# Perspectives and Challenges in Robotic Neurorehabilitation
## 3 Current Trends of Robot-Aided Neurorehabilitation
### Multimodal Assessment of Recovery
#### 3.2.1 Clinical Scales  
The current clinical procedure to assess movement abnormalities is mostly represented by qualitative evaluations performed by human operators using clinical scales. The administration of these scales consists of proposing a series of tasks, tests, and questionnaires to the patients and observing their performance in order to assign a score proportional to the performance.  
Developed clinical scales can be divided into those measuring motor performance and those assessing sensory functions. Among the former group, the most widely adopted are: the Quality of Upper Extremity Skills Test (QUEST) to evaluate movement patterns and hand function [169], the Modified Ashworth Scale (MAS) to measure the upper limb degree of spasticity based on the muscle resistance to passive stretches [170], the Fugl-Meyer Assessment (FMA) to quantitatively measure sensorimotor impairments [171], the Melbourne Assessment of Unilateral Upper Limb Function (MAUULF) to assess the quality of the movements [172], and finally the Box and Block Test (BBT) to evaluate gross manual dexterity [173]. Besides, the clinical rating scales validated and mostly used to measure sensory functions are the Nottingham Sensory Assessment [174] or the Rivermead Assessment of Somatosensory Performance [175] and the Joint Position Matching (JPM) test [176] to measure position sense acuity, the threshold to detection of passive motion (TTDPM) [177] for the testing of kinesthesia, and the tuning fork test to measure vibration sense [178].  
All the afore-mentioned sensory clinical scales are applied also to the lower limbs. Other scales used for the lower limb are the five times sit to stand test [179], the timed up and go test (TUG) [180], the two minutes walking test, and ten meters walking test [181]. To test balance control ability during quiet standing, the most common clinical scales are the Romberg test [182] and the Berg balance scale [183]. Despite such scales being widely adopted and recognized worldwide, and despite them actually providing important measures about patients' sensorimotor function, they are mostly qualitative and have low resolution. For this reason, they may be subjective and hardly repeatable and therefore not suitable to provide accurate and reliable measures. Current limitations for the application of these tests lie within the scarce presence of objective measurement technology in many clinical settings. The commonly used tools, such as hand-held goniometers, are known to lack sensitivity and reliability.  
Given the low resolution of such scales, most of the patients get an intermediate score, which does not fully characterize their condition; furthermore, improvements that are below the scale resolution remain invisible, resulting in the same score over a long period of time [184]. Another disadvantage is that many operators consider the administration of these scales too complex and time-consuming [185]. This is not only a matter of comfort, but it also reflects on the reliability of the assessment. Finally, since many assessments can take a long time to complete, clinicians tend to delay treatment in favor of a heavy assessment, despite evidence on the importance of timing and early rehabilitation [186].