{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T06:27:10Z","timestamp":1786602430381,"version":"build-2736575974"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cognitive and motor impairments are major determinants of functional independence after stroke. While robot-assisted training is effective for motor recovery, its impact on cognitive function through integrated cognitive\u2013motor training remains less explored. This study evaluated the effects of an end-effector robot-assisted integrated cognitive\u2013motor rehabilitation program on global cognitive function and upper limb motor outcomes in patients with chronic stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this single-center, randomized, assessor-blinded exploratory trial, 30 patients with stroke were randomized into an intervention group (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f15) or a control group (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f15). The intervention group received robot-assisted cognitive\u2013motor training using the Rebless Planar system (30\u202fmin\/session, 10 sessions over 3\u202fweeks), which integrated goal-directed reaching with tasks involving attention, memory, and executive function. The control group received time- and dose-matched conventional paper-based cognitive rehabilitation. Primary outcomes were the Korean Mini-Mental State Examination (MMSE) and the Korean Montreal Cognitive Assessment (MoCA). Secondary outcomes included CERAD subdomains, Fugl\u2013Meyer Assessment of the Upper Extremity (FMA-UE), and the Modified Barthel Index (MBI). This study was registered with the Korean Clinical Research Information Service (KCT0010564).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both groups exhibited significant within-group improvements in MMSE and MoCA, with no statistically significant between-group differences. For secondary CERAD subdomains, observed within-group gains did not maintain statistically significant between-group differences after False Discovery Rate adjustment. However, upper extremity motor recovery was significantly superior in the intervention group (FMA-UE 33.6 to 37.5) compared to controls (25.7 to 25.9) (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.012, Cohen\u2019s\n                      <jats:italic>d<\/jats:italic>\n                      \u202f=\u202f0.98).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Robot-assisted integrated cognitive\u2013motor rehabilitation using an end-effector system is feasible and safe in chronic stroke patients. While both robotic and conventional cognitive rehabilitation led to comparable improvements in global cognition, the robot-assisted group demonstrated superior upper limb motor recovery. These findings suggest that integrated dual-task training is a promising strategy for post-stroke motor recovery, though its incremental cognitive benefit over conventional therapy requires further investigation in larger trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trail registration<\/jats:title>\n                    <jats:p>This study was registered with the Korean Clinical Research Information Service (KCT0010564).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1866135","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:32:39Z","timestamp":1786599159000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Robot-assisted integrated cognitive-motor rehabilitation in patients with chronic stroke: a randomized controlled trial"],"prefix":"10.3389","volume":"17","author":[{"given":"Seungwoo","family":"Cha","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyojin","family":"Jeon","sequence":"additional","affiliation":[{"name":"Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Ho Chun","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e98","DOI":"10.1161\/STR.0000000000000098","article-title":"Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"47","author":"Winstein","year":"2016","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1016\/S1474-4422(19)30415-6","article-title":"Advances and challenges in stroke rehabilitation","volume":"19","author":"Stinear","year":"2020","journal-title":"Lancet Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1186\/s12984-025-01662-4","article-title":"Upper limb robotic rehabilitation following stroke: a systematic review and meta-analysis investigating efficacy and the influence of device features and program parameters","volume":"22","author":"Boardsworth","year":"2025","journal-title":"J Neuroeng Rehabil"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/S0140-6736(19)31055-4","article-title":"Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial","volume":"394","author":"Rodgers","year":"2019","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1161\/STROKEAHA.124.048183","article-title":"Effects of robot-assisted therapy for upper limb rehabilitation after stroke: an umbrella review of systematic reviews","volume":"56","author":"Park","year":"2025","journal-title":"Stroke"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S174","DOI":"10.1016\/j.pmrj.2018.06.005","article-title":"Exoskeleton and end-effector robots for upper and lower limbs rehabilitation: narrative