Effects of robot-assisted therapy on upper limb recovery after stroke_a systematic review.pdf

Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review Gert Kwakkel, PhD1,2, Boudewijn J. Kollen, PhD3, and Hermano I. Krebs, PhD4,5,6 1 Department Rehabilitation and Research Institute MOVE, VU University Medical Center Amsterdam, The Netherlands 2 Department Rehabilitation, Rudolf Magnus Institute of NeuroScience, University Medical Center Utrecht, The Netherlands 3 Research Bureau, Isala Klinieken Zwolle, The Netherlands 4 Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA 5 Department of Neurology and Neuroscience, Burke Institute of Medical Research, Weill Medical College, Cornell University, White Plains, NY, USA 6 Department of Neurology, University of Maryland, School of Medicine, Baltimore, MD, USA Abstract Background and Purpose—To present a systematic review of studies that investigates the effects of robot-assisted therapy on motor and functional recovery in patients with stroke. Summary of Review—A database of articles published up to October 2006 was compiled using the following MEDLINE key words: cerebral vascular accident, cerebral vascular disorders, stroke, paresis, hemiplegia, upper extremity, arm and robot. References listed in relevant publications were also screened. Studies that satisfied the following selection criteria were included: (1) patients were diagnosed with cerebral vascular accident; (2) effects of robot-assisted therapy for the upper limb were investigated; (3) the outcome was measured in terms of motor and/or functional recovery of the upper paretic limb; (4) The study was a randomised clinical trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for motor recovery and functional ability (ADL) using fixed and random effect models. Ten studies, involving 218 patients, were included in the synthesis. Their methodological quality ranged from 4 to