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1. Citation: Kwakkel, G., 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. doi: 10.1177/1545968307305457
Keywords: robotics, cerebrovascular accident, activities of daily living, upper limb, systematic review
Abstract: Background: Stroke is the leading cause of disability in the US, and many findings show that very few stroke patients demonstrate full functional recovery. Strong evidence exists indicating that highly repetitive movement training can improve recovery. Using robotics to enhance and augment exercise treatment with stroke patients is a promising development.

Objectives: To conduct a systematic review of studies that investigates the effects of robot-assisted therapy on motor and functional recovery in patients with stroke.

Search Strategy: Studies were found by conducting a search of electronic databases MEDLINE, CINAHL, EMBASE, Cochrane Controlled Trials Register, DARE, SciSearch, DocOnline, and PEDro).  The following MEDLINE key words were used: cerebral vascular accident, cerebral vascular disorders, stroke, paresis, hemiplegia, upper extremity, arm, and robot. References listed in relevant publications were also screened.

Selection Criteria: Studies that satisfied the following selection criteria were included: (1) patients were diagnosed with cerebral vascular accident; (2) effects of robot-assisted therapy for the upper limb were investigated; (3) the outcome was measured in terms of motor and/or functional recovery of the upper paretic limb; and (4) the study was a randomized clinical trial.

Data Collection and Analysis:
A single independent reviewer selected articles based on title and abstract. Two independent reviewers employed the PEDro scale to rate the quality of the studies; a third reviewer was used to reach consensus when differences occurred. For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for motor recovery and activities of daily living (ADLs) using fixed and random effect models.

Main Results: Ten studies met eligibility and inclusion requirements.  The authors summarize and describe findings on robot-assisted therapy’s effect on upper limb motor recovery, paretic limb motor recovery, and activities of daily living.

Conclusions: No significant overall effect in favor of robot-assisted therapy was found. However, sensitivity analysis showed a significant improvement in upper limb motor function after stroke for upper arm robotics. No significant improvement was found in ADL function. However, valid instruments that measure outcome of dexterity of the paretic arm and hand are mostly absent in the selected studies, thus ADL scales administered do not reflect adequately the recovery of the paretic upper limb.
Full-Text Availability Options:The publisher of this journal charges a fee.
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Record Updated:2016-07-27

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