On-line control of movement in plants.

At first glance, plants seem relatively immobile and, unlike animals, unable to interact with the surroundings or escape stressful environments. But, although markedly different from those of animals, movement pervades all aspects of plant behaviour. Here, we focused our investigation on the approaching movement of climbing plants, that is the movement they perform to reach-to-climb a support. In particular, we examined whether climbing plants evolved a motor accuracy mechanism as to improve the precision of their movement and how this eventually differs from animal species. For this purpose, by means of three-dimensional kinematical analysis, we investigated whether climbing plants have the ability to correct online their movement by means of secondary submovements, and if their frequency production is influenced by the difficulty of the task. Results showed, not only that plants correct their movement in flight, but also that they strategically increase the production of secondary submovements when the task requires more precision, exactly as humans do. These findings support the hypothesis that the movement of plants is far cry from being a simple cause-effect mechanism, but rather is appropriately planned, controlled and eventually corrected.

Reactive Exercises with Interactive Objects: Interim Analysis of a Randomized Trial on Task-Driven NMES Grasp Rehabilitation for Subacute and Early Chronic Stroke Patients.

Enriched environments and tools are believed to promote grasp rehabilitation after stroke. We designed S2, an interactive grasp rehabilitation system consisting of smart objects, custom orthoses for selective grasp constraining, and an electrode array system for forearm NMES. Motor improvements and perceived usability of a new enriched upper limb training system for sub-acute stroke patients was assessed in this interim analysis. INCLUSION CRITERIA: sub-acute stroke patients with MMSE>20, ipsilesional MI>80%, and contralesional MI<80%. Effects of 30-min therapy supplements, conventional vs. S2 prototype, are compared through a parallel two-arms dose-matched open-label trial, lasting 27 sessions. Clinical centres: Asklepios Neurologische Klinik Falkenstein, Königstein im Taunus, Germany, and Clinica Villa Beretta, Costa Masnaga, Italy. Assessment scales: ARAT, System Usability, and Technology Acceptance. METHODOLOGY: 26 participants were block randomized, allocated to the study (control N=12, experimental N=14) and underwent the training protocol. Among them, 11 participants with ARAT score at inclusion below 35, n = 6 in the experimental group, and n = 5 in the control group were analysed. RESULTS: participants in the enriched treatment group displayed a larger improvement in the ARAT scale (+14.9 pts, pval=0.0494). Perceived usability differed between clinics. No adverse effect was observed in relation to the treatments. Trial status: closed. CONCLUSIONS: The S2 system, developed according to shared clinical directives, was tested in a clinical proof of concept. Variations of ARAT scores confirm the feasibility of clinical investigation for hand rehabilitation after stroke.

Using UHF RFID Properties to Develop and Optimize an Upper-Limb Rehabilitation System.

Rehabilitation of the upper limb is an important aspect of the therapy for people affected by neuromotor diseases for the recovery of the capability to perform activities of daily living (ADLs). Nonetheless, the costs associated with the administration of rehabilitation therapy and the increasing number of patients highlight the need for new solutions. Technology-based solutions and, in particular, telerehabilitation could strongly impact in this field. In this paper, a new system based on radiofrequency (RF) technology is presented which is able to effectively provide home-based telerehabilitation and extract meaningful information on the therapy execution performance. The technology has been tuned to the needs of the rehabilitation system, optimizing the hardware, the communication protocol and the software control. A methodology for extracting the execution time of the rehabilitation tasks, the distance covered by the patient's hand in each subtask and the velocity profile is presented. The results show that a highly usable system for the rehabilitation of the upper limb has been developed using the RF technology and that performance metrics can be reliably extracted by the acquired signals.

Selective reaching in macaques: evidence for action-centred attention.

