RiceWrist Robotic Device for Upper Limb Training: Feasibility Study and Case Report of Two Tetraplegic Persons with Spinal Cord Injury

Abstract

Regaining upper extremity function is the primary concern of persons with tetraplegia caused by spinal cord injury (SCI). Robotic rehabilitation has been inadequately tested and underutilized in rehabilitation of the upper extremity in the SCI population. Given the acceptance of robotic train ing in stroke rehabilitation and SCI gait training, coupled with recent evidence that the spinal cord, like the brain, demonstrates plasticity that can be enhanced by repetitive movement training such as that available with robotic devices, it is probable that robotic upper ext remity train ing of persons with SCI could be clin ically beneficial. The primary goal of th is pilot study was to test the feasibility of using a novel robotic device -the RiceWrist Exoskeleton-for rehabilitation of the upper limbs (UL) of t wo tetraplegic persons with inco mplete SCI. Two pilot experiments were conducted. Experiment 1was the first novel attempt to admin ister treatment with the RiceWrist. The left UL of a tetraplegic subject was treated during seven therapy sessions. The subject's feedback and the investigator's observations were used to enhance the robotic device and the corresponding graphical-interface. In Experiment 2, a second tetraplegic subject underwent 10 three-hour train ing sessions admin istered by a physical therapist. Smoothness factor (F S ) -a new measure developed in Experiment 1-was used as the primary outcome to test the subject's performance before and after the training. The RiceWrist was modified accord ing to the feedback obtained in Experiment 1. Thereafter, the device was successfully administered for upper limb training of the tetraplegic individual. Noticeable improvements in F S were observed for the stronger arm of the subject who co mpleted 10 sessions of train ing. Improvements were also observed in the subject's hand according to the Jebsen-Taylor Hand Function Test. Results fro m this study suggest a potential application of the RiceWrist for rehabilitation of SCI individuals and offer valuable in formation regard ing development of UL robotic devices for this population.

Transcranial direct current stimulation (tDCS) of the primary motor cortex and robot-assisted arm training in chronic incomplete cervical spinal cord injury: A proof of concept sham-randomized clinical study

“…Second, we used repetitive robotic-assisted training instead of repetitive task practice. Robotic-assisted training with MAHI Exo-II exoskeleton device has produced positive outcomes in other studies from our lab with spinal cord injury patients (Kadivar et al, 2012;Yozbatiran et al, 2012) High intensity repetitive training of elbow flexion/ extension, forearm pronation/ supination, wrist flexion/extension and ulnar/radial deviation was successfully delivered. Within subjects' number of repetition reached up to 1000 on average in onehour.…”

Improved motor performance in chronic spinal cord injury following upper-limb robotic training

“…None of the participants dropped out of the study. Some case reports have described the safety and feasibility of the upper limb robotic training in this population with similar results, high tolerance and no increase in pain or spasticity (Yozbatiran et al, 2012; Sledziewski et al, 2012; Kadivar et al, 2012), using different robotic devices (Armeo, Geo Ro).…”

“…It has recently been suggested that when patients present with severely limited capabilities, a longer (>36 weeks) or alternative form of therapy, for example, one combined with stimulation, may be warranted (Kadivar et al, 2012). Lastly, the study lacks adequate follow-up measurements to ensure that the functional gain is retained over time.…”

“…Despite the abundant literature supporting the efficacy of upper-limb robotic training in stroke population, there are a limited number of studies showing feasibility, safety and efficacy in chronic SCI population (Kadivar et al., 2011, 2012; H. Krebs et al, 2008; Sledziewski, Schaaf, & Mount, 2012; Yozbatiran et al, 2012).…”

Dynamic Measurement of Legs Motion in Sagittal Plane Based on Soft Wearable Sensors

“…Motion capture systems for tracking leg motion are widely applied in many fields, such as rehabilitation [1][2][3], competitive training [4], human-computer interaction [5], movie, animation [6], and exoskeleton assist systems [7]. The measurement of joint motion can ensure safe and effectual rehabilitation of leg motion [8]; several systems for leg rehabilitation have been developed that are applied to rehabilitation of spinal cord injury and neurological or orthopedic lesions [9][10][11]. In addition, the capture and analysis of joint motions can improve the competitiveness of some sports.…”