Abstract P219: Somatosensory Impairments at Baseline Limit Motor Recovery in Stroke Survivors Using a BCI

Objective: This study is part of a clinical trial designed to test the efficacy of an EEG-based BCI intervention for upper extremity motor rehabilitation in stroke survivors. The analyses presented here focus on the effectiveness of BCI intervention as a function of somatosensory integrity. Introduction: Human motor control requires integration of sensory and motor signals in the generation of motor commands. Stroke lesions often result in sensorimotor impairments and survivors may require rehabilitation to regain motor function and capacity. Stroke affects individuals differentially, based on a range of factors, including, but not limited to, lesion location and volume. Such factors may restrain recovery potential. Hypothesis: We tested the hypothesis that stroke survivors with measurable somatosensory impairments realize the same amount of motor recovery as those participants without somatosensory impairments. Methods: N= 23 stroke survivors participated in up to 30 hours of BCI intervention (13.8 ±1.3, mean + SD) for upper extremity rehabilitation, as measured by the ARAT. Participants were grouped post-hoc on presence or absence of somatosensory impairments, as measured by the NIHSS subdomains of Sensory (i.e. cutaneous), and Motor Arm (i.e. proprioceptive) and their group means compared. Results: The hypothesis was not confirmed. Mean ARAT scores at completion and follow up differed between groups (Cutaneous loss: ARAT mean change at completion: 0.9 ± 2.23, p= 0.234; ARAT mean change at follow-up: 1.20 ± 2.860, p = 0.217), (No Cutaneous loss: ARAT mean change at completion: 2.15 ± 6.34, p= 0.244; ARAT mean change at follow-up: 4.39 ± 6.41, p= 0.0297) (Proprioceptive loss: ARAT mean change at completion: 0.867 ± 3.66, p= 0.375, ARAT mean change at follow-up: 2.47 ± 5.38, p= 0.097), (No Proprioceptive loss: ARAT mean change at completion: 3 ± 6.80, p= 0.252, ARAT mean change at follow-up: 4 ± 5.42, p= 0.075). Conclusions: These results suggest that BCI intervention is more effective at delivering motor improvements in participants with less somatosensory impairments. These results are consistent with the view that somatosensory system integrity may be key to BCI motor rehabilitation of brain injuries following stroke.

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Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽

10.1161/strokeaha.119.025898 ◽

2019 ◽

Vol 50 (12) ◽

pp. 3569-3577 ◽

Cited By ~ 9

Author(s):

David J. Lin ◽

Alison M. Cloutier ◽

Kimberly S. Erler ◽

Jessica M. Cassidy ◽

Samuel B. Snider ◽

...

Keyword(s):

Acute Stroke ◽

Upper Extremity ◽

Corticospinal Tract ◽

Area Under The Curve ◽

Standard Of Care ◽

Major Effect ◽

Motor Recovery ◽

Stroke Imaging ◽

Recovery Potential

Background and Purpose— Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods— Patients with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using 4 different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict ΔFugl-Meyer. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results— N=48 patients were enrolled 4.2±2.7 days poststroke and completed 3-month follow-up (median 90-day modified Rankin Scale score, 3; interquartile range, 1.5). CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with area under the curve values ranging from 0.70 to 0.8. In addition, CST injury explained ≈20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing 4 different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions— Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in poststroke upper extremity motor recovery.

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Abstract 13: Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽

10.1161/str.51.suppl_1.13 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

David J Lin ◽

Alison M Cloutier ◽

Kimberly S Erler ◽

Jessica M Cassidy ◽

Samuel B Snider ◽

...

Keyword(s):

Acute Stroke ◽

Upper Extremity ◽

Corticospinal Tract ◽

Standard Of Care ◽

Major Effect ◽

Motor Recovery ◽

Post Stroke ◽

Stroke Imaging ◽

Recovery Potential ◽

Structural Injury

Introduction: Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods: Patients (N = 48) with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer (FM) during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using four different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict delta FM. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results: 48 patients were enrolled 4.2 ± 2.7 days post-stroke and completed this study. CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with AUC values ranging from 0.75 to 0.8. In addition, CST injury explained ~20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing four different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions: Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in post-stroke upper extremity motor recovery.

