Effectiveness of wearable upper limb assistive devices in hemiparesis for improvement of functional abilities: A systematic review

Introduction/Background Assess short-term benefits of wearable devices in activities of daily living (ADLs) and functional tasks, for people suffering from upper-limb impairment due to acquired brain injuries(ABI). Material and method Two independent reviewers conducted a systematic review across Cochrane Database of Clinical Trials, Medline, Web Of Science, PEDro, OT-Seeker and Open Grey databases until November 2017, identifying citations in included studies and systematic reviews. Inclusion criteria included: adults with hemiparesisdue to all causes of ABI; wearable devices such as orthosis, prosthesis, exoskeleton, electrical stimulation devices, neuroprosthetics; use of functional outcome measures assessing ADLs and functional tasks with and without device. Methodological quality of articles was assessed according to the Joanna Brigs Institute (JBI) scale for case series. Results From 1452 titles initially selected, eleven studies were finally selected ( n = 95 participants), all focusing on post-stroke hemiparesis. Nine were self-controlled case-series and two were single-case reports. Six studies described functional electrical stimulationdevices, three described use of exoskeletonsand two passive devices. Command of the nine active devices included electromyography, kinematic data, push-button, inertial unit measurementand force sensors. Quality assessment using JBI Scale found low quality evidence of all studies with heterogeneity of outcomes. One of the two studies describing passive assistive devices demonstrated significant improvement in the size of block lifted during the box and block test (BBT). Only one of the three studies using exoskeletonfound significant improvement in the BBT and various functional tasks. Four of the six neuroprostheticsstudies found moderate to significant improvement across outcomes. Conclusion Considering high heterogeneity of studied assistive devices, small samples sizes and study designs implicating insufficient high quality evidence, it is not possible to either support or reject the use of assistive devices on the ABI population. Further research is needed to investigate the use of these devices on functional outcomes.