Limb Training Research Articles

A multi-feature fusion decoding study for unilateral upper-limb fine motor imagery.

To address the fact that the classical motor imagination paradigm has no noticeable effect on the rehabilitation training of upper limbs in patients after stroke and the corresponding feature extraction algorithm is limited to a single domain, this paper describes the design of a unilateral upper-limb fine motor imagination paradigm and the collection of data from 20 healthy people. It presents a feature extraction algorithm for multi-domain fusion and compares the common spatial pattern (CSP), improved multiscale permutation entropy (IMPE) and multi-domain fusion features of all participants through the use of decision tree, linear discriminant analysis, naive Bayes, a support vector machine, k-nearest neighbor and ensemble classification precision algorithms in the ensemble classifier. For the same subject, the average classification accuracy improvement of the same classifier for multi-domain feature extraction relative to CSP feature results went up by 1.52%. The average classification accuracy improvement of the same classifier went up by 32.87% relative to the IMPE feature classification results. This study's unilateral fine motor imagery paradigm and multi-domain feature fusion algorithm provide new ideas for upper limb rehabilitation after stroke.

A case of short-term hybrid upper limb training in a hemiplegic stroke patient using the Fugl-Meyer Assessment key form

A case of short-term hybrid upper limb training in a hemiplegic stroke patient using the Fugl-Meyer Assessment key form

Robot-Assisted Upper Limb Training for Patients with Multiple Sclerosis: An Evidence-Based Review of Clinical Applications and Effectiveness

Upper extremities limitation is a common functional impairment in patients with Multiple Sclerosis (PwMS). Novel technological devices are increasingly used in neurorehabilitation to support motor function improvement and the quantitative assessment of motor performance during training in patients with neurological diseases. In this review, we systematically report the evidence on clinical applications and robotic-assisted arm training (RAT) in functional recovery in PwMS. PubMed/MEDLINE, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to March 2021. The 10-item PEDro scale assessed the study quality for the RCT, and the AMSTAR-2 was used to assess the quality of the systematic review. The 5-item Oxford CEBM scale was used to rate the level of evidence. A total of 10 studies (161 subjects) were included. The selected studies included one systematic review, four RCTs, one randomized crossover, and four case series. The RCTs were scored as high-quality studies, while the systematic review was determined to be of low quality. Shoulder range of motion, handgrip strength, and proximal arm impairment improved after RAT. Manual dexterity, arm function, and use in daily life also ameliorated arm function. The high clinical heterogeneity of treatment programs and the variety of robot devices affects the generalizability of the study results; therefore, we emphasize the need to standardize the intervention type in future studies that evaluate the role of robotic-assisted training in PwMS. Robot-assisted treatment seems safe and useful to increase manual dexterity and the quality of movement execution in PwMS with moderate to severe disability. Additional studies with an adequate sample size and methodological rigour are warranted to drive definite conclusions.

A proposed model to test the hypothesis of exercise-induced localized fat reduction (spot reduction), including a systematic review with meta-analysis

PurposeThe process in which specific exercises reduce localized adipose tissue depots (targeted fat loss) and modify fat distribution is commonly termed spot reduction. According to this long-held popular belief, exercising a limb would lead to greater reduction in the adjacent adipose tissue in comparison with the contralateral limb. Aside from popular wisdom, scientific evidence from the 20th and 21st century seems to offer inconclusive results. The study aim was to summarize peer-reviewed literature assessing the effects of unilateral limb training, compared with the contralateral limb, on the localized adipose tissue depots in healthy participants, and to meta-analyse its results.MethodsWe followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Web of Science, and Scopus electronic databases using several relevant keyword combinations. Independent experts were contacted to help identify additional relevant articles. Following the PICOS approach, we included controlled studies that incorporated a localized exercise intervention (i.e., single-leg training) to cohorts of healthy participants (i.e., no restriction for fitness, age, or sex) compared with a control condition (i.e., contralateral limb), where the main outcome was the pre-to-post-intervention change of localized fat. The methodological quality of the studies was assessed with the Physiotherapy Evidence Database scale. Pre- and post-intervention means ± standard deviations of the fat-related outcome in the trained and control groups (limbs) were converted to Hedges’ g effect size (ES; with 95% confidence intervals [CI]) by using a random-effects model. The impact of heterogeneity was assessed with the I<SUP>2</SUP> statistic. Extended Egger’s test served to explore the risk of reporting bias. The statistical significance threshold was set at <i>p</i> < 0.05.ResultsFrom 1833 search records initially identified, 13 were included in the meta-analysis, involving 1158 male and female participants (age, 14–71 years). The 13 studies achieved a high methodological quality, and presented results with low heterogeneity (I<SUP>2</SUP> = 24.3%) and no bias (Egger’s test <i>p</i> = 0.133). The meta-analysis involved 37 comparisons, with 17 of these favouring (i.e., greater reduction of localized fat) the trained limb, and 20 favouring the untrained limb, but the ES ranged between –1.21 and 1.07. The effects were consistent, with a pooled ES = –0.03, 95% CI: –0.10 to 0.05, <i>p</i> = 0.508, meaning that spot reduction was not observed.ConclusionsLocalized muscle training had no effect on localized adipose tissue depots, i.e., there was no spot reduction, regardless of the characteristics of the population and of the exercise program. The popular belief concerning spot reduction is probably derived from wishful thinking and convenient marketing strategies, such as influencers seeking increased popularity and procedure sellers interested in increasing advertising.

