Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review

BACKGROUND: Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE: To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS: The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS: Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION: Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation

Quantification of age-related differences in reaching and circle-drawing using a robotic rehabilitation device

BACKGROUND: Although robotic therapy is at the forefront of upper limb rehabilitation, there is limited information about the importance of selecting age-matched subjects to evaluate recovery of arm movement during rehabilitation. OBJECTIVE: This study aims to quantify differences in the arm motion of healthy children and adults when they interact with a planar robot, in order to determine whether an age-matched control group is necessary in clinical studies involving pediatric patients. METHODS: Ten children (aged 7 to 10 years) and ten adults (aged 23 to 25 years) performed, at self-selected speed and accuracy, planar-reaching and circle-drawing movements with a robotic device. We analyzed the motor performances for the two groups quantifying the participants’ dexterity in completing two chosen tasks. The measurement of the entire upper limb was obtained by merging the data provided by the robot with that of an optical tracking system. RESULTS: Children drew circles with less smoothness than adults but with the same accuracy and joint coordination. During planar reaching task, children optimized only the coordination but performed the movement with less accuracy and smoothness than adults. CONCLUSIONS: Our findings provide evidence that age-matched healthy children should be used to quantify the recovery of robot-mediated therapy in children with upper limb impairments