Upper limb robotic rehabilitation devices can collect quantitative data about the user's movements. Identifying relationships between robotic sensor data and manual clinical assessment scores would enable more precise tracking of the time course of recovery after injury and reduce the need for time-consuming manual assessments by skilled personnel. This study used measurements from robotic rehabilitation sessions to predict clinical scores in a traumatic cervical spinal cord injury (SCI) population. A retrospective analysis was conducted on data collected from subjects using the Armeo Spring (Hocoma, AG) in three rehabilitation centers. Fourteen predictive variables were explored, relating to range-of-motion, movement smoothness, and grip ability. Regression models using up to four predictors were developed to describe the following clinical scores: the GRASSP (consisting of four sub-scores), the ARAT, and the SCIM. The resulting adjusted R(2) value was highest for the GRASSP "Quantitative Prehension" component (0.78), and lowest for the GRASSP "Sensibility" component (0.54). In contrast to comparable studies in stroke survivors, movement smoothness was least beneficial for predicting clinical scores in SCI. Prediction of upper-limb clinical scores in SCI is feasible using measurements from a robotic rehabilitation device, without the need for dedicated assessment procedures.

The objective of this study was to evaluate the relevant sensory spinal pathways involved in conveying conduction of electrical perceptual threshold (EPT). In 34 individuals with cervical spinal cord injury (SCI) and eight healthy control subjects, combined EPT and electrical pain perception (EPP), and dermatomal somatosensory evoked potentials (dSSEP) from cervical dermatomes were examined. Stimulation intensities for EPT were recorded to determine quantitative sensory perception and related neurophysiological dSSEP interpretation of posterior spinal cord conduction based on onset latency and waveform configuration. The preservation of EPP in dermatomes was examined relative to EPT to dissociate the involvement of the posterior (dorsal horn and ascending dorsal column) and anterior (decussating and ascending spinothalamic fibers) spinal cord according to different nerve fiber recruitment in the periphery. Pathological EPT values were significantly (p < 0.05) accurate at predicting pathological and abolished dSSEP recordings (>80%), and the mean EPT of pathological and abolished dSSEPs was significantly (p < 0.05) increased compared to non-affected and control dSSEPs. dSSEPs demonstrated normal early onset latency at perceptually low stimulation intensities (<2.5 mA), and selectively absent EPP was dissociated from preserved EPT and/or dSSEP in 22.2% of dermatomes with incomplete sensory deficit. The relationship between EPT and dSSEP interpretation, dSSEP early onset latency and perceptual stimulation intensity, and the dissociation of EPT from EPP suggests that EPT is conducted within the posterior spinal cord. The combination of EPT and EPP with dSSEPs provides reliable quantitative sensory information to assess the segmental integrity of the posterior and anterior spinal cord, and may improve the sensitivity to monitor changes in sensory function after SCI.

SSEPs and EPT can be reliably recorded to monitor changes in sensory function for each individual spinal segment after cervical SCI. dSSEPs may be potentially useful to monitor the safety of a therapeutic drug or cell transplant in early-phase (I/II) clinical trials as well as document the potential efficacy of interventions where the standard neurological assessment might not detect subtle therapeutic effects.