Effectiveness of robot-assisted arm therapy in stroke rehabilitation: An overview of systematic reviews

Abstract

BACKGROUND:

Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs).

OBJECTIVE:

The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments.

METHODS:

The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality of the included SRs was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction.

RESULTS:

18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity.

CONCLUSION:

RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results.

Keywords

Stroke arm rehabilitation robot-assisted arm therapy end-effector devices exoskeleton devices

Get full access to this article

View all access options for this article.

References

199-comprehensive-icf-core-set-stroke.pdf. (s.d.). Retrieved on April 29th 2022, from: https://www.icf-research-branch.org/icf-core-sets/send/12-cardiovascularandrespiratoryconditions/199-comprehensive-icf-core-set-stroke

Arya,

K. N.

Pandian,

, & Puri,

(2018). Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: A systematic review. Topics in Stroke Rehabilitation, 25(1), 68–81. https://doi.org/10.1080/10749357.2017.1383712

Baker,

P. R. A.

Costello,

J. T.

Dobbins,

, & Waters,

E. B.

(2014). The benefits and challenges of conducting an overview of systematic reviews in public health: A focus on physical activity. Journal of Public Health (Oxford, England), 36(3), 517–521. https://doi.org/10.1093/pubmed/fdu050

Berkman,

N. D.

Lohr,

K. N.

Morgan,

L. C.

Kuo,

T.-M.

, & Morton,

S. C.

(2013). Interrater reliability of grading strength of evidence varies with the complexity of the evidence in systematic reviews. Journal of Clinical Epidemiology, 66(10), 1105–1117.e1. https://doi.org/10.1016/j.jclinepi.2013.06.002

Burridge,

J. H.

Turk,

Notley,

S. V.

Pickering,

R. M.

, & Simpson,

D. M.

(2009). The relationship between upper limb activity and impairment in post-stroke hemiplegia. Disability and Rehabilitation, 31(2), 109–117. https://doi.org/10.1080/09638280701824699

Da-Silva,

R. H.

Moore,

S. A.

, & Price,

C. I.

(2018). Self-directed therapy programmes for arm rehabilitation after stroke: A systematic review. Clinical Rehabilitation, 32(8), 1022–1036. https://doi.org/10.1177/0269215518775170

Dixit,

, & Tedla,

J. S.

(2019). Effectiveness of robotics in improving upper extremity functions among people with neurological dysfunction: A systematic review. The International Journal of Neuroscience, 129(4), 369–383. https://doi.org/10.1080/00207454.2018.1536051

Ferreira,

F. M. R. M.

Chaves,

M. E. A.

Oliveira,

V. C.

Van Petten,

A. M. V. N.

, & Vimieiro,

C. B. S.

(2018). Effectiveness of robot therapy on body function and structure in people with limited upper limb function: A systematic review and meta-analysis. PloS One, 13(7), e0200330. https://doi.org/10.1371/journal.pone.0200330

Fugl-Meyer,

A. R.

Jääskö,

Leyman,

Olsson,

, & Steglind,

(1975). The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scandinavian Journal of Rehabilitation Medicine, 7(1), 13–31.

10.

Gadidi,

Katz-Leurer,

Carmeli,

, & Bornstein,

N. M.

(2011). Long-term outcome poststroke: Predictors of activity limitation and participation restriction. Archives of Physical Medicine and Rehabilitation, 92(11), 1802–1808. https://doi.org/10.1016/j.apmr.2011.06.014

11.

Gassert,

, & Dietz,

(2018). Rehabilitation robots for the treatment of sensorimotor deficits: A neurophysiological perspective. Journal of Neuroengineering and Rehabilitation, 15(1), 46. https://doi.org/10.1186/s12984-018-0383-x

12.

Hayward,

Barker,

, & Brauer,

(2010). Interventions to promote upper limb recovery in stroke survivors with severe paresis: A systematic review. Disability and Rehabilitation, 32(24), 1973–1986. https://doi.org/10.3109/09638288.2010.481027

13.

Hesse,

Heß,

Werner

C, C.

Kabbert,

, & Buschfort,

(2014). Effect on arm function and cost of robot-assisted group therapy in subacute patients with stroke and a moderately to severely affected arm: A randomized controlled trial. Clinical Rehabilitation, 28(7), 637–647. https://doi.org/10.1177/0269215513516967

14.

