OBJECTIVES: To determine the efficacy of 2 distinct 6-week robot-assisted reaching programs compared with an intensive conventional arm exercise program (ICAE) for chronic, stroke-related upper-extremity (UE) impairment. To examine whether the addition of robot-assisted training out of the horizontal plane leads to improved outcomes. DESIGN: Randomized controlled trial, single-blinded, with 12-week follow-up. SETTING: Research setting in a large medical center. PARTICIPANTS: Adults (n = 62) with chronic, stroke-related arm weakness stratified by impairment severity using baseline UE motor assessments. INTERVENTIONS: Sixty minutes, 3 times a week for 6 weeks of robot-assisted planar reaching (gravity compensated), combined planar with vertical robot-assisted reaching, or intensive conventional arm exercise program. MAIN OUTCOME MEASURE: UE Fugl-Meyer Assessment (FMA) mean change from baseline to final training. RESULTS: All groups showed modest gains in the FMA from baseline to final with no significant between group differences. Most change occurred in the planar robot group (mean change +/- SD 2.94 +/- 0.77; 95% confidence interval (CI) 1.40 to 4.47). Participants with greater motor impairment (n = 41) demonstrated a larger difference in response (mean change +/- SD 2.29 +/- 0.72; 95% CI 0.85 to 3.72) for planar robot-assisted exercise compared with the intensive conventional arm exercise program (mean change +/- SD 0.43 +/- 0.72; 95% CI -1.00 to 1.86). CONCLUSIONS: Chronic UE deficits because of stroke are responsive to intensive motor task training. However, training outside the horizontal plane in a gravity present environment using a combination of vertical with planar robots was not superior to training with the planar robot alone.

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