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A comparison of the effects and usability of two exoskeletal robots with and without robotic actuation for upper extremity rehabilitation among patients with stroke: a single-blinded randomised controlled pilot study

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-020-00763-6 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Jin Ho Park ◽

Gyulee Park ◽

Ha Yeon Kim ◽

Ji-Yeong Lee ◽

Yeajin Ham ◽

...

Keyword(s):

Upper Extremity ◽

Pilot Trial ◽

Stroke Survivors ◽

Robotic Rehabilitation ◽

Time Interaction ◽

Stroke Impact Scale ◽

Impact Scale ◽

Wolf Motor Function Test ◽

Upper Extremity Rehabilitation ◽

Randomised Controlled

Abstract Background Robotic rehabilitation of stroke survivors with upper extremity dysfunction may yield different outcomes depending on the robot type. Considering that excessive dependence on assistive force by robotic actuators may interfere with the patient’s active learning and participation, we hypothesised that the use of an active-assistive robot with robotic actuators does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of a passive robot without robotic actuators. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active-assistive and passive robotic rehabilitation among stroke survivors. Methods In this single-blinded randomised controlled pilot trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active-assistive robotic intervention (ACT) and passive robotic intervention (PSV) groups in a 1:1 ratio and administered 20 sessions of 30-min robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robots through interviews with patients, therapists, and physiatrists. Results In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p < 0.05). The PSV group showed better improvement in participation and smoothness than the ACT group. In contrast, the ACT group exhibited better improvement in mean speed. Conclusions There were no differences between the two groups regarding the impairment and activity domains. However, the PSV robots were more beneficial than ACT robots regarding participation and smoothness. Considering the high cost and complexity of ACT robots, PSV robots might be more suitable for rehabilitation in stroke survivors capable of voluntary movement. Trial registration The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).

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Feasibility and preliminary efficacy of a combined virtual reality, robotics and electrical stimulation intervention in upper extremity stroke rehabilitation

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00851-1 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Nahid Norouzi-Gheidari ◽

Philippe S. Archambault ◽

Katia Monte-Silva ◽

Dahlia Kairy ◽

Heidi Sveistrup ◽

...

Keyword(s):

Virtual Reality ◽

Electrical Stimulation ◽

Upper Extremity ◽

Motor Evoked Potentials ◽

Neuromuscular Electrical Stimulation ◽

Manual Muscle Testing ◽

Recovery Potential ◽

Muscle Testing ◽

Upper Extremity Rehabilitation ◽

Personalized Approach

Abstract Background Approximately 80% of individuals with chronic stroke present with long lasting upper extremity (UE) impairments. We designed the perSonalized UPper Extremity Rehabilitation (SUPER) intervention, which combines robotics, virtual reality activities, and neuromuscular electrical stimulation (NMES). The objectives of our study were to determine the feasibility and the preliminary efficacy of the SUPER intervention in individuals with moderate/severe stroke. Methods Stroke participants (n = 28) received a 4-week intervention (3 × per week), tailored to their functional level. The functional integrity of the corticospinal tract was assessed using the Predict Recovery Potential algorithm, involving measurements of motor evoked potentials and manual muscle testing. Those with low potential for hand recovery (shoulder group; n = 18) received a robotic-rehabilitation intervention focusing on elbow and shoulder movements only. Those with a good potential for hand recovery (hand group; n = 10) received EMG-triggered NMES, in addition to robot therapy. The primary outcomes were the Fugl-Meyer UE assessment and the ABILHAND assessment. Secondary outcomes included the Motor Activity Log and the Stroke Impact Scale. Results Eighteen participants (64%), in either the hand or the shoulder group, showed changes in the Fugl-Meyer UE or in the ABILHAND assessment superior to the minimal clinically important difference. Conclusions This indicates that our personalized approach is feasible and may be beneficial in improving UE function in individuals with moderate to severe impairments due to stroke. Trial registration ClinicalTrials.gov NCT03903770. Registered 4 April 2019. Registered retrospectively.

