{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:09:19Z","timestamp":1791259759195,"version":"4.1.0"},"reference-count":48,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Innovation Technology Fund","award":["ITS\/062\/19"],"award-info":[{"award-number":["ITS\/062\/19"]}]},{"name":"Innovation Technology Fund","award":["GRF15207120"],"award-info":[{"award-number":["GRF15207120"]}]},{"name":"University Grants Committee Research Grants Council, Hong Kong","award":["ITS\/062\/19"],"award-info":[{"award-number":["ITS\/062\/19"]}]},{"name":"University Grants Committee Research Grants Council, Hong Kong","award":["GRF15207120"],"award-info":[{"award-number":["GRF15207120"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Rehabilitation robots are helpful in poststroke telerehabilitation; however, their feasibility and rehabilitation effectiveness in clinical settings have not been sufficiently investigated. A non-randomized controlled trial was conducted to investigate the feasibility of translating a telerehabilitation program assisted by a mobile wrist\/hand exoneuromusculoskeleton (WH-ENMS) into routine clinical services and to compare the rehabilitative effects achieved in the hospital-service-based group (n = 12, clinic group) with the laboratory-research-based group (n = 12, lab group). Both groups showed significant improvements (p \u2264 0.05) in clinical assessments of behavioral motor functions and in muscular coordination and kinematic evaluations after the training and at the 3-month follow-up, with the lab group demonstrating better motor gains than the clinic group (p \u2264 0.05). The results indicated that the WH-ENMS-assisted tele-program was feasible and effective for upper limb rehabilitation when integrated into routine practice, and the quality of patient\u2013operator interactions physically and remotely affected the rehabilitative outcomes.<\/jats:p>","DOI":"10.3390\/bioengineering10080976","type":"journal-article","created":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T10:29:25Z","timestamp":1692354565000},"page":"976","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The Translation of Mobile-Exoneuromusculoskeleton-Assisted Wrist\u2013Hand Poststroke Telerehabilitation from Laboratory to Clinical Service"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1497-4204","authenticated-orcid":false,"given":"Wanyi","family":"Qing","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Yi","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey Man-Hok","family":"Shum","sequence":"additional","affiliation":[{"name":"Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko Ka-Leung","family":"Chan","sequence":"additional","affiliation":[{"name":"Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"King-Pong","family":"Yu","sequence":"additional","affiliation":[{"name":"Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena Sin-Wah","family":"Ng","sequence":"additional","affiliation":[{"name":"Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bibo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3188-3005","authenticated-orcid":false,"given":"Xiaoling","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Appleby, E., Gill, S.T., Hayes, L.K., Walker, T.L., Walsh, M., and Kumar, S. (2019). Effectiveness of telerehabilitation in the management of adults with stroke: A systematic review. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0225150"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Woo, J., Chan, S.Y., Sum, M.W.C., Wong, E., and Chui, Y.P.M. (2008). In patient stroke rehabilitation efficiency: Influence of organization of service delivery and staff numbers. BMC Health Serv. Res., 8.","DOI":"10.1186\/1472-6963-8-86"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ijmedinf.2018.12.001","article-title":"Home-based technologies for stroke rehabilitation: A systematic review","volume":"123","author":"Chen","year":"2019","journal-title":"Int. J. Med. Inform."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/1743-0003-11-111","article-title":"Training modalities in robot-mediated upper limb rehabilitation in stroke: A framework for classification based on a systematic review","volume":"11","author":"Basteris","year":"2014","journal-title":"J. NeuroEngi. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1743-0003-11-3","article-title":"A survey on robotic devices for upper limb rehabilitation","volume":"11","author":"Maciejasz","year":"2014","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"547","DOI":"10.3389\/fnins.2017.00547","article-title":"Design and preliminary feasibility study of a soft robotic glove for hand function assistance in stroke survivors","volume":"11","author":"Yap","year":"2017","journal-title":"Front. Neurosci."},{"key":"ref_7","first-page":"3738219","article-title":"Effectiveness of a Soft Robotic Glove to Assist Hand Function in Stroke Patients: A Cross-Sectional Pilot Study","volume":"2022","author":"Thimabut","year":"2022","journal-title":"Rehabil. Res. