NeuroRehabilitation 33 (2013) 33–39 DOI:10.3233/NRE-130925 IOS Press 33 Effects of proximal and distal robot-assisted upper limb rehabilitation on chronic stroke recovery Stefano Mazzoleni a,b,∗ , Patrizio Sale c , Marco Franceschini c , Samuele Bigazzi d , Maria Chiara Carrozza a,b , Paolo Dario a,b and Federico Posteraro b,d a The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy b Bioengineering Rehabilitation Laboratory, Volterra, Italy c IRCCS San Raffaele Pisana, Roma, Italy d Neurological Rehabilitation and Brain Injury Unit, Auxilium Vitae Rehabilitation Center, Volterra, Italy Abstract. OBJECTIVE: To evaluate the effects of add-on distal upper limb robot-assisted treatment on the outcome of proximal regions. DESIGN: 64 chronic stroke patients divided into two groups participated in the study. Group A was assigned to the proximal robot-assisted rehabilitation, Group B to the proximal and distal. Shoulder/elbow subsection of Fugl-Meyer Assessment scale was collected for Group A, whereas for Group B wrist subsection was also collected. Motricity Index was used and a set of kinematic parameters was computed for both groups. RESULTS: A decrease in impairment after the treatment in both groups of patients (Group A: Shoulder/elbow FM p < 0.001 and MI p < 0.001; Group B: Shoulder/elbow FM p < 0.001 and MI p < 0.001) was found. In the Group B wrist subsection of FM showed an improvement as well (p < 0.001). No difference between groups was found in changes of clinical scales. Movement velocity and accuracy increased after the robot-assisted treatment in both groups; group B showed a greater improvement in velocity. CONCLUSIONS: Robotic treatment is effective to reduce motor impairment in chronic stroke patients even if distal training added to proximal segments in the Group B does not provide any incremental benefit to the proximal segments. It remains unclear if the effectiveness of robot-assisted treatment is directly related to the upper limb segment specifically treated and which order may lead to better outcome. Our study suggests that kinematic parameters should be computed in order to better clarify the role of distal training (wrist) on proximal segments (shoulder/elbow) as well. Keywords: Rehabilitation, robotics, stroke, upper limb, assessment ∗ Address for correspondence: Stepano Mazzoleni, The BioRobo- tics Institute, Scuola Superiore Sant’Anna, Polo Sant’Anna Valdera, Viale R. Piaggio, 34 - 56025 Pontedera (Pisa) – Italy and Rehabil- itation Bioengineering Laboratory, Borgo San Lazzaro, 5 – 56048 Volterra (Pisa) - Italy. Tel.: +39 050883132; Fax: +39 050883101; E-mail: s.mazzoleni@sssup.it. 1. Introduction Recent systematic reviews showed that upper limb robot-assisted rehabilitation treatments in stroke sub- jects improve short- and long-term motor control, even if no consistent influence on functional abilities (Kwakkel, Kollen, & Krebs, 2008) (Prange, Jannink, Groothuis-Oudshoorn, Hermens, & Ijzerman, 2006) 1053-8135/13/$27.50 © 2013 – IOS Press and the authors. All rights reserved