We express gratitude to the patients and medical staff of the Second Hospital of Jiaxing for their support and cooperation during the research process.

This study (Approval No. JXEY-2020SW038) was approved by the Medical Ethics Committee of the Second Hospital of Jiaxing, with all participants providing informed consent. It aimed to assess the feasibility and effectiveness of a protocol through a randomized, single-blind, controlled trial. Between January and December 2021, 60 stroke patients admitted to the Second Hospital of Jiaxing were enrolled.
NOTE: Inclusion criteria comprised: 1) confirmed diagnosis of cerebral infarction or hemorrhag...

Dual Upper Limb Robotic Training in Stroke Rehabilitation

<ol>
	<li>Feigin, V. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=World+Stroke+Organization+(WSO):+Global+stroke+fact+sheet+2022.">World Stroke Organization (WSO): Global stroke fact sheet 2022.</a> Int J Stroke. 17 (1), 18-29 (2022).</li><li>Kiper, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+immersive+virtual+reality+on+upper-extremity+stroke+rehabilitation:+A+systematic+review+with+meta-analysis.">Effects of immersive virtual reality on upper-extremity stroke rehabilitation: A systematic review with meta-analysis.</a> J Clin Med. 13 (1), 146 (2023).</li><li>Yao, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cognitive+function+and+upper+limb+rehabilitation+training+post-stroke+using+a+digital+occupational+training+system.">Cognitive function and upper limb rehabilitation training post-stroke using a digital occupational training system.</a> J Vis Exp. (202), e65994 (2023).</li><li>Tang, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+upper+limb+robot-assisted+rehabilitation+improves+upper+limb+motor+function+in+stroke+patients:+a+study+based+on+quantitative+EEG.">Bilateral upper limb robot-assisted rehabilitation improves upper limb motor function in stroke patients: a study based on quantitative EEG.</a> Eur J Med Res. 28 (1), 603 (2023).</li><li>Yang, S. -. W., Ma, S. -. R., Choi, J. -. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+3-dimensional+robotic+therapy+combined+with+electromyography-triggered+neuromuscular+electrical+stimulation+on+upper+limb+function+and+cerebral+cortex+activation+in+stroke+patients:+A+randomized+controlled+trial.">Effect of 3-dimensional robotic therapy combined with electromyography-triggered neuromuscular electrical stimulation on upper limb function and cerebral cortex activation in stroke patients: A randomized controlled trial.</a> Bioengineering. 11 (1), 12 (2023).</li><li>Chen, P. M., Kwong, P. W. H., Lai, C. K. Y., Ng, S. S. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+bilateral+and+unilateral+upper+limb+training+in+people+with+stroke:+A+systematic+review+and+meta-analysis.">Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis.</a> PLoS One. 14 (5), e0216357 (2019).</li><li>Dhakate, D., Bhattad, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Study+the+effectiveness+of+bilateral+arm+training+on+upper+extremity+motor+function+and+activity+level+in+patients+with+sub-acute+stroke.">Study the effectiveness of bilateral arm training on upper extremity motor function and activity level in patients with sub-acute stroke.</a> Int J Cur Res Rev. 12 (20), 2987 (2020).</li><li>Ahn, S. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Benefits+of+robot-assisted+upper-limb+rehabilitation+from+the+subacute+stage+after+a+stroke+of+varying+severity:+A+multicenter+randomized+controlled+trial.">Benefits of robot-assisted upper-limb rehabilitation from the subacute stage after a stroke of varying severity: A multicenter randomized controlled trial.</a> J Clin Med. 13 (3), 808 (2024).</li><li>Li, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dual-tDCS+combined+with+sensorimotor+training+promotes+upper+limb+function+in+subacute+stroke+patients:+A+randomized,+double-blinded,+sham-controlled+study.">Dual-tDCS combined with sensorimotor training promotes upper limb function in subacute stroke patients: A randomized, double-blinded, sham-controlled study.</a> CNS Neurosci Ther. 30 (4), e14530 (2023).</li><li>Yuan, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+uni-+vs.+bilateral+upper+limb+robot-assisted+rehabilitation+on+motor+function,+activities+of+daily+living,+and+electromyography+in+hemiplegic+stroke:+A+single-blinded+three-arm+randomized+controlled+trial.">Effects of uni- vs. bilateral upper limb robot-assisted rehabilitation on motor function, activities of daily living, and electromyography in hemiplegic stroke: A single-blinded three-arm randomized controlled trial.</a> J Clin Med. 12 (8), 2950 (2023).</li><li>Song, Y. -. H., Lee, H. -. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+immersive+virtual+reality-based+bilateral+arm+training+in+patients+with+chronic+stroke.">Effect of immersive virtual reality-based bilateral arm training in patients with chronic stroke.</a> Brain Sci. 11 (8), 1032 (2021).</li><li>Dembele, J., Triccas, L. T., Amanzonw&#233;, L. E. R., Kossi, O., Spooren, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+versus+unilateral+upper+limb+training+in+(sub)acute+stroke:+A+systematic+and+meta-analysis.">Bilateral versus unilateral upper limb training in (sub)acute stroke: A systematic and meta-analysis.</a> S Afr J Physiother. 80 (1), 1985 (2024).</li><li>Wu, J. Y., Cheng, H., Zhang, J. Q., Bai, Z. F., Cai, S. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+modulatory+effects+of+bilateral+arm+training+(BAT)+on+the+brain+in+stroke+patients:+a+systematic+review.">The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review.</a> Neurol Sci. 42 (2), 501-511 (2021).</li><li>Yang, X. W., Shi, X. B., Xue, X. L., Deng, Z. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+robot-assisted+training+on+rehabilitation+of+upper+limb+function+in+patients+with+stroke:+A+systematic+review+and+meta-analysis.">Efficacy of robot-assisted training on rehabilitation of upper limb function in patients with stroke: A systematic review and meta-analysis.</a> Arch Phys Med Rehabil. 104 (9), 1498-1513 (2023).</li><li>Wu, J. Y., Cheng, H., Zhang, J. Q., Yang, S. L., Cai, S. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+therapy+for+upper+extremity+motor+impairment+after+stroke:+A+systematic+review+and+meta-analysis.">Robot-assisted therapy for upper extremity motor impairment after stroke: A systematic review and meta-analysis.</a> Phys Ther. 101 (4), pzab010 (2021).</li><li>Meseguer-Henarejos, A. B., S&#225;nchez-Meca, J., L&#243;pez-Pina, J. A., Carles-Hern&#225;ndez, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Inter-+and+intra-rater+reliability+of+the+Modified+Ashworth+Scale:+a+systematic+review+and+meta-analysis.">Inter- and intra-rater reliability of the Modified Ashworth Scale: a systematic review and meta-analysis.