What does this research mean for the field?

Robot-assisted upper-limb rehabilitation after stroke is associated with improvements in motor impairment and corticospinal excitability, though current neuroplasticity biomarker evidence remains sparse, heterogeneous, and exploratory. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To synthesize and quantify biomarker evidence related to robot-assisted upper-limb rehabilitation after stroke compared to non-robot interventions.

June 7, 2026Open Access

Robot‐Assisted Upper‐Limb Rehabilitation After Stroke: A Systematic Review and Meta‐Analysis of Cortical Reorganization and Neuroplasticity Biomarkers

Key Points

To synthesize and quantify biomarker evidence related to robot-assisted upper-limb rehabilitation after stroke compared to non-robot interventions.
Systematic review and meta-analysis of studies from multiple databases up to December 31, 2025.
Included randomized controlled trials and non-randomized intervention studies reporting neuroplasticity biomarkers in stroke patients.
Primary comparison focused on robot-assisted training versus non-robot control using random-effects models.
Robot-assisted training improved ipsilesional resting motor threshold (SMD 1.77, 95% CI: 0.46-3.08; k = 2).
Improved upper-limb impairment measured by Fugl-Meyer assessment-upper extremity (MD 4.48 points, 95% CI: 0.33-8.62; k = 3).
Uncertain effects for motor-evoked potential amplitude and activities of daily living; overall effect sizes showed moderate to substantial heterogeneity.

Abstract

BACKGROUND: Robot-assisted upper-limb rehabilitation is widely used after stroke, but links to neuroplasticity biomarkers remain uncertain. OBJECTIVE: To synthesize biomarker evidence after robot-assisted upper-limb training and quantify post-intervention effects versus non-robot comparators. METHODS: We searched PubMed, Web of Science, Embase, Cochrane Library, EBSCOhost, and Scopus from inception to December 31, 2025. Randomized controlled trials (RCTs) and nonrandomized intervention studies enrolling adults with stroke were eligible if they reported at least one neuroplasticity biomarker. Prespecified comparison classes were used; only the primary contrast (robot-assisted training vs. non-robot control) was pooled at post using DerSimonian-Laird random-effects models. Effects were expressed as standardized mean differences (SMDs; Hedges' g) or mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Fifty-five studies, including 24 RCTs, were included. Four RCTs contributed to the primary quantitative synthesis, and each pooled endpoint included two or three trials. Robot-assisted training was associated with improved ipsilesional resting motor threshold (RMT; SMD 1.77, 95% CI: 0.46-3.08; k = 2) and upper-limb impairment (Fugl-Meyer assessment-upper extremity FMA-UE; MD 4.48 points, 95% CI: 0.33-8.62; k = 3). Effects were uncertain for ipsilesional motor-evoked potential (MEP) amplitude (SMD 0.52, 95% CI: -0.31-1.34; k = 2) and activities of daily living (ADL). Heterogeneity was moderate to substantial, prediction intervals crossed the null, and certainty was low or very low. CONCLUSIONS: Robot-assisted training may improve impairment and corticospinal excitability, but randomized biomarker evidence remains sparse and heterogeneous. Biomarkers should be interpreted as exploratory observations, not validated surrogates or causal evidence of cortical restitution.

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Cite This Study

Calabrò et al. (Thu,) studied this question.

synapsesocial.com/papers/6a250ac07def13d035e1ac64 https://doi.org/https://doi.org/10.1155/np/9282578

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