A mathematical model of the fractional differential method for structural design dynamics simulation of lower limb force movement step structure based on Sanda movement

Abstract In order to promote the development of sports training robots and improve the training of lower limbs in Sanda, a new mechanical structure of Sanda training robots is designed. The thesis combines the mathematical method of fractional differential equations to design a new type of omnidirectional moving platform mechanism, which realises the movement in any direction in the plane and can turn at any radius during the movement. From the perspective of kinematics, the mathematical relationship between wheel speed and robot trajectory is analysed, and a virtual prototype technology combined with Pro/E and Adams joint modelling and simulation method is used to establish an accurate and reliable virtual prototype model. The experimental simulation results show that the designed virtual prototype model is consistent with the mathematical model, which verifies the practical feasibility of the mechanical structure of the lower limb power generation robot for Sanda movement, and provides a reliable basis for the establishment of the physical prototype.

Occupational therapy interventions in pulmonary rehabilitation – an update in the COVID-19 ERA

Background. As symptoms of COVID-19 infection are varying in severity and type, the long-term disability is yet to be established due to a short time-window since the pandemic started. Most survivors will have persistent pulmonary symptoms even after the infection, which raises the awareness of the importance of pulmonary rehabilitation in these patients, as they are mostly young, with severely diminished quality of life as they are unable to perform their basic activities of daily living as before. Occupational therapy is a form of rehabilitation treatment aimed at maximizing functionality and independence in performing activities of daily living, improvement of the patient’s autonomy and prevention of further functional decline. Objective. The purpose of the current work is to review the most important occupational therapy interventions applicable during a pulmonary rehabilitation program for chronic pulmonary pathologies, that can also be applied in COVID-19 survivors with persistent respiratory symptoms. Discussion. The main objectives of occupational therapy in pulmonary rehabilitation are training using breathing techniques at rest and during task performance, upper limbs training to increase exercise tolerance, programming and simplifying daily activities, informing patients of the importance of asking for help, planning the day/week, organizing the environment, educating the patient. All these objectives can be achieved in a simple way and at low-cost. Conclusions. Occupational therapy intervention during comprehensive pulmonary rehabilitation must be promoted to specifically evaluate and solve problems related to respiratory disability. Occupational tasks should be related to symptoms occurring during specific activities. Standardized protocols and definition of outcomes during occupational therapy intervention are lacking. Keywords: occupational therapy, pulmonary rehabilitation, COVID-19, activities of daily living, quality of life,

Efficacy of Bilateral Lower Limb Training over Unilateral to Re-educate Balance and Walking in Post-stroke Survivors: A Protocol for Randomized Clinical Trial

