Rehabilitation robots are helpful in poststroke telerehabilitation; however, their feasibility and rehabilitation effectiveness in clinical settings have not been sufficiently investigated. A non-randomized controlled trial was conducted to investigate the feasibility of translating a telerehabilitation program assisted by a mobile wrist/hand exoneuromusculoskeleton (WH-ENMS) into routine clinical services and to compare the rehabilitative effects achieved in the hospital-service-based group (n = 12, clinic group) with the laboratory-research-based group (n = 12, lab group). Both groups showed significant improvements (p ≤ 0.05) in clinical assessments of behavioral motor functions and in muscular coordination and kinematic evaluations after the training and at the 3-month follow-up, with the lab group demonstrating better motor gains than the clinic group (p ≤ 0.05). The results indicated that the WH-ENMS-assisted tele-program was feasible and effective for upper limb rehabilitation when integrated into routine practice, and the quality of patient–operator interactions physically and remotely affected the rehabilitative outcomes.

Focal vibratory stimulation (FVS) and neuromuscular electrical stimulation (NMES) are promising technologies for sensory rehabilitation after stroke. However, the differences between these techniques in immediate neuromodulatory effects on the poststroke cortex are not yet fully understood. In this research, cortical responses in persons with chronic stroke (n = 15) and unimpaired controls (n = 15) were measured by whole-brain electroencephalography (EEG) when FVS and NMES at different intensities were applied transcutaneously to the forearm muscles. Both FVS and sensory-level NMES induced alpha and beta oscillations in the sensorimotor cortex after stroke, significantly exceeding baseline levels (p < 0.05). These oscillations exhibited bilateral sensory deficiency, early adaptation, and contralesional compensation compared to the control group. FVS resulted in a significantly faster P300 response (p < 0.05) and higher theta oscillation (p < 0.05) compared to NMES. The beta desynchronization over the contralesional frontal–parietal area remained during NMES (p > 0.05), but it was significantly weakened during FVS (p < 0.05) after stroke. The results indicated that both FVS and NMES effectively activated the sensorimotor cortex after stroke. However, FVS was particularly effective in eliciting transient involuntary attention, while NMES primarily fostered the cortical responses of the targeted muscles in the contralesional motor cortex.

Restoring precise muscular control in the poststroke wrist/hand (W/H) demands sensorimotor integration to correct compensatory neuroplasticity. However, current rehabilitation robots inadequately modulate ascending somatosensory pathways from specific muscles. This study developed an electromyography (EMG)-driven soft robot with electro-vibro-feedback (EVF-robot) for targeted somatosensory priming in W/H muscles. This system integrates (a) focal vibratory stimulation and neuromuscular electrical stimulation for recruiting the somatosensory pathways of the targeted W/H flexors and extensors; (b) an EMG-driven control algorithm for strengthening the voluntary motor control of a driving muscle; and (c) robot assistance to achieve coordinated joint extension and flexion. In a single-arm trial with 20 sessions, 15 chronic stroke participants assisted by the system achieved significant improvements in voluntary W/H behavioral control, somatosensory feedback, and intermuscular coordination in the paretic upper limb ( P < 0.05). During their W/H extension, the cortical peaks of corticomuscular coherence shifted contralaterally for W/H extensors, and the ascending corticomuscular coherence from W/H flexors increased ( P < 0.05). These improvements persisted at the 3-month follow-up. The findings provide preliminary evidence that sensorimotor integration training with the EMG-driven EVF-robot may modulate compensatory neuroplasticity and facilitate improvements in coordinated motor control of the distal joints in individuals with chronic stroke.

After stroke, maladaptive neuroplasticity often presents as excessive recruitment of contralesional motor areas and the adoption of proximal compensatory m

Rehabilitation robots have demonstrated potential in poststroke recovery; however, their feasibility and effectiveness in self-help telerehabilitation, and clinical settings remain underexplored. This chapter examines the translation process of robot-assisted rehabilitation with a focus on restoring wrist–hand function after stroke. The first study, a single-group design, investigated the feasibility of a home-based self-help telerehabilitation program assisted by the wrist–hand exoneuromusculoskeleton (WH-ENMS) and its rehabilitation effects after stroke. The second study, a non-randomized controlled trial, explored the integration of the telerehabilitation program into clinical practice using the WH-ENMS and compared the rehabilitative outcomes between a hospital-based clinical group (n = 12) and a laboratory-based research group (n = 12). Both studies demonstrated significant improvements in clinical assessments, muscular coordination, and kinematic performance following the intervention, with most of the gains maintained at a three-month follow-up. <!----> <!----> <!----> <!---->

Invasive vagus nerve stimulation paired with rehabilitation improves upper-limb recovery after ischemic stroke, but clinical evidence after intracerebral hemorrhage remains limited. We evaluated the feasibility, safety, and descriptive functional signal of invasive vagus nerve stimulation-paired rehabilitation in chronic intracerebral hemorrhage. Twelve participants with chronic upper-limb motor dysfunction after intracerebral hemorrhage underwent left cervical invasive vagus nerve stimulation implantation followed by 6 weeks of supervised in-clinic rehabilitation and 90 days of home-based rehabilitation. The primary outcome was change in Fugl-Meyer Assessment Upper Extremity from baseline to day 1 after inclinic rehabilitation. Secondary and exploratory outcomes included Fugl-Meyer Assessment Upper Extremity change on day 90, Fugl-Meyer Assessment Upper Extremity subscores, modified Ashworth scale scores, quality of life, safety, and exploratory positron emission tomography/computed tomography and arterial spin labeling findings. All participants completed follow-up. Fugl-Meyer Assessment Upper Extremity increased from 23.50 ± 15.63 points at baseline to 27.58 ± 17.15 on day 1, with a mean change of 4.08 ± 3.48 points ( P = 0.002). On day 90, Fugl-Meyer Assessment Upper Extremity was 27.75 ± 17.23 points, with a mean change of 4.25 ± 3.60 points from baseline. Six participants reached the minimal clinically important difference threshold on days 1 and 90. No serious perioperative complications were observed in this small cohort. Exploratory imaging in two participants showed postoperative changes in metabolic and perfusion ratios within cortical-subcortical motor-network regions. Invasive vagus nerve stimulation-paired rehabilitation was feasible and had an acceptable safety profile in this pilot intracerebral hemorrhage cohort, with a descriptive signal of upper-limb functional improvement. This study was registered on ClinicalTrials.gov (Identifier: NCT07736573).