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. 2021 Nov 11;10(22):5245.
doi: 10.3390/jcm10225245.

Robot-Assisted Training for Upper Limb in Stroke (ROBOTAS): An Observational, Multicenter Study to Identify Determinants of Efficacy

Rocco Salvatore Calabrò  1 , Giovanni Morone  2 , Antonino Naro  3 , Marialuisa Gandolfi  4 , Vitalma Liotti  5 , Carlo D'aurizio  5 , Sofia Straudi  6 , Antonella Focacci  7 , Sanaz Pournajaf  8 , Irene Aprile  9 , Serena Filoni  10 , Claudia Zanetti  11 , Maria Rosaria Leo  11 , Lucia Tedesco  12 , Vincenzo Spina  13 , Carmelo Chisari  13 , Giovanni Taveggia  14 , Stefano Mazzoleni  15 , Nicola Smania  4 , Stefano Paolucci  2 , Marco Franceschini  8 , Donatella Bonaiuti  16
Affiliations

Robot-Assisted Training for Upper Limb in Stroke (ROBOTAS): An Observational, Multicenter Study to Identify Determinants of Efficacy

Rocco Salvatore Calabrò et al. J Clin Med. .

Abstract

Background: The loss of arm function is a common and disabling outcome after stroke. Robot-assisted upper limb (UL) training may improve outcomes. The aim of this study was to explore the effect of robot-assisted training using end-effector and exoskeleton robots on UL function following a stroke in real-life clinical practice.

Methods: A total of 105 patients affected by a first-ever supratentorial stroke were enrolled in 18 neurorehabilitation centers and treated with electromechanically assisted arm training as an add-on to conventional therapy. Both interventions provided either an exoskeleton or an end-effector device (as per clinical practice) and consisted of 20 sessions (3/5 times per week; 6-8 weeks). Patients were assessed by validated UL scales at baseline (T0), post-treatment (T1), and at three-month follow-up (T2). The primary outcome was the Fugl-Meyer Assessment for the upper extremity (FMA-UE).

Results: FMA-UE improved at T1 by 6 points on average in the end-effector group and 11 points on average in the exoskeleton group (p < 0.0001). Exoskeletons were more effective in the subacute phase, whereas the end-effectors were more effective in the chronic phase (p < 0.0001).

Conclusions: robot-assisted training might help improve UL function in stroke patients as an add-on treatment in both subacute and chronic stages. Pragmatic and highmethodological studies are needed to confirm the showed effectiveness of the exoskeleton and end-effector devices.

Keywords: exoskeleton; rehabilitation; robot-assisted therapy; stroke; upper limp therapy.

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Conflict of interest statement

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
Patients’ flow diagram.
Figure 2
Figure 2
Fugl-Meyer Assessment for the upper extremity (FMA-UE) in the different subgroups at T0 and T1 (data from all the participants as well as from improved and notimproved patients). T1–T0 comparisons were significant (all p < 0.0001) only in all patients grouped together and in the improved patients (i.e., those who achieved the MCID). The vertical error bars refer to SD. Minimal clinically important difference, MCID.
Figure 3
Figure 3
Post-treatment Fugl-Meyer Assessment for the upper extremity (FMA-UE) gain (i.e., at T1 and T2 with respect to the level of impairment of the baseline (T0) FMA-UE value, calculated as T1/T0 × 100 and T2/T0 × 100) in both groups and from all the patients. The vertical error bars refer to SD.
See this image and copyright information in PMC

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