Strategies for Exoskeletal Upper Limb Robot with Bio-Sensors in Stroke Rehabilitation: A Scoping Review

Background: Upper extremity motor impairment is common after stroke. The Hybrid Assistive Limb single-joint type (HAL-SJ), an exoskeletal robot with biosensors, assists voluntary movement by detecting biopotential signals. While there are reports of positive effects, optimal strategies and patient selection criteria remain unclear. Objective: To map the evidence on HAL-SJ use for upper extremity recovery after stroke. Methods: A scoping review was conducted using five databases (search date: September 20, 2025). The studies included stroke patients treated with HAL-SJ and reported motor function outcomes. Reviews, abstracts, and commentaries were excluded. Results: Eight studies met the inclusion criteria. HAL-SJ improved upper limb motor function across recovery phases, with several studies reporting clinically meaningful improvements assessed by measures such as the Fugl-Meyer Assessment and Action Research Arm Test. Effective strategies included combining HAL-SJ with therapies such as botulinum toxin A and occupational therapy, and high-frequency training. Patients with moderate impairment benefited most; early intervention showed potential in severe cases. Conclusion: HAL-SJ shows potential as a rehabilitation tool for stroke-related upper extremity motor impairment. However, all included studies were conducted in Japan, which may limit the generalizability of these findings. Large-scale, multicenter studies are needed to establish optimal intervention protocols.