The role of feedback in the robotic-assisted upper limb rehabilitation in people with multiple sclerosis: a systematic review

ABSTRACT

Introduction

Robotic-assisted upper limb rehabilitation might improve upper limb recovery in people with multiple sclerosis (PwMS) with moderate-to-severe disability. In the few existing studies, the training effects have been related to the type of intervention, if intensive, repetitive, or task-oriented training might promote neuroplasticity and recovery. Notably, most of these devices operate within a serious game context providing different feedback. Since feedback is a key component of motor control and thus involved in motor and cognitive rehabilitation, clinicians cannot desist from considering the potential contribution of feedback in the upper limb robot-assisted rehabilitation effects.

Area covered

In this systematic review, we reported the rehabilitation protocols used in the robot-assisted upper limb training in PwMS to provide state-of-the-art on the role of feedback in robotic-assisted Upper Limb rehabilitation. PubMed, the Cochrane Library, and the Physiotherapy Evidence Database databases were systematically searched from inception to March 2022. After a literature search, the classification systems for feedback and the serious game were applied.

Expert opinion

There is a need for sharing standard definitions and components of feedback and serious game in technologically assisted upper limb rehabilitation. Indeed, improving these aspects might further improve the effectiveness of such training in the management of PwMS.

KEYWORDS:

• Serious game
• sensorimotor learning
• engagement
• neuroplasticity

Article highlights

• The literature on robot-assisted rehabilitation of the upper limb in PwMS is limited compared to those that regard subjects affected by stroke.

• Much more attention has been paid to the hardware components of robots, neglecting how these devices operate: the serious game context, modalities of feedback, and pathology-adapted virtual context.

• Augmented feedback enhances learning, driving motor recovery and neuroplasticity, and is crucial in rehabilitation.

• Appropriate feedback modalities might help to pay more attention to cognitive, emotional, and motivational aspects during robotic rehabilitation

• A greater effort should be made to the knowledge of the neuroplasticity mechanism underlying different feedback modalities

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17434440.2023.2169129

Additional information

Funding

This paper was not funded.