Motor Neuroprosthesis for promoting recovery of function after stroke

Importance of this review

Stroke is the most common cause of disability. It has been estimated that by 2030 there will be 70 million stroke survivors, with higher prevalence among people ages 74 to 79 years.

Motor neuroprosthesis is an assistive device using electrical-stimulation that can facilitate daily activities and motor recovery.

For whom is the review important?

This Cochrane systematic review is relevant for persons with stroke, their families, professionals working in rehabilitation, researchers, and policymakers.

Review objectives and methodology details

The analysis included 4 trials up to August, 2019, involving 831 adults (above 18 years with a mean age of 53 to 64). All trials compared the use of motor neuroprosthesis versus another assistive device (ankle-foot orthosis – AFO).

The objectives of this Cochrane systematic review were to assess the effects of motor neuroprosthesis for improving independence in activities of daily living (ADL), activities involving limbs, participation scales of health-related quality of life (HRQoL), exercise capacity, balance, and adverse events in people after stroke.

Key Results

There is limited evidence that motor neuroprosthesis as an orthosis used for walking may not improve activities like walking speed (low-certainty evidence), Timed Up and Go (moderate-certainty evidence), modified Emory Functional Ambulation Profile (low-certainty evidence), health-related quality of life participation (very low-certainty evidence), exercise capacity (low-certainty evidence), and balance (moderate-certainty evidence), compared with people after stroke who use AFO.

There was no difference in effects on walking speed between motor neuroprosthesis with surface versus motor neuroprosthesis with implantable electrodes.

No study reported outcomes related to independence in activities of daily living.

Authors reported no evidence evaluating the costs of delivering motor neuroprosthesis.

Similar adverse events (such as falls) for motor neuroprosthesis and AFO were reported in a majority of studies (moderate- and low-certainty evidence). More people who received motor neuroprosthesis withdrew from the studies than those who used AFO (low-certainty evidence).

Authors’ conclusions in the review

Currently there is insufficient certainty to make conclusions about the benefits or harms of motor neuroprosthesis, and further information is needed.

Future aspects of this review

New well designed, larger sample, properly reported studies are needed to provide high-quality evidence, preferably with blinded outcome related to independence of daily-living activities and adverse events (participation-motivation, compliance, satisfaction). To understand the effectiveness of the whole motor neuroprosthesis category on activities and participation post-stroke, it is essential to design trials (i) directed to both lower and upper limbs, and (ii) involving implantable motor neuroprosthesis devices with non-biological and biological signal (electromyography, electroencephalography, electroneurography)

Comment by Sunita Gudwani