{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T06:58:24Z","timestamp":1790578704691,"version":"4.1.0"},"reference-count":23,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>\n                    Introduction Stroke is a primary contributor to global adult morbidity, frequently resulting in debilitating gait disturbances that impede independence. While standard neurorehabilitation remains essential, the advent of robot-assisted gait training (RAGT) provides a platform for high-intensity, reproducible interventions designed to stimulate neuroplasticity. This systematic review evaluated the literature from 2015 to 2025 to determine the influence of RAGT on neural reorganization and functional outcomes in stroke survivors. Methodology A systematic search of MEDLINE, PubMed, Scopus, and Cochrane Library was performed for studies published between 2015 and 2025. The inclusion criteria were randomized controlled trials, systematic reviews, and meta-analyses investigating RAGT in acute, subacute, and chronic stroke patients. The evaluation metrics included clinical functional scales (e.g., the Berg Balance Scale and the 10-Meter Walk Test) and neurophysiological markers (e.g., fMRI, fNIRS, QEEG, and BDNF). Results Analysis of 23 randomized trials and multiple meta-analyses indicated that RAGT combined with conventional therapy yielded significant improvements in gait speed (standardized mean difference [SMD]\u00a0=\u00a00.47) and balance (mean difference [MD]\u00a0=\u00a04.58). Neuroimaging revealed increased activation of the primary motor cortex and supplementary motor areas. Electrophysiological data confirmed reductions in the Power Ratio Index, suggesting normalized cortical activity. End-effector systems have demonstrated superior efficacy in the subacute phase compared to exoskeletons. Conclusion RAGT serves as a potent driver of cortical and spinal neuroplasticity by facilitating high-repetition task-specific stimuli. Early intervention during the subacute phase maximizes functional recovery. Future research should prioritize standardizing the dosing and longitudinal monitoring of neural connectivity.\n                    <ns3:bold>Trial Registration Status:<\/ns3:bold>\n                    Not Applicable.\n                  <\/ns3:p>","DOI":"10.12688\/f1000research.180596.1","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:04:09Z","timestamp":1779192249000},"page":"762","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic Training and Neural Reorganization in Stroke: A Systematic Review"],"prefix":"10.12688","volume":"15","author":[{"given":"Iyyappan","family":"Manickavasagam","sequence":"first","affiliation":[{"name":"Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Science (SIMATS) Chennai Tamil Nadu SIMATS Deemed University"},{"name":"Dubai Health Dubai Dubai Physiotherapy and Rehabilitation Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vignesh","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Science (SIMATS) Chennai Tamil Nadu SIMATS Deemed University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6962-8168","authenticated-orcid":false,"given":"Satheeskumar","family":"Durairaj","sequence":"additional","affiliation":[{"name":"College of Health Sciences Ajman Ajman Gulf Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3936-5029","authenticated-orcid":false,"given":"Animesh","family":"Hazari","sequence":"additional","affiliation":[{"name":"College of Health Sciences Ajman Ajman Gulf Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2669-4488","authenticated-orcid":false,"given":"Praveen Kumar","family":"Kanadakurti","sequence":"additional","affiliation":[{"name":"College of Health Sciences Ajman Ajman Gulf Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1-14","DOI":"10.5114\/hm.2024.136050","article-title":"Brain-derived neurotrophic factor and stroke: Perspectives on exercise as a health care strategy.","volume":"25","author":"G De Assis","year":"2024","journal-title":"Human Movement."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"4809","DOI":"10.3390\/jcm14134809","article-title":"Effectiveness of robot-assisted gait training in stroke rehabilitation: A systematic review and meta-analysis.","volume":"14","author":"J Lee","year":"2025","journal-title":"J. Clin. Med."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"161","DOI":"10.3390\/jfmk10020161","article-title":"May patients with chronic stroke benefit from robotic gait training with an end-effector? A case-control study.","volume":"10","author":"M Bonanno","year":"2025","journal-title":"Journal of Functional Morphology and Kinesiology."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1655409","DOI":"10.3389\/fneur.2025.1655409","article-title":"Combine effects of robotic assisted gait training with transcranial magnetic stimulation on gait metrics and balance in stroke patients: A pilot randomized control.","volume":"16","author":"A Jehangir","year":"2025","journal-title":"Front. Neurol."},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.26502\/acbr.50170453","article-title":"Enhancing post-stroke gait rehabilitation with robot-assisted therapy: A focus on step repetitions and neuroplasticity.","volume":"9","author":"A Pichardo","year":"2025","journal-title":"Archives of Clinical and Biomedical Research."},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-025-01656-2","article-title":"Neural mechanisms underlying the improvement of gait disturbances in stroke patients through robot-assisted gait training based on QEEG and fNIRS: A randomized controlled study.","volume":"22","author":"X Li","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"Article 12461","DOI":"10.1038\/s41598-020-69367-3","article-title":"Neuroplastic effects of end-effector robotic gait training for hemiparetic stroke: A randomised controlled trial.","volume":"10","author":"H Kim","year":"2020","journal-title":"Sci. Rep."