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Comparison of the effects of and usability of active and active-assistive rehabilitation robots for the upper extremity function among patients with stroke: a single-blinded randomized controlled pilot study

10.21203/rs.3.rs-24709/v2 ◽

2020 ◽

Author(s):

Jin Ho Park ◽

Gyulee Park ◽

Ha Yeon Kim ◽

Ji-Yeong Lee ◽

Yeajin Ham ◽

...

Keyword(s):

Upper Extremity ◽

Controlled Trial ◽

Stroke Survivors ◽

Robotic Rehabilitation ◽

Randomized Controlled ◽

Time Interaction ◽

Stroke Impact Scale ◽

Wolf Motor Function Test ◽

Robotic Devices ◽

Upper Extremity Rehabilitation

Abstract Background: Robotic rehabilitation of stroke survivors with upper extremity dysfunction yields different outcomes depending on the robot type. Considering that excessive dependence on assistive force provided by robots may interfere with the patient’s active learning and participation, we hypothesized that the use of an active-assistive robot does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of an active robot. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active and active-assistive robotic rehabilitation among stroke survivors.Methods: In this single-blinded randomized controlled trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active (ACT) and active-assistive (ACAS) robotic rehabilitation groups in a 1:1 ratio and administered 20 sessions of 30-minute robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robotic devices by conducting interviews with the patients, therapists, and physiatrists. Results: In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p <0.05). The ACT group showed better improvement in participation and smoothness than the ACAS group. In contrast, the ACAS group exhibited better improvement in mean speed. Conclusions: There were no differences between the two groups regarding the impairment and activity domains. However, the ACT robots were more beneficial than ACAS robots regarding participation and smoothness. Considering the high cost and complexity of ACAS robots, ACT robots may be more suitable for robotic rehabilitation in stroke survivors who can perform voluntary movement.Trial registration: The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).

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Abstract WMP89: Bilateral Priming Followed by Task Specific Training Can Improve Moderate to Severe Post-Stroke Upper Extremity Hemiparesis

Stroke ◽

10.1161/str.44.suppl_1.awmp89 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Mary E Stoykov ◽

Daniel M Corcos

Keyword(s):

Upper Extremity ◽

Activity Index ◽

Stroke Survivors ◽

Specific Training ◽

Post Intervention ◽

Transcallosal Inhibition ◽

Motor Priming ◽

Point Increase ◽

Priming Technique

INTRODUCTION: Priming techniques to facilitate improved motor performance have been examined in stroke rehabilitation research. Reported techniques include transcranial electric (TES) or magnetic (TMS) stimulation, both of which are costly and approved only for research purposes. Here, we examine a motor priming technique which is cost-effective and clinically feasible. This priming technique consists of continuous, symmetrical, rhythmic, wrist flexion and extension. A novel device, the “rocker,” is used which has a mechanical linkage promoting symmetry of both arms. Previous studies examining bilateral priming plus task specific training (TST) found the combination to be more effective than TST alone. However, there have been no studies that: 1) compare bilateral priming to a unilateral version of the same, and 2) examine priming in severely impaired stroke survivors. Hypothesis: The objective of this pilot study was to test our hypothesis that bilateral priming combined with task specific training (TST) would be effective in stroke survivors with severe upper limb impairment. Methods: We collected pilot data in 6 individuals with severe upper extremity hemparesis receiving either bilateral priming or unilateral priming followed by TST. The entire intervention was approximately 4 weeks with a total of 30 hours of priming plus training. Participants were tested at pre-/post-intervention, and at 4-week follow-up. Behavioral Measures included a bilateral motor function measure (Chedoke Arm and Hand Activity Index, CAHAI) and a unilateral measure (Fugl-Meyer Test of Upper Extremity Function, FMUE). Transcallosal inhibition (TCI) persistence was measured using TMS. Results: At post intervention, the bilateral priming group demonstrated a 9 point increase (improvement) as compared to the unilateral one (3.67 point increase) in the CAHAI. The FMUE change scores were 6.0 and 3.66 for the bilateral and unilateral priming groups respectively. Gains persisted at 4-week follow-up. Transcallosal inhibition was more normalized in the bilateral priming group at discharge. Conclusion: In conclusion, we found preliminary evidence to support our hypothesis that bilateral priming plus TST is effective for individuals with severe hemiparesis.