When a monkey selects a piece of food lying on the ground from among other viable objects in the near vicinity, only the desired item governs the particular pattern and direction of the animal's reaching action. It would seem then that selection is an important component controlling the animal's action. But, we may ask, is the selection process in such cases impervious to the presence of other objects that could constitute potential obstacles to or constraints on movement execution? And if it is, in fact, pervious to other objects, do they have a direct influence on the organization of the response? The kinematics of macaques' reaching movements were examined by the current study that analysed some exemplars as they selectively reached to grasp a food item in the absence as well as in the presence of potential obstacles (i.e., stones) that could affect the arm trajectory. Changes in movement parameterization were noted in temporal measures, such as movement time, as well as in spatial ones, such as paths of trajectory. Generally speaking, the presence of stones in the vicinity of the acting hand stalled the reaching movement and affected the arm trajectory as the hand veered away from the stone even when it was not a physical obstacle. We concluded that nearby objects evoke a motor response in macaques, and the attentional mechanisms that allow for a successful action selection are revealed in the reaching path. The data outlined here concur with human studies indicating that potential obstacles are internally represented, a finding implying basic cognitive operations allowing for action selection in macaques.

How posture affects macaques' reach-to-grasp movements.

Although there is a wealth of behavioral data regarding grasping movements in non-human primates, how posture influences the kinematics of prehensile behavior is not yet clearly understood. The purpose of this study was to examine and compare kinematic descriptions of grip behaviors while primates (macaque monkeys) were in a sitting posture or when stopping after quadrupedal locomotion (i.e., tripedal stance). Video footage taken while macaques grasped objects was analyzed frame-by-frame using digitalization techniques. Each of the two grip types considered (power and precision grips) was found to be characterized by specific, distinct kinematic signatures for both the reaching and the grasping components when those actions were performed in a sitting position. The grasping component did not differentiate in relation to the type of grip that was needed when, instead, the prehensile action took place in a tripedal stance. Quadrupedal locomotion affected the concomitant organization of prehensile activities determining in fact a similar kinematic patterning for the two grips regardless of the size of the object to be grasped. It is suggested that using a single kinematic grip patterning for all prehensile activities might be both the by-product of planning a grasping action while walking and a way to simplify motor programming during unstable tripedal stance.

Facilitation of action planning in children with autism: the contribution of the maternal body odor.

Imitation is a key socio-cognitive skill impaired in individuals with Autism Spectrum Conditions (ASC). It is known that the familiarity with an actor facilitates the appearance of imitative abilities. Here, we explore whether a highly familiar and socially relevant stimulus presented in the olfactory modality is able to improve spontaneous imitation as early as at the level of action planning. A group of 20 children with ASC and 20 controls observed their own mother or the mother of another child performing a reach-to-grasp action towards an object, under the exposure to their maternal odor, the odor of the mother of another child or no odor. Subsequently, children acted upon the same object with no specific instruction to imitate. Child's movement initiation time (MIT) served as an indicator of motor planning facilitation induced by action observation. Results suggest that for children with ASC (but not controls) MIT was significantly lower when exposed to the maternal odor both when interacting with a familiar or an unfamiliar model. In the former case, the performance is comparable to controls. The familiar model in the absence of any olfactory cue is able to induce a facilitation effect, but the maximal facilitation on MIT is evident when maternal odor and familiar model are paired. We hypothesize that for children with ASC the maternal odor provides relevant social motivation for taking advantage of others' actions when planning movements in an imitative context.

'United we stand, divided we fall': intertwining as evidence of joint actions in pea plants.

In life, it is common for almost every kind of organism to interact with one another. In the human realm, such interactions are at the basis of joint actions, when two or more agents syntonize their actions to achieve a common goal. Shared intentionality is the theoretical construct referring to the suite of abilities that enable such coordinated and collaborative interactions. While shared intentionality has become an important concept in research on social cognition, there is controversy surrounding its evolutionary origins. An aspect still unexplored but promising to bring new insights into this open debate is the study of aneural organisms. To fill this gap, here we investigate whether climbing plants can act jointly to achieve a common goal, i.e. reaching the light. We examined Pisum Sativum plants growing intertwined when there is a need to climb but a potential support is not present in the environment. Three-dimensional kinematic analysis of their movement revealed a coordinated and complementary behaviour. They tend to coordinate their movement in time and space to achieve a joint climbing. By deliberately extending the context in which a joint action takes place, we pay tribute to the complex nature of this social phenomenon. The next challenge for the field of joint action is to generate a perspective that links coordination mechanisms to an evolutionary framework across taxa.