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1303-1311","DOI":"10.2147\/NDT.S114102","article-title":"Robot-assisted gait training for stroke patients: Current state of the art and perspectives of robotics.","volume":"13","author":"G Morone","year":"2017","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2025.1622661","article-title":"Systematic review and meta-analysis of effectiveness of robotic therapy in the recovery of motor functions after stroke.","volume":"19","author":"M Amirbekova","year":"2025","journal-title":"Front. Hum. Neurosci."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"Article e074481","DOI":"10.1136\/bmjopen-2023-074481","article-title":"Effect of exoskeleton robot-assisted training on gait function in chronic stroke survivors: A systematic review of randomised controlled trials.","volume":"13","author":"J Yang","year":"2023","journal-title":"BMJ Open."},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-074481","article-title":"Current state and future prospects of EEG and fNIRS in Robot-assisted gait rehabilitation: A brief review.","volume":"13","author":"A Berger","year":"2019","journal-title":"Front. Hum. Neurosci."},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-025-01827-1","article-title":"Effect of robot-assisted gait training combined with electroacupuncture on lower limb motor function and brain network characteristics in stroke: An EEG study.","volume":"22","author":"H Huang","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"483-489","DOI":"10.3233\/NRE-203054","article-title":"Robot-assisted gait training promotes brain reorganization after stroke: A randomized controlled pilot study.","volume":"46","author":"D Kim","year":"2020","journal-title":"NeuroRehabilitation."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s12984-015-0073-x","article-title":"Spinal plasticity in robot-mediated therapy for the lower limbs.","volume":"12","author":"A Stevenson","year":"2015","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"793-799","DOI":"10.1177\/1545968317732668","article-title":"Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce.","volume":"31","author":"J Bernhardt","year":"2017","journal-title":"Neurorehabil. Neural Repair."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1-14","DOI":"10.3892\/etm.2025.12932","article-title":"Integrated neuroimaging and robotic rehabilitation in chronic stroke: Neural correlates and predictors of motor recovery.","volume":"30","author":"M Magouni","year":"2025","journal-title":"Exp. Ther. Med."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"Article 1054","DOI":"10.3390\/brainsci10110821","article-title":"Changes in balance, gait and electroencephalography oscillations after robot-assisted gait training: An exploratory study in people with chronic stroke.","volume":"12","author":"H Heng","year":"2022","journal-title":"Brain Sci."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"001-004","DOI":"10.17352\/jnnsd.0000026","article-title":"Exercise induced operant conditioning of the H-reflex in stroke patients: Hopes for improving motor function through inducing plastic changes in the spinal pathways.","volume":"5","author":"B Tahayori","year":"2019","journal-title":"Journal of Neurology, Neurological Science and Disorders."},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2018.00637","article-title":"Post-stroke BDNF concentration changes following physical exercise: A systematic review.","volume":"9","author":"C Alcantara","year":"2018","journal-title":"Front. Neurol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"126","DOI":"10.3390\/biomedicines10010126","article-title":"Impact of physical activity and exercise on the epigenome in skeletal muscle and effects on systemic metabolism.","volume":"10","author":"J Plaza-Diaz","year":"2022","journal-title":"Biomedicine."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"Article 1752104","DOI":"10.3389\/fneur.2025.1752104","article-title":"Effect of end-effector robot training on lower limb motor function and balance in stroke patients: A systematic review and meta-analysis.","volume":"16","author":"Z Lou","year":"2026","journal-title":"Front. Neurol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"128-131","DOI":"10.28982\/josam.877434","article-title":"Comparison of end-effector and exoskeleton devices with robot-assisted gait training in patients with stroke.","volume":"5","author":"A Sar\u0131","year":"2021","journal-title":"Journal of Surgery and Medicine."},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.32064228.v2","author":"S Durairaj","year":"2026","journal-title":"figshare."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/15-762\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/15-762\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/15-762\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T06:54:10Z","timestamp":1790578450000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/15-762\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":23,"URL":"https:\/\/doi.org\/10.12688\/f1000research.180596.1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.199215.r493939","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.199215.r522014","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.199215.r522014","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.199215.r493939","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/15-762\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.199215.r493939, S. Jeyakumar Jeyakumar, Garden City University, Bangalore, Karnataka, 08 Jul 2026, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/15-762\/v1#referee-response-493939","order":0,"name":"referee-response-493939","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.199215.r522014, Rajan Balakrishnan, MAHSA University Malaysia, Selangor, 28 Sep 2026, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/15-762\/v1#referee-response-522014","order":1,"name":"referee-response-522014","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}