Impact of Gravity-assisted Exoskeleton on Upper Limb Function in Patients with Acquired Brain Injury: A Retrospective Analysis Across Recovery Stages and Impairment Levels

Abstract Background: Robotic therapy has emerged as a promising approach for enhancing motor function in patients with upper limb impairments, particularly those recovering from acquired brain injury (ABI). However, the impact across various recovery phases and impairment levels is not well understood. Objective: This study assessed the impact of robotic therapy on motor function, comparing improvements among acute, subacute, and chronic patients while analyzing the influence of impairment severity in ABI patients. Study Design: A retrospective analysis. Methods: The study involved 35 ABI patients who received robotic training alongside conventional therapy between June 2023 and May 2024. Outcomes were evaluated using the Box and Blocks Test, grip strength, A-Move, Fugl-Meyer Assessment for Upper Extremity (FMA-UE), and modified Barthel Index (MBI). Patients were categorized by recovery phase (acute, subacute, and chronic) and severity of motor impairment (mild, moderate, and severe). Results: Robotic therapy resulted in significant improvements across all outcomes, including the Box and Blocks Test ( P = 0.003; 95% confidence interval [CI] [−8.41, −1.83]), grip strength ( P = 0.009; 95% CI [−3.53, −0.61]), A-MOVE ( P < 0.001; 95% CI [−89,422.76, −36,141.14]), FMA-UE ( P < 0.001; 95% CI [−15.94, −7.96]), and MBI (P < 0.001; 95% CI [−41.78, −16.96]). Subacute patients demonstrated greater improvement in the Box and Blocks Test ( P = 0.007; 95% CI [10, 243.4, 49,590.9]), whereas moderately impaired patients showed better gains in A-MOVE and FMA-UE scores than severely impaired patients ( P < 0.05). Conclusion: Robotic therapy effectively enhances motor and functional outcomes in ABI patients, supporting its integration into rehabilitation strategies to improve motor function and daily living activities across various demographics and severity levels.