Effects of Robotic Therapy Associated With Noninvasive Brain Stimulation on Upper-Limb Rehabilitation After Stroke: Systematic Review and Meta-analysis of Randomized Clinical Trials

Abstract

Background Robot-assisted therapy and noninvasive brain stimulation (NIBS) are promising strategies for stroke rehabilitation. Objective This systematic review and meta-analysis aims to evaluate the evidence of NIBS as an add-on intervention to robotic therapy in order to improve outcomes of upper-limb motor impairment or activity in individuals with stroke. Methods This study was performed according to the PRISMA Protocol and was previously registered on the PROSPERO Platform (CRD42017054563). Seven databases and gray literature were systematically searched by 2 reviewers, and 1176 registers were accessed. Eight randomized clinical trials with upper-limb body structure/function or activity limitation outcome measures were included. Subgroup analyses were performed according to phase poststroke, device characteristics (ie, arm support, joints involved, unimanual or bimanual training), NIBS paradigm, timing of stimulation, and number of sessions. The Grade-Pro Software was used to assess quality of the evidence. Results A nonsignificant homogeneous summary effect size was found both for body structure function domain (mean difference [MD] = 0.15; 95% CI = −3.10 to 3.40; P = 0.93; I2 = 0%) and activity limitation domain (standard MD = 0.03; 95% CI = −0.28 to 0.33; P = 0.87; I2 = 0%). Conclusions According to this systematic review and meta-analysis, at the moment, there are not enough data about the benefits of NIBS as an add-on intervention to robot-assisted therapy on upper-limb motor function or activity in individuals with stroke.

Improving Upper Limb and Gait Rehabilitation Outcomes in Post-Stroke Patients: A Scoping Review on the Additional Effects of Non-Invasive Brain Stimulation When Combined with Robot-Aided Rehabilitation

“…These include early reperfusion therapies (i.e., intravenous thrombolysis and mechanical thrombectomy) aimed at limiting damage and preventing further cell death to contain lesion size and disability [ 1 ]. Furthermore, traditional (neurofacilitation or functional retraining through either shaping or task practice) and advanced rehabilitation protocols, including pharmacological manipulation to increase sprouting and anatomical plasticity, non-invasive brain stimulation (NIBS) to modulate the activity of targeted brain areas, and robot-aided rehabilitation (RAR) to perform an intensive, repetitive, assisted-as-needed, and task-oriented motor practice, are available in any phase of the post-stroke recovery process [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. These rehabilitation strategies aim to increase the adaptive plasticity processes (mainly experience-dependent plasticity mechanisms) that develop in lesional and perilesional tissues [ 10 , 11 , 12 ].…”

Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials

“…Similarly, a recent meta-analysis showed that NIBS combined with other therapies was effective in improving upper extremity motor function and activities of daily living in acute/subacute stroke patients, but not in chronic stroke patients ( 28 ). In contrast, a meta-analysis by Reis et al ( 29 ) indicated that there were not enough data about the benefits of NIBS as an additional intervention to robotic-assisted therapy on upper extremity motor function or activity in stroke patients. Therefore, to the best of our knowledge, this study is the first meta-analysis summarizing the findings on MT combined with NIBS in upper limb motor function recovery after stroke.…”

The Effect of Transcranial Direct Current Stimulation Therapy on Upper Extremity Motor Functions in Patients with Chronic Stroke: A Prospective Randomized Controlled Study

“…1,2 Literatürde noninvaziv beyin stimülasyon (NIBS) tedavilerinin tıbbi rehabilitasyon uygulamalarına ilave edilmesinin üst ekstremite fonksiyonel gelişimini artırdığına dair birçok klinik çalışma yer almaktadır. [3][4][5][6][7][8][9][10][11][12] NIBS uygulamaları ile lezyonlu hemisferdeki motor korteksin uyarılabilirliğini artırmak ya da kontralezyonel hemisferde aşırı uyarılabilirliği azaltmak ve inmeli hastalarda interhemisferik dengenin tekrar kurulmasına yardımcı olmak hedeflenmektedir. NIBS uygulamaları içerisinde yer alan repetetif transkraniyal manyetik stimülasyon (rTMS), transkraniyal doğru akım stimülasyonu (TDAS), transkraniyal alternatif akım stimülasyonu gibi farklı stimülasyon prosedürlerinin birbirlerine üstünlüğünü gösteren çalışma bulunmamaktadır.…”