Background: One of the significant causes of morbidity worldwide and an essential contributor to disability is Stroke. As said by the National Stroke Association, nine post-stroke survivors out of 10 experience some degree of weakness post-stroke. The hemiplegic patients with sub-acute stroke, who will undergo training to both the lower limb overtraining to only involved side will have an improvement in balance and walking. The goal of this study is to see how much training to both the lower limb improves functional recovery in patients who have had a subacute stroke compared to unilateral, more insufficient limb training.
 Objective: The goal of this study was to see how training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients.
 Methods: A randomized clinical study with assessor blinding will be conducted with participants with subacute stroke (n=40). Participants will be randomized to one of two groups after performing baseline assessments: Group A or Group B.1st group will receive training only to the hemiparetic side, i.e., Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation, and 2nd group participants will receive bilateral training, i.e., Strengthening to the unaffected side along with Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation to the affected side. During the therapy period, we will assess lower limb function through static and dynamic balance, walking, and gait measures.
 Results: The purpose of the research is to look into the effect of training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients. The results of this study will be based on the outcome measures that are static and dynamic balance in the stroke patients and walking.
 Conclusion: The study's findings will shed more light on the benefits of training to both the lower limb overtraining to only involved side in patients post-stroke. If this trial proves successful, it will help post-stroke patients improve their balance and walking.

Effects of evidence-based nursing combined with enhanced recovery after surgery on shoulder joint function and neurological function after arthroscopic rotator cuff injury repair.

To explore the effect of Enhanced Recovery After Surgery (ERAS) nursing combined with limbs training on shoulder joint range of motion and neurological function of patients with rotator cuff injury after surgery.60 patients who underwent arthroscopic rotator cuff repair were randomly divided into experimental group and control group, with 30 cases in each group. The experimental group received ERAS nursing combined with rehabilitation training, while the control group received routine nursing. The prognostic effects of nursing care and shoulder joint range of motion between the two groups were compared.There were differences in general indicators between the two groups (P = .001). There was no significant difference in the evaluation indexes of the two groups of patients (P > .05). The visual analog scale score and the degree of swelling of the affected limb of the experimental group were lower than those of the control group (P = .001; .001). After 1, 6, 12 weeks of treatment, the Constant-Murley, American Shoulder and Elbow Surgeons and University of California-Los Angeles scores of the experimental group were higher than those of the control group (P = .001; .001; .001). After 2, 4 weeks of treatment, the National Institutes of Health Stroke Scale scores of the experimental group were lower than those of the control group (P = .001). The self-efficacy evaluation of the experimental group was significantly better than that of the control group (P = .001); the complication rate was lower than that of the control group (P = .006).Compared with simple postoperative nursing recovery, ERAS nursing combined with limbs training can improve the exercise capacity of the shoulder joint and the recovery of neurological function, reduce the occurrence of complications.

Robot-Assisted Training for Upper Limb in Stroke (ROBOTAS): An Observational, Multicenter Study to Identify Determinants of Efficacy.

Background: The loss of arm function is a common and disabling outcome after stroke. Robot-assisted upper limb (UL) training may improve outcomes. The aim of this study was to explore the effect of robot-assisted training using end-effector and exoskeleton robots on UL function following a stroke in real-life clinical practice. Methods: A total of 105 patients affected by a first-ever supratentorial stroke were enrolled in 18 neurorehabilitation centers and treated with electromechanically assisted arm training as an add-on to conventional therapy. Both interventions provided either an exoskeleton or an end-effector device (as per clinical practice) and consisted of 20 sessions (3/5 times per week; 6–8 weeks). Patients were assessed by validated UL scales at baseline (T0), post-treatment (T1), and at three-month follow-up (T2). The primary outcome was the Fugl-Meyer Assessment for the upper extremity (FMA-UE). Results: FMA-UE improved at T1 by 6 points on average in the end-effector group and 11 points on average in the exoskeleton group (p < 0.0001). Exoskeletons were more effective in the subacute phase, whereas the end-effectors were more effective in the chronic phase (p < 0.0001). Conclusions: robot-assisted training might help improve UL function in stroke patients as an add-on treatment in both subacute and chronic stages. Pragmatic and highmethodological studies are needed to confirm the showed effectiveness of the exoskeleton and end-effector devices.

Throwing in the deep end, upper limb injuries and training load in elite women's water polo: experiences, perceptions and beliefs of athletes, coaches and staff

Introduction: Upper limb injuries impact training availability and are putatively considered related to upper limb training loads in elite women’s water polo athletes. Little is known about the experiences of coaches, athletes and support staff in managing upper limb injuries and monitoring training load. We sought stakeholders’ experiences with managing upper limb injuries and monitoring training loads – with a view to understanding any perceived barriers or enablers.

