# Modification of Hand Muscular Synergies in Stroke Patients After Robot-Aided Rehabilitation
## 5 Conclusions  
The introduction of robotic systems for rehabilitation can favor a progressive recovery of distal motor ability in chronic stroke subjects in performing challenging manipulation tasks. Understanding if hand muscle patterns present alterations and whether robot-aided rehabilitation allows improving these patterns is certainly ambitious, taking into account that the CNS control strategies are not yet completely clear, especially for the hand. The preliminary analysis carried out in this work on seven post-stroke patients revealed that the muscular synergies of the healthy hand and the injured one before and after robot-mediated rehabilitation present a good level of similarity. The performed analysis shows how, despite very similar muscular patterns between the injured and the healthy limb, there is an evident reduction in terms of mobility and capacity of manipulation of the patient's hand. The involved subjects also show a partial recovery following the robot-aided rehabilitation treatment, also testified by the results of the clinical scales. However, although the present study shows an improvement in terms of the level of similitude of the muscle synergy patterns before and after the rehabilitation treatment, it will be necessary to carry out more in-depth studies involving more patients to evaluate and estimate the effectiveness of robot-mediated rehabilitation treatment. Future works will be devoted to involving a higher number of chronic stroke patients to estimate the improvement in hand muscular synergies after robot-aided rehabilitation and to extend this study to acute and chronic stroke patients during the execution of isometric tasks, in order to verify and evaluate the improvement of distal muscle activation patterns in both static and dynamic conditions.  
Conceptualization, F.S.d.L. and F.C.; Data curation, F.S.d.L., F.C., M.B., F.S. and L.Z.; Formal analysis, F.S.d.L., F.C. and L.Z.; Funding acquisition, L.Z.; Investigation, F.S.d.L., M.B., F.S. and F.B.; Methodology, F.C., M.B., F.B. and S.S.; Project administration, S.S. and L.Z.; Resources, F.S.; Software, F.S.d.L.; Supervision, F.C., F.B., S.S. and L.Z.; Validation, F.S.; Visualization, F.S.d.L. and M.B.; Writing--original draft, F.S.d.L., F.C. and L.Z. All authors have read and agreed to the published version of the manuscript.  
This work was supported partly by Regione Lazio with HeAL9000 project (CUP: B84I20001880002), partly by the Italian Institute for Labour Accidents (INAIL) with the BioARM (CUP: E58D19000650005) and WI-FI MyoHand projects (CUP: E59E19001460005) and partly by the European Union's Horizon 2020 Research and Innovation Programme with ODIN project (CUP: C85F21000670006).  
The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Universita Campus Bio-Medico di Roma (Ethical Approval N. 41/17 OSS Com Et CBM).  
Written informed consent was obtained from all subjects involved in the study.  
Data Availability Statement: Data and software code will be made available by materials transfer agreement upon reasonable request.  
The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.