Effects of Combined Upper Limb Robotic Therapy in Patients With Tetraplegic Spinal Cord Injury

Abstract

ObjectiveTo confirm the effects of combined upper limb robotic therapy (RT) as compared to conventional occupational therapy (OT) in tetraplegic spinal cord injury (SCI) patients and to suggest the optimized treatment guidelines of combined upper limb RT.MethodsAfter subject recruitment and screening for eligibility, the baseline evaluation for outcome measures were performed. We evaluated the Graded and Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), the American Spinal Injury Association upper extremity motor score, grip and pinch strength, and the Spinal Cord Independence Measurement III (SCIM-III). In this study, the pre-tested participants were divided randomly into the RT and OT group. The utilized interventions included combined upper limb RT using ArmeoPower and Amadeo (RT group), or conventional OT (OT group) in addition to daily inpatient rehabilitation program. The participants underwent 40 minutes×3 sessions×5 weeks of interventions.ResultsA total of 30 tetraplegic SCI patients completed entire study program. After 5 weeks of intervention, both groups demonstrated increases in GRASSP-strength and SCIM-III. The manual muscle test scores of elbow flexion, elbow extension, 2-5th metacarpophalangeal extension, and SCIM-III subscores of bathing-upper, dressing-upper, and grooming as well as the GRASSP-qualitative prehension score were noted to have been significantly increased in the RT group as evaluated. The OT group showed improvements in the GRASSP-quantitative prehension score and some items in grip and pinch strength. There was no significant difference between the two groups in almost all measurements except for the SCIM-III bathing-upper subscore.ConclusionCombined upper limb RT demonstrated beneficial effects on the upper limb motor function in patients with tetraplegic SCI, which were comparable with conventional OT.

Effect of Task-Oriented Training on Upper Extremity Function for Patients with Spinal Cord and Traumatic Brain Injuries: Systematic Review

“…Previous evidence regarding spinal cord injuries suggested that training of the upper limb following spinal cord injury leads to improvements in muscle strength, upper limb function and activities of daily living or quality of life [15,16] . Some of them investigated the effects of some types of TOT without technology intrusion, others examined technology interference generally without specifying a training approach [31,32] .…”

Upper Limb Robotic Rehabilitation for Patients With Cervical Spinal Cord Injury: A Comprehensive Review

“…Subsequently, 39 articles were excluded because they did not respect eligibility criteria. As a result, 11 papers were included in the qualitative synthesis (PRISMA flow diagram was depicted by Figure 1): 5 case series, [25][26][27][28][29] 1 parallel-group controlled trial, [30] 2 RCT, [31,34] 2 systematic reviews [32,33] and one longitudinal intervention study. [35] The studies included in this systematic review were published from 201225 to 202034, covering several Nations from all over the world; more in detail, seven studies were from the Americas (two from Canada [25,32] and five from USA [26,27,29,30,33]), two from Europe (1 from Netherlands [28] and one from UK [35]), and two from Asia (Republic of Korea [31,34]).…”

“…Evidence level and study quality of the included studies Due to the high clinical heterogeneity of the included studies; thus, the results are described qualitatively. Based on the Oxford Centre for Evidence-Based (OCEBM) 2011 Levels of Evidence, [34] we included two systematic reviews [32,33] (Level 1), 2 RCT [31,34] (Level 2), one parallel-group controlled trial [30] (Level 3), one longitudinal intervention trial [35] (Level 3), and five case series (Level 4). [25][26][27][28][29] The study cohort sample sizes were highly heterogeneous in the research studies, ranging from 5 (case series) [28] to 34 (RCT) [31] for clinical trials; nevertheless, the systematic reviews included larger samples (73 study participants by Singh et al [32] and 88 by Yozbatiran et al [33]).…”

“…Concerning the study quality of the clinical studies, we reported one good-quality [31], one fair-quality [34], according to the PEDro scale. [24] The two systematic reviews showed a low quality [31] and a critically low quality [33] according to AMSTAR 2 scale.…”

Robotics in physical medicine and neurorehabilitation

“…Robotics in rehabilitation is of utter importance, because it works on principle of neuroplasticity, i.e. the brain's ability to change, reorganize, and establish new synapses and enable the development of new types of rehabilitation treatment [12]. The application of specially designed virtual games using robots can provide an entertaining therapy experience, promoting the patient to put in effort into the exercises [13].…”