Reaching and grasping behavior in Macaca fascicularis: a kinematic study.

The prehensile hand is one of the major traits distinguishing primates from other mammal species. All primates, in fact, are able to grasp an object and hold it in part or entirely using a single hand. Although there is a wealth of behavioral data regarding grasping movements in humans and apes, there is relatively little material on macaques, the animal model often used to investigate neuronal mechanisms responsible for grip control in humans. To date, evidence regarding free-ranging macaques is confined to observational data, while quantitative reports describe studies carried out in laboratory settings or in captivity. The purpose of the present study was to provide the first kinematic descriptions of basic grip behavior with regard to precision and power grips in free-ranging macaque monkeys. Video footage of those animals grasping objects was analyzed frame-by-frame using digitalization techniques. The results revealed that the two types of grips considered are each characterized by specific kinematic signatures. It was also found that hand kinematics was scaled depending on the type of grasp needing to be adopted and the intrinsic properties of the object to be grasped. In accordance with data concerning humans, these findings indicate that the intrinsic features of an object affect the planning and control of reach-to-grasp movements even in free-ranging macaques. The data presented here take research in the field of comparative reach-to-grasp kinematics in human and non-human primates another step forward as they are based on precise measurements of spontaneous grasping movements by animals living/acting in their natural environment.

MUNDUS project: MUltimodal neuroprosthesis for daily upper limb support.

BACKGROUND: MUNDUS is an assistive framework for recovering direct interaction capability of severely motor impaired people based on arm reaching and hand functions. It aims at achieving personalization, modularity and maximization of the user's direct involvement in assistive systems. To this, MUNDUS exploits any residual control of the end-user and can be adapted to the level of severity or to the progression of the disease allowing the user to voluntarily interact with the environment. MUNDUS target pathologies are high-level spinal cord injury (SCI) and neurodegenerative and genetic neuromuscular diseases, such as amyotrophic lateral sclerosis, Friedreich ataxia, and multiple sclerosis (MS). The system can be alternatively driven by residual voluntary muscular activation, head/eye motion, and brain signals. MUNDUS modularly combines an antigravity lightweight and non-cumbersome exoskeleton, closed-loop controlled Neuromuscular Electrical Stimulation for arm and hand motion, and potentially a motorized hand orthosis, for grasping interactive objects. METHODS: The definition of the requirements and of the interaction tasks were designed by a focus group with experts and a questionnaire with 36 potential end-users. RESULTS: The functionality of all modules has been successfully demonstrated. User's intention was detected with a 100% success. Averaging all subjects and tasks, the minimum evaluation score obtained was 1.13 ± 0.99 for the release of the handle during the drinking task, whilst all the other sub-actions achieved a mean value above 1.6. All users, but one, subjectively perceived the usefulness of the assistance and could easily control the system. Donning time ranged from 6 to 65 minutes, scaled on the configuration complexity. CONCLUSIONS: The MUNDUS platform provides functional assistance to daily life activities; the modules integration depends on the user's need, the functionality of the system have been demonstrated for all the possible configurations, and preliminary assessment of usability and acceptance is promising.

Decision-Making Underlying Support-Searching in Pea Plants.

Finding a suitable support is a key process in the life history of climbing plants. Those that find a suitable support have greater performance and fitness than those that remain prostrate. Numerous studies on climbing plant behavior have elucidated the mechanistic details of support-searching and attachment. Far fewer studies have addressed the ecological significance of support-searching behavior and the factors that affect it. Among these, the diameter of supports influences their suitability. When the support diameter increases beyond some point, climbing plants are unable to maintain tensional forces and therefore lose attachment to the trellis. Here, we further investigate this issue by placing pea plants (Pisum sativum L.) in the situation of choosing between supports of different diameters while their movement was recorded by means of a three-dimensional motion analysis system. The results indicate that the way pea plants move can vary depending on whether they are presented with one or two potential supports. Furthermore, when presented with a choice between thin and thick supports, the plants showed a distinct preference for the former than the latter. The present findings shed further light on how climbing plants make decisions regarding support-searching and provide evidence that plants adopt one of several alternative plastic responses in a way that optimally corresponds to environmental scenarios.

