BACKGROUND: Recovering upper-limb motor function has important implications for improving independence of patients with tetraplegia after traumatic spinal cord injury (SCI). OBJECTIVE: To evaluate the feasibility, safety and effectiveness of robotic-assisted training of upper limb in a chronic SCI population. METHODS: A total of 10 chronic tetraplegic SCI patients (C4 to C6 level of injury, American Spinal Injury Association Impairment Scale, A to D) participated in a 6-week wrist-robot training protocol (1 hour/day 3 times/week). The following outcome measures were recorded at baseline and after the robotic training: a) motor performance, assessed by robot-measured kinematics, b) corticospinal excitability measured by transcranial magnetic stimulation (TMS), and c) changes in clinical scales: motor strength (Upper extremity motor score), pain level (Visual Analog Scale) and spasticity (Modified Ashworth scale). RESULTS: No adverse effects were observed during or after the robotic training. Statistically significant improvements were found in motor performance kinematics: aim (pre 1.17 ± 0.11 raduans, post 1.03 ± 0.08 raduans, p = 0.03) and smoothness of movement (pre 0.26 ± 0.03, post 0.31 ± 0.02, p = 0.03). These changes were not accompanied by changes in upper-extremity muscle strength or corticospinal excitability. No changes in pain or spasticity were found. CONCLUSIONS: Robotic-assisted training of the upper limb over six weeks is a feasible and safe intervention that can enhance movement kinematics without negatively affecting pain or spasticity in chronic SCI. In addition, robot-assisted devices are an excellent tool to quantify motor performance (kinematics) and can be used to sensitively measure changes after a given rehabilitative intervention.
BACKGROUND: Recovering upper-limb motor function has important implications for improving independence of patients with tetraplegia after traumatic spinal cord injury (SCI). OBJECTIVE: To evaluate the feasibility, safety and effectiveness of robotic-assisted training of upper limb in a chronic SCI population. METHODS: A total of 10 chronic tetraplegic SCI patients (C4 to C6 level of injury, American Spinal Injury Association Impairment Scale, A to D) participated in a 6-week wrist-robot training protocol (1 hour/day 3 times/week). The following outcome measures were recorded at baseline and after the robotic training: a) motor performance, assessed by robot-measured kinematics, b) corticospinal excitability measured by transcranial magnetic stimulation (TMS), and c) changes in clinical scales: motor strength (Upper extremity motor score), pain level (Visual Analog Scale) and spasticity (Modified Ashworth scale). RESULTS: No adverse effects were observed during or after the robotic training. Statistically significant improvements were found in motor performance kinematics: aim (pre 1.17 ± 0.11 raduans, post 1.03 ± 0.08 raduans, p = 0.03) and smoothness of movement (pre 0.26 ± 0.03, post 0.31 ± 0.02, p = 0.03). These changes were not accompanied by changes in upper-extremity muscle strength or corticospinal excitability. No changes in pain or spasticity were found. CONCLUSIONS: Robotic-assisted training of the upper limb over six weeks is a feasible and safe intervention that can enhance movement kinematics without negatively affecting pain or spasticity in chronic SCI. In addition, robot-assisted devices are an excellent tool to quantify motor performance (kinematics) and can be used to sensitively measure changes after a given rehabilitative intervention.
Authors: J Zariffa; N Kapadia; J L K Kramer; P Taylor; M Alizadeh-Meghrazi; V Zivanovic; R Willms; A Townson; A Curt; M R Popovic; J D Steeves Journal: Spinal Cord Date: 2011-09-13 Impact factor: 2.772
Authors: Stephen Burns; Fin Biering-Sørensen; William Donovan; Daniel E Graves; Amitabh Jha; Mark Johansen; Linda Jones; Andrei Krassioukov; Steven Kirshblum; M J Mulcahey; Mary Schmidt Read; William Waring Journal: Top Spinal Cord Inj Rehabil Date: 2012
Authors: Bruce T Volpe; Patricio T Huerta; Johanna L Zipse; Avrielle Rykman; Dylan Edwards; Laura Dipietro; Neville Hogan; Hermano I Krebs Journal: Arch Neurol Date: 2009-09
Authors: Nuray Yozbatiran; Zafer Keser; Khader Hasan; Argyrios Stampas; Radha Korupolu; Sam Kim; Marcia K O'Malley; Felipe Fregni; Gerard E Francisco Journal: Spinal Cord Ser Cases Date: 2017-06-15
Authors: Richard A Macklin; Jihye Bae; Melanie Orell; Kim D Anderson; Peter H Ellaway; Monica A Perez Journal: J Neurotrauma Date: 2016-07-08 Impact factor: 5.269
Authors: Soo Jeong Kim; Hye Jin Lee; Seung Won Hwang; Hannah Pyo; Sung Phil Yang; Mun-Hee Lim; Gyu Lee Park; Eun Joo Kim Journal: Ann Rehabil Med Date: 2016-04-25