Reactive Exercises with Interactive Objects: Interim Analysis of a Randomized Trial on Task-Driven NMES Grasp Rehabilitation for Subacute and Early Chronic Stroke Patients.

Enriched environments and tools are believed to promote grasp rehabilitation after stroke. We designed S2, an interactive grasp rehabilitation system consisting of smart objects, custom orthoses for selective grasp constraining, and an electrode array system for forearm NMES. Motor improvements and perceived usability of a new enriched upper limb training system for sub-acute stroke patients was assessed in this interim analysis. Inclusion criteria: sub-acute stroke patients with , ipsilesional , and contralesional . Effects of 30-min therapy supplements, conventional vs. S2 prototype, are compared through a parallel two-arms dose-matched open-label trial, lasting 27 sessions. Clinical centres: Asklepios Neurologische Klinik Falkenstein, Königstein im Taunus, Germany, and Clinica Villa Beretta, Costa Masnaga, Italy. Assessment scales: ARAT, System Usability, and Technology Acceptance. Methodology: 26 participants were block randomized, allocated to the study (control , experimental ) and underwent the training protocol. Among them, 11 participants with ARAT score at inclusion below 35, n = 6 in the experimental group, and n = 5 in the control group were analysed. Results: participants in the enriched treatment group displayed a larger improvement in the ARAT scale (+14.9 pts, ). Perceived usability differed between clinics. No adverse effect was observed in relation to the treatments. Trial status: closed. Conclusions: The S2 system, developed according to shared clinical directives, was tested in a clinical proof of concept. Variations of ARAT scores confirm the feasibility of clinical investigation for hand rehabilitation after stroke.

Safety and Feasibility of Integrating Video Gaming Technology in Acute Early Stroke Recovery

<h3>Research Objectives</h3> This study aims to examine the safety and feasibility of implementing an additional hour of time-on-task upper limb training using video game technology (VGT) or conventional Occupational Therapy (COT) in the early phase post-stroke. <h3>Design</h3> This is a randomized controlled, single-site trial. After a rollup period, sixty participants will be randomized to either a therapy group (VGT or COT) versus standard of care. Patients receive an additional hour of time-on-task upper limb training 5 days a week for the duration of their hospital stay. <h3>Setting</h3> Hospital acute stroke unit or acute rehabilitation unit. <h3>Participants</h3> Patients are eligible if they had stroke within the previous four weeks and have upper extremity weakness. <h3>Interventions</h3> VGT therapy includes the MindPod Dolphin, immersive gaming software that promotes motor recovery and bimanual arm trainer. COT includes Graded Repetitive Arm Supplementary Program. <h3>Main Outcome Measures</h3> Primary outcomes are safety and feasibility of adding an additional hour of VGT or COT into acute stroke units as measured by successful completion of the extra session. Secondary outcomes include time on task and session duration. <h3>Results</h3> In the rollup period, 14 patients were enrolled. They had an average age of 57 years. Initially, patients spent an average of 15 minutes time-on-task during 23 minute session; after protocol iteration they achieved 43 minutes during 80 minutes sessions. There have been no safety issues and motor endpoints and perceived exertion are measured. Study is ongoing. <h3>Conclusions</h3> This study is examining the safety and feasibility of integrating VGT for an additional hour of upper limb training in the early phase of post-stroke care. <h3>Author(s) Disclosures</h3> Authors have no disclosures.

Ventilatory Function Response to Upper Versus Lower Limbs Aerobic Training in Elderly Men

Abstract Background: Ventilatory function and aerobic capacity each decline by ~40%, with aging leading to ventilatory limitation, dyspnea, exercise intolerance, which affected by performance of upper and lower limbs, so it is important in the elderly to use aerobic training to improve ventilatory function, by training upper limbs as well as lower limbs which not investigated previously. Aim of Study: To compare between the impact of upper versus lower limbs training on ventilatory function in elderly men. Material and Methods: Eligible 40 elderly men their age ranged from (60-65) years old, body mass index (BMI) ranged from 25 to 34.9kg/m2 participants were recruited from the Outpatient Clinic of Faculty of Physical Therapy, Cairo University, Egypt. Patients were divided into two groups equal in number; the group (A) performed upper limbs training by arm ergometer, while the group (B) performed lower limbs training by cycle ergometer for three times per a week for 12 weeks. Ventilatory function included (Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio) were evaluated pre and post intervention for 12 weeks (36 sessions). Results: After 12 weeks of intervention, both groups demonstrated significant increase of FEV 1 and FVC (p 0.05) in both groups. Conclusion: The results demonstrated that moderate intensity aerobic exercise using both arm ergometer and cycle ergometer has equally effect on improvement of the ventilatory function of elderly men.so we recommended aerobic training of upper limbs as an integral intervention in pulmonary rehabilitation program of elderly subjects.

