{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T01:11:14Z","timestamp":1790212274317,"version":"4.1.0"},"reference-count":57,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T00:00:00Z","timestamp":1691366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Paresis of the upper limb (UL) is the most frequent impairment after a stroke. Hybrid neuroprostheses, i.e., the combination of robots and electrical stimulation, have emerged as an option to treat these impairments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To give an overview of existing devices, their features, and how they are linked to clinical metrics, four different databases were systematically searched for studies on hybrid neuroprostheses for UL rehabilitation after stroke. The evidence on the efficacy of hybrid therapies was synthesized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010three studies were identified, introducing 32 hybrid systems. Among the most recent devices (<jats:italic>n<\/jats:italic>\u2009=\u200920), most actively reinforce movement (3 passively) and are typical exoskeletons (3 end\u2010effectors). If classified according to the International Classification of Functioning, Disability and Health, systems for proximal support are expected to affect body structures and functions, while the activity and participation level are targeted when applying Functional Electrical Stimulation distally plus the robotic component proximally. The meta\u2010analysis reveals a significant positive effect on UL functions (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), evident in a 7.8\u2010point <jats:italic>M<\/jats:italic><jats:sub>diff<\/jats:sub> between groups in the Fugl\u2013Meyer assessment. This positive effect remains at the 3\u2010month follow\u2010up (<jats:italic>M<\/jats:italic><jats:sub>diff<\/jats:sub>\u2009=\u20098.4, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hybrid neuroprostheses have a positive effect on UL recovery after stroke, with effects persisting at least three months after the intervention. Non\u2010significant studies were those with the shortest intervention periods and the oldest patients. Improvements in UL functions are not only present in the subacute phase after stroke but also in long\u2010term chronic stages. In addition to further technical development, more RCTs are needed to make assumptions about the determinants of successful therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14618","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T10:45:49Z","timestamp":1691405149000},"page":"232-253","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["The efficacy of hybrid neuroprostheses in the rehabilitation of upper limb impairment after stroke, a narrative and systematic review with a meta\u2010analysis"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6533-7841","authenticated-orcid":false,"given":"Chiara","family":"H\u00f6hler","sequence":"first","affiliation":[{"name":"Research Department Schoen Clinic Bad Aibling  Bad Aibling Germany"},{"name":"Chair of Human Movement Science, Faculty of Sport and Health Science Technical University Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3725-5694","authenticated-orcid":false,"given":"Emilio","family":"Trigili","sequence":"additional","affiliation":[{"name":"The Biorobotics Institute, Scuola Superiore Sant'Anna  Pisa Italy"},{"name":"Department of Excellence in Robotics &amp; AI Scuola Superiore Sant'Anna  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0140-3405","authenticated-orcid":false,"given":"Davide","family":"Astarita","sequence":"additional","affiliation":[{"name":"The Biorobotics Institute, Scuola Superiore Sant'Anna  Pisa Italy"},{"name":"Department of Excellence in Robotics &amp; AI Scuola Superiore Sant'Anna  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6843-4871","authenticated-orcid":false,"given":"Joachim","family":"Hermsd\u00f6rfer","sequence":"additional","affiliation":[{"name":"Chair of Human Movement Science, Faculty of Sport and Health Science Technical University Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1669-3652","authenticated-orcid":false,"given":"Klaus","family":"Jahn","sequence":"additional","affiliation":[{"name":"Research Department Schoen Clinic Bad Aibling  Bad Aibling Germany"},{"name":"German Center for Vertigo and Balance Disorders (DSGZ), Ludwig\u2010Maximilians University of Munich (LMU)  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4153-0791","authenticated-orcid":false,"given":"Carmen","family":"Krewer","sequence":"additional","affiliation":[{"name":"Research Department Schoen Clinic Bad Aibling  Bad Aibling Germany"},{"name":"Chair of Human Movement Science, Faculty of Sport and Health Science Technical University Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,7]]},"reference":[{"issue":"36","key":"e_1_2_8_2_1","first-page":"600","article-title":"Rehabilitation after stroke","volume":"108","author":"Knecht S","year":"2011","journal-title":"Dtsch Arztebl Int"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.6.1279"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000260967.77422.97"},{"key":"e_1_2_8_5_1","first-page":"132","article-title":"S3\u2010Leitlinie \u201cRehabilitative Therapie bei Armparese nach Schlaganfall\u201d der DGNR\u2010Langversion","author":"Platz T","year":"2020","journal-title":"AWMF"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2011.03.0043"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2016.00518"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2005.02.0048"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2005.04.0076"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968307305457"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1109\/ICORR.2013.6650414"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1109\/MCS.2007.914689"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0014-4886(79)90280-2"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42490-019-0028-6"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ifacol.2017.08.2266"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2016.09.001"},{"key":"e_1_2_8_17_1","volume-title":"Cochrane handbook for systematic reviews of interventions version 6.2.","author":"Higgins JPT","year":"2021"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-021-01626-4"},{"key":"e_1_2_8_20_1","first-page":"272","volume-title":"International Seminar on Intelligent Technology and Its Applications (ISITIA)","author":"Agnanto D","year":"2021"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12938-020-00774-3"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968321997769"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1108\/IR-02-2020-0041"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1109\/NER.2015.7146710"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2015.00168"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1109\/ICORR.2013.6650493"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.4316\/AECE.2016.04014"},{"key":"e_1_2_8_28_1","article-title":"Hybrid neuroprosthesis for the upper limb: combining brain\u2010controlled neuromuscular stimulation with a multi\u2010joint arm exoskeleton","volume":"10","author":"Grimm F","year":"2016","journal-title":"Front Neurosci"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968314565510"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bspc.2019.101723"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968308328718"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-015-0088-3"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/1743-0003-11-51"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/1743-0003-9-32"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bspc.2021.102624"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2016.07.010"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.2196\/12339"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1089\/soro.2020.0090"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1109\/ICARM.2019.8834141"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.3109\/03091902.2015.1088094"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/1743-0003-10-66"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1109\/EHB52898.2021.9657726"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2017.00447"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-019-0537-5"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1109\/EMBC.2016.7592188"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.3390\/app10228090"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10586-017-0880-x"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMRB.2020.2990318"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1109\/EMBC.2014.6944275"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-017-0312-4"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.06.023"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2018.00752"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-022-01043-1"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.658807"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.488"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1177\/154596802401105171"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2008.02.022"}],"container-title":["Artificial Organs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aor.14618","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T08:57:55Z","timestamp":1709629075000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aor.14618"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,7]]},"references-count":57,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/aor.14618"],"URL":"https:\/\/doi.org\/10.1111\/aor.14618","archive":["Portico"],"relation":{},"ISSN":["0160-564X","1525-1594"],"issn-type":[{"value":"0160-564X","type":"print"},{"value":"1525-1594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,7]]},"assertion":[{"value":"2023-01-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}