Ingemanson,

M. L.

Rowe,

J. R.

Chan,

Wolbrecht,

E. T.

Reinkensmeyer,

D. J.

, & Cramer,

S. C.

(2019). Somatosensory system integrity explains differences in treatment response after stroke. Neurology, 92(10), e1098–e1108. https://doi.org/10.1212/WNL.0000000000007041

15.

Kim,

Lim,

Kim,

Lee,

Seo,

Cho,

, & Lee,

(2017). Is robot-assisted therapy effective in upper extremity recovery in early stage stroke? -A systematic literature review. Journal of Physical Therapy Science, 29(6), 1108–1112. https://doi.org/10.1589/jpts.29.1108

16.

Klamroth-Marganska,

Blanco,

Campen,

Curt,

Dietz,

Ettlin,

Felder,

Fellinghauer,

Guidali,

Kollmar,

Luft,

Nef,

Schuster-Amft,

Stahel,

, & Riener,

(2014). Three-dimensional, task-specific robot therapy of the arm after stroke: A multicentre, parallel-group randomised trial. The Lancet. Neurology, 13(2), 159–166. https://doi.org/10.1016/S1474-4422(13)70305-3

17.

Kwakkel,

(2006). Impact of intensity of practice after stroke: Issues for consideration. Disability and Rehabilitation, 28(13-14), 823–830. https://doi.org/10.1080/09638280500534861

18.

Kwakkel,

Kollen,

B. J.

, & Krebs,

H. I.

(2008). Effects of robot-assisted therapy on upper limb recovery after stroke: A systematic review. Neurorehabilitation and Neural Repair, 22(2), 111–121. https://doi.org/10.1177/1545968307305457

19.

Kwakkel,

Kollen,

, & Twisk,

(2006). Impact of time on improvement of outcome after stroke. Stroke, 37(9), 2348–2353. https://doi.org/10.1161/01.STR.0000238594.91938.1e

20.

Lewthwaite,

Winstein,

C. J.

Lane,

C. J.

Blanton,

Wagenheim,

B. R.

Nelsen,

M. A.

Dromerick,

A. W.

, & Wolf,

S. L.

(2018). Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial. Neurorehabilitation and Neural Repair, 32(2), 150–165. https://doi.org/10.1177/1545968318760726

21.

Li,

Rusák,

Horváth,

, & Ji,

(2014). Influence of complementing a robotic upper limb rehabilitation system with video games on the engagement of the participants: A study focusing on muscle activities. International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale De Recherches De Readaptation, 37(4), 334–342. https://doi.org/10.1097/MRR.0000000000000076

22.

Lin,

I.-H.

Tsai,

H.-T.

Wang,

C.-Y.

Hsu,

C.-Y.

Liou,

T.-H.

, & Lin,

Y.-N.

(2019). Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within Months Poststroke: A Systemic Review. Archives of Physical Medicine and Rehabilitation, 100(2), 366–378. https://doi.org/10.1016/j.apmr.2018.09.123

23.

Lo,

A. C.

Guarino,

P. D.

Richards,

L. G.

Haselkorn,

J. K.

Wittenberg,

G. F.

Federman,

D. G.

Ringer,

R. J.

Wagner,

T. H.

Krebs,

H. I.

Volpe,

B. T.

Bever,

C. T.

Bravata,

D. M.

Duncan,

P. W.

Corn,

B. H.

Maffucci,

A. D.

Nadeau,

S. E.

Conroy,

S. S.

Powell,

J. M.

Huang,

G. D.

, & Peduzzi,

(2010). Robot-assisted therapy for long-term upper-limb impairment after stroke. The New England Journal of Medicine, 362(19), 1772–1783. https://doi.org/10.1056/NEJMoa0911341

24.

Lo,

Stephenson,

, & Lockwood,

(2017). Effectiveness of robotic assisted rehabilitation for mobility and functional ability in adult stroke patients: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 15(12), 3049–3091. https://doi.org/10.11124/JBISRIR-2017-003456

25.

Lum,

P. S.

Burgar,

C. G.

Shor,

P. C.

Majmundar,

, & Van der Loos,

(2002). Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Archives of Physical Medicine and Rehabilitation, 83(7), 952–959. https://doi.org/10.1053/apmr.2001.33101

26.

