Robot-Assisted Therapy (RT) is an innovative approach to neurological rehabilitation that uses intensive, repetitive, interactive, and individualized practice. This systematic review aimed to investigate the effectiveness of RT on the body function and structure of people with upper limb impairments (PROSPERO registration: CRD42017054982). A search strategy conducted on seven databases identified randomized controlled studies. Methodological quality was assessed using the PEDro scale. When possible, the data were pooled, the strength of evidence was assessed using the GRADE system, and the effect sizes were assessed using Cohen coefficient. Subgroup analyses investigated the impact on the estimated effects of the following parameters: methodological quality; portion of the assessed upper limb; duration of stroke; and intervention dose and duration. Thirty-eight studies involving 1174 participants were included. Pooled estimates revealed small effects of RT on motor control and medium effects on strength compared with other intervention (OI) at a short-term follow-up. Standardized differences in means were as follows: 0.3 (95% CI 0.1 to 0.4) and 0.5 (95% CI 0.2 to 0.8). Effects at other time points and on other investigated outcomes related to body function and structure were not found (p>0.05). The strength of the current evidence was usually low quality. Subgroup analyses suggested that the methodological quality, and duration and dose of RT may influence the estimated effects. In conclusion, RT has small effects on motor control and medium effects on strength in people with limited upper limb function. Poor methodological quality, and lower treatment dose and duration may impact negatively the estimated effects.

This review aims to identify factors related to abandonment of assistive technology devices in face of the increased number of individuals with disabilities, as well as the importance of the assistive technology devices (ATD) to improve their occupational performance, the increased abandonment rates of these devices and the high costs associated with them. We used a critical literature review with the keywords: assistive technology/tecnologia assistiva, abandonment/abandono, rejection/rejeição, and disuse/desuso, published between the years 2002 and 2013. The search was conducted in MEDLINE, LILACS and SciELO and identified a total of 49 articles and\ud 9 publications that met the inclusion criterion. It found that the most cited factors related to the abandonment of devices are problems with the user’s physical condition; lack of information and training both professionals and users; pain; lack of functionality; ATD preference or other use of remaining capacity; increased weight; changes in ADT conditions; use difficulty; unsatisfactoriness; discomfort; inadequacy/inappropriate; and “lot of noise”. The better understanding of these factors is critical to improve the effectiveness of prescription and intervention\ud by professionals and imperative to increase membership and promote effective results

Stroke has a considerable incidence in the world population and would cause sequelae in the upper limbs. One way to increase the efficiency in the rehabilitation process of patients with these sequelae is through robot-assisted therapy. The present study developed a portable robotic orthosis called Pinotti Portable Robotic Exoskeleton (PPRE) and validated its functioning in clinical tests. The static and dynamic parts of the device modules are described. Design issues, such as heavyweight and engine positioning, have been optimized. The implementation of control was through a smartphone application that communicates with a microcontroller to perform desired movements. Four individuals with motor impairment of the upper limbs due to stroke performed clinical tests to validate the device. Participants did not mention pain, discomfort, tingling, and paresthesia. The robotic device showed the ability to perform the flexion and extension movements of the fingers and elbow. The PPRE was confirmed to be adequate and functional at different levels of motor impairment assessed. The orthosis presented advantages over the currently existing devices, concerning its biomechanical functioning, portability, comfort, and versatility. Thus, the apparatus has the great innovative potential to become a device for home use, serving as an aid to the therapist and facilitating the rehabilitation of patients after an injury. In a larger sample, future studies are needed to assess the effect of a robotic orthosis on the level of rehabilitation in individuals with upper limb impairment.

Background. Previous studies have suggested that robot-assisted therapy (RT) is effective in treating impairment and that it may also improve individuals participation. Objective. To investigate the effect of RT on the participation of individuals with limited upper limb functioning (PROSPERO: CRD42019133880). Data Sources: PEDro, Embase, MEDLINE, CINAHL, Cochrane, AMED, and Compendex. Inclusion Criteria. We selected randomized or quasirandomized controlled studies comparing the effects of RT with minimal or other interventions on participation of individuals with limited upper limb functioning. Data Extraction and Synthesis. Methodological quality of the included studies was assessed using the 0-10 PEDro scale, and effect estimates were reported using standardized mean differences (SMDs) with 95 confidence intervals (CIs), and the certainty of the current evidence was assessed using the GRADE. Results. Twelve randomized controlled studies involving 845 participants were included. The estimates of medium effects between RT and minimal intervention (MI) at a short-term follow-up were pooled, but there are no short-term effects between RT and OI. Standardized differences in means were as follows: 0.6 (95 CI 0.1 to 1.2) and 0.2 (95 CI -0.0 to 0.4). There were also no effects of additional RT in the short- or medium-term follow-up periods. Standardized differences in means were as follows: -0.6 (95 CI -1.1 to -0.1) and 0.2 (95 CI -0.3 to 0.8). The methodological quality of the included studies potentially compromised the effect estimates of RT. The existing evidence was very low-quality with many confounding variables between studies. Conclusions. For patients with upper limb neurological dysfunction, low-quality evidence supports RT over MI in terms of improving individual participation in the short term. The existing low- to very low-quality evidence does not support RT over OI in either the short- or medium-term follow-up periods with respect to community participation.

This study aims to present the design, selection and testing of commercial ropes (artificial tendons) used on robotic orthosis to perform the hand movements for stroke individuals over upper limb rehabilitation. It was determined the load applied in the rope would through direct measurements performed on four individuals after stroke using a bulb dynamometer. A tensile strength test was performed using eight commercial ropes in order to evaluate the maximum breaking force and select the most suitable to be used in this application. Finally, a pilot test was performed with a user of the device to ratify the effectiveness of the rope. The load on the cable was 12.38 kgf (121.4 N) in the stroke-affected hand, which is the maximum tensile force that the rope must to supports. Paragliding rope (DuPont™ Kevlar ${}^{\circledR }$ ) supporting a load of 250 N at a strain of 37 mm was selected. The clinical test proved the effectiveness of the rope, supporting the requested efforts, without presenting permanent deformation, effectively performing the participant’s finger opening.