Can a Robot Bring Your Life Back? A Systematic Review for Robotics in Rehabilitation

Abstract

Stroke is a leading cause of disability in the world and the use of robots in rehabilitation has become increasingly common. The Fourth Industrial Revolutions has created a novel and wide range of options for the involvement of computer-guided and artificially intelligent machines to be used in rehabilitation. In this chapter we critically review some of the literature on the use of robots in rehabilitation, and emphasize the diversity of approaches in this burgeoning field. We argue that there is a need to consolidate interdisciplinary evidence on robotics and rehabilitation in a systematic way, as the alternative is to have a literature that continues to grow, following the interests of various specialists, but without offering a synoptic assessment of what is available to medical specialists and patients. A literature review using Scopus and Web of Science, coupled with the Briggs Institute’s Critical Appraisal Tool: Checklist for Case Reports was conducted. The two databases were systematically searched using inter-disciplinary keywords in Feb 2019. An initial search of the databases produced 9894 articles. After rigorous reviews, 35 articles were screened and selected for further interpretation. We examined the current studies on the efficiency and effectiveness of the robot interventions and produced a taxonomy of the review. An original finding of the current robotics in rehabilitation landscaping are critical presented with recommendations and concluding remarks concerning interdisciplinary impact.

Appendices

Appendices

1.1.1 Appendix A: Disciplines that Lead in Robotics in Rehabilitation (Figs. 1.11, 1.12, 1.13, 1.14, 1.15, 1.16, 1.17 and 1.18)

Fig. 1.11

Robotics in Rehab – Engineering Publications

Fig. 1.12

Robotics in Rehab – Computer Science Publications

Fig. 1.13

Robotics in Rehab – Medicine Publications

Fig. 1.14

Robotics in Rehab – Maths Publications

Fig. 1.15

Robotics in Rehab – Social Science and Interdisciplinary Publications

Fig. 1.16

Robotics in Rehab – The Leading Researchers in the Field

Fig. 1.17

Robotics in Rehab – The Leading Researchers in the Field (Details)

Fig. 1.18

Historical Results by Publication Venues – Social Science and Interdisciplinary Research

1.1.2 Appendix B: Sample of Inclusion Screening Using JBI

1.1.3 Appendix C: Summary of Included Articles

References	Research methods	Key findings & limitations	Recommendations & future work
Robot-patients interactions
1. Tuisku et al. [53]	Empirical case study (interpretative content analysis) for implement Zora robot in elderly-care services. The data consist of interviews with personnel (n = 39) who operated and work with Zora and comments from the general public: 107 (comments were collected from online and print media)	The results show that public opinion is mainly negative	There is clearly a need for more information, for a better informed discussion on how robots can be used in elderly care and how to involve the general public in this discussion in a constructive way
		The personnel had more positive views; they saw it as a recreational tool, not as a replacement for their own roles
Zora NAO Robot
2. Carrillo et al. [11]	Report on physiotherapists’ acceptance of a Socially Assistive Robot (SAR) as a therapeutic aid for paediatric rehabilitation	Results show SAR achieves a high degree of acceptance, i.e. its perceived usefulness and ease-of-use. Multiple sessions operating the SAR appears to strengthen positive perceptions of the system. The emphasis on robust performance over ambitious AI has contributed to the system’s successful integration. The current study is not a clinical trial and thus cannot provide conclusive statements regarding actual therapeutic benefits attributable to the SAR	This engagement has also delivered a prototype that is acceptable to therapists as part of clinical practice
			Analysis of survey results reveals overall positive perceptions of the SAR as a therapeutic aid, with particularly strong results for the SAR’s perceived usefulness and usability
NAO Robot	As part of the clinical care of patients at the Royal Children’s Hospital in Melbourne, Australia, SAR is equipped to lead rehabilitation sessions of up to 30 min under the guidance of a therapist, and without technician support or Wizard-of-Oz operation. Both quantitative and qualitative data collected from 8 therapists participating across 19 rehab sessions
3. Andriella et al. [3]	A tool for caregivers to monitor patient affected from Mild Cognitive Impairment (MD) and Alzheimer’s Disease (AD). A robot/decision system can assist a patient through several levels of interaction. A robot can be employed to train and evaluate a patient by playing Syndrom Kurztest neuropsychological battery (SKT)	The results indicated that the robot can take profit of the initial interaction with the caregiver to provide a quicker personalisation, and it can adapt to different user responses and provide support and assistance at different levels of interaction	A tool for caregivers to monitor patient affected from Mild Cognitive Impairment (MD) and Alzheimer’s Disease (AD)
			Human emotions are difficult to represent and analyze but, when available, they can be used to provide better Human-Robot Interaction (HRI) experiences
Robotic Arms
	Double loop of interaction: Caregiver-robot interaction and patient-robot interaction
		New and better instruments will be crucial to assess the disease severity and progression, as well as to improve its treatment, stimulation, and rehabilitation
4. Gnjatovic et al. [16]	This paper reports on a pilot corpus of child-robot interaction in therapeutic settings. The corpus comprises recordings of the interactions between twenty-one children and the conversational humanoid robot MARKO, in the kinesitherapeutic room at the Clinic of Paediatric Rehabilitation in Novi Sad, Serbia. The subject group included both healthy children and children with cerebral palsy and similar movement disorders. Approximately 156 min of session time was recorded. All dialogues were transcribed, and nonverbal acts were annotated	The initial evaluation of the corpus indicates that children positively respond to MARKO, engage in interaction with MARKO, perform verbal instructions given by MARKO, and experience increased motivation for therapy	In the next experimental phase, the interaction scenario will be adapted to particular therapeutic exercises. The goal of that phase will be to develop a computational model of interaction context of therapeutic exercises for children with cerebral palsy and similar movement disorders, and introduce a set of adaptive behavioral strategies for the robot MARK
MAKRO Robot
		This technical ability is essential for establishing a long-term attachment of children to the robotic system, which in turn has an important role in facilitating human-machine coexistence and cognitive infocommunication in the observed therapeutic setting
5. Shamsuddin et al. [45]	Participants will be selected from SOCSO rehabilitation Centre (SRC) Melaka, Malaysia. Criteria of potential participants includes but not limited to having symptoms of depression, e.g. low mood, withdrawal from social activities, sleep disturbance, loss of appetite and short attention span. The interaction includes but not limited to group therapy consisting of 6–10 participants undergoing group intervention with PARO as assistive device. The duration of group session is twice a week for 2 months. Each session will last for 30 min. Each participant will be able to have the opportunity to interact with PARO within the stipulated time	A robotic animal is a proposed solution to provide constant mental support and induce warm and empathetic feelings from the patients. Comparing assessment scores of pre and post robotic therapy shall shed light on the suitability of PARO to help patients with depression	An animal robot, though small, is a therapeutic robotic companion that can make people happy with its comforting presence. Moreover, the study will deploy the concepts and structures of robot therapy in the field of rehabilitation robotics. This study is the first one in Malaysia to propose an animal robot to provide mental support to patients with depression. The main objective of this paper is to introduce PARO the seal robot as a remedy to reduce the need for psychotropic drugs during depression therapy at a rehabilitation center
PARO Robot
		Sessions in terms of:
		1. Visual- where it can be seen from the face of people interacting with PARO. There are happier and are always smiling
		2. Verbal- People who interacts often with PARO has courage to start conversations
		3. Psychological- After interacting with PARO, people are less stressed and find that their mood improve
6. Naganuma et al. [31] Sony AIBO	Trial studies of the application of robotic pets in therapeutic rehabilitation at several hospitals and geriatric nursing homes are ongoing. In these settings, a variety of robotic devices have been introduced and implemented, mainly for physical rehabilitation	The key issue in the promotion and successful completion of rehabilitation by older people is how to cultivate feelings of self-efficacy. With this in mind, this chapter describes the results of a study with two aims: first, to introduce a feeling of play and games and, second, to reverse the participant’s role from passive to active by giving them control over the robot rather than it being controlled by a therapist or operator	The robotic pet used in this study was the Sony AIBO, and all other components used were commercially available, allowing the easy implementation of these activities by any interested medical or welfare institutions
	In contrast with rehabilitation using living animals, robotic animals have advantages in that they avoid the problem of infection, can be controlled, and can sense and record healthy human states in conjunction with information communication technology
7. Ochoa-Guaraca et al. [32]	This paper presents a low-cost robotic assistant able to support children rehabilitation process through Speech-Language Therapy (SLT). It has been tested with 29 children with cerebral palsy and communication disorders	The results are encouraging, given that it was possible to success fully integrate the robot to the therapy sessions	This robotic assistant is able to interact with a mobile application that is aimed to conduct reinforcement activities at home with the parents of the children
SLT Robot
Robotics for upper limbs rehabilitation
1. Hansen et al. [18]	We propose instead to validate the design of a hand exoskeleton in a fully digital environment, without the need for a physical prototype. The purpose of this study is thus to examine whether finger kinematics are altered when using a given hand exoskeleton. Therefore, user specific musculoskeletal models were created and driven by a motion capture system to evaluate the fingers’ joint kinematics when performing two industrial related tasks. The kinematic chain of the exoskeleton was added to the musculoskeletal models and its compliance with the hand movements was evaluated	Our results show that the proposed exoskeleton design does not influence fingers’ joints angles, the coefficient of determination between the model with and without exoskeleton being consistently high (R2 = 0.93) and the nRMSE consistently low (nRMSE = 5.42 °)	These results are promising and this approach combining musculoskeletal and robotic modelling driven by motion capture data could be a key factor in the ergonomics validation of the design of orthotic devices and exoskeletons prior to manufacturing
Virtual Hand Exoskelet
2. Hughes et al. [19]	In this paper we introduce a low cost, limited supervision, portable robot (H-Man) designed for upper extremity rehabilitation	A usability and feasibility study indicates that out-patient robotic treatment with the H-Man leads to positive improvements in arm movement, and that the system is usable and well accepted by key stakeholders	This paper also introduces an implementation strategy to assess the effectiveness, benefits and barriers of using the H-Man robot for community-based neuro-rehabilitation in underserved populations, such as those that live in low income neighbourhoods or in rural areas
Portable robot, H-Man
3. Galloway et al. [15]	We present the development of a soft robotic glove designed to support basic hand function. The glove uses soft fluidic actuators programmed to apply assistive forces to support the range of motion of a human hand	More specifically, we present a method of fabrication and characterization of these soft actuators as well as consider an approach for controlling the glove	This analysis concludes with results from preliminary human subjects testing where glove performance was evaluated on a healthy and an impaired subject
Robotics Glove
4. Palermo et al. [36] Armeo Power robot	Despite the fact that so many studies claim the validity of robot-mediated therapy in post-stroke patient rehabilitation, it is still difficult to assess to what extent its adoption improves the efficacy of traditional therapy in daily life, and also because most of the studies involved planar robots	We report the effects of a 20-session-rehabilitation project involving the Armeo Power robot, an assistive exoskeleton to perform 3D upper limb movements, in addition to conventional rehabilitation therapy, on 10 subacute stroke survivors. Patients were evaluated through clinical scales and a kinematic assessment of the upper limbs, both pre- and post-treatment. A set of indices based on the patients’ 3D kinematic data, gathered from an optoelectronic system, was calculated. Statistical analysis showed a remarkable difference in most parameters between pre- and post-treatment	Significant correlations between the kinematic parameters and clinical scales were found. Our findings suggest that 3D robot-mediated rehabilitation, in addition to conventional therapy, could represent an effective means for the recovery of upper limb disability. Kinematic assessment may represent a valid tool for objectively evaluating the efficacy of the rehabilitation treatment
5. Niyetkaliyev et al. [33]	Robotic rehabilitation devices are more frequently used for the physical therapy of people with upper limb weakness, which is the most common type of stroke-induced disability. This is a challenging task to achieve for one of the most biomechanically complex joints of human body, i.e., the shoulder. Therefore, specific considerations have been made in the development of various existing robotic shoulder rehabilitation orthoses. Different types of actuation, degrees of freedom (DOFs), and control strategies have been utilized for the development of these shoulder rehabilitation orthoses	Control strategies for the robotic upper limb rehabilitation orthoses are developed to repetitively guide the patients’ limbs on anatomically and ergonomically feasible trajectories so that the patients can regain muscular strength	The design of the robotic exoskeletons could be enhanced by using biomechanical principles of human motion. Thus, it is important for robotic specialists to thoroughly study shoulder biomechanics and cooperate with physiologists when designing future robotic orthoses. Understanding the shoulder anatomy and movement characteristics, structure of the bones, and articulations, muscle functions and their points of attachments will give a greater perspective toward the development of future robotic rehabilitation orthoses that can stimulate the natural movements of the shoulder complex
Various robotics for upper limbs are reviewed
		The main challenges are that these exoskeletons should be accurately aligned with the human joints, safely adjusted to match different individuals’ size, and provide naturalistic complex shoulder movements. The robotic shoulder rehabilitation orthoses that take into consideration only three rotational shoulder DOFs provide less workspace for patients and cause discomfort during the training sessions. Hence, to avoid the misalignments between the exoskeleton and human joints and provide larger ranges of motion, shoulder girdle mechanisms should be designed and implemented
	This paper presents a comprehensive review of these shoulder rehabilitation orthoses. Recent advancements in the mechanism design, their advantages and disadvantages, overview of hardware, actuation system, and power transmission are discussed in detail with the emphasis on the assisted DOFs for shoulder motion
6. Miao et al. [30]	A comprehensive review of high-level control techniques for upper-limb robotic training. It aims to compare and discuss the potentials of these different control algorithms, and specify future research direction. Included studies mainly come from selected papers in four review articles. o make selected studies complete and comprehensive, especially some recently-developed upper-limb robotic devices, a search was further conducted in IEEE Xplore, Google Scholar, Scopus and Web of Science using keywords (‘upper limb∗’ or ‘upper body∗’) and (‘rehabilitation∗’ or ‘treatment∗’) and (‘robot∗’ or ‘device∗’ or ‘exoskeleton∗’). The search is limited to English-language articles published between January 2013 and December 2017	Comparative analysis shows that high-level interaction control strategies can be implemented in a range of methods, mainly including impedance/admittance based strategies, adaptive control techniques, and physiological signal control. Even though the potentials of existing interactive control strategies have been demonstrated, it is hard to identify the one leading to maximum encouragement from human users. However, it is reasonable to suggest that future studies should combine different control strategies to be application specific, and deliver appropriate robotic assistance based on physical disability levels of human users	To summarize in the field of control strategies for interactive rehabilitation training, (1) the impedance and admittance method is simply implemented with intuitive properties; (2) adaptive control is needed when incorporating time-varying capabilities of human users; and (3) physiological signal control is an effective way of avoiding slacking and providing robotic support only when the brain is particularly responsive to peripheral input
7. Univadis	https://www.univadis.co.uk/viewarticle/robot-assisted-stroke-rehab-benefits-patients-with-upper-limb-motor-functional-impairments-esc-522765?s1=news		Patients who receive robot-assisted rehabilitation of the upper limb following acute stroke in addition to conventional therapy experience greater reduction in motor impairment and greater improvement in function relative to patients who receive conventional therapy alone
	Title: Robot-assisted stroke rehab benefits patients with upper limb motor functional impairments | ESC
	2017 Conference reports – RSi Communications
Robotics for lower limbs rehabilitation
1. Rachakorakit and Charoensuk [39]	To restore musculature, it is necessary to prepare for the next step of therapeutics	Hip flexion-extension adduct-abduct, knee flexion-extension, ankle dorsiflexion-plantarflexion by applied PID controller for control each other joint of robot	The robot can be operated by the specify computer program which develop from the human interface. The subject can also operate by itself from three human interfaces included manual, active and passive
	The passive exercise is one of the method to maintain the musculature and prevent complication as deep vein thrombosis (DVT) as the patient cannot move leg until patient has been recovered. After that active exercise can be applied afterwards to maintain leg muscle and recover strength. In the past, the physical therapists are the person to use for treatment. The passive exercise and active exercise required a long time that makes physical therapists get fatigue
		The design of the machine when transferring force with the gear of the robot can lift the distal weight up to 41 kg. The wheelchair-like design can be movable to the other place which is easier than moving the patient
Lehab robot
			The future prototype will be considered to add the other device such as the electromyography (EMG), to assess the ability of the muscle. The system can also be developed to have the other mode to increase the muscle strength
	Lehab robot was designed to assist therapist and improve quality of treatment. This robot was designed with four degree of freedom	The Lehab robot can function smoothly with four degree of freedom
2. Ballesteros et al. [6]	Shared control is a strategy used in assistive platforms to combine human and robot orders to achieve a goal. Collaborative control is a specific shared control approach, in which user’s and robot’s commands are merged into an emergent one in a continuous way. Robot commands tend to improve efficiency and safety. However, sometimes, assistance can be rejected by users when their commands are too altered. This provokes frustration and stress and, usually, decreases emergent efficiency. To improve acceptance, robotnavigation algorithms can be adapted to mimic human behavior when possible	We propose a novel variation of the well-known dynamic window approach (DWA) that we call biomimetical DWA (BDWA)	We have compared the BDWA with other reactive algorithms in terms of similarity to paths completed by people with disabilities using a robotic rollator in a rehabilitation hospital unit. The BDWA outperforms all tested algorithms in terms of likeness to human paths and success rate
		The BDWA relies on a reward function extracted from real traces from volunteers presenting different motor disabilities navigating in a hospital environment using a rollator for support
BDWA with a robotic rollator
3. Ozaki et al. [35]	To examine the efficacy of postural strategy training using a balance exercise assist robot (BEAR) as compared with conventional balance training for frail older adults. The present study was designed as a cross-over trial without a washout term. A total of 27 community-dwelling frail or prefrail elderly residents (7 men, 20 women; age range 65–85 years) were selected from a volunteer sample.Two exercises were prepared for interventions: robotic exercise moving the center of gravity by the balance exercise assistrobot system; and conventional balance training combining muscle-strengthening exercise, postural strategy training and applied motion exercise. Each exercise was carried out twice a week for 6 weeks. Participants were allocated randomly to either the robotic exercise first group or the conventional balance exercise first group	Main outcome measures: preferred and maximal gait speeds, tandem gait speeds, timed up-and-go test, functional reach test, functional base of support, center of pressure, and muscle strength of the lower extremities were assessed before and after completion of each exercise program	In frail or prefrail older adults, robotic exercise was more effective for improving dynamic balance andlower extremity muscle strength than conventional exercise. These findings suggest that postural strategy training with the balance exercise assist robot is effective to improve the gait instability and muscle weakness often seen in frail older adults
Balance exercise assist robot (BEAR)
		Robotic exercise achieved significant improvements for tandem gait speed (P = 0.012), functional reach test(P = 0.002), timed up-and-go test (P = 0.023) and muscle strength of the lower extremities (P = 0.001–0.030) compared with conventional exercise
4. Galli et al. [14]	The aim of this research was to quantify the effects of an end-effector robotic rehabilitation locomotion training in a group of Parkinson’s disease (PD) patients using 3D gait analysis (GA). In particular, spatiotemporal parameters and kinematics variables by means of synthetic indexes (Gait Profile Score, GPS, and its Gait Variable Scores GVSs) were computed from GA at baseline, before the treatment (T0), and at the end of the rehabilitative program (T1)	At T1 statistically significant improvements were found particularly in terms of spatio-temporal parameters (velocity, step length and cadence). No changes were observed as for GPS, while a trend towards improvement was found in terms of GVSs of pelvis and hip on the frontal plane	From these results, the use of Gait analysis has allowed to provide quantitative data about the end-effector robotic rehabilitation evidencing those joints more sensible to the treatment. The robotic locomotion training seems to improve gait pattern in patients with PD and in particular, the effect is on spatio-temporal parameters
		This approach can contribute to increase a short time lower limb motor recovery in PD Patients
	Patients underwent a cycle of out-patients rehabilitation treatment, consisting of at least a daily 3-h cycle, divided into 45 min of treatment for lower limb with robotic device and a treatment of occupational therapy for the upper limb
5. Kang and Agrawal [22]	Children with cerebral palsy (CP) often suffer from movement disorders. They show poor balance and motor coordination. These children typically use passive walkers in their early years. However, there are no prior studies that document the effects of robot-enhanced walkers on functional improvements of these children. This paper reports the results of two pilot studies where children were trained to walk with a robot to perform a series of tasks with increasing levels of difficulty over a number of training sessions	The outcome measures are based on both data collected by the robot such as travel distance, average speed, and success ratio of given task and clinical variables to characterize their levels of disability and motor function	This pilot study documents the training outcomes for children with CP and compares results (i) between small and large number of training sessions and (ii) between toddlers and older children
6. Zhang et al. [57]	The aim of this study was to provide a systematic review of studies that investigated the effectiveness of robot-assisted therapy on ankle motor and function recovery from musculoskeletal or neurologic ankle injuries. METHODS: Thirteen electronic databases of articles published from January, 1980 to June, 2012 were searched using keywords ‘ankle∗’, ‘robot∗’, ‘rehabilitat∗’ or ‘treat∗’ and a free search in Google Scholar based on effects of ankle rehabilitation robots was also conducted. References listed in relevant publications were further screened	RESULTS: Twenty-nine studies met the inclusion criteria and a total of 164 patients and 24 healthy subjects participated in these trials. Ankle performance and gait function were the main outcome measures used to assess the therapeutic effects of robot-assisted ankle rehabilitation. The protocols and therapy treatments were varied, which made comparison among different studies difficult or impossible. Few comparative trials were conducted among different devices or control strategies. Moreover, the majority of study designs met levels of evidence that were no higher than American Academy for Cerebral Palsy (CP) and Developmental Medicine (AACPDM) level IV. Only one study used a Randomized Control Trial (RCT) approach with the evidence level being discussed	All the selected studies showed improvements in terms of ankle performance or gait function after a period of robot-assisted ankle rehabilitation training. The most effective robot-assisted intervention cannot be determined due to the lack of universal evaluation criteria for various devices and control strategies. Future research into the effects of robot-assisted ankle rehabilitation should be carried out based on universal evaluation criteria, which could determine the most effective method of intervention. It is also essential to conduct trials to analyse the differences among different devices or control strategies
	Eventually, twenty-nine articles were selected for review and they focused on effects of robot-assisted ankle rehabilitation
7. Lee et al. [27]	This review included 10 trials involving 502 participants to meta-analysis. The acute RAGT groups showed significantly greater improvements in gait distance, leg strength, and functional level of mobility and independence than the over-ground training (OGT) groups T	120 participants) were observed than in the group with no intervention. Thus, RAGT improves mobility-related outcomes to a greater degree than conventional OGT for patients with incomplete SCI, particularly during the acute stage. RAGT treatment is a promising technique to restore functional walking and improve locomotor ability, which might enable SCI patients to maintain a healthy lifestyle and increase their level of physical activity
8. Piau et al. [37]	Study design 20 participants with psychomotor disadaptation admitted to an academic rehabilitation ward were randomised to receive physiotherapist care supported by the SafeWalker® robotic walking aid or standard care only, for 10 days. SafeWalker® supports the body weight whilst securing postural stability without relying on upper body strength or high cognitive demand. Main outcome measures the primary outcome was the feasibility and acceptability of rehabilitation sessions at 5 and 10 days based on (i) questionnaires completed by patient and physiotherapist, (ii) the number of steps performed during sessions, (iii) replacement of a robotic session by a conventional one	Results the mean age of the participants was 85.2 years	During follow-up, no robotic session had to be replaced by a conventional session
		The robotic procedure was significantly simpler according to participants
			All participants who benefited from the program completed the protocol
SafeWalker Robotics Walking Aid
		Regarding acceptability, there were no differences between the two groups
9. Belda-Lois et al. [8]	CPWalker consists of a smart walker with body weight and autonomous locomotion support and an exoskeleton for joint motion support. Likewise, CPWalker enables strategies to improve postural control during walking. The integrated robotic platform provides means for testing novel gait rehabilitation therapies in subjects with CP and similar motor disorders. Patient-tailored therapies were programmed in the device for its evaluation in three children with spastic diplegia for 5 weeks	After ten sessions of personalized training with CPWalker, the children improved the mean velocity (51.94 ± 41.97%), cadence (29.19 ± 33.36%) and step length (26.49 ± 19.58%) in each leg. Post-3D gait assessments provided kinematic outcomes closer to normal values than Pre-3D assessments	The results show the potential of the novel robotic platform to serve as a rehabilitation tool. The autonomous locomotion and impedance control enhanced the children’s participation during therapies. Moreover, participants’ postural control was substantially improved, which indicates the usefulness of the approach based on promoting the patient’s trunk control while the locomotion therapy is executed
