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01.12.2014 | Review | Ausgabe 1/2014 Open Access

Journal of NeuroEngineering and Rehabilitation 1/2014

Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review

Journal of NeuroEngineering and Rehabilitation > Ausgabe 1/2014
Angelo Basteris, Sharon M Nijenhuis, Arno HA Stienen, Jaap H Buurke, Gerdienke B Prange, Farshid Amirabdollahian
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1743-0003-11-111) contains supplementary material, which is available to authorized users.

Competing interests

The author(s) declare that they have no competing interest.

Authors’ contributions

FA conceived of the idea to clarify the mechanism of interaction between human and robots. AB and SN contributed equally to data collection and analysis, and writing of the manuscript. AB and SN both reviewed all abstracts and full articles included in this review. AS, JB, GP and FA provided edits and revisions. All authors read and approved the final manuscript.


Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.
Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.

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