Evidence of motor intentions in plants: A kinematical study.

"How" an action is performed is not solely determined by biomechanical constraints, but it depends on the agent's intention, that is, "why" the action is performed. Recent findings suggest that intentions can be specified at a tangible and quantifiable level in the kinematics of movements; that is, different motor intentions translate into different kinematic patterns. In the present study, we used 3D kinematical analysis to investigate whether the organization of climbing plants' approach-to-grasp action is sensitive to the kind of intention driving their movement toward potential support, namely individual or social. For the individual condition, a plant in isolation acted upon the support. For the social condition, two plants were located in the same pot opposite to each other with a support in the middle. Results indicate differences in kinematics depending on the context within which the plant is acting. In the presence of neighbors, climbing plants are able to modify their behaviors to maximize their long-term gains, including the grasping of a potential support. Overall, these data suggest that the organization of climbing plants' kinematics is sensitive to the "intention" driving their movement toward a potential support. To discuss this phenomenon, we capitalize on the concept of motor intentionality in plants and on available theories concerned to motor cognition. We suggest how they could be revisited to explain the intentionality component inherent in plant life and other brainless organisms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cardiometabolic risk estimation using exposome data and machine learning.

BACKGROUND: The human exposome encompasses all exposures that individuals encounter throughout their lifetime. It is now widely acknowledged that health outcomes are influenced not only by genetic factors but also by the interactions between these factors and various exposures. Consequently, the exposome has emerged as a significant contributor to the overall risk of developing major diseases, such as cardiovascular disease (CVD) and diabetes. Therefore, personalized early risk assessment based on exposome attributes might be a promising tool for identifying high-risk individuals and improving disease prevention. OBJECTIVE: Develop and evaluate a novel and fair machine learning (ML) model for CVD and type 2 diabetes (T2D) risk prediction based on a set of readily available exposome factors. We evaluated our model using internal and external validation groups from a multi-center cohort. To be considered fair, the model was required to demonstrate consistent performance across different sub-groups of the cohort. METHODS: From the UK Biobank, we identified 5,348 and 1,534 participants who within 13 years from the baseline visit were diagnosed with CVD and T2D, respectively. An equal number of participants who did not develop these pathologies were randomly selected as the control group. 109 readily available exposure variables from six different categories (physical measures, environmental, lifestyle, mental health events, sociodemographics, and early-life factors) from the participant's baseline visit were considered. We adopted the XGBoost ensemble model to predict individuals at risk of developing the diseases. The model's performance was compared to that of an integrative ML model which is based on a set of biological, clinical, physical, and sociodemographic variables, and, additionally for CVD, to the Framingham risk score. Moreover, we assessed the proposed model for potential bias related to sex, ethnicity, and age. Lastly, we interpreted the model's results using SHAP, a state-of-the-art explainability method. RESULTS: The proposed ML model presents a comparable performance to the integrative ML model despite using solely exposome information, achieving a ROC-AUC of 0.78±0.01 and 0.77±0.01 for CVD and T2D, respectively. Additionally, for CVD risk prediction, the exposome-based model presents an improved performance over the traditional Framingham risk score. No bias in terms of key sensitive variables was identified. CONCLUSIONS: We identified exposome factors that play an important role in identifying patients at risk of CVD and T2D, such as naps during the day, age completed full-time education, past tobacco smoking, frequency of tiredness/unenthusiasm, and current work status. Overall, this work demonstrates the potential of exposome-based machine learning as a fair CVD and T2D risk assessment tool.

Integrating Social Assistive Robots, IoT, Virtual Communities and Smart Objects to Assist at-Home Independently Living Elders: the MoveCare Project.