Maciejasz,

Eschweiler,

Gerlach-Hahn,

Jansen-Troy,

, & Leonhardt,

(2014). A survey on robotic devices for upper limb rehabilitation. Journal of Neuroengineering and Rehabilitation, 11, 3. https://doi.org/10.1186/1743-0003-11-3

27.

Masiero,

Poli,

Rosati,

Zanotto,

Iosa,

Paolucci,

, & Morone,

(2014). The value of robotic systems in stroke rehabilitation. Expert Review of Medical Devices, 11(2), 187–198. https://doi.org/10.1586/17434440.2014.882766

28.

McDougall,

Wright,

, & Rosenbaum,

(2010). The ICF model of functioning and disability: Incorporating quality of life and human development. Developmental Neurorehabilitation, 13(3), 204–211. https://doi.org/10.3109/17518421003620525

29.

Mehrholz,

Pohl,

Platz,

Kugler,

, & Elsner,

(2018). Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. The Cochrane Database of Systematic Reviews, 693, CD006876. https://doi.org/10.1002/14651858.CD006876.pub5

30.

Moher,

Liberati,

Tetzlaff,

Altman,

D. G.

, & PRISMA

Grou.

(2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ (Clinical Research Ed.), 339, b2535. https://doi.org/10.1136/bmj.b2535

31.

Molteni,

Gasperini,

Cannaviello,

, & Guanziroli,

(2018). Exoskeleton and End-Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review. PM & R: The Journal of Injury, Function, and Rehabilitation, 10(9 Suppl 2), 188. https://doi.org/10.1016/j.pmrj.2018.06.005

32.

Morone,

Cocchi,

Paolucci,

, & Iosa,

(2020). Robot-assisted therapy for arm recovery for stroke patients: State of the art and clinical implication. Expert Review of Medical Devices, 17(3), 223–233. https://doi.org/10.1080/17434440.2020.1733408

33.

Mubin,

Alnajjar,

Jishtu,

Alsinglawi,

, & Al Mahmud,

(2019). Exoskeletons With Virtual Reality, Augmented Reality, and Gamification for Stroke Patients’ Rehabilitation: Systematic Review. JMIR Rehabilitation and Assistive Technologies, 6(2), 12010. https://doi.org/10.2196/12010

34.

Nichols-Larsen,

D. S.

Clark,

P. C.

Zeringue,

Greenspan,

, & Blanton,

(2005). Factors influencing stroke survivors’ quality of life during subacute recovery. Stroke, 36(7), 1480–1484. https://doi.org/10.1161/01.STR.0000170706.13595.4f

35.

Norouzi-Gheidari,

Archambault,

P. S.

, & Fung,

(2012). Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: Systematic review and meta-analysis of the literature. Journal of Rehabilitation Research and Development, 49(4), 479–496. https://doi.org/10.1682/jrrd.2010.10.0210

36.

Pelton,

van Vliet,

, & Hollands,

(2012). Interventions for improving coordination of reach to grasp following stroke: A systematic review. International Journal of Evidence-Based Healthcare, 10(2), 89–102. https://doi.org/10.1111/j.1744-1609.2012.00261.x

37.

Péter,

Fazekas,

Zsiga,

, & Dénes,

(2011). Robot-mediated upper limb physiotherapy: Review and recommendations for future clinical trials. International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale De Recherches De Readaptation, 34(3), 196–202. https://doi.org/10.1097/MRR.0b013e328346e8ad

38.

Pieper,

Pollock,

Fernandes,

R. M.

Büchter,

R. B.

, & Hartling,

(2017). Epidemiology and reporting characteristics of overviews of reviews of healthcare interventions published 2012-2016: Protocol for a systematic review. Systematic Reviews, 6(1), 73. https://doi.org/10.1186/s13643-017-0468-9

39.

Prange,

G. B.

Jannink,

M. J. A.

Groothuis-Oudshoorn,

C. G. M.

Hermens,

H. J.

, & Ijzerman,

M. J.

(2006). Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. Journal of Rehabilitation Research and Development, 43(2), 171–184. https://doi.org/10.1682/jrrd.2005.04.0076

40.

Ranzani,

Lambercy,

Metzger,

J.-C.

Califfi,

Regazzi,

Dinacci,

Petrillo,

Rossi,

Conti,

F. M.

, & Gassert,

(2020). Neurocognitive robot-assisted rehabilitation of hand function: A randomized control trial on motor recovery in subacute stroke. Journal of Neuroengineering and Rehabilitation, 17(1), 115. https://doi.org/10.1186/s12984-020-00746-7

41.