</a> Eur J Phys Rehabil Med. 54 (4), 576-590 (2018).</li><li>Groppa, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+practical+guide+to+diagnostic+transcranial+magnetic+stimulation:+report+of+an+IFCN+committee.">A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee.</a> Clin Neurophysiol. 123 (5), 858-882 (2012).</li><li>Fong, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+the+Hong+Kong+version+of+the+functional+test+for+the+hemiplegic+upper+extremity+(FTHUE-HK).">Development of the Hong Kong version of the functional test for the hemiplegic upper extremity (FTHUE-HK).</a> Hong Kong J Occup Th. 14 (1), 21-29 (2004).</li><li>Hern&#225;ndez, E. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-+and+inter-rater+reliability+of+Fugl-Meyer+Assessment+of+Upper+Extremity+in+stroke.">Intra- and inter-rater reliability of Fugl-Meyer Assessment of Upper Extremity in stroke.</a> J Rehabil Med. 51 (9), 652-659 (2019).</li><li>Ohura, T., Hase, K., Nakajima, Y., Nakayama, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validity+and+reliability+of+a+performance+evaluation+tool+based+on+the+modified+Barthel+Index+for+stroke+patients.">Validity and reliability of a performance evaluation tool based on the modified Barthel Index for stroke patients.</a> BMC Med Res Methodol. 17 (1), 131 (2017).</li><li>Wu, J., Cheng, H., Zhang, J., Bai, Z., Cai, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+modulatory+effects+of+bilateral+arm+training+(BAT)+on+the+brain+in+stroke+patients:+a+systematic+review.">The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review.</a> Neurol Sci. 42 (2), 501-511 (2021).</li><li>Hsu, H. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic-assisted+therapy+with+bilateral+practice+improves+task+and+motor+performance+in+the+upper+extremities+of+chronic+stroke+patients:+A+randomised+controlled+trial.">Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial.</a> Aust Occup Ther J. 66 (5), 637-647 (2019).</li><li>Kitsos, G. H., Hubbard, I. J., Kitsos, A. R., Parsons, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+ipsilesional+upper+limb+can+be+affected+following+stroke.">The ipsilesional upper limb can be affected following stroke.</a> ScientificWorldJournal. 2013, 684860 (2013).</li><li>Bustr&#233;n, E. L., Sunnerhagen, K. S., Alt Murphy, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Movement+kinematics+of+the+ipsilesional+upper+extremity+in+persons+with+moderate+or+mild+stroke.">Movement kinematics of the ipsilesional upper extremity in persons with moderate or mild stroke.</a> Neurorehabil Neural Repair. 31 (4), 376-386 (2017).</li><li>da Silva, E. S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+priming+on+outcomes+of+task-oriented+training+for+the+upper+extremity+in+chronic+stroke:+A+systematic+review+and+meta-analysis.">The effect of priming on outcomes of task-oriented training for the upper extremity in chronic stroke: A systematic review and meta-analysis.</a> Neurorehabil Neural Repair. 34 (6), 479-504 (2020).</li><li>Lee, C. Y., Howe, T. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+of+activity-based+task-oriented+training+on+upper+extremity+recovery+for+adults+with+stroke:+A+systematic+review.">Effectiveness of activity-based task-oriented training on upper extremity recovery for adults with stroke: A systematic review.</a> Am J Occup Ther. 78 (2), 7802180070 (2024).</li></ol>