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A review: Motor rehabilitation after stroke with control based on human intent

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411918755828 ◽

2018 ◽

Vol 232 (4) ◽

pp. 344-360 ◽

Cited By ~ 16

Author(s):

Min Li ◽

Guanghua Xu ◽

Jun Xie ◽

Chaoyang Chen

Keyword(s):

Motor Recovery ◽

Stroke Survivors ◽

Motor Rehabilitation ◽

Stroke Patients ◽

Acquired Disability ◽

Human Motor ◽

Rehabilitation Assessment

Strokes are a leading cause of acquired disability worldwide, and there is a significant need for novel interventions and further research to facilitate functional motor recovery in stroke patients. This article reviews motor rehabilitation methods for stroke survivors with a focus on rehabilitation controlled by human motor intent. The review begins with the neurodevelopmental principles of motor rehabilitation that provide the neuroscientific basis for intuitively controlled rehabilitation, followed by a review of methods allowing human motor intent detection, biofeedback approaches, and quantitative motor rehabilitation assessment. Challenges for future advances in motor rehabilitation after stroke using intuitively controlled approaches are addressed.

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Does Measurement of Corticospinal Tract Involvement Add Value to Clinical Behavioral Biomarkers in Predicting Motor Recovery after Stroke?

Neural Plasticity ◽

10.1155/2020/8883839 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Jong Youb Lim ◽

Mi-Kyoung Oh ◽

Jihong Park ◽

Nam-Jong Paik

Keyword(s):

Upper Extremity ◽

Corticospinal Tract ◽

Prediction Models ◽

Explanatory Power ◽

Brain Magnetic Resonance Imaging ◽

Motor Recovery ◽

Motor Deficit ◽

Motor Deficits ◽

Unique Contribution

Background. The prediction of motor recovery after stroke is an important issue, and various prediction models have been proposed using either clinical behavioral or neurological biomarkers. This study sought to identify the effects of clinical behavioral biomarkers combined with corticospinal tract (CST) injury measurement on the prediction of motor recovery after stroke. Methods. The region of interest was drawn on the normalized brain magnetic resonance imaging scans of patients with first-ever unilateral hemispheric stroke, and the degree of CST injury was calculated in a total of 67 such subjects. Patients who had initial minor deficits and showed a ceiling effect on motor recovery were excluded. To predict the follow-up Fugl-Meyer assessment (FMA) scores, correlation and regression analyses were performed using various clinical behavioral biomarkers, including age, sex, lesion location, and initial FMA scores and CST injury measurements. Results. Only the initial FMA-upper extremity (UE) score was statistically correlated with the follow-up FMA-UE score at ≥2 months after the onset (adjusted R 2 = 0.626 ), and the relationship between CST injury and follow-up FMA-UE score was unclear ( n = 53 ). Hierarchical clustering between the initial and follow-up FMA-UE scores showed three clusters. After exclusion of a cluster with an initial FMA-UE ≥ 35, the prediction of the follow-up FMA-UE score was possible by incorporating the initial FMA-UE score and CST injury measurements ( n = 39 ). However, the explanatory power decreased (adjusted R 2 = 0.445 ), and the unique contribution of the CST injury (10.1%) was lower than that of the initial FMA-UE score (26.7%). With respect to the FMA-lower extremity score, CST injury was not related to recovery. Conclusions. Motor recovery of the upper and lower extremities after stroke could be predicted using the initial FMA score. CST injury was significant for the prediction of motor recovery of the upper extremity in patients with severe initial motor deficits (FMA-UE < 35); however, its portion of prediction of motor recovery was low. The prediction of poststroke motor recovery using the initial motor deficit was not improved by the addition of CST injury measurements.

