A motor learning-based postural intervention with a robotic trunk support trainer to improve functional sitting in spinal cord injury: case report

Spinal Cord Series and Cases, 2022 · DOI: https://doi.org/10.1038/s41394-022-00554-2 · Published: November 8, 2022

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This case report explores using a robotic Trunk-Support-Trainer (TruST) to help someone with a spinal cord injury (SCI) improve their ability to sit and control their posture. The TruST provides support as needed while the person practices motor learning-based exercises. The intervention involved six sessions where the TruST adjusted its assistance based on the participant's improvements in trunk control. Researchers used a T-shirt test and other measures to track changes in dressing ability, upper body movement, muscle force, and muscle activity. The results showed that the participant was able to dress faster, had increased trunk muscle strength, better sitting posture, and a larger sitting workspace after the TruST intervention, suggesting it could be a useful tool for improving functional sitting in SCI.

Study Duration

5 weeks

Participants

1 participant with spinal cord injury (SCI)

Evidence Level

Single-subject-research-design

Key Findings

1
The participant halved the time needed to don and doff a T-shirt after the TruST intervention, indicating improved dressing ability.
2
The participant increased muscle force of trunk muscles (mean = 3 kg) after the intervention, demonstrating improved trunk strength.
3
The participant expanded his sitting workspace area (mean baseline: 36.7 ± 2 SD = 36.6 cm2 and post-intervention: 419.2 cm2), indicating improved postural control and reach.

Research Summary

This single-subject study investigated the use of a robotic Trunk-Support-Trainer (TruST) to improve seated postural control in a participant with spinal cord injury (SCI). The TruST delivered “assist-as-needed” forces during a motor learning-based intervention. The results indicated that the participant halved the time needed to don and doff a T-shirt, increased muscle force of trunk muscles, acquired a steadier postural sitting control, and expanded his sitting workspace area after the intervention. The study concluded that TruST-intervention has the potential to promote functional sitting in SCI, improving dressing skills, seated postural control strategies, and force-generation capacity of trunk muscles.

Practical Implications

Rehabilitation Strategy

TruST-intervention can be implemented as a rehabilitation strategy to improve trunk control and functional abilities in individuals with SCI.

Technology Application

The study highlights the potential of robotics and assist-as-needed force field technology in neurorehabilitation to address postural support and task-progression.

Motor Learