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Groundbreaking research is confirming the potential of Brain-Computer Interface (BCI) systems to revolutionise stroke rehabilitation. By directly linking a stroke survivor’s brain signals to an external device, BCI technology is proving to be a powerful tool for promoting motor recovery, especially for those with severe impairment.

BCIs use a ‘closed-loop’ feedback system, where brain signals reflecting the intention to move trigger a response from a connected device, like a robotic limb or functional electrical stimulation (FES). This process reinforces the neural pathways associated with the intended movement, effectively rewiring the brain to regain function.

Compared to traditional therapy alone, in stroke rehab research studies, BCI training is consistently showing significant superior effects in improving upper-limb motor function. Studies report clinically meaningful gains in Fugl-Meyer Assessment (FMA) scores. Meta-analyses show that BCI systems are most effective when combined with other technologies. BCI integrated with FES consistently demonstrates the highest effect sizes, likely because it activates both the brain’s intention and the muscle’s response, providing powerful and rich sensory feedback.

For survivors, BCI training can be incredibly motivating; by providing immediate, tangible feedback on progress, it can make training more engaging and rewarding, addressing the common challenge of low patient adherence. And non-invasive BCI methods, typically using EEG electrodes, are proven to be very safe and well-tolerated, with adverse effects being extremely rare. BCI represents a significant tech-driven leap forward; turning intention into action and offering new hope for us stroke survivors.

The RELab tenoexo 2.0 is an updated version of a wearable soft robotic hand orthosis designed to provide grasping assistance and support for rehabilitation in individuals with sensorimotor hand impairments, such as those following a stroke. This improved design features enhanced finger and actuation systems for greater simplicity and robustness, aiming to increase user independence and quality of life by facilitating high-dose, task-specific training in both clinic and home environments.

The latest findings on the RELab tenoexo 2.0 are of significant interest for our stroke rehabilitation community. A feasibility study just published in the Journal of NeuroEngineering and Rehabilitation demonstrates how this innovative, wearable device can significantly enhance hand and arm function for stroke survivors.

Researchers evaluated its effectiveness through a two-phase study involving individuals with chronic stroke. The survivors who used it achieved an impressive number of high-intensity repetitions, logging over 150 supported grasps per hour at home—a rate nearly five times higher than conventional therapy.

The intervention led to clinically meaningful functional gains in upper limb function, as measured by standardised tests like the Action Research Arm Test (ARAT) and Fugl-Meyer Assessment (FMA-UE). The functional gains observed were retained even one month after the intervention period ended, highlighting the therapy’s lasting impact. The study showed strong user acceptance and high adherence rates for both in-clinic and at-home training, proving its viability for continuous care.

For stroke survivors facing long-term hand impairments, accessing high-intensity, repetitive therapy is often a major challenge. The RELab tenoexo 2.0 clearly offers a useful addition to retraining solution as it’s a portable, easy-to-use tool. This approach can empower survivors to take control of their own recoveries, helping to promote neuroplasticity and improve independence in daily activities.

It looks to us at ARNI Stroke Rehab UK that wearable soft robotics are not just futuristic concepts; they are becoming a really useful augment to neurorehab.

Research continues to validate the effectiveness of advanced wearable technology, like the Neofect Smart Glove for upper-limb rehab. Smart Glove is a San Fran-based high-tech stroke rehab product for your hand that follows your hand motions, measuring the slightest movements in your hand with accelerometer and bending sensors while performing gamified exercises.

A recent study published in the Journal of NeuroEngineering and Rehabilitation showed significant functional gains for patients using the glove alongside conventional therapy compared to conventional therapy alone. It proved a motivating way to perform progressive hand exercises at home.

The Smart Glove uses engaging, game-based virtual reality to provide high-repetition, task-specific practice, a crucial component for inducing neuroplasticity. Integrated sensors monitor individual finger and wrist movements, giving patients and clinicians real-time feedback and objective tracking data on progress.

Functional near-infrared spectroscopy (fNIRS) analysis demonstrates increased brain activity in the motor cortex during Smart Glove training, providing objective evidence of cortical reorganisation. Patients showed statistically significant improvements in standardised tests of hand function (e.g., Fugl-Meyer Assessment and Jebsen-Taylor Hand Function Test).

This tech for stroke seems to offer a promising tool for increasing a survivor’s motivation and extending rehabilitation beyond the clinic; hopefully accelerating recoveries and improving the quality of survivors’ lives.

A new pilot programme at the Irvine Unit, Bexhill Hospital, is showcasing the power of collaborative, supervised exercise for stroke survivors. The Active Sussex Reconditioning Pilot demonstrates how targeted physical activity, delivered by health instructors alongside NHS physiotherapists, can significantly boost recovery. The pilot, which ran for six months, yielded significant, data-driven improvements.

Patients saw a substantial increase in their balance (balance across all survivors increased 50%), a critical factor for preventing falls and increasing mobility. Sit-to-Stand ability increased by 34%, indicating greater leg strength and functional independence in a key daily activity. The pilot also enabled greater independence for patients, with rehabilitation complexity reducing by 22%, potentially leading to faster and more successful discharges.

According to Karen Poole, AHP Rehabilitation Consultant at East Sussex Healthcare NHS Trust, the pilot demonstrated the power of cross-sector collaboration. She notes that ‘increased access to physical and social activity for patients contributed to their mood, wellbeing and a positive culture across our workforce.’

This initiative proves the potential for integrating fitness and healthcare sectors, with plans to expand the model to other hospitals across Sussex. This project highlights how innovative approaches to addressing inactivity can improve patient mood and wellbeing, challenging traditional rehabilitation models.

Subject to future funding, there are plans to expand this model by live-streaming exercise sessions to other hospitals in the region. This would enable wider adoption of the successful approach and potentially help inspire other NHS trusts to rethink their rehabilitation programmes.

Recent data from the NHS reveals a worrying and significant trend in cardiovascular health: a 28% increase in hospital admissions for stroke over the last two decades. While advances in care have improved survival rates, the sheer volume of cases is putting immense pressure on healthcare systems and signalling deeper public health issues that demand our attention.

Admissions surged from 87,069 in 2004/05 to 111,137 in 2023/24. Part of this is due to an aging population, but significant spikes are occurring in younger cohorts. The highest increase was a staggering 55% among those aged 50-59, underscoring that stroke is not just a risk for the elderly. Lifestyle factors like obesity, poor diet, and lack of exercise are contributing to this growing burden on cardiovascular health.

Stroke is basically an ever-growing public health crisis impacting people at younger ages.  These findings serve as a critical wake-up call for a renewed focus on primary prevention; ARNI notes that we must move beyond just treating the aftermath of a stroke and address the root causes driving this trend. It’s a shared responsibility of healthcare professionals, policymakers… and the public too… to take proactive steps to address the underlying causes and mitigate this alarming trend.

In Scotland, The Sir Jules Thorn Centre for Co-Creation of Rehabilitation Technology, located at the Wolfson Centre at the University of Strathclyde in Glasgow, is helping stroke survivors with leading-edge, tech-enriched retraining programmes to help them regain independence. The centre is a partnership between the University, NHS Lanarkshire, and the charity Chest Heart & Stroke Scotland. Its mission is to make intensive, technology-enriched rehabilitation more accessible to stroke survivors, helping them regain independence and hope.

Rehab exercises can sometimes feel repetitive, but the Sir Jules Thorn Centre is making them fun and engaging. They adapt controllers and use computer games to help survivors recover dexterity in their hands and arms. As one survivor put it, the machines are ‘rigged to computer games and they work you hard, but also make it interesting and fun’. This playful approach keeps motivation high, encouraging people to push themselves further.

For survivors with walking difficulties, a high-tech treadmill with a harness system provides crucial support and feedback. The technology uses cameras to track movement, allowing patients to see exactly how they walk and make corrections in real time. This real-time visual feedback, often within virtual reality environments, is not only supportive but also highly motivating, boosting confidence with every step.

With the help of advanced technology, patients can achieve a level of intensive, tailored rehab that isn’t possible with traditional methods alone. The centre’s eight-week programme is designed to push patients toward their goals, whether it’s recovering the ability to walk and talk at the same time or achieving a small but hugely significant personal goal like zipping up a jacket. This personalised attention is making a massive difference.

They work directly with stroke survivors, clinicians, and engineers to develop technologies that are genuinely useful and user-friendly. By involving the people who will use the technology, they ensure the solutions are truly patient-centred and address real-world challenges.

In prototype form at the moment, the tech from researchers at the Harvard John A. Paulson School of Engineering and Applied Sciences and the Wyss Institute may possibly transform upper-limb rehabilitation potential for stroke survivors by offering several key advantages over their rigid counterparts.

Instead of a bulky, mechanical frame, the new device, named ‘Reachable’, is a comfortable, sensor-loaded vest with an inflatable bladder under the arm. This design is less restrictive, more portable, and can be worn for longer durations, which is critical for intensive, repetitive therapy needed for motor recovery.

The Reachable device utilises a combination of a physics-based model and a machine learning algorithm to tailor assistance to each individual’s unique movement patterns. The system tracks movement and pressure with sensors and uses this data to learn the user’s intent. By doing so, the robot provides assistance that feels more natural and intuitive.

In testing, the device demonstrated the ability to distinguish a user’s intended shoulder movements with high accuracy. It effectively reduced the amount of force needed to lower an arm by about a third and users showed larger, more efficient ranges of motion in their shoulders, elbows, and wrists, reducing the need for compensatory movements like body leaning.

A major strength of the Harvard research is its strong emphasis on user feedback. Patients with stroke and ALS were involved in testing and development from the early stages, ensuring that the final device is not only clinically effective but also comfortable and easy to use. This patient-centered approach was highlighted by one volunteer who noted feeling engaged in the process rather than feeling like a ‘lab rat’. This feedback loop was instrumental in refining the design for better aesthetics and wearability, which are vital for real-world adoption.

The development of this lightweight, wearable technology holds significant promise for home-based rehabilitation. Many stroke survivors face challenges accessing consistent in-clinic therapy due to cost and travel. A portable device like Reachable could allow patients to perform therapeutic exercises more frequently and regain independence in their daily lives, from eating and drinking to other routine tasks. Researchers have secured grants to further test the device with users in their homes, a crucial step toward commercialisation.

Based on recent research, the SoftHand-X offers a promising new approach to task-specific practice for stroke patients, particularly for those with severe hand impairment. Recent studies highlight its potential to reduce spasticity, improve hand function, and enhance patient participation in rehabilitation.

The SoftHand-X is a supernumerary robotic limb, which is a wearable device that augments the human body with robotic fingers. The patient’s residual, minimal active finger or wrist extension movements are used to control the device’s finger extension, while relaxing their extensor muscles controls the robotic hand’s flexion.

A 2022 pilot study published in Nature utilised the SoftHand-X to administer task-specific training (TST) to sub-acute stroke patients who lacked sufficient active finger extension to perform these tasks unaided. Patients using it showed a decrease in spasticity, with the Modified Ashworth Scale (MAS) scores improving from a baseline of 1 (mild spasticity) to 0 (no spasticity) in most patients shortly after treatment. This reduction in spasticity was also supported by electromyographic (EMG) recordings, which showed a decreased stretch reflex in the wrist and/or finger flexors.

In a usability study, patients rated the SoftHand-X as ‘well-accepted’ and ‘good’ for its usability and showed excellent participation levels; demonstrating high motivation for the intensive, goal-directed motor tasks facilitated by the device.

Another study found the SoftHand-X could partially compensate for severely impaired hand function in chronic stroke patients and reduce spasticity.

Preliminary data suggests that using other control methods, like EMG measurements from extensor muscles, could expand the number of patients who can benefit from SoftHand-X-assisted therapy.

Future research will focus on expanding the sample sise and refining control mechanisms to make the SoftHand-X accessible to a wider range of patients. These soft robotic devices represent a paradigm shift towards personalised, accessible, and engaging neurorehabilitation, with the potential to improve recovery outcomes and quality of life for stroke survivors.

Ref for you: Trompetto, C., Catalano, M.G., Farina, A. et al. A soft supernumerary hand for rehabilitation in sub-acute stroke: a pilot study. Sci Rep 12, 21504 (2022).

* Stroke-Specific Resistance Training: Incorporating strength and conditioning exercises adapted for neurological limitations helps build stability and strength, empowering survivors to discard assistive devices and enhance their functional independence.

Implications for Clinical Practice & Research: The ARNI model challenges the traditional paradigm that recovery plateaus shortly after hospital discharge. Its success highlights the value of personalised, intensive, and long-term neurorehabilitation strategies. For clinicians and researchers, ARNI’s integration of psychological support, functional training, and strength conditioning offers a powerful framework for enhancing patient outcomes and promoting self-reliance.