Robot-assisted Versus Conventional Physical Therapy for Hand in Sub-acute Stroke

Stroke is one of the leading causes of long-term disability worldwide and frequently results in upper-limb impairments that significantly affect independence and quality of life. Hand dysfunction, including reduced grip strength, poor dexterity, impaired coordination, and difficulty performing functional tasks, is common during the sub-acute phase following stroke. Recovery of hand and upper-limb function is considered a major goal of neurorehabilitation because deficits in grasping, object manipulation, and coordinated movement restrict performance of activities of daily living and social participation.

Conventional physiotherapy remains a widely used rehabilitation approach for upper-limb recovery after stroke. It typically involves therapist-guided range-of-motion exercises, strengthening, task-oriented training, neuromuscular facilitation, and functional retraining techniques. Although beneficial, conventional therapy may be limited by therapist fatigue, reduced intensity of repetitions, and variability in treatment delivery. Emerging rehabilitation technologies such as robotic-assisted physiotherapy have been introduced to overcome these limitations by providing high-intensity, repetitive, task-specific, and feedback-driven training that may enhance neuroplasticity and motor relearning.

Robotic-assisted physiotherapy allows patients to perform repeated wrist and finger movements with adjustable assistance or resistance while receiving visual or sensory feedback. These systems can increase the number of movement repetitions, promote active participation, and objectively monitor patient performance. Previous studies have suggested that robotic rehabilitation may improve motor control, muscle strength, and functional outcomes in stroke survivors; however, evidence comparing robotic-assisted therapy with conventional physiotherapy specifically for hand recovery in sub-acute stroke patients remains limited.

This randomized controlled trial will compare robotic-assisted physiotherapy with conventional physiotherapy for improving hand function in individuals with sub-acute stroke. Thirty participants meeting the eligibility criteria will be recruited from the University of Lahore Hospital and randomly allocated into two equal groups using the sealed-envelope randomization method. Group A will receive robotic-assisted physiotherapy targeting wrist and finger extension through repetitive, task-specific robotic training combined with visual feedback and progressive assistance or resistance. Group B will receive conventional physiotherapy consisting of active-assisted and resistive exercises, task-oriented training, neuromuscular facilitation, mirror therapy, and activities of daily living training. Both groups will receive treatment five days per week for four weeks, with each session lasting approximately 30-45 minutes.

Primary outcomes will include hand muscle strength measured by a hand-held dynamometer, hand dexterity assessed using the Action Research Arm Test (ARAT), and upper-limb functional recovery measured through the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Secondary outcomes will include spasticity using the Modified Ashworth Scale, activities of daily living using the Modified Barthel Index, and quality of life using the EQ-5D questionnaire. Outcome assessments will be performed at baseline, midpoint, and post-intervention by a blinded assessor using standardized protocols.