JMIR Publications

ABSTRACT

Background:

Stroke remains a leading cause of disability worldwide, with upper extremity (UE) impairment reported in over 60% of stroke survivors chronically. High intensity UE therapy has been shown to support restoration of function and optimized UE motor control post stroke. Exoskeletal robotics have emerged as a meaningful tool to facilitate quality, high intensity UE rehabilitation.

Objective:

This present work seeks to evaluate the use of a soft exoskeletal robotic in UE therapy with the Bioliberty Lifeglov (Edinburgh, UK), to optimize rehabilitation for patients with chronic stroke.

Methods:

Patients with stroke (>3 months) over the age of 18 seen at the Abilities Research Center were included in this analysis. Patients used the Lifeglov soft exoskeletal robotic and Lifehub rehabilitation software between September 2024-December 2025 in UE therapy. Lifeglov includes a soft exoskeleton liner, an actuator that inflates to facilitate flexion/extension of the digits, and a connecting splint. Lifehub activities included a passive range of motion mode, active assisted range of motion strength training exercises, and gamified therapy using the exoskeleton as a controller in exergames targeting grip, gross digit flexion/extension, and motor planning. Patients received 60 minutes of therapy, 3 times per week, for 8 weeks. Patients were assessed at baseline and discharge including upper limb function (Fugl Meyer Upper Extremity Assessment [FMA-UE], Action Research Arm Test [ARAT], grip strength) functional recovery (NIH Stroke Scale (NIHSS]), spasticity (Modified Ashworth Scale [MAS]), and quality of life (EQ-5D-5L). Descriptive statistics and non-parametric statistics (Wilcoxon Signed-Rank Tests) were used to evaluate functional and behavioral outcomes.

Results:

Twenty-eight patients were included in this analysis At the group level, patients showed statistically significant functional upper extremity improvements, including gains in total ARAT score (mean difference 2.61, p=0.005), with significant improvements in grasp (0.82, p=0.02), pinch (0.82, p=0.02), and gross movement (0.46, p=0.019), as well as reductions in spasticity on the MAS for total score (-0.62, p=0.05), finger extension (-0.36, p=0.01), and elbow extension (-0.25, p=0.02). Grip strength showed a non-significant improvement (mean 3.2 kg, p>0.05), and the FMA-UE showed no significant motor or non-motor changes across subscales. Quality of life measures trended positively, with a mean NIHSS reduction of -0.29 (42.9% of patients improving), and EQ-5D-5L improvements in mobility (96.6% to 82.8%), self-care (79.3% to 67.9%), pain/discomfort (79.3% to 75%), and anxiety/depression (67.9% to 55.6%), with a mean utility score improvement of 0.048, though none reached statistical significance, and social participation remained unchanged (mean difference t-score 0.33).

Conclusions:

The use of a soft exoskeletal robotic paired with bespoke digital therapy interventions facilitates meaningful improvements in UE and hand function and spasticity in chronic stroke survivors. translating to improved quality of life and reduction in functional impairment. .