Objective: The aim of the study was to demonstrate the feasibility, tolerability, and effectiveness of robotic-assisted arm training in incomplete chronic tetraplegia. Design: Pretest/posttest/follow-up was conducted. Ten individuals with chronic cervical spinal cord injury were enrolled. Participants performed single degree-of-freedom exercise of upper limbs at an intensity of 3-hr per session for 3 times a week for 4 wks with MAHI Exo-II. T etraplegia caused by injury to spinal cord has a significant disabling effect on independence in daily life. Approximately half of people with tetraplegia reported regaining arm and hand functions as the most important factor to improve their quality of life.1,2 Treatment options aiming to improve upper limb motor functions are sparse; functional electrical stimulation 3 and exercise 4 are aimed at sensory-motor recovery, whereas other treatments offer functional gains with minimal or no effects on neurorecovery. For example, neuroprostheses 5 and brain computer interface systems 6 increase motor control through alternative communication and control systems, whereas reconstructive surgery of the upper limb offers permanent changes to muscle structure. 7 There is evidence that repetitive and intensive practice can induce practice-dependent brain and spinal plasticity and that exercise intensity has a profound effect on sensory-motor recovery of patients with spinal cord injury (SCI). 8,9 In this regard, rehabilitation robots hold promise for enhancing traditional physical and/or occupational therapy. They can deliver repetitive exercises at high intensities, for extended time periods, in a consistent and precise manner. In addition, real-time measurement of performance may provide advantage to therapists to modify the therapy protocol based on improvement in performance. In this context, previous studies have reported that robotic-assisted rehabilitation can improve motor recovery after stroke and that robotic devices are safe and feasible in rehabilitation.10 Despite considerable interest in robotic gait training after SCI, 11,12 very few reports have evaluated the effect of robotic training of arm and hand function in patients with tetraplegia. [13][14][15] The current study aimed to demonstrate the feasibility and tolerability and to assess effectiveness of robotic-assisted training in improving arm and hand functions in chronic, incomplete cervical SCI. We hypothesized that intense active repetitive movement training, with a robotic device, would

BackgroundRobotic wearable exoskeletons have been utilized as a gait training device in persons with spinal cord injury. This pilot study investigated the feasibility of offering exoskeleton-assisted gait training (EGT) on gait in individuals with incomplete spinal cord injury (iSCI) in preparation for a phase III RCT. The objective was to assess treatment reliability and potential efficacy of EGT and conventional physical therapy (CPT).MethodsForty-four individuals were screened, and 13 were eligible to participate in the study. Nine participants consented and were randomly assigned to receive either EGT or CPT with focus on gait. Subjects received EGT or CPT, five sessions a week (1 h/session daily) for 3 weeks. American Spinal Injury Association (ASIA) Lower Extremity Motor Score (LEMS), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Timed Up and Go (TUG) test, and gait characteristics including stride and step length, cadence and stance, and swing phase durations were assessed at the pre- and immediate post- training. Mean difference estimates with 95% confidence intervals were used to analyze the differences.ResultsAfter training, improvement was observed in the 6MWT for the EGT group. The CPT group showed significant improvement in the TUG test. Both the EGT and the CPT groups showed significant increase in the right step length. EGT group also showed improvement in the stride length.ConclusionEGT could be applied to individuals with iSCI to facilitate gait recovery. The subjects were able to tolerate the treatment; however, exoskeleton size range may be a limiting factor in recruiting larger cohort of patients. Future studies with larger sample size are needed to investigate the effectiveness and efficacy of exoskeleton-assisted gait training as single gait training and combined with other gait training strategies.Trial registrationClinicaltrials.org, NCT03011099, retrospectively registered on January 3, 2017.