Combined effects and timing of robotic training and botulinum toxin on upper limb spasticity and motor function: a single‑blinded randomized controlled pilot study.
Joon-Ho Shin, Gyulee Park, Hayeon Kim and 2 others
PMID 40050906WHAT IT FOUND
In this small pilot, delaying robotic training until four weeks after botulinum toxin injection produced the greatest motor function gains.
Spasticity reduction depended on the toxin alone, not the timing of the robot.
Key findings
01The group that received botulinum toxin at week 0 and robot training at week 4 showed significantly greater improvement in upper limb motor function scores than the reference group.
02Spasticity reduction in elbow flexors occurred only in groups receiving botulinum toxin, with no significant difference in spasticity across groups over the full eight weeks.
03All participants received 30 minutes of conventional therapy daily, meaning the study cannot isolate the specific contribution of the robot or the toxin from standard care.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was a pilot with a small sample size (40 participants) and no power analysis, so the findings are preliminary and may not be generalizable. All participants received conventional therapy, which means the specific effect of the robot or the toxin cannot be isolated from standard care. The study only included individuals with chronic stroke (≥6 months post-onset), so these timing recommendations may not apply to those in the acute or subacute phases. The primary outcome (FMA) showed no significant difference between groups in the first four weeks, with the positive finding emerging only in the secondary analysis of the full eight-week period.
Declared interests
The study was funded by the Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Republic of Korea. The authors declared no other conflicts of interest.
The easy way to misread this
Do not conclude that robot training reduces spasticity. The study found that spasticity reduction was driven by the botulinum toxin, while the robot's benefit was in improving motor function and movement quality, particularly when timed after the toxin took effect.