Influence of upper limb training and analyzed muscles on estimate of physical activity during cereal grinding using saddle quern and rotary quern

Experimental grinding has been used to study the relationship between human humeral robusticity and cereal grinding in the early Holocene. However, such replication studies raise two questions regarding the robusticity of the results: whether female nonathletes used in previous research are sufficiently comparable to early agricultural females, and whether previous analysis of muscle activation of only four upper limb muscles is sufficient to capture the stress of cereal grinding on upper limb bones. We test the influence of both of these factors. Electromyographic activity of eight upper limb muscles was recorded during cereal grinding in an athletic sample of 10 female rowers and in 25 female nonathletes and analyzed using both an eight- and four-muscle model. Athletes had lower activation than nonathletes in the majority of measured muscles, but except for posterior deltoid these differences were non-significant. Furthermore, both athletes and nonathletes had lower muscle activation during saddle quern grinding than rotary quern grinding suggesting that the nonathletes can be used to model early agricultural females during saddle and rotary quern grinding. Similarly, in both eight- and four-muscle models, upper limb loading was lower during saddle quern grinding than during rotary quern grinding, suggesting that the upper limb muscles may be reduced to the previously used four-muscle model for evaluation of the upper limb loading during cereal grinding. Another implication of our measurements is to question the assumption that skeletal indicators of high involvement of the biceps brachii muscle can be interpreted as specifically indicative of saddle quern grinding.

Effect of Immersive Virtual Reality-Based Bilateral Arm Training in Patients with Chronic Stroke.

Virtual reality (VR)-based therapies are widely used in stroke rehabilitation. Although various studies have used VR techniques for bilateral upper limb training, most have been only semi-immersive and have only been performed in an artificial environment. This study developed VR content and protocols based on activities of daily living to provide immersive VR-based bilateral arm training (VRBAT) for upper limb rehabilitation in stroke patients. Twelve patients with chronic stroke were randomized to a VRBAT group or a normal bilateral arm training (NBAT) group and attended 30-min training sessions five times a week for four weeks. At the end of the training, there was a significant difference in upper limb function in both groups (p < 0.05) and in the upper limb function sensory test for proprioception in the NBAT group (p < 0.05). There was no significant between-group difference in upper limb muscle activity after training. The relative alpha and beta power values for electroencephalographic measurements were significantly improved in both groups. These findings indicate that both VRBAT and NBAT are effective interventions for improving upper limb function and electroencephalographic activity in patients with chronic stroke.

Nano-ligament combined with sports rehabilitation training on the therapeutic effect after ligament reconstruction

As for the postoperative treatment effect of joint reconstruction, researchers have recognized the following point of view: surgical treatment alone not only has many complications, but also the recovery of knee joint function in some patients is not ideal. The effect of ligament reconstruction depends not only on the level of operation, but also on the postoperative rehabilitation. In order to study the effect of the new nano ligament combined with sports rehabilitation training on the treatment effect of ligament reconstruction, strict method analysis and control experiment were carried out in this paper.This paper first studies the importance, significance and related research status of link reconstruction at home and abroad, and then studies the proprioception training rehabilitation methods, rood multi sensory stimulation promotion, Mrs lower limb training methods and so on. Based on the theoretical support of these methods, this paper carried out the experimental study on the influence of rehabilitation training on the therapeutic effect of ligament reconstruction and the experimental results. This paper innovated on the traditional rehabilitation training: using more technical experimental results and comparing the experimental results of this paper, setting more control groups than the traditional reference experiments. In order to achieve more in-depth research results.The results showed that at the early stage of recovery, the passive flexion of bilateral knee joints was also slightly limited. After 24 weeks of rehabilitation training, the passive flexibility angle of the injured side of the three patients increased from 84 degrees to 92 degrees, from 148 degrees to 154 degrees, and the maximum increase was 64 degrees. At the early stage of rehabilitation, it gradually decreases with the rehabilitation process, and finally tends to be stable, which shows that the effect of early rehabilitation is very obvious, and it proves that early rehabilitation is more important in the whole rehabilitation training.