Bilateral training has been shown to normalize intercortical inhibition in stroke patients, facilitate brain functional network reorganization, and ultimately enhance upper limb function21. This study presents a program for upper limb functional training in stroke patients utilizing a dual upper limb task-oriented robotic system. The program integrates bilateral upper limb movement, task-oriented activities, and robot-assisted training to enhance the rehabilitation of upper limb function in stroke...

Stroke is one of the major causes of disability and the second leading cause of death globally1,2. Stroke patients often face various challenges, such as motor, sensory, and cognitive deficits3. Upper limb dysfunction is a common problem after stroke, characterized by muscle weakness, spasticity, and reduced motor ability of the upper limb on the hemiplegic side4. It is reported to be present in more than 70% of stroke patients, and only around 5% recover to normal, while 20% regain some upper limb capabilities5. More than half of human life requires the participation of the upper limbs6, and upper limb dysfunction after a stroke severely affects patients' activities of daily living7, significantly decreasing their quality of life8 and increasing their financial burden9. Therefore, it is particularly important to explore effective methods of upper limb functional rehabilitation.
Various clinical upper limb rehabilitation treatments, such as mirror therapy, constraint-induced movement therapy, functional electrical stimulation, and other active or passive training, are commonly utilized for stroke patients3,10. In recent years, bilateral arm training has garnered increased attention6,11,12. It has been demonstrated to enhance neural connectivity between the sensorimotor areas of both ipsilateral and contralateral hemispheres12. This type of training helps correct abnormalities in interhemispheric inhibition, facilitates reorganization of brain functional networks, and ultimately leads to improvements in upper limb function12,13. Furthermore, robot-assisted training has also been shown to assist patients in consistently executing accurate limb movements and engaging in task-specific training14. This process provides the brain with substantial feedback stimulation, ultimately boosting neuroplasticity and aiding in the restoration of upper limb function in individuals with hemiplegia14,15. There is currently limited research on strategies utilizing robot-assisted dual upper limb training for stroke patients. This study employed a dual upper limb task-oriented robotic system to combine robot-assisted training with bilateral upper limb training. The robotic device was utilized to aid stroke patients in conducting dual upper limb task-oriented training with high repetitions in a proper movement pattern. The objective of the research was to evaluate the effects of this method on the corticospinal pathway, upper-limb function, and activities of daily living in stroke survivors, with the aim of discovering innovative strategies for upper limb functional rehabilitation.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Dual upper limb task-oriented robotic system</td>
			<td>Auckland Tongji Rehabilitation Medical Equipment Research Center, Tongji Zhejiang College</td>
			<td>N/A</td>
			<td>The dual upper limb task-oriented robotic system can aid stroke patients in bilateral upper limb virtual game training by regulating force transmission between the healthy and affected upper limbs.</td>
		</tr>
		<tr>
			<td>Magnetic stimulation therapy system</td>
			<td>Sichuan Junjian Wanfeng Medical Equipment Co.,Ltd.</td>
			<td>http://www.jjwf-med.com</td>
			<td> 
			This system can be used to measure the Motor evoked potential (MEP)</td>
		</tr>
		<tr>
			<td>SPSS 25.0</td>
			<td>IBM</td>
			<td>Version 25.0</td>
			<td>https://www.ibm.com/support/pages/downloading-ibm-spss-statistics-25</td>
		</tr>
	</tbody>
</table>

application of a dual upper limb task-oriented robotic system for the functional recovery of the upper limb in stroke patients

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm training can help stroke survivors regain their upper limb function and improve their daily activities. The dual upper limb task-oriented robotic system is designed to assist the healthy side of the stroke patient in driving the affected side to perform bilateral arm training through the use of a robotic device. It can also guide the patient in carrying out dual upper limb coordinated movements and engage them in a task-oriented virtual game using force feedback and human-computer interaction technology. This study aimed to assess the efficacy of the system in enhancing upper limb function and activities of daily living in stroke patients. The assessment methods used included motor evoked potential (MEP), functional test for the hemiplegic upper extremity-Hong Kong (FTHUE-HK), Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), and modified Barthel index (MBI). The results of the study indicate that the dual upper limb task-oriented robotic system can significantly improve the corticospinal pathway, upper limb function, and activities of daily living in stroke patients after 6 weeks of treatment. This system can serve as an effective adjunct to upper limb functional rehabilitation in stroke survivors, reducing the dependence on rehabilitation therapists. In conclusion, the dual upper limb task-oriented robotic system provides a new strategy for post-stroke limb functional rehabilitation and holds great potential for application, as it offers certain social and financial benefits.

Author Spotlight: Enhancing Upper Limb Rehabilitation in Stroke Patients Through Advanced Robotic and Neuromodulation Technologies

Application of a Dual Upper Limb Task-Oriented Robotic System for the Functional Recovery of the Upper Limb in Stroke Patients

Our research is focused on the rehabilitation of patients who have suffered a stroke or traumatic brain injury, and we're trying to investigate the impact of our robot-assisted to upper limb training strategy on the recovery of upper limb function in stroke patients. Our protocol integrates bilateral upper limb training, task-oriented activities, and robot-assisted training to enhance the rehabilitation of upper limb function in stroke patients. We will focus on the impact of neuromodulation technology, virtual reality technology, and artificial intelligence robotic assistants on post-stroke limb function rehabilitation.

