Background: Post-stroke pain (PSP), particularly shoulder pain, is frequent and often underdiagnosed, limiting rehabilitation adherence and functional recovery. Current pharmacological and physical treatments offer only partial relief. Robotic-assisted therapy (RAT), such as the gravity-supporting Armeo^® Spring exoskeleton, delivers intensive, task-specific training with visual 2D feedback that may also alleviate PSP while enhancing motor outcomes. This study investigates whether RAT performed with the Armeo^® Spring reduces upper-limb PSP in chronic stroke patients versus conventional therapy and evaluates its effects on motor function and functional independence. Methods: In this retrospective parallel group study, 32 chronic post-stroke patients (8 females and 24 males with a mean age of 57 ± 11.74) were allocated to two groups: 16 received upper-limb RAT with the Armeo^® Spring, a gravity-supporting exoskeleton, (RAT group) and 16 underwent conventional rehabilitation (CR). The RAT group completed one-hour sessions 6 days/week for 8 weeks, performing 2D/3D gamified tasks targeting shoulder, elbow and forearm movements. The CR group received an equivalent amount of standard therapy, including passive/active-assisted mobilization, Bobath-based neuromuscular facilitation and reaching exercises. Results: Both the Armeo^® Spring and conventional therapy groups showed significant reductions in post-stroke pain (RAT p < 0.001 and conventional rehabilitation p = 0.004) and improvements in upper-limb motor function and functional independence (both p ≤ 0.002). Spasticity in the impaired limb decreased modestly in the RAT group (p = 0.031), with no significant between-group differences in pain or spasticity change (p = 0.437; p > 0.05, respectively). Conclusions: Gravity-support exoskeleton training reduced upper-limb spasticity, and no statistically significant between-group differences were observed compared with conventional physiotherapy for pain, mobility, and functional independence. Although clinical outcomes improved, health-related quality-of-life domains showed heterogeneous trajectories, underscoring the complexity of perceived health changes during chronic stroke rehabilitation. Larger randomized controlled trials incorporating neurophysiological and kinematic endpoints and longer follow-up are warranted to confirm effectiveness, particularly in chronic stroke and durability.

Background: PLP1-related disorders, including the Pelizaeus–Merzbacher disease spectrum and X-linked spastic paraplegia type 2, are rare hypomyelinating conditions characterized by progressive gait impairment, lower limb spasticity, and motor disability. Evidence supporting rehabilitation strategies in these disorders remains limited, particularly for technology-assisted interventions. Case presentation: We report the case of a 29-year-old man with progressive PLP1-related spastic paraparesis, prominent gait impairment, recurrent falls, lower limb spasticity, and preserved independence in activities of daily living. Genetic testing identified a hemizygous PLP1 variant, classified as likely pathogenic. The patient underwent a 20-session outpatient rehabilitation program organized into two sequential blocks: 10 sessions of anti-gravity treadmill training (Alter-G), followed by 10 sessions combining Alter-G and EXOPULSE Mollii Suit stimulation. Methods and outcomes: Clinical, gait analysis, and posturographic outcomes were collected at baseline (T0), after the first block (T1), and after completion of the full intervention (T2). Across the intervention period, balance, lower limb strength, and spasticity showed overall improvement, whereas timed mobility and endurance displayed an initial worsening at T1 followed by partial recovery at T2. Instrumental gait analysis revealed marked step-length reduction after the first block, with substantial recovery by T2, alongside side-specific changes in gait quality indices. Static posturography showed progressive normalization of foot load distribution under eyes-open conditions, while residual asymmetry persisted with eyes closed. Fatigue scores, assessed during the second block only, improved over time. Conclusion: This case suggests that sequential technology-assisted rehabilitation combining body weight-supported treadmill training and wearable electrical stimulation is feasible in PLP1-related spastic paraparesis and may be associated with improvements in selected domains, including balance, strength, spasticity, and selected gait parameters. Given the single-case design, multimodal treatment structure, and potential confounding factors, these findings should be considered exploratory and hypothesis-generating.