{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T15:16:07Z","timestamp":1781968567003,"version":"3.54.5"},"reference-count":19,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Technology and Health Care"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stroke remains a leading cause of long-term disability worldwide. Robotic-assisted rehabilitation, particularly with the Hybrid Assistive Limb (HAL), has emerged as an innovative approach to enhance motor recovery and functional outcomes. HAL is a wearable exoskeleton that detects bioelectrical signals and provides real-time support, offering unique opportunities for task-specific and intensive neurorehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This narrative review summarizes recent clinical evidence on the application of HAL in stroke rehabilitation, focusing on its effects on gait, upper limb recovery, activities of daily living (ADL), and safety, while discussing its limitations and future directions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A literature search of PubMed and Scopus was conducted for studies investigating HAL-assisted rehabilitation in stroke patients. Eligible studies included randomized controlled trials, systematic reviews, pilot studies, and relevant narrative reviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence from randomized and non-randomized studies suggests that HAL-assisted rehabilitation can improve gait velocity, balance, and, to a lesser extent, upper limb function in both acute and chronic stroke populations. Several systematic reviews and RCTs (2022\u20132025) have confirmed its potential benefits compared to conventional physiotherapy, though findings remain heterogeneous. HAL is generally safe and well tolerated, but high costs, limited availability, and methodological variations across studies constrain generalizability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HAL-assisted rehabilitation represents a promising adjunct to conventional stroke therapy, with growing evidence supporting its efficacy in motor recovery. However, current data are limited by small sample sizes, inconsistent protocols, and lack of long-term follow-up. Large-scale, multicenter randomized controlled trials are warranted to establish its clinical utility, cost-effectiveness, and integration into routine care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09287329261440743","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:20:15Z","timestamp":1776349215000},"page":"516-521","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Robotic-assisted rehabilitation in stroke patients using the Hybrid Assistive Limb (HAL): A narrative review"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5968-1746","authenticated-orcid":false,"given":"Liu","family":"Yuzhu","sequence":"first","affiliation":[{"name":"Master in Medical Science, Faculty of Medicine, Bioscience &amp; Nursing, MAHSA University, Selangor,\u00a0Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6546-977X","authenticated-orcid":false,"given":"Gauri","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Department of Primary Care Medicine, MAHSA University, Selangor,\u00a0Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.308413"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968307305457"},{"key":"e_1_3_3_4_2","article-title":"Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke","volume":"9","author":"Mehrholz J","year":"2018","unstructured":"Mehrholz J, Pohl M, Platz T, et al. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev 2018; 9: CD006876.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-016-0162-5"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S114102"},{"key":"e_1_3_3_7_2","first-page":"1649","article-title":"Pilot study of locomotion improvement using HAL in chronic stroke patients","volume":"24","author":"Kawamoto H","year":"2010","unstructured":"Kawamoto H, Tsuji T, Hasegawa Y, et al. Pilot study of locomotion improvement using HAL in chronic stroke patients. 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J Neurol Sci 2023; 448: 120678.","journal-title":"J Neurol Sci"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2022.04.001"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1453781"},{"key":"e_1_3_3_12_2","first-page":"12021254","article-title":"Single-joint hybrid assistive limb (HAL-SJ) robotic therapy combined with conventional therapy for wrist function in stroke patients","volume":"16","author":"Tan EW","year":"2025","unstructured":"Tan EW, Lee J, Wong K, , et al. Single-joint hybrid assistive limb (HAL-SJ) robotic therapy combined with conventional therapy for wrist function in stroke patients. Front Neurol 2025; 16: 12021254.","journal-title":"Front Neurol"},{"key":"e_1_3_3_13_2","first-page":"182","article-title":"Gait training of subacute stroke patients using a hybrid assistive limb: pilot study","volume":"373","author":"Mizukami M","year":"2016","unstructured":"Mizukami M, Yoshikawa K, Kawamoto H, et al. Gait training of subacute stroke patients using a hybrid assistive limb: pilot study. J Neurol Sci 2016; 373: 182\u2013187.","journal-title":"J Neurol Sci"},{"key":"e_1_3_3_14_2","first-page":"174","article-title":"Effect of HAL-assisted occupational therapy on activities of daily living in acute stroke: a pilot study","volume":"14","author":"Iwamoto Y","year":"2019","unstructured":"Iwamoto Y, Imura T, Taki S, et al. Effect of HAL-assisted occupational therapy on activities of daily living in acute stroke: a pilot study. Disabil Rehabil Assist Technol 2019; 14: 174\u2013181.","journal-title":"Disabil Rehabil Assist Technol"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-025-01621-z"},{"key":"e_1_3_3_16_2","first-page":"1235","article-title":"Efficacy of robotic exoskeleton for gait rehabilitation in patients with subacute stroke: a systematic review with meta-analysis","volume":"36","author":"Mehrholz J","year":"2022","unstructured":"Mehrholz J, Thomas S, Elsner B. Efficacy of robotic exoskeleton for gait rehabilitation in patients with subacute stroke: a systematic review with meta-analysis. 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