{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:55:41Z","timestamp":1791618941299,"version":"4.3.4"},"reference-count":49,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Key Research and Development Program of China","award":["2022YFC2009700"],"award-info":[{"award-number":["2022YFC2009700"]}]},{"name":"National Key Research and Development Program of China","award":["BE2020718"],"award-info":[{"award-number":["BE2020718"]}]},{"name":"National Key Research and Development Program of China","award":["H202120503"],"award-info":[{"award-number":["H202120503"]}]},{"name":"Jiangsu Key Research and Development Program","award":["2022YFC2009700"],"award-info":[{"award-number":["2022YFC2009700"]}]},{"name":"Jiangsu Key Research and Development Program","award":["BE2020718"],"award-info":[{"award-number":["BE2020718"]}]},{"name":"Jiangsu Key Research and Development Program","award":["H202120503"],"award-info":[{"award-number":["H202120503"]}]},{"name":"Horizontal Project of Nanjing Estun Co., LTD","award":["2022YFC2009700"],"award-info":[{"award-number":["2022YFC2009700"]}]},{"name":"Horizontal Project of Nanjing Estun Co., LTD","award":["BE2020718"],"award-info":[{"award-number":["BE2020718"]}]},{"name":"Horizontal Project of Nanjing Estun Co., LTD","award":["H202120503"],"award-info":[{"award-number":["H202120503"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: To evaluate if bilateral or unilateral upper limb robot-assisted rehabilitation training using a new three-dimensional end-effector robot that targets shoulder and elbow flexion and abduction is superior to conventional therapy with regard to upper extremity motor function recovery and neuromuscular improvement in stroke patients. Design: Randomized, controlled, parallel, assessor-blinded, three-arm clinical trial. Setting: Southeast University Zhongda Hospital Nanjing, Jiangsu, China. Methods: Seventy patients with hemiplegic stroke were randomly assigned to conventional training (Control, n = 23) or unilateral (URT, n = 23), or bilateral robotic training (BRT, n = 24). The conventional group received routine rehabilitation, 60 min\/day, 6 days\/week, for 3 weeks. For URT and BRT upper limb robot-assisted rehabilitation training was added. This was 60 min\/day, 6 days\/week, for 3 weeks. The primary outcome was upper limb motor function assessed with Fugl-Meyer\u2013Upper Extremity Scale (FMA\u2013UE). Secondary outcomes were activities of daily living (ADL) assessed with the Modified Barthel Index (MBI), Motor Evoked Potential (MEP) to assess corticospinal tract connectivity, Root Mean Square (RMS) value, and integrate Electromyography (iEMG) value recorded by surface electromyography to evaluate muscle contraction function. Results: The primary outcome indicator FMA\u2013UE (least square mean (LSMEAN): 31.40, 95% confidence interval (95% CI): 27.74\u201335.07) and the secondary outcome indicator MBI (LSMEAN: 69.95, 95% CI: 66.69\u201373.21) were significantly improved in BRT as opposed to control (FMA\u2013UE, LSMEAN: 24.79, 95% CI: 22.23\u201327.35; MBI, LSMEAN: 62.75, 95% CI: 59.42\u201366.09); and unilateral (FMA\u2013UE, LSMEAN: 25.97, 95% CI: 23.57\u201328.36; MBI, LSMEAN: 64.34, 95% CI: 61.01\u201367.68). BRT also showed greater improvement in the anterior deltoid bundle with regard to muscle contraction function indicated by RMS (LSMEAN: 257.79, 95% CI: 211.45\u2013304.12) and iEMG (LSMEAN: 202.01, 95% CI: 167.09\u2013236.94), as compared to the controls (RMS, LSMEAN: 170.77, 95% CI: 148.97\u2013192.58; iEMG, LSMEAN: 132.09, 95% CI: 114.51\u2013149.68), and URT (RMS, LSMEAN: 179.05, 95% CI: 156.03\u2013202.07; iEMG, LSMEAN: 130.38, 95% CI: 107.50\u2013153.26). There was no statistically significant difference between URT and conventional training for any outcome. There was no significant difference in MEP extraction rate after treatment between groups (p = 0.54 for URT, p = 0.08 for BRT). Conclusions: A 60 min daily training for upper extremities using a three-dimensional end-effector targeting elbow and shoulder adding conventional rehabilitation appears to promote upper limb function and ADL in stroke patients only if delivered bilaterally. URT does not seem to result in better outcomes than conventional rehabilitation. Electrophysiological results suggest that training using a bilateral upper limb robot increases the recruitment of motor neurons rather than improving the conduction function of the corticospinal tract.<\/jats:p>","DOI":"10.3390\/jcm12082950","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T01:09:22Z","timestamp":1681866562000},"page":"2950","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Effects of Uni- vs. Bilateral Upper Limb Robot-Assisted Rehabilitation on Motor Function, Activities of Daily Living, and Electromyography in Hemiplegic Stroke: A Single-Blinded Three-Arm Randomized Controlled Trial"],"prefix":"10.3390","volume":"12","author":[{"given":"Runping","family":"Yuan","sequence":"first","affiliation":[{"name":"Graduate School of Bengbu Medical College, Bengbu 233030, China"},{"name":"Southeast University Zhongda Hospital, Nanjing 210003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7417-7034","authenticated-orcid":false,"given":"Xu","family":"Qiao","sequence":"additional","affiliation":[{"name":"Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu 610041, China"},{"name":"West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Congzhi","family":"Tang","sequence":"additional","affiliation":[{"name":"Southeast University Zhongda Hospital, Nanjing 210003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Zhou","sequence":"additional","affiliation":[{"name":"Southeast University Zhongda Hospital, Nanjing 210003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenli","family":"Chen","sequence":"additional","affiliation":[{"name":"Southeast University Zhongda Hospital, Nanjing 210003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruyan","family":"Song","sequence":"additional","affiliation":[{"name":"Southeast University Zhongda Hospital, Nanjing 210003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Jiang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Bengbu Medical College, Bengbu 233099, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan D.","family":"Reinhardt","sequence":"additional","affiliation":[{"name":"Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu 610041, China"},{"name":"Swiss Paraplegic Research, 6207 Nottwil, Switzerland"},{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland"},{"name":"Center for Rehabilitation Medicine, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongxing","family":"Wang","sequence":"additional","affiliation":[{"name":"Southeast University Zhongda Hospital, Nanjing 210003, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1212\/WNL.0000000000012781","article-title":"Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions","volume":"97","author":"Saini","year":"2021","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","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":"ref_3","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S1474-4422(09)70150-4","article-title":"Motor recovery after stroke: A systematic review","volume":"8","author":"Langhorne","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1007\/s13311-020-00882-x","article-title":"Proactive Motor Functional Recovery Following Immersive Virtual Reality\u2013Based Limb Mirroring Therapy in Patients with Subacute Stroke","volume":"17","author":"Mekbib","year":"2020","journal-title":"Neurotherapeutics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.rehab.2019.04.002","article-title":"Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial","volume":"62","author":"Dehem","year":"2019","journal-title":"Ann. 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