Portable Wearable Upper Limb Exoskeletons on Activities of Daily Living and Motor Function After Stroke: A Systematic Review and Meta-Analysis

Abstract

Aim: To summarise, appraise, and analyse current literature to determine the effectiveness of portable wearable exoskeletons in improving activities of daily living and gross motor function in the upper limb of stroke survivors. Design: Systematic review and meta-analysis. Method: A systematic review of the literature was conducted using four databases to evaluate portable wearable exoskeletons on activities of daily living and gross motor function. Included studies were independently reviewed, and data was extracted and synthesized as per the PRIMSA guidelines. Studies with similar data points were compared with a meta-analysis. Results: Eleven articles, 147 participants, were included in this review. Two studies used the same exoskeleton whereas nine studies used different exoskeletons. The methodological critically appraisal ranged from poor to good. Six studies used elbow exoskeletons and five studies used hand exoskeletons. Meta-analysis showed statistically significant improvements in gross motor function and range of motion for elbow exoskeletons, and positive trends were seen for hand exoskeletons. No significant changes were demonstrated for activities of daily living outcomes. Conclusion: When using portable wearable exoskeletons for post-stroke upper limb rehabilitation can aid the gross motor recovery. However, no significant changes were seen for activities of daily livings. Key Practice Points: Following a stroke, thousands of movement repetitions are needed for recovery. Utilizing an exoskeleton with stroke survivors could allow them to complete their therapy in the comfort of their homes or outside of structured therapy. Clinicians prescribing exoskeletons of the elbow will observe an improvement in gross motor function