The integration of Ambient Assisted Living (AAL) frameworks with Socially Assistive Robots (SARs) has proven useful for monitoring and assisting older adults in their own home. However, the difficulties associated with long-term deployments in real-world complex environments are still highly under-explored. In this work, we first present the MoveCare system, an unobtrusive platform that, through the integration of a SAR into an AAL framework, aimed to monitor, assist and provide social, cognitive, and physical stimulation in the own houses of elders living alone and at risk of falling into frailty. We then focus on the evaluation and analysis of a long-term pilot campaign of more than 300 weeks of usages. We evaluated the system's acceptability and feasibility through various questionnaires and empirically assessed the impact of the presence of an assistive robot by deploying the system with and without it. Our results provide strong empirical evidence that Socially Assistive Robots integrated with monitoring and stimulation platforms can be successfully used for long-term support to older adults. We describe how the robot's presence significantly incentivised the use of the system, but slightly lowered the system's overall acceptability. Finally, we emphasise that real-world long-term deployment of SARs introduces a significant technical, organisational, and logistical overhead that should not be neglected nor underestimated in the pursuit of long-term robust systems. We hope that the findings and lessons learned from our work can bring value towards future long-term real-world and widespread use of SARs.

SPEAKapp: Language as Digital Biomarker for Mental Health.

Language has always been a rich source of amnestic information in the context of cognitive and affective disorders. Many of the language tests and metrics that are employed today have been designed when the only available technology was paper and pencil. Here we present a novel digital tool to administer and score a set of tests based on language.

Kinematic Evidence of Root-to-Shoot Signaling for the Coding of Support Thickness in Pea Plants.

Plants such as climbers characterized by stems or tendrils need to find a potential support (e.g., pole, stick, other plants or trees) to reach greater light exposure. Since the time when Darwin carried out research on climbing plants, several studies on plants' searching and attachment behaviors have demonstrated their unique ability to process some features of a support to modulate their movements accordingly. Nevertheless, the strategies underlying this ability have yet to be uncovered. The present research tries to fill this gap by investigating how the interaction between above- (i.e., stems, tendrils, …) and below-ground (i.e., the root system) plant organs influences the kinematics of their approach-to-grasp movements. Using three-dimensional (3D) kinematic analysis, we characterized the movements of pea plants (Pisum sativum L.) as they leaned towards supports whose below- and above-ground parts were characterized by different thicknesses (i.e., thin below- thick above-ground, or the opposite). As a control condition, the plants were placed next to supports with the same thickness below and above ground (i.e., either entirely thin or thick). The results suggest that the information regarding below- and above-ground parts of a support appears to be integrated and modulates the reach-to-grasp behavior of the plant. Information about the support conveyed by the root system seems to be particularly important to achieve the end-goal of movement.

When flavor guides motor control: an effector independence study.

Research on multisensory integration during natural tasks has revealed how chemical senses contribute to plan and control movements. An aspect which has yet to be investigated regards whether the motor representations evoked by chemosensory stimuli, once established for a particular movement, can be used to control different effectors. Here, we investigate this issue by asking participants to drink a sip of flavored solution, grasp with the hand a visual target, and then bring it to the mouth, miming the action of biting. Results show that hand and lip apertures were scaled according to the size of the object evoked by the flavor. Maximum hand and lip apertures were greater when the action toward a small visual target (e.g., strawberry) was preceded by a sip of a "large" (e.g., orange) than a "small" (e.g., almond) flavor solution. Conversely, maximum hand and lip apertures were smaller when the action toward a large visual target (e.g., apple) was preceded by the presentation of a "small" (e.g., strawberry) rather than a "large" flavor solution. These findings support previous evidence on the presence of a unique motor plan underlying the act of grasping with-the-hand and with-the-mouth, extending the knowledge of chemosensorimotor transformations to motor equivalence.

Smartphone-Based Passive Sensing for Behavioral and Physical Monitoring in Free-Life Conditions: Technical Usability Study.

