The Effect of Robotic Therapy on Range Of Motion and Musle Tone in Ischemic Stroke Patients

  • Adelia Pangesti Universitas Diponegoro, Semarang
  • Hari Peni Julianti Bagian Ilmu Kedokteran Fisik dan Rehabilitasi Fakultas Kedokteran Universitas Diponegoro
  • Dwi Pudjonarko Bagian Neurologi Fakultas Kedokteran Universitas Diponegoro
  • Maria Belladonna Rahmawati Bagian Neurologi Fakultas Kedokteran Universitas Diponegoro
  • Rifky Ismail Departemen Teknik Mesin, Fakultas Teknik, Universitas Diponegoro
Keywords: Stroke, elbow active ROM, muscle tone,  exoskeleton robotic



After stroke occurs, the patients generally have upper extremity hemiparesis. It makes movement restrictions due to decreased elbow active ROM and abnormal upper arm muscle tone, so they need to get rehabilitation therapy. Besides conventional therapy, robotic therapy has now been developed to restore their motor funtions.


To prove that the effect of robotic therapy in increasing elbow active ROM and improving upper arm muscle tone in ischemic stroke patients is better than the effect of conventional rehabilitation exercises.


A quasy-experimental study with two groups pre-test and post-test design was carried out among outpatient ischemic stroke patients in Diponegoro National Hospital and William Booth General Hospital Semarang which was chosen using consecutive sampling.The interventions were by doing exercises using an exoskeleton robotic hand in the robotic  group and conventional rehabilitation exercises in the control group. Pre-test and post-test data of robotic group were analyzed using Wilcoxon test, while pre-test dan post-test data of control group were analyzed using Wilcoxon test and paired t-test. Pre-test an post-test data between two groups were analyzed using Mann-Whitney test and unpaired-t test.




The robotic  group experienced an insignificant increase in ROM (p= 0,593) and significant improvement in muscle tone (p= 0,025). The control group experienced  insignificant reduction in ROM (p= 0,980) and insignificant improvement in muscle tone (p= 0,081).


There was a significant improvement of upper arm muscle tone in ischemic stroke patients after had exoskeleton robotic hand exercise.


Keywords: Stroke, elbow active ROM, muscle tone,  exoskeleton robotic


Download data is not yet available.


Kemenkes RI. Kebijakan dan Strategi Pencegahan dan Pengendalian Stroke di Indonesia. Jakarta: Direktorat Jenderal Pencegahan dan Pengendalian Penyakit; 2018.

Kemenkes RI. Hasil Utama Riset Kesehatan Dasar 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan; 2018.

Högg S, Holzgraefe M, Wingendorf I, Mehrholz J, Herrmann C, Obermann M. Upper limb strength training in subacute stroke patients: Study protocol of a randomised controlled trial. Trials. 2019;20(1):1–11.

Da Silva FC, Da Silva DFT, Mesquita-Ferrari RA, Fernandes KPS, Bussadori SK. Correlation between upper limb function and oral health impact in stroke survivors. J Phys Ther Sci. 2015;27(7):2065–8.

Eby S, Zhao H. Quantitative Evaluation of Passive Muscle Stiffness in Chronic Stroke. J Phys Med Rehabil. 2017;176(1):139–48.

De Haan J. Stability of the Elbow Joint: Relevant Anatomy and Clinical Implications of In Vitro Biomechanical Studies. Open Orthop J. 2011;5(1):168–76.

Oosterwijk AM, Nieuwenhuis MK, van der Schans CP, Mouton LJ. Shoulder and elbow range of motion for the performance of activities of daily living: A systematic review. Physiother Theory Pract. 2018;34(7):505–8.

Li S. Spasticity, motor recovery, and neural plasticity after stroke. Front Neurol. 2017;8(4):1–8.

Susanti S, B Istara DN. Pengaruh Range of Motion (ROM) terhadap Kekuatan Otot pada Pasien Stroke. J Kesehat Vokasional. 2019;4(2):112.

Saebo. Stroke Exercises for Your Body [Internet]. United Kingdom; 2017 [cited 2020 Feb 7]. p. 26–8. Available from:

Brewer B. Full Body Rehab Exercises [Internet]. California; 2018 [cited 2020 Feb 11]. p. 9–12. Available from:

Kemenkes RI. Rencana Pengembangan Tenaga Kesehatan Tahun 2011 – 2025. Jakarta; 2011.