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2878","DOI":"10.3389\/frobt.2021.602878","article-title":"Safety Assessment of Rehabilitation Robots: A Review Identifying Safety Skills and Current Knowledge Gaps","volume":"8","author":"Bessler","year":"2021","journal-title":"Front. Robot. AI"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1038\/nrn.2017.26","article-title":"Motor compensation and its effects on neural reorganization after stroke","volume":"18","author":"Jones","year":"2017","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"612746","DOI":"10.3389\/frobt.2021.612746","article-title":"Expectations and perceptions of healthcare professionals for robot deployment in hospital environments during the COVID-19 pandemic","volume":"8","author":"Roberti","year":"2021","journal-title":"Front. Robot. AI"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/sres.2442","article-title":"The paradoxes of telehealth: A review of the literature 2000\u20132015","volume":"35","author":"Standing","year":"2018","journal-title":"Syst. Res. Behav. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1089\/soro.2020.0090","article-title":"An Exoneuromusculoskeleton for Self-Help Upper Limb Rehabilitation after Stroke","volume":"9","author":"Nam","year":"2022","journal-title":"Soft Robot."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1177\/1545968309338191","article-title":"A comparison between electromyography-driven robot and passive motion device on wrist rehabilitation for chronic stroke","volume":"23","author":"Hu","year":"2009","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12984-017-0245-y","article-title":"A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke","volume":"14","author":"Rong","year":"2017","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1177\/1545968314565510","article-title":"Wrist rehabilitation assisted by an electromyography-driven neuromuscular electrical stimulation robot after stroke","volume":"29","author":"Hu","year":"2015","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12984-015-0088-3","article-title":"Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: A double-blinded randomized controlled trial","volume":"12","author":"Lee","year":"2015","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s12984-021-00930-3","article-title":"Home-based self-help telerehabilitation of the upper limb assisted by an electromyography-driven wrist\/hand exoneuromusculoskeleton after stroke","volume":"18","author":"Nam","year":"2021","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_18","first-page":"540","article-title":"Preliminary trial of carisoprodal in multiple sclerosis","volume":"192","author":"Ashworth","year":"1964","journal-title":"Practitioner"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2340\/1650197771331","article-title":"The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance","volume":"7","author":"Leyman","year":"1975","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1136\/jnnp.2006.109074","article-title":"Measuring cognitive change in older adults: Reliable change indices for the Mini-Mental State Examination","volume":"78","author":"Hensel","year":"2007","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3925","DOI":"10.1080\/09638288.2021.1894490","article-title":"Chronic stroke survivors with upper limb spasticity: Linking experience to the ICF","volume":"44","author":"Pike","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/MRR.0b013e32834d330a","article-title":"The responsiveness and correlation between Fugl-Meyer Assessment, Motor Status Scale, and the Action Research Arm Test in chronic stroke with upper-extremity rehabilitation robotic training","volume":"34","author":"Wei","year":"2011","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1097\/00004356-198112000-00001","article-title":"A performance test for assessment of upper limb function in physical rehabilitation treatment and research","volume":"4","author":"Lyle","year":"1981","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_24","first-page":"65","article-title":"Functional Independence Measure","volume":"55","author":"Mackintosh","year":"2009","journal-title":"J. Physiother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0014-4886(89)80005-6","article-title":"Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients","volume":"104","author":"Wolf","year":"1989","journal-title":"Exp. Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/S0003-9993(99)90053-9","article-title":"Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity","volume":"80","author":"Gregson","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.jelekin.2008.04.002","article-title":"Quantitative evaluation of motor functional recovery process in chronic stroke patients during robot-assisted wrist training","volume":"19","author":"Hu","year":"2009","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jbiomech.2005.01.008","article-title":"An upper extremity kinematic model for evaluation of hemiparetic stroke","volume":"39","author":"Hingtgen","year":"2006","journal-title":"J. Biomech."