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Comparison of the effects of and usability of active and active-assistive rehabilitation robots for the upper extremity function among patients with stroke: a single-blinded randomized controlled pilot study

10.21203/rs.3.rs-24709/v1 ◽

2020 ◽

Author(s):

Jin Ho Park ◽

Gyulee Park ◽

Ha Yeon Kim ◽

Ji-Yeong Lee ◽

Yeajin Ham ◽

...

Keyword(s):

Upper Extremity ◽

Controlled Trial ◽

Stroke Survivors ◽

Robotic Rehabilitation ◽

Randomized Controlled ◽

Time Interaction ◽

Movement Trial ◽

Wolf Motor Function Test ◽

Robotic Devices ◽

Upper Extremity Rehabilitation

Abstract Background Robotic rehabilitation of stroke survivors with upper extremity dysfunction yields different outcomes depending on the robot type. Considering that excessive dependence on assistive force provided by robots may interfere with the patient’s active learning and participation, we hypothesized that the use of an active-assistive robot does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of an active robot. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active and active-assistive robotic rehabilitation among stroke survivors. Methods In this single-blinded randomized controlled trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active (ACT) and active-assistive (ACAS) robotic rehabilitation groups in a 1:1 ratio and administered 20 sessions of 30-minute robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robotic devices by conducting interviews with the patients, therapists, and physiatrists. Results In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p < 0.05). The ACT group showed better improvement in participation and smoothness than the ACAS group. In contrast, the ACAS group exhibited better improvement in mean speed. Conclusions There were no differences between the two groups regarding the impairment and activity domains. However, the ACT robots were more beneficial than ACAS robots regarding participation and smoothness. Considering the high cost and complexity of ACAS robots, ACT robots may be more suitable for robotic rehabilitation in stroke survivors who can perform voluntary movement. Trial registration: The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).

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A comparison of the effects and usability of two exoskeletal robots with and without robotic actuation for upper extremity rehabilitation among patients with stroke: a single-blinded randomised controlled pilot study

10.21203/rs.3.rs-24709/v3 ◽

2020 ◽

Author(s):

Jin Ho Park ◽

Gyulee Park ◽

Ha Yeon Kim ◽

Ji-Yeong Lee ◽

Yeajin Ham ◽

...

Keyword(s):

Upper Extremity ◽

Pilot Trial ◽

Stroke Survivors ◽

Robotic Rehabilitation ◽

Time Interaction ◽

Movement Trial ◽

Stroke Impact Scale ◽

Wolf Motor Function Test ◽

Upper Extremity Rehabilitation ◽

Randomised Controlled

Abstract Background : Robotic rehabilitation of stroke survivors with upper extremity dysfunction may yield different outcomes depending on the robot type. Considering that excessive dependence on assistive force by robotic actuators may interfere with the patient’s active learning and participation, we hypothesised that the use of an active-assistive robot with robotic actuators does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of a passive robot without robotic actuators. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active-assistive and passive robotic rehabilitation among stroke survivors. Methods: In this single-blinded randomised controlled pilot trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active-assistive robotic intervention (ACT) and passive robotic intervention (PSV) groups in a 1:1 ratio and administered 20 sessions of 30-minute robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robots through interviews with patients, therapists, and physiatrists. Results: In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p <0.05). The PSV group showed better improvement in participation and smoothness than the ACT group. In contrast, the ACT group exhibited better improvement in mean speed. Conclusions: There were no differences between the two groups regarding the impairment and activity domains. However, the PSV robots were more beneficial than ACT robots regarding participation and smoothness. Considering the high cost and complexity of ACT robots, PSV robots might be more suitable for rehabilitation in stroke survivors capable of voluntary movement. Trial registration: The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).

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