BACKGROUND: Smartphone use is widely spreading in society. Their embedded functions and sensors may play an important role in therapy monitoring and planning. However, the use of smartphones for intrapersonal behavioral and physical monitoring is not yet fully supported by adequate studies addressing technical reliability and acceptance. OBJECTIVE: The objective of this paper is to identify and discuss technical issues that may impact on the wide use of smartphones as clinical monitoring tools. The focus is on the quality of the data and transparency of the acquisition process. METHODS: QuantifyMyPerson is a platform for continuous monitoring of smartphone use and embedded sensors data. The platform consists of an app for data acquisition, a backend cloud server for data storage and processing, and a web-based dashboard for data management and visualization. The data processing aims to extract meaningful features for the description of daily life such as phone status, calls, app use, GPS, and accelerometer data. A total of health subjects installed the app on their smartphones, running it for 7 months. The acquired data were analyzed to assess impact on smartphone performance (ie, battery consumption and anomalies in functioning) and data integrity. Relevance of the selected features in describing changes in daily life was assessed through the computation of a k-nearest neighbors global anomaly score to detect days that differ from others. RESULTS: The effectiveness of smartphone-based monitoring depends on the acceptability and interoperability of the system as user retention and data integrity are key aspects. Acceptability was confirmed by the full transparency of the app and the absence of any conflicts with daily smartphone use. The only perceived issue was the battery consumption even though the trend of battery drain with and without the app running was comparable. Regarding interoperability, the app was successfully installed and run on several Android brands. The study shows that some smartphone manufacturers implement power-saving policies not allowing continuous sensor data acquisition and impacting integrity. Data integrity was 96% on smartphones whose power-saving policies do not impact the embedded sensor management and 84% overall. CONCLUSIONS: The main technological barriers to continuous behavioral and physical monitoring (ie, battery consumption and power-saving policies of manufacturers) may be overcome. Battery consumption increase is mainly due to GPS triangulation and may be limited, while data missing because of power-saving policies are related only to periods of nonuse of the phone since the embedded sensors are reactivated by any smartphone event. Overall, smartphone-based passive sensing is fully feasible and scalable despite the Android market fragmentation.

The coding of object thickness in plants: When roots matter.

Tendrils are clasping structures used by climbing plants to anchor and support their vines that coil around suitable hosts to achieve the greatest exposure to sunlight. Although recent evidence suggests that climbing plants are able to sense the presence of a potential stimulus in the environment and to plan the tendrils' movements depending on properties such as its thickness, the mechanisms underlying thickness sensing in climbing plants have yet to be uncovered. The current research set out to use three-dimensional kinematical analysis to investigate if and in what way the root system contributed to thickness sensing. Experiment 1 was designed to confirm that the movement of the tendrils of pea plants (Pisum sativum L.) is planned and controlled on the basis of stimulus thickness when the stimulus is inserted into the substrate. Experiment 2 was designed to investigate what happens when the stimulus is lifted to the ground so as to impede the root system from sensing it. The results confirmed that tendrils' kinematics depend on thickness when the stimulus is available to the root system but not when it is unavailable to it. These findings suggest that the root system plays a pivotal role in sensing the presence and the thickness of a stimulus and that the information perceived affects the planning and the execution of the climbing plants' reach-to-grasp movements. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Can Plants Move Like Animals? A Three-Dimensional Stereovision Analysis of Movement in Plants.

In this article we adapt a methodology customarily used to investigate movement in animals to study the movement of plants. The targeted movement is circumnutation, a helical organ movement widespread among plants. It is variable due to a different magnitude of the trajectory (amplitude) exhibited by the organ tip, duration of one cycle (period), circular, elliptical, pendulum-like or irregular shape and the clockwise and counterclockwise direction of rotation. The acquisition setup consists of two cameras used to obtain a stereoscopic vision for each plant. Cameras switch to infrared recording mode for low light level conditions, allowing continuous motion acquisition during the night. A dedicated software enables semi-automatic tracking of key points of the plant and reconstructs the 3D trajectory of each point along the whole movement. Three-dimensional trajectories for different points undergo a specific processing to compute those features suitable to describe circumnutation (e.g., maximum speed, circumnutation center, circumnutation length, etc.). By applying our method to the approach-to-grasp movement exhibited by climbing plants (Pisum sativum L.) it appears clear that the plants scale movement kinematics according to the features of the support in ways that are adaptive, flexible, anticipatory and goal-directed, reminiscent of how animals would act.

A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors.

BACKGROUND: Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing. OBJECTIVE: To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke. METHODS: A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council. RESULTS: All outcomes but SSQoL significantly improved over time in both groups (P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points (P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8). CONCLUSIONS: Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.