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• 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]

• 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]

• 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]

Background This study was a prospective, randomized, open, blinded-endpoint trial with the aim of examining whether gait training with a gait-assistance robot (GAR) improves gait disturbances in subacute non-ambulatory hemiplegic stroke patients more than overground conventional gait training. The GAR adopts a robot arm control system with full weight bearing and foot pressure visual biofeedback. Methods Twenty-six hemiplegic patients were randomly assigned to either the GAR-assisted gait training (GAGT) group or the overground conventional gait training (OCGT) group. Both groups underwent 60 min of standard physical therapy and 20 min of GAGT or OCGT 5 days a week for 4 weeks. The primary outcome measure was the Functional Ambulation Classification (FAC). The secondary outcome measures were the peak torque of the extensor muscles in the lower extremities and a 10-m walking test. The lower extremity function was evaluated using the Fugl-Meyer Assessment, and activities of daily living were assessed using the Functional Independence Measure. Results The GAGT group demonstrated significantly greater improvements in FAC and peak torque on the unaffected side ( p = 0.02) than the OCGT group. Additionally, gait speed tended to be faster ( p = 0.07) in the GAGT group. Conclusions GAGT combined with standard physical therapy in subacute non-ambulatory hemiplegic patients led to significant improvements in gait and peak torque on the unaffected side compared to OCGT. [ABSTRACT FROM AUTHOR]

Objective In stroke patients, motor impairments evaluated during the first few weeks usually predict upper limb motor outcomes after rehabilitation. However, a recent growing literature suggests that severe patients might not follow this principle [1] . This study aimed at exploring predictors of motor recovery after intensive training in that sub population of stroke patients. Material/Patients and methods Thirty-eight patients with sub-acute hemiparesis (19 females, age 56 ± 17 [19–87] years; time from stroke, 55 ± 22 days) carried out 16 sessions (33 ± 12 days) of robot-assisted adaptive training using a shoulder/elbow device integrated into conventional care. Motor outcomes were assessed using the Fugl-Meyer Assessment (FMA) scale and kinematic measures at baseline and after treatment. Potential predictors were baseline neurological, cognitive (i.e. aphasia and neglect scores) status and kinematic measures. Age, gender, type of stroke, time since stroke, side of paresis and duration of training were also collected. Statistical analyzes explored potential predictors of motor changes and of favorable changes (Minimal Clinical Important Difference [MCID]). Results Analyzes didn’t show any clinical predictor of motor outcomes. Moreover, baseline patients’ clinical characteristics did not predict clinically important improvement. Baseline kinematic measures were poor predictors of change in FM scores after training. Discussion - Conclusion The results suggested that pre-therapy motor impairments, motion kinematic measures and associated cognitive deficits might not be reliable predictors of motor outcomes after an intensive rehabilitation program for the upper limb in severe stroke patients 2 months after onset. Intensive upper limb interventions could contribute to enhance motor recovery, especially in severe subacute stroke patients. [ABSTRACT FROM AUTHOR]

Summary: In a chronic and disabling disease like multiple sclerosis, rehabilitation becomes of major importance in the preservation of physical, psychological and social functioning. Approximately 80% of patients have multiple sclerosis for more than 35 years and most will develop disability at some point of their lives, emphasising the importance of rehabilitation in order to maintain quality of life. An important aspect of multiple sclerosis rehabilitation is the preservation of physical functioning. Hot topics in the rehabilitation of physical function include (1) exercise therapy, (2) robot-assisted training and (3) pharmacological interventions. Exercise therapy has for many years been a controversial issue in multiple sclerosis rehabilitation and the advice generally given to patients was not to participate in physical exercise, since it was thought to lead to a worsening of symptoms or fatigue. However, a paradigm shift is taking place and it is now increasingly acknowledged that exercise therapy is both safe and beneficial. Robot-assisted training is also attracting attention in multiple sclerosis rehabilitation. Several sophisticated commercial robots exist, but so far the number of scientific studies that have evaluated these is limited, although some promising results have been reported. Finally, recent studies have shown that certain pharmacological interventions have the potential to improve functional capacity substantially, with the potassium channel blocker fampridine being one of the most promising. This drug has been shown to improve walking ability in some patients with multiple sclerosis, associated with a reduction of patients'' self-reported ambulatory disability. Rehabilitation strategies involving these different approaches, or combinations of them, may be of great use in improving everyday functioning and quality of life in patients with MS. [ABSTRACT FROM AUTHOR]