10. Li et al. [28]	The aim of this study was to explore the application value of the lower limbs robot-assisted training system for post-total knee replacement (TKR) gait rehabilitation. A total of 60 patients with osteoarthritis of the knee were equally randomized into the traditional and robot-assisted rehabilitation training groups within 1 week after TKR. All patients received 2-week training	Scores of hospital for special surgery (HSS), knee kinesthesia grades, knee proprioception grades, functional ambulation (FAC) scores, Berg balance scores, 10-m sitting--standing time, and 6-min walking distances were compared between the groups. The HSS score, Berg score, 10-m sitting--standing time, and 6-min walking distance of the robot-assisted training group were significantly higher than the control group (P < 0.05). Its knee kinesthesia grade, knee proprioception grade, and FAC score were better than the control group but not significantly (P > 0.05)	Lower limbs robot-assisted rehabilitation training improves post-TKR patients’ knee proprioception and stability more effectively compared with the traditional method
			It improves patients’ gait and symptoms, increases their walking speed, and prolongs their walking distances, which benefit their return to family and society
Brain-Computer-Interface (BCI) or Brain–machine interface (BMI)
1. Tang et al. [48]	Brain-computer interface (BCI) directly translate human thought into machine command. It provides a new and promising method for rehabilitation of persons with disabilities. BCI actuated robotic arm is an effective rehabilitation way for patients with upper limb disability. This paper proposed a method of combining electromyography (EMG) and Electroencephalogram (EEG) to control the manipulator. Specifically, we collect EMG signals from the human leg and use tcalahe leg movements to quickly and reliably select the joints which are currently activated	The robot arm joints are precisely controlled by movement imagination (MI) brain-computer interfaces. The use of two non-homologous signals, scattered the burden of the brain and therefore reduce the work load. In addition, the program allows two kinds of operations at the same time, so the program is flexible and efficient. Offline experiment was designed to construct the classifier and optimal parameters. In the online experiment, subjects were instructed to control the robot arm to move an object from one location to another	Three subjects participated in the experiment, the accuracy rates of classifiers in the offline experiment were exceeded 95% and they all completed the online control
BCI-Robotic Arm
2. Khan and Hong [23]	In this paper, a hybrid electroencephalography- functional near infrared spectroscopy (EEG-fNIRS) scheme to decode eight active brain commands from the frontal brain region for brain-computer interface is presented. A total of eight commands are decoded by fNIRS, as positioned on the prefrontal cortex, and by EEG, around the frontal, parietal, and visual cortices. Mental arithmetic, mental counting, mental rotation, and word formation tasks are decoded with fNIRS, in which the selected features for classification and command generation are the peak, minimum, and mean ∆HbO values within a 2-s moving window	In the case of EEG, two eye-blinks, three eye-blinks, and eye movement in the up/down and left/right directions are used for four-command generation	The testing results show the possibility of controlling a quadcopter online and in real-time using eight commands from the prefrontal and frontal cortices via the proposed hybrid EEG-fNIRS interface
		The features in this case are the number of peaks and the mean of the EEG signal during 1 s window. We tested the generated commands on a quadcopter in an open space. An average accuracy of 75.6% was achieved with fNIRS for four-command decoding and 86% with EEG for another four-command decoding
BMI- quadcopter
3. Belda-Lois et al. [7]	This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity. The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI)	Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait	Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy
4. Bellingham et al. [9]	Advances in robotics have also extended human sensory experience, cognition, and physical abilities. Direct brain control has offered disabled individuals a possibility to restore basic motor function. Soekadar et al. (4) give an example on how a non-invasive, hybrid electroencephalography and electrooculography—based brain and neural hand exoskeleton can restore intuitive control of grasping motions for quadriplegia patients, allowing them to perform basic daily living activities	As noted by H. Herr, an advisory board member of Science Robotics, “future technologies will not only compensate for human disability but will drive human capacities beyond innate physiological levels, enabling humans to perform a diverse set of tasks with both anthropomorphic and non-anthropomorphic extended bodies.”	Such augmentative technologies “will have a transformative influence on broad social, political, and economic spheres, affecting the future of sport, labor productivity, human longevity, and disability.”
Journal articles on overall literature review
1. Bustamante Valles et al. [10] Robotic Rehabilitation (Robot Gym)	A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the robot gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6–8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies	Robot Gym consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches	The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5–6 times more patients for the approximately same cost in the long term
