Ann Rehabil Med.  2019 Aug;43(4):445-457. 10.5535/arm.2019.43.4.445.

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

Affiliations
  • 1Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea. entreciel80@korea.kr
  • 2Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Seoul, Korea.

Abstract


OBJECTIVE
To 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.
METHODS
After 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.
RESULTS
A 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.
CONCLUSION
Combined upper limb RT demonstrated beneficial effects on the upper limb motor function in patients with tetraplegic SCI, which were comparable with conventional OT.

Keyword

Spinal cord injuries; Upper extremity; Robotics; Rehabilitation

MeSH Terms

Animals
Elbow
Grooming
Hand Strength
Humans
Inpatients
Mass Screening
Occupational Therapy
Outcome Assessment (Health Care)
Pinch Strength
Rehabilitation
Robotics
Spinal Cord Injuries*
Spinal Cord*
Spinal Injuries
Upper Extremity*

Figure

  • Fig. 1. (A) ArmeoPower, a rehabilitation exoskeleton that mainly trains proximal upper limb including shoulder, elbow, and wrist. (B) The patient training proximal upper limb with ArmeoPower.

  • Fig. 2. (A) Amadeo, a rehabilitation exoskeleton that trains distal upper limb including hand and fingers. (B) The patient training distal upper limb with Amadeo.

  • Fig. 3. Flow chart of subject recruitment. RT, combining upper limb robotic therapy with conventional occupational therapy; OT, only conventional occupational therapy.


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