EMG-Driven Robotic Therapy for Neurological Rehabilitation: A Systematic Review and Meta-Analysis

Surface electromyography (EMG) can drive assistive training systems in neurorehabilitation. This systematic review and meta-analysis evaluated whether EMG-driven device-assisted rehabilitation improves upper-limb (UL) and lower-limb (LL) outcomes versus conventional therapy (CT). The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in PROSPERO (CRD420251029642). We searched databases for randomized controlled trials in adults with neurological disorders; three reviewers screened records, extracted data, and assessed risk of bias using the Revised Cochrane risk-of-bias tool (RoB 2). Seven trials (n = 160) were included, all in post-stroke populations (UL: 3; LL: 4). UL trials showed mixed findings, and pooled effects were imprecise and not statistically significant for activities of daily living (ADL) (standardized mean difference, SMD −0.55; p = 0.09; I2 = 0%). LL pooled estimates showed no significant differences in motor function (Fugl-Meyer Assessment, lower extremity, FMA-LE) (mean difference, MD −1.69; p = 0.40), walking independence (Functional Ambulation Categories, FAC) (MD −0.24; p = 0.61), balance (SMD 0.12; p = 0.61), mobility (Timed Up and Go, TUG) (MD −3.24; p = 0.71), or endurance (SMD −0.19; p = 0.43). Current evidence does not demonstrate clinical superiority over CT. EMG-driven systems may be used as an adjunct, but larger trials with standardized protocols, implementation outcomes, and neurological pathologies beyond stroke are needed.