Robot-assisted rehabilitation has rapidly emerged as a key adjunct in post-stroke neurological recovery. Three systematic reviews and meta-analyses published in 2025–2026 now provide robust, convergent evidence supporting its integration into routine neurorehabilitation practice across European centres.
Amirbekova et al. (2025) analysed 13 randomised controlled trials (n = 424) and demonstrated that robotic therapy produced a moderate but statistically significant benefit over conventional rehabilitation (SMD = 0.59, 95% CI: 0.33–0.84, p < 0.001), with low-to-moderate heterogeneity across studies. Critically, subgroup analysis revealed the strongest treatment effects during the acute and subacute phases of recovery, while the chronic phase yielded substantially more limited improvement. These findings have important implications for the timing of robotic intervention — supporting early initiation within the optimal neuroplasticity window.
Wang et al. (2026) confirmed and extended these findings in a larger stratified meta-analysis of 42 RCTs (n = 1,678). Robotic-assisted therapy significantly improved upper extremity motor function as measured by the Fugl-Meyer Assessment (FMA-UE: WMD = 8.82, 95% CI: 4.42–13.23), grip strength, activities of daily living (Modified Barthel Index: WMD = 8.00, 95% CI: 4.96–11.03), and social participation. Notably, subacute patients with severe baseline impairment achieved improvements exceeding Minimal Clinically Important Difference thresholds — a finding of direct clinical relevance for patient selection and rehabilitation planning.
For lower extremity and gait recovery, Kim et al. (2025) conducted a meta-analysis specifically examining robot-assisted gait training. Subgroup analyses revealed that end-effector robotic systems outperformed exoskeletons in subacute stroke patients, with the most pronounced benefits observed in gait velocity and dynamic balance. Importantly, the greatest gains were achieved with 15 or fewer training sessions, suggesting that early, concentrated robotic gait training may be optimal — a finding relevant to resource allocation and protocol design in European rehabilitation units.
Taken together, these three meta-analyses establish a consistent evidence base: robot-assisted therapy delivers clinically meaningful improvements in both upper and lower extremity function after stroke, with greatest benefit in the subacute phase and for patients with severe impairment. The data support the integration of robotic systems into early inpatient neurorehabilitation pathways and underscore the need for phase-stratified, severity-informed patient selection protocols across European centres.
Co Author: Vincent Leqlerc, Erasmus Hospital Bruxelles
Key Points:
Robot-assisted therapy produces a moderate but statistically significant improvement in post-stroke upper extremity motor function compared to conventional rehabilitation alone (SMD = 0.59, 95% CI: 0.33–0.84)
The strongest treatment effects occur in the acute and subacute phases of stroke recovery; the chronic phase yields substantially smaller and clinically less meaningful gains
In subacute patients with severe impairment, robotic therapy surpasses established Minimal Clinically Important Difference thresholds for both motor function (FMA-UE: WMD = 8.82) and activities of daily living (Modified Barthel Index: WMD = 8.00)
End-effector robotic systems outperform exoskeletons for gait recovery, with the greatest benefits in gait velocity and dynamic balance — particularly with ≤15 training sessions in subacute stroke
Early integration of robotic systems into inpatient neurorehabilitation protocols is clinically warranted and scalable across European rehabilitation centres
References:
1. De Iaco L, Veerbeek JM, Ket JCF, Kwakkel G. Upper limb robots for recovery of motor arm function in patients with stroke: a systematic review and meta-analysis. Neurology. 2024 Jun 13;103(2):e209495. doi:10.1212/WNL.0000000000209495
Rationale: Published in the EAN-affiliated flagship journal; provides a rigorous synthesis of robotic upper limb therapy evidence and sets the benchmark for future trials — essential reading for residents managing stroke rehabilitation.
2. Morone G, Calabrò RS. Neurorehabilitation Insights in 2024: Where Neuroscience Meets Next-Gen Tech. Brain Sci. 2025 Sep 25;15(10):1043. doi:10.3390/brainsci15101043
Rationale: An accessible, contemporary overview of robotics, VR, brain-computer interfaces and telerehabilitation with direct clinical applicability — ideal for residents entering the field.
3. Wang L, Li X, Liu Y, Zhang E, Li C. Effects of robotic-assisted upper extremity therapy for stroke patients in different recovery phases. Front Neurol. 2026 Jan 12;16:1640522. doi:10.3389/fneur.2025.1640522
Rationale: The most current high-level evidence on phase-stratified robotic rehabilitation, directly guiding clinical decision-making on timing and patient selection.
Publish on behalf of the Scientific Panel on Neurorehabilitation