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1177\/1545968310370748","article-title":"Kinematic variables quantifying upper-extremity performance after stroke during reaching and drinking from a glass","volume":"25","author":"Murphy","year":"2011","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_30","first-page":"3","article-title":"Measuring usability with the USE questionnaire","volume":"8","author":"Lund","year":"2001","journal-title":"Usability Interface"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1080\/02701367.1989.10607413","article-title":"Psychometric properties of the Intrinsic Motivation Inventory in a competitive sport setting: A confirmatory factor analysis","volume":"60","author":"McAuley","year":"1989","journal-title":"Res. Q. Exerc. Sport"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1038\/sc.2014.250","article-title":"Robot-assisted task-oriented upper extremity skill training in cervical spinal cord injury: A feasibility study","volume":"53","author":"Vanmulken","year":"2015","journal-title":"Spinal Cord"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1080\/10749357.2016.1266750","article-title":"Motivation, expectations, and usability of a driven gait orthosis in stroke patients and their therapists","volume":"24","author":"Swinnen","year":"2017","journal-title":"Top. Stroke Rehabil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12984-021-00837-z","article-title":"A usability study in patients with stroke using MERLIN, a robotic system based on serious games for upper limb rehabilitation in the home setting","volume":"18","author":"Garzo","year":"2021","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1080\/01621459.1968.10480932","article-title":"A comparative study of various tests for normality","volume":"63","author":"Shapiro","year":"1968","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12984-019-0537-5","article-title":"Distal versus proximal\u2014An investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: A randomized controlled trial","volume":"16","author":"Qian","year":"2019","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1109\/TNSRE.2018.2864935","article-title":"Wrist Robot-assisted Rehabilitation Treatment in Subacute and Chronic Stroke Patients: From Distal to Proximal Motor Recovery","volume":"26","author":"Mazzoleni","year":"2018","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"359728","DOI":"10.1155\/2012\/359728","article-title":"Maladaptive plasticity for motor recovery after stroke: Mechanisms and approaches","volume":"2012","author":"Takeuchi","year":"2012","journal-title":"Neural Plast."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.ijge.2018.05.005","article-title":"Post-stroke Spasticity: A Review of Epidemiology, Pathophysiology, and Treatments","volume":"12","author":"Kuo","year":"2018","journal-title":"Int. J. Gerontol."},{"key":"ref_40","unstructured":"Valenzuela, M., and Varacallo, M. (2022). StatPearls, StatPearls Publishing LLC. StatPearls Publishing Copyright \u00a9 2023."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1152\/jn.01020.2002","article-title":"Role of cocontraction in arm movement accuracy","volume":"89","author":"Gribble","year":"2003","journal-title":"J. Neurophysiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"8297","DOI":"10.1523\/JNEUROSCI.22-18-08297.2002","article-title":"Movement smoothness changes during stroke recovery","volume":"22","author":"Rohrer","year":"2002","journal-title":"J. Neurosci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1177\/1545968312440745","article-title":"Getting neurorehabilitation right: What can be learned from animal models?","volume":"26","author":"Krakauer","year":"2012","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1310\/tsr1906-457","article-title":"Time to Rethink Long-Term Rehabilitation Management of Stroke Patients","volume":"19","author":"Teasell","year":"2012","journal-title":"Top. Stroke Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.pmr.2015.06.008","article-title":"Upper limb motor impairment after stroke","volume":"26","author":"Raghavan","year":"2015","journal-title":"Phys. Med. Rehabil. Clin."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/01.wco.0000200544.29915.cc","article-title":"Motor learning: Its relevance to stroke recovery and neurorehabilitation","volume":"19","author":"Krakauer","year":"2006","journal-title":"Curr. Opin. Neurol."},{"key":"ref_47","first-page":"1423","article-title":"Effective physician-patient communication and health outcomes: A review","volume":"152","author":"Stewart","year":"1995","journal-title":"CMAJ Can. Med. Assoc. J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e16407","DOI":"10.2196\/16407","article-title":"Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients\u2019 homes: Systematic literature review","volume":"22","author":"Almathami","year":"2020","journal-title":"J. Med. Internet Res."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/8\/976\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:36:40Z","timestamp":1760128600000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/8\/976"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,18]]},"references-count":48,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["bioengineering10080976"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering10080976","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,18]]}}}