A total of 60 stroke patients were divided into a control group (n = 30) and an experimental group (n = 30) for this study. Upon comparing age, gender, stroke type, disease duration, side of hemiplegia, and other general information between the two groups, no statistically significant differences were found (P &#62; 0.05), indicating their comparability (Table 1). Patients in the experimental group, who underwent training with a dual upper limb task-oriented robotic system, showed greater improvements in...

This experimental protocol outlines the use of a dual upper limb task-oriented robotic system for stroke patients with upper limb dysfunction. The findings indicate that this system can significantly improve stroke patients' upper limb function and daily living activities.

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm ...

application-dual-upper-limb-task-oriented-robotic-system-for

Without Section

Research

JoVE Journal

Medicine

Dual Upper Limb Task-Oriented Robotic System Training Sessions for Stroke Patients with Upper Limb Dysfunction

To begin, start the robotic system equipment and turn on the system's computer. Open the ULCOT Rehab application and enter the main interface of the system. After entering the patient's details, click Log In and select the patient from the list.Assist the patient to sit in front of the robotic device, ensuring a safe and comfortable distance. Click Adjustment to set the appropriate parameters. In the platform height adjustment module, click on plus or minus to increase or decrease the height of the platform.Next, in the arm tilt angle adjustment module, click plus or minus to adjust the tilt angle of the robotic arm. In the arm angle adjustment module, click plus or minus to increase or decrease the angle between the two robot arms. Click Training to enter the training program setting interface.For patients unable to fully manipulate the mechanical handle on the hemiplegic side, click Assistance to enter the assisted training mode interface. Set the time to 30 minutes In the training time module, and select the level set for the patient in the assisted level module. Click Air Flying or Ping-Pong.Then, click Start To enter the game interface. In the Air Flying game, instruct the patient to use the affected upper limb through the healthy side with the assistance of a robotic device to control and guide the virtual airplane along the designated flight trajectory and capture gold coins. In the Ping-Pong game, with the assistance of the robot, instruct the patient to use the unaffected side to drive the affected-side upper limb to control the virtual table tennis racket.Move the racket to catch the flying ping-pong. For patients able to actively manipulate the mechanical handle on the hemiplegic side, click Resistance. Set the time to 30 minutes in the training time module.In the Healthy Level and Affected Level modules, select the resistance levels for the healthy side and the affected side respectively. In the healthy side resistance direction and affected side resistance direction modules, select the resistance direction indicated by the system for each side. In the Holding Time module, select the duration for holding the target.In the Bridge Road game, instruct the patient to complete the task of building a wooden bridge by resisting the resistance provided by the robotic arm on both the healthy and affected upper limbs. Control both ends of the wooden bridge displayed on the screen. Move two ladder platforms of different heights and hold them for a certain time to allow the virtual character to pass.In the Weightlifting game, instruct the patient to complete the task of pushing a barbell. Control the ends of a weightlifting barbell displayed on the screen. Adjust the barbell position to reach a target location and maintain the position for a specified time.In the Pop Matching game, instruct the patient to complete the task of deleting pictures. Have the patient control two virtual fingers located at the left and right ends of the screen. Then, select identical items from the left and right columns of pictures through the virtual fingers, and maintain this position for a designated duration.After six weeks of training, the experimental group demonstrated a higher detection ratio of motor evoked potentials compared to the control group. Following the training period, both groups of patients exhibited improvements in FTHUE-HK compared to pre-treatment levels. Improvements in FMA-UE and MBI scores were observed in control and experimental groups, indicating the recovery of upper limb function in stroke patients.

171 Views.  Graduate School of Zhejiang Chinese Medical University.  This experimental protocol outlines the use of a dual upper limb task-oriented robotic system for stroke patients with upper limb dysfunction. The findings indicate that this system can significantly improve stroke patients' upper limb function and daily living activities.

Dual Upper Limb Robotic Training in Stroke Rehabilitation

Summary