Robotic-assisted rehabilitation in stroke patients using the Hybrid Assistive Limb (HAL): A narrative review

BackgroundStroke remains a leading cause of long-term disability worldwide. Robotic-assisted rehabilitation, particularly with the Hybrid Assistive Limb (HAL), has emerged as an innovative approach to enhance motor recovery and functional outcomes. HAL is a wearable exoskeleton that detects bioelectrical signals and provides real-time support, offering unique opportunities for task-specific and intensive neurorehabilitation.ObjectiveThis narrative review summarizes recent clinical evidence on the application of HAL in stroke rehabilitation, focusing on its effects on gait, upper limb recovery, activities of daily living (ADL), and safety, while discussing its limitations and future directions.MethodsA literature search of PubMed and Scopus was conducted for studies investigating HAL-assisted rehabilitation in stroke patients. Eligible studies included randomized controlled trials, systematic reviews, pilot studies, and relevant narrative reviews.ResultsEvidence from randomized and non-randomized studies suggests that HAL-assisted rehabilitation can improve gait velocity, balance, and, to a lesser extent, upper limb function in both acute and chronic stroke populations. Several systematic reviews and RCTs (2022-2025) have confirmed its potential benefits compared to conventional physiotherapy, though findings remain heterogeneous. HAL is generally safe and well tolerated, but high costs, limited availability, and methodological variations across studies constrain generalizability.ConclusionHAL-assisted rehabilitation represents a promising adjunct to conventional stroke therapy, with growing evidence supporting its efficacy in motor recovery. However, current data are limited by small sample sizes, inconsistent protocols, and lack of long-term follow-up. Large-scale, multicenter randomized controlled trials are warranted to establish its clinical utility, cost-effectiveness, and integration into routine care.