review","volume":"10","author":"Molteni","year":"2018","journal-title":"PM R"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1806","DOI":"10.1038\/s41598-020-58630-2","article-title":"Comparisons between end-effector and exoskeleton rehabilitation robots regarding upper extremity function among chronic stroke patients with moderate-to-severe upper limb impairment","volume":"10","author":"Lee","year":"2020","journal-title":"Sci Rep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"5245","DOI":"10.3390\/jcm10225245","article-title":"Robot-assisted training for upper limb in stroke (ROBOTAS): an observational, multicenter study to identify determinants of efficacy","volume":"10","author":"Calabr\u00f2","year":"2021","journal-title":"J Clin Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"jrm44943","DOI":"10.2340\/jrm.v58.44943","article-title":"Robot-assisted therapy following stroke: what effects on quality of life, cognitive and psychosocial outcomes? A systematic review","volume":"58","author":"Zanatta","year":"2026","journal-title":"J Rehabil Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e73687","DOI":"10.2196\/73687","article-title":"Digital interventions for cognitive dysfunction in patients with stroke: systematic review and meta-analysis","volume":"27","author":"Wang","year":"2025","journal-title":"J Med Internet Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1770","DOI":"10.1016\/j.apmr.2023.12.013","article-title":"Effects of hand motor interventions on cognitive outcomes post-stroke: a systematic review and Bayesian network Meta-analysis","volume":"105","author":"Valenzuela-L\u00f3pez","year":"2024","journal-title":"Arch Phys Med Rehabil"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e11764","DOI":"10.1016\/j.heliyon.2022.e11764","article-title":"The effect of gamified robot-enhanced training on motor performance in chronic stroke survivors","volume":"8","author":"Ozgur","year":"2022","journal-title":"Heliyon"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s12984-025-01551-w","article-title":"Clinical validation of an individualized auto-adaptative serious game for combined cognitive and upper limb motor robotic rehabilitation after stroke","volume":"22","author":"Doumas","year":"2025","journal-title":"J Neuroeng Rehabil"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2019\/4347281","article-title":"The efficacy of cognitive training for elderly Chinese individuals with mild cognitive impairment","volume":"2019","author":"Peng","year":"2019","journal-title":"Biomed Res Int"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e38753","DOI":"10.1097\/MD.0000000000038753","article-title":"Effects of training with a rehabilitation device (Rebless\u00ae) on upper limb function in patients with chronic stroke: a randomized controlled trial","volume":"103","author":"Chang","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1161\/STROKEAHA.110.579888","article-title":"Underestimation of cognitive impairment by Mini-mental state examination versus the Montreal cognitive assessment in patients with transient ischemic attack and stroke: a population-based study","volume":"41","author":"Pendlebury","year":"2010","journal-title":"Stroke"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"P47","DOI":"10.1093\/geronb\/57.1.P47","article-title":"Development of the Korean version of the consortium to establish a registry for Alzheimer's disease assessment packet (CERAD-K): clinical and neuropsychological assessment batteries","volume":"57","author":"Lee","year":"2002","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1186\/s12883-025-04305-2","article-title":"Effect of dual task-based training on motor and cognitive function in stroke patients: a systematic review and meta-analysis of randomized controlled trails","volume":"25","author":"Mou","year":"2025","journal-title":"BMC Neurol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2559","DOI":"10.2147\/NDT.S562404","article-title":"Improving post-stroke cognitive impairment via cognitive and motor dual task gait training: potential mechanisms and clinical value","volume":"21","author":"Cao","year":"2025","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1177\/15459683211062898","article-title":"Reward during arm training improves impairment and activity after stroke: a randomized controlled trial","volume":"36","author":"Widmer","year":"2022","journal-title":"Neurorehabil Neural Repair"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"791","DOI":"10.2522\/ptj.20110009","article-title":"Clinically important differences for the upper-extremity Fugl-Meyer scale in people with minimal to moderate impairment due to chronic stroke","volume":"92","author":"Page","year":"2012","journal-title":"Phys Ther"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1866135\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:32:40Z","timestamp":1786599160000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1866135\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":21,"alternative-id":["10.3389\/fneur.2026.1866135"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1866135","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"article-number":"1866135"}}