Robotics in Neurorehabilitation: From Research to Clinical Practice

Recent advances in neurorehabilitation allowed the implementation of robotic systems in clinical practice. Robotic devices are fundamental to provide an intensive, repetitive, and task-oriented training to promote neural plasticity, as documented in most recent studies. Nonetheless, these devices can be used in active or passive motion assistance, depending on the level of injury or neurological disease. Commonly, authors tend to classify robotic systems in end-effectors and exoskeletons based on some biomechanical features. In fact, end-effectors can be used by patients who are able to produce movements actively, while exoskeletons are wearable devices used by people with severe motor impairments, including spinal cord injury (SCI), due to their attitude to provide a complete guidance during movements. From an anatomical point of view, there is a distinction into upper and lower limb robotic systems that addressed different functions to meet patients’ needs in the activity of daily living and rehabilitation training. Currently, there are no evidence about the superiority of one robotic device than another one, because they should be addressed according to damage and timing extension as well as age of patients to ensure the most tailored rehabilitation treatment. Finally, the use of combined approach (i.e. non-invasive brain stimulation plus robotics) is getting popular in rehabilitation field. This approach is administered to further enhance brain plasticity mechanisms after a brain/spinal cord injury. However, there is not enough evidence to recommend it, especially when NIBS is added to robotic-assisted therapy for upper limb. Future studies should investigate more deeply the association between NIBS and robotics and their effects in clinical practice potentiating neuroplastic processes, as it could be the future direction of research in the neurorehabilitation field.