Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function. A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up. Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot. The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy.

Background. Many stroke patients exhibit excessive compensatory trunk movements during reaching. Compensatory movement behaviors may improve upper extremity function in the short-term but be detrimental to long-term recovery. Objective. To evaluate the evidence that trunk restraint limits compensatory trunk movement and/or promotes better upper extremity recovery in stroke patients. Methods. A search was conducted through electronic databases from January 1980 to June 2013. Only randomized controlled trials (RCTs) comparing upper extremity training with and without trunk restraint were selected for review. Three review authors independently assessed the methodological quality and extracted data from the studies. Meta-analysis was conducted when there was sufficient homogenous data. Results. Six RCTs involving 187 chronic stroke patients were identified. Meta-analysis of key outcome measures showed that trunk restraint has a moderate statistically significant effect on improving Fugl-Meyer Upper Extremity (FMA-UE) score, active shoulder flexion, and reduction in trunk displacement during reaching. There was a small, nonsignificant effect of trunk restraint on upper extremity function. Conclusion. Trunk restraint has a moderate effect on reduction of upper extremity impairment in chronic stroke patients, in terms of FMA-UE score, increased shoulder flexion, and reduction in excessive trunk movement during reaching. There is insufficient evidence to demonstrate that trunk restraint improves upper extremity function and reaching trajectory smoothness and straightness in chronic stroke patients. Future research on stroke patients at different phases of recovery and with different levels of upper extremity impairment is recommended.

Stroke can be a devastating condition that impairs the upper limb and reduces mobility. Wearable robots can aid impaired users by supporting performance of Activities of Daily Living (ADLs). In the past decade, soft devices have become popular due to their inherent malleable and low-weight properties that makes them generally safer and more ergonomic. In this study, we present an improved version of our previously developed gravity-compensating upper limb exosuit and introduce a novel hand exoskeleton. The latter uses 3D-printed structures that are attached to the back of the fingers which prevent undesired hyperextension of joints. We explored the feasibility of using this integrated system in a sample of 10 chronic stroke patients who performed 10 ADLs. We observed a significant reduction of 30.3 ± 3.5% (mean ± standard error), 31.2 ± 3.2% and 14.0 ± 5.1% in the mean muscular activity of the Biceps Brachii (BB), Anterior Deltoid (AD) and Extensor Digitorum Communis muscles, respectively. Additionally, we observed a reduction of 14.0 ± 11.5%, 14.7 ± 6.9% and 12.8 ± 4.4% in the coactivation of the pairs of muscles BB and Triceps Brachii (TB), BB and AD, and TB and Pectoralis Major (PM), respectively, typically associated to pathological muscular synergies, without significant degradation of healthy muscular coactivation. There was also a significant increase of elbow flexion angle ( $12.1\pm 1.5^\circ $ ). These results further cement the potential of using lightweight wearable devices to assist impaired users.

Background and Objective: Previous clinical studies have shown that Neuroaid (MLC 601) may be beneficial in post-stroke rehabilitation. Our aim was to investigate the efficacy of Neuroaid on motor recovery in ischemic stroke patients using rehabilitation endpoints in accordance with the International Conference on Harmonization/Good Clinical Practice guidelines, in order to provide predictive information for further larger trials. Methods:This is a phase II double-blind, placebo-controlled pilot study of 40 subjects admitted with a recent (less than 1 month) ischemic stroke. All subjects were given either Neuroaid or placebo, 4 capsules 3 times a day for 4 weeks. Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale and Functional Independence Measure scores were measured at initiation of the treatment, and at 4 and 8 weeks. Results: None of the outcomes was statistically significant between the two groups. However, FMA scores showed a positive trend for improvement with Neuroaid treatment over time. Subgroup analysis of subjects with posterior circulation infarction and severe stroke both showed a tendency for better recovery. Conclusion: Some positive trends were observed in the Neuroaid group. A larger multicenter trial focusing on severe stroke patients is needed to better evaluate the role of Neuroaid in aiding stroke recovery in rehabilitation.

Background: Trunk control is thought to contribute to upper extremity (UE) function. However, this common assumption in neurorehabilitation has not been validated in clinical trials. Objective: The study objectives were to investigate the effect of providing external trunk support on trunk control and UE function and to examine the relationship between trunk control and UE function in people with chronic stroke and people who were healthy. Design: A cross-sectional study was conducted. Methods: Twenty-five people with chronic stroke and 34 people who were healthy and matched for age and sex were recruited. Trunk control was assessed with the Trunk Impairment Scale (TIS), and UE impairment and UE function were assessed with the UE subsection of the Fugl-Meyer Assessment (FMA-UE) and the Streamlined Wolf Motor Function Test (SWMFT), respectively. The TIS and SWMFT were evaluated, with and without external trunk support; the FMA-UE was evaluated without trunk support. Results: With trunk support, people with stroke showed improvement from 18 to 20 points on the TIS, a reduction in SWMFT performance times from 37.20 seconds to 35.37 seconds for the affected UE, and improvement from 3.3 points to 3.4 points on the SWMFT Functional Ability Scale for the function of the affected UE. With trunk support, the SWMFT performance time for people who were healthy was reduced from 1.61 seconds to 1.48 seconds for the dominant UE and from 1.71 seconds to 1.59 seconds for the nondominant UE. A significant moderate correlation was found between the TIS and the FMA-UE (r=.53) for people with stroke. Limitations: The limitations included a nonmasked assessor and a standardized height of the external trunk support. Conclusions: External trunk support improved trunk control in people with chronic stroke and had a statistically significant effect on UE function in both people with chronic stroke and people who were healthy. The findings suggest an association between trunk control and the UE when external trunk support was provided and support the hypothesis that lower trunk and lumbar stabilization provided by external support enables an improvement in the ability to use the UE for functional activities.

BACKGROUND: Post-stroke trunk control is reported to be associated with trunk performance and recovery of the upper limb, but the evidence for the influence of trunk exercise on both of these is unclear. OBJECTIVE: To evaluate the effect of trunk exe