Xiloyannis M, Chiaradia D, Frisoli A, Masia L. Physiological and kinematic effects of a soft exosuit on arm movements. J ofNeuroEngineering Rehabil. 2019;16(29):1–15.

Yue Z, Zhang X, Wang J. Hand Rehabilitation Robotics on Poststroke Motor Recovery. Behav Neurol. 2017;16(8):3–6.

Bertani R, Melegari C, De Cola MC, Bramanti A, Bramanti P, Calabrò RS. Effects of robot-assisted upper limb rehabilitation in stroke patients: a systematic review with meta-analysis. Neurol Sci. 2017;38(9):1561–9.

Frisoli A, Procopio C, Chisari C, Creatini I, Bonfiglio L, Bergamasco M, et al. Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke. J Neuroeng Rehabil. 2012;9(1):1–16.

Balasubramanian S, Klein J, Burdet E. Robot-assisted rehabilitation of hand function. Curr Opin Neurol. 2010;23(6):661–70.

Frolov AA, Kozlovskaya IB, Biryukova E V., Bobrov PD. Use of Robotic Devices in Post-Stroke Rehabilitation. Neurosci Behav Physiol. 2018;48(9):1053–66.

Cerasa A, Pignolo L, Gramigna V, Serra S, Olivadese G, Rocca F, et al. Exoskeleton-Robot Assisted Therapy in Stroke Patients: A Lesion Mapping Study. Front Neuroinform. 2018;12(7):1–10.

Crea S, Cempini M, Moise M, Baldoni A, Trigili E, Marconi D, et al. A novel shoulder-elbow exoskeleton with series elastic actuators. Biomed Robot Biomechatronics. 2016;16(7):1248–53.

Dinh BK, Xiloyannis M, Cappello L, Antuvan CW, Yen SC, Masia L. Adaptive backlash compensation in upper limb soft wearable exoskeletons. Rob Auton Syst. 2017;92(18):173–86.

Jones TA, Adkins DL. Motor system reorganization after stroke: Stimulating and training toward perfection. Int Union Physiol Sci. 2015;30(5):358–70.

Rotzinger DC, Mosimann PJ, Meuli RA, Maeder P, Michel P. Site and rate of occlusive disease in cervicocerebral arteries: A CT angiography study of 2209 patients with acute ischemic stroke. Am J Neuroradiol. 2017;38(5):868–74.

Robert M, Norhayati M. Chapter 3: Background Concepts in Stroke Rehabilitation [Internet]. 2018 [cited 2020 Feb 11]. p. 34. Available from:

Park W, Ramachandran J, Weisman P, Jung ES. Obesity effect on male active joint range of motion. Ergonomics. 2010;53(1):102–8.

Borboni A, Villafañe JH, Mullè C, Valdes K, Faglia R, Taveggia G, et al. Robot-Assisted Rehabilitation of Hand Paralysis After Stroke Reduces Wrist Edema and Pain: A Prospective Clinical Trial. J Manipulative Physiol Ther. 2017;40(1):21–30.

Takahashi CD, Der-Yeghiaian L, Le V, Motiwala RR, Cramer SC. Robot-based hand motor therapy after stroke. Brain. 2008;131(2):425–37.

Chowdhury A, Nishad SS, Meena YK, Dutta A, Prasad G. Hand-Exoskeleton Assisted Progressive Neurorehabilitation Using Impedance Adaptation Based Challenge Level Adjustment Method. IEEE Trans Haptics. 2019;12(2):128–40.

Thibaut A, Chatelle C, Ziegler E, Bruno MA, Laureys S, Gosseries O. Spasticity after stroke: Physiology, assessment and treatment. Brain Inj. 2013;27(10):1093–105.

Anita F, Pongantung H, Ada PV, Hingkam V. Pengaruh Latihan Range Of Motion terhadap Rentang Gerak Sendi Ekstremitas Atas pada Pasien Pasca Stroke Di Makassar. J Islam Nurs. 2018;3(1):97–9.

Purwaningtyas D. Pengaruh Pemberian Hold Relax terhadap Spastisitas pada Pasien Pasca Stroke. J Nas Ilmu Kesehat. 2016;22(03):84–8.

Original Article