Quantitative Assessment of Motor Function by an End-Effector Upper Limb Rehabilitation Robot Based on Admittance Control

Various rehabilitation robots have been developed to assist the movement training of the upper limbs of stroke patients, among which some have been used to evaluate the motor recovery. However, how to understand the recovery of motor function from the quantitative assessment following robot-assisted rehabilitation training is still not clear. The objective of this study is to propose a quantitative assessment method of motor function based on the force and trajectory characteristics during robotic training to reflect motor functional recovery. To assist stroke patients who are not able to move voluntarily, an assistive training mode was developed for the robot-assisted rehabilitation system based on admittance control. Then, to validate the relationship between characteristic information and functional recovery, a clinical experiment was conducted, in which nine stroke patients and nine healthy subjects were recruited. The results showed a significant difference in movement range and movement smoothness during trajectory tracking tasks between stroke patients and healthy subjects. The two parameters above have a correlation with the Fugl-Meyer Assessment for Upper Extremity (FMU) of the involved patients. The multiple linear regression analysis showed FMU was positively correlated with parameters (R2=0.91,p&lt;0.005). This finding indicated that the above-mentioned method can achieve quantitative assessment of motor function for stroke patients during robot-assisted rehabilitation training, which can contribute to promoting rehabilitation robots in clinical practice.

Sensory-Based Priming for Upper Extremity Hemiparesis After Stroke: A Scoping Review.

Sensory priming is a technique to facilitate neuroplasticity and improve motor skills after injury. Common sensory priming modalities include peripheral nerve stimulation/somatosensory electrical stimulation (PNS/SES), transient functional deafferentation (TFD), and vibration. The aim of this study was to determine whether sensory priming with a motor intervention results in improved upper limb motor impairment or function after stroke. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and EMBASE were the databases used to search the literature in July 2020. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and recommendations for the Cochrane collaboration. In total, 30 studies were included in the analysis: three studies examined TFD, 16 examined PNS/SES, 10 studied vibration, and one combined the three stimulation techniques. Most studies reported significant improvements for participants receiving sensory priming. Given the low risk, it may be advantageous to use sensory-based priming prior to or concurrent with upper limb training after stroke.

A Comparative Efficacy Study of Robotic Priming of Bilateral Approach in Stroke Rehabilitation.

Background: Stroke survivors can remain impaired in body functions, activity, and participation. A novel rehabilitation regimen is required to obtain scientific evidence and to help clinicians determine effective interventions for stroke. Mirror therapy (MT) and bilateral upper limb training (BULT) are based on the tenet of bilateral movement practice; however, the additional effect of bilateral robotic priming combined with these two therapies is unclear.Objectives: This study examined the effects of two hybrid therapies, robotic priming combined with MT and robotic priming combined with BULT, in stroke survivors.Methodology: The study randomized 31 participants to groups that received robotic priming combined with MT (n = 15) or robotic priming combined with BULT (n = 16). Outcome measures included the Fugl–Meyer Assessment (FMA), the revised Nottingham Sensory Assessment (rNSA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and accelerometer data.Results: Both groups showed statistically significant within-group improvements in most outcome measures. Significant between-group differences and medium-to-large effect sizes were found in favor of the group that received robotic priming combined with MT based on the FMA distal part subscale scores, FMA total scores, and accelerometer data.Conclusion: Robotic priming combined with MT may have beneficial effects for patients in the improvements of overall and distal arm motor impairment as well as affected arm use in real life. Additional follow-up, a larger sample size, and consideration of the effect of lesion location or different levels of cognitive impairment are warranted to validate our findings in future studies.Clinical trial registration: www.ClinicalTrials.gov, identifier NCT03773653.

Critically appraised paper: Non-invasive brain stimulation does not enhance the effect of robotic-assisted upper limb training on arm motor recovery after stroke [commentary

Critically appraised paper: Non-invasive brain stimulation does not enhance the effect of robotic-assisted upper limb training on arm motor recovery after stroke [commentary