal pain expressions based on the exerted palpation force and position on the abdominal phantom of the robopatient. A pilot study is conducted to test the proposed system, and we show the potential of integrating vocal pain expressions to the robopatient. The platform has also been tested by two clinical experts with prior experience in abdominal palpation. Their evaluations on functionality and suggestions for improvements are presented. We highlight the advantages of the proposed robopatient with real-time vocal and facial pain expressions as a controllable simulator platform for abdominal palpation training studies. Finally, we discuss the limitations of the proposed approach and suggest several future directions for improvements., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Protpagorn, Lalitharatne, Costi and Iida.)

Purpose: This case series investigated immediate effects of three different robot-assisted training (RAT) modes post stroke. Methods: A repeated measures descriptive case series design was applied. Patients after stroke (sub‐acute or chronic) received 4 × 30 min RAT for 3 weeks. Every week, a different randomly selected RAT-mode was applied: passive mobilisation, games, or activities of daily living (ADL). Outcome measures were bilateral upper limb function evaluated with the Chedoke McMaster Arm and Hand Activity Inventory (CAHAI‐9), muscle tone investigated with the Modified Modified Ashworth Scale (MMAS), and active and passive range of motion measured with a goniometer (aROM, pROM). Assessments were conducted by a blinded examiner at baseline, before and after each intervention week. Patients qualitatively evaluated RAT. There was no control on the patients receiving other therapies or treatments during the study period. For statistical analyses the Wilcoxon signed-rank test was used. Results: In total, seven patients participated (2 females, 5 males, mean ± SD: age 62.4 ± 6.9; time since stroke 35.4 ± 23.6 months, except for 1 sub-acute patient). CAHAI-9 scores changed: 35.9 ± 17.1 at baseline to 39.4 ± 16.6 after RAT, with a significant improvement after ADL-mode (p = 0.028). Patients reported larger ROM, less muscle tone, increased upper limb motor function, and no adverse events. Conclusions: An overall improvement in upper limb function was found in all cases. Despite the significant improvement after the ADL-mode, it remains recommended to include all three RAT modes. RAT did subjectively but not objectively influence muscle tone and ROM.

Purpose: This case series investigated immediate effects of three different robot-assisted training (RAT) modes post stroke. Methods: A repeated measures descriptive case series design was applied. Patients after stroke (sub‐acute or chronic) received 4 × 30 min RAT for 3 weeks. Every week, a different randomly selected RAT-mode was applied: passive mobilisation, games, or activities of daily living (ADL). Outcome measures were bilateral upper limb function evaluated with the Chedoke McMaster Arm and Hand Activity Inventory (CAHAI‐9), muscle tone investigated with the Modified Modified Ashworth Scale (MMAS), and active and passive range of motion measured with a goniometer (aROM, pROM). Assessments were conducted by a blinded examiner at baseline, before and after each intervention week. Patients qualitatively evaluated RAT. There was no control on the patients receiving other therapies or treatments during the study period. For statistical analyses the Wilcoxon signed-rank test was used. Results: In total, seven patients participated (2 females, 5 males, mean ± SD: age 62.4 ± 6.9; time since stroke 35.4 ± 23.6 months, except for 1 sub-acute patient). CAHAI-9 scores changed: 35.9 ± 17.1 at baseline to 39.4 ± 16.6 after RAT, with a significant improvement after ADL-mode (p = 0.028). Patients reported larger ROM, less muscle tone, increased upper limb motor function, and no adverse events. Conclusions: An overall improvement in upper limb function was found in all cases. Despite the significant improvement after the ADLmode, it remains recommended to include all three RAT modes. RAT did subjectively but not objectively influence muscle tone and ROM. [ABSTRACT FROM AUTHOR]

Haptic guidance has previously been investigated to facilitate motor skill training, whereupon a robotic device assists a trainee in executing the desired movement. However, many studies have reported a null or even detrimental effect of haptic guidance on training compared to unassisted practice. While prior studies have focused on using haptic guidance to refine a movement strategy, our study explores its effect on the discovery of a new strategy. Subjects learned to manipulate a virtual under-actuated system via a haptic device either with or without haptic guidance (and without haptic feedback of system dynamics). The guidance enabled subjects to experience a range of successful movements, rather than strictly enforcing one trajectory. Subjects who trained with guidance adopted a strategy that involved faster reaches, required greater control of the system's degrees of freedom, and increased the potential for faster task completion. However, overall improvement of task performance was limited with the new strategy. [ABSTRACT FROM PUBLISHER]