Rehabilitation Robots Market Size, Share | Global Analysis 2026. (s.d.). Retrieved on January 8th 2021, from: https://www.fortunebusinessinsights.com/industry-reports/rehabilitation-robots-market-101013

42.

Rodgers,

Bosomworth,

Krebs,

H. I.

van Wijck,

Howel,

Wilson,

Aird,

Alvarado,

Andole,

Cohen,

D. L.

Dawson,

Fernandez-Garcia,

Finch,

Ford,

G. A.

Francis,

Hogg,

Hughes,

Price,

C. I.

Ternent,

, . . . Shaw,

(2019). Robot assisted training for the upper limb after stroke (RATULS): A multicentre randomised controlled trial. Lancet (London, England), 394(10192), 51–62. https://doi.org/10.1016/S0140-6736(19)31055-4

43.

Shea,

B. J.

Reeves,

B. C.

Wells,

Thuku,

Hamel,

Moran,

Moher,

Tugwell,

Welch,

Kristjansson,

, & Henry,

D. A.

(2017). AMSTAR: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ (Clinical Research Ed.), 358, j4008. https://doi.org/10.1136/bmj.j4008

44.

Sivan,

O’Connor,

R. J.

Makower,

Levesley,

, & Bhakta,

(2011). Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke. Journal of Rehabilitation Medicine, 43(3), 181–189. https://doi.org/10.2340/16501977-0674

45.

Stucki,

Kostanjsek,

Ustün,

, & Cieza,

(2008). ICF-based classification and measurement of functioning. European Journal of Physical and Rehabilitation Medicine, 44(3), 315–328.

46.

Takahashi,

Domen,

Sakamoto,

Toshima,

Otaka,

Seto,

Irie,

Haga,

Takebayashi,

, & Hachisuka,

(2016). Efficacy of Upper Extremity Robotic Therapy in Subacute Poststroke Hemiplegia: An Exploratory Randomized Trial. Stroke, 47(5), 1385–1388. https://doi.org/10.1161/STROKEAHA.115.012520

47.

Thomson,

Russell,

Becker,

Klassen,

, & Hartling,

(2010). The evolution of a new publication type: Steps and challenges of producing overviews of reviews. Research Synthesis Methods, 1(3-4), 198–211. https://doi.org/10.1002/jrsm.30

48.

Veerbeek,

J. M.

Langbroek-Amersfoort,

A. C.

van Wegen,

E. E. H.

Meskers,

C. G. M.

, & Kwakkel,

(2017). Effects of Robot-Assisted Therapy for the Upper Limb After Stroke. Neurorehabilitation and Neural Repair, 31(2), 107–121. https://doi.org/10.1177/1545968316666957

49.

Winstein,

C. J.

Stein,

Arena,

Bates,

Cherney,

L. R.

Cramer,

S. C.

Deruyter,

Eng,

J. J.

Fisher,

Harvey,

R. L.

Lang,

C. E.

MacKay-Lyons,

Ottenbacher,

K. J.

Pugh,

Reeves,

M. J.

Richards,

L. G.

Stiers,

, & Zorowitz,

R. D.

, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. (2016). Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 47(6), e98–e169. https://doi.org/10.1161/STR.0000000000000098

50.

Wolf,

Scheiderer,

Napolitan,

Belden,

Shaub,

, & Whitford,

(2014). Efficacy and task structure of bimanual training post stroke: A systematic review. Topics in Stroke Rehabilitation, 21(3), 181–196. https://doi.org/10.1310/tsr2103-181

51.

Wu,

Dodakian,

See,

Burke Quinlan,

Meng,

Abraham,

Wong,

E. C.

Le,

McKenzie,

, & Cramer,

S. C.

(2020). Gains Across WHO Dimensions of Function After Robot-Based Therapy in Stroke Subjects. Neurorehabilitation and Neural Repair, 34(12), 1150–1158. https://doi.org/10.1177/1545968320956648

52.

Zhang,

Li-Tsang,

C. W. P.

, & Au,

R. K. C.

(2017). Robotic approaches for the rehabilitation of upper limb recovery after stroke: A systematic review and meta-analysis. International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale De Recherches De Readaptation, 40(1), 19–28. https://doi.org/10.1097/MRR.0000000000000204