Robot-assisted integrated cognitive-motor rehabilitation in patients with chronic stroke: a randomized controlled trial.

BACKGROUND: Cognitive and motor impairments are major determinants of functional independence after stroke. While robot-assisted training is effective for motor recovery, its impact on cognitive function through integrated cognitive-motor training remains less explored. This study evaluated the effects of an end-effector robot-assisted integrated cognitive-motor rehabilitation program on global cognitive function and upper limb motor outcomes in patients with chronic stroke. METHODS: In this single-center, randomized, assessor-blinded exploratory trial, 30 patients with stroke were randomized into an intervention group (n = 15) or a control group (n = 15). The intervention group received robot-assisted cognitive-motor training using the Rebless Planar system (30 min/session, 10 sessions over 3 weeks), which integrated goal-directed reaching with tasks involving attention, memory, and executive function. The control group received time- and dose-matched conventional paper-based cognitive rehabilitation. Primary outcomes were the Korean Mini-Mental State Examination (MMSE) and the Korean Montreal Cognitive Assessment (MoCA). Secondary outcomes included CERAD subdomains, Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), and the Modified Barthel Index (MBI). This study was registered with the Korean Clinical Research Information Service (KCT0010564). RESULTS: Both groups exhibited significant within-group improvements in MMSE and MoCA, with no statistically significant between-group differences. For secondary CERAD subdomains, observed within-group gains did not maintain statistically significant between-group differences after False Discovery Rate adjustment. However, upper extremity motor recovery was significantly superior in the intervention group (FMA-UE 33.6 to 37.5) compared to controls (25.7 to 25.9) (p = 0.012, Cohen's d = 0.98). CONCLUSION: Robot-assisted integrated cognitive-motor rehabilitation using an end-effector system is feasible and safe in chronic stroke patients. While both robotic and conventional cognitive rehabilitation led to comparable improvements in global cognition, the robot-assisted group demonstrated superior upper limb motor recovery. These findings suggest that integrated dual-task training is a promising strategy for post-stroke motor recovery, though its incremental cognitive benefit over conventional therapy requires further investigation in larger trials. CLINICAL TRAIL REGISTRATION: This study was registered with the Korean Clinical Research Information Service (KCT0010564).