		No statistically significant differences between the groups
2. Schröder et al. [42]	Aim: To evaluate the feasibility of repetitive gait training within the first 3 months post-stroke and the effects on gait-specific outcomes	Repetitive training can safely be provided through body weight support and locomotor assistance from therapists or a robotic device. No difference in drop-out rates was reported despite the demanding nature of the intervention. The meta-analysis yielded significant, but small, effects on walking independence and endurance. Training with end-effector robots appears most effective. However, the mechanisms underlying these effects remain poorly understood	Conclusion: Robots enable a substantial, yet feasible, increase in the quantity of walking practice early post-stroke, which might enhance functional recovery
	Methods: PubMed, Web of Science, Cochrane Library, Rehab Data and PEDro databases were searched systematically. Randomized controlled trials were included to descriptively analyse the feasibility and quantitatively investigate the effectiveness of repetitive gait training compared with conventional therapy. Fifteen randomized controlled trials were included
3. Chen et al. [13]	The systematic review aims to synthesize the current knowledge of technologies and human factors in home-based technologies for stroke rehabilitation. We conducted a systematic literature search in three electronic databases (IEEE, ACM, PubMed), including secondary citations from the literature search. We included articles that used technological means to help stroke patients conduct rehabilitation at home, reported empirical studies that evaluated the technologies with patients in the home environment, and were published in English	The search yielded 832 potentially relevant articles, leading to 31 articles that were included for indepth analysis. We then derive two main human factors in designing home-based technologies for stroke rehabilitation: designing for engagement (including external and internal motivation) and designing for the home environment (including understanding the social context, practical challenges, and technical proficiency)	This systematic review presents an overview of key technologies and human factors for designing home-based technologies for stroke rehabilitation
Saebo Mobile Arm Support, Haptic Master, Hand Mentor Pro (HMP), Hand Mentor, and Myomo mPower 1000			The robotic devices mainly aid the movement of the arm, wrist, and hands to improve the active flexion and extension range of motion
	The types of technology of reviewed articles included games, telerehabilitation, robotic devices, virtual reality devices, sensors, and tablets. We present the merits and limitations of each type of technology
		Robotic devices automate therapy procedure and generate a wide variety of forces and motions for training. Another benefit of robotic devices is to deliver measurable and optimal dose and intensity for intensive therapy
4. Law [26]	The chapter argues that if the assistive technologies can only restore the biological and physical functioning of the disabled, they remain a robot only. When these technologies also manage to improve the social life of the disabled, they can turn into social robots	Following this line of thought, the chapter argues that rehabilitation programmes facilitating the use of assistive technologies in Hong Kong have difficulties in transforming assistive technologies into social robots	The chapter is concluded by further elaborating these difficulties at both the micro- and macro-level
Home-based Rehab technologies
5. Agrawal [2]	Rehabilitation robotics, is dedicated to the state-of-the-art of an emerging interdisciplinary field where robotics, sensors, and feedback are used in novel ways to relearn, improve, or restore functional movements in humans	The significant advances in and novel designs of soft actuators and wearable systems that have emerged in the area of prosthetic lower limbs and ankles in recent years, which offer potential for both rehabilitation and human augmentation	The rehab devices for the pediatric population. Their impairments are life-long and rehabilitation robotics can have an even bigger impact during their lifespan. In recent years, a number of new developments have been made to promote mobility, socialization, and rehabilitation among the very young: the infants and toddlers
Rehabilitation Robotics for infants and toddlers	Four distinct areas of Medical robotics, namely: Minimally Invasive Surgical Robotics, Micro and Nano Robotics in Medicine, Image-guided Surgical Procedures and Interventions, and Rehabilitation Robotics
		The next section addresses an important emphasis in the field of medicine today that strives to bring rehabilitation out from the clinic into the home environment, so that these medical aids are more readily available to users
6. Kim et al. [24]	Since the first industrial robot was introduced in the 1960s, robotic technologies have contributed to enhance the physical limits of human workers in terms of repeatability, safety, durability, and accuracy in many industrial factories. In the twenty-first century, robots are expected to be further applied in healthcare, which requires procedures that are objective, repetitive, robust and safe for users	We focus on research and clinical activities that have followed successful demonstrations of early pioneering robots such as daVinci telesurgical robots and LOKOMAT training robots	First, we categorize major areas of healthcare robotics. Second, we discuss robotics for surgical operating rooms. Third, we review rehabilitation and assistive technologies