REVIEW ARTICLE Effects of robot-assisted upper limb rehabilitation in stroke patients: a systematic review with meta-analysis Rachele Bertani 1 & Corrado Melegari 1 & Maria C. De Cola 2 & Alessia Bramanti 2 & Placido Bramanti 2 & Rocco Salvatore Calabrò 2 Received: 16 January 2017 /Accepted: 4 May 2017 /Published online: 24 May 2017 # Springer-Verlag Italia 2017 Abstract Technology-supported training is emerging as a solu- tion to support therapists in their efforts providing high-intensity, repetitive, and task-specific treatment, in order to enhance the recovery process. The aim of this review is to assess the effec- tiveness of different robotic devices (end-effector and exoskeleton robots) in comparison with any other type of inter- vention. Furthermore, we aim to assess whether or not better improvements are obtained in the sub-acute phase after stroke onset than in the chronic phase. A research was conducted in the electronic bibliographic databases Cochrane, MEDLINE, and EMBASE. A total of 17 studies were included: 14 randomized controlled trials, 2 systematic reviews, and one meta-analysis. Fugl-Meyer and modified Ashworth scale were selected to mea- sure primary outcomes, i.e., motor function and muscle tone. Functional independence measure and motor activity log were selected to measure secondary outcomes, i.e., activities of daily living. In comparison with conventional therapy, the robot- assisted rehabilitation is more effective in improving upper limb motor function recovery, especially in chronic stroke patients. No significant improvements are observed in the reduction of muscle tone or daily living activities. The present systematic review shows that the use of robotic devices can positively affect the recovery of arm function in patients with stroke. Keywords Neuroreabilitation . Robotics . Motor recovery . Post-stroke UL impairment Introduction The World Health Organization (WHO) defines stroke as Brapidly developing clinical signs of focal (or global) distur- bance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin^ [1]. Currently, stroke is the leading cause of adult disability in Western countries [2], and one of the most common causes of death in the world [3]: 80% out of them are first event and 20% relapses. The annual stroke in- cidence in Italy is approximately 200,000 patients, and the disease is the third cause of death, after cardiovascular dis- eases and neoplasia. Incidence increases progressively with age: 75% of strokes affect people over 65 years of age [4]. The majority of people with stroke live with long-term disabilities, leading to serious social and economic impacts. The most frequent impairment caused by stroke is the restriction of motor activity, which reduces muscle movement and mobility [5], although stroke may also lead to a variety of sensory and cognitive disabilities as well. Moreover, the ability to carry out the activities of daily living in an autonomous way and to be engaged in social and community participation is strongly reduced. More than two-third of all patients affected by stroke have impaired upper limb motor function and have difficulty in independently performing activities of daily living [6]. Six months after stroke, approximately 50% of patients remain with a chronic reduction of arm function [7]. This lack of functional recovery restricts patients’ activities in daily living, decreases productivity, affects social re-integration, and leads to economic burden. Therefore, one of the challenging aspects of stroke rehabilitation is upper limb intervention. While the initial degree of stroke and paresis severity is a good predictor of upper limb function recovery, task-specific, high-intensity exercises in an active, functional, and highly repetitive manner * Rocco Salvatore Calabrò salbro77@tiscali.it; roccos.calabro@irccsme.it 1 Elias, Neuroriabilitazione, Parma, Italy 2 IRCCS Centro Neurolesi, BBonino -Pulejo^, S.S.113 Via Palermo C/da Casazza, 98123 Messina, Italy Neurol Sci (2017) 38:1561–1569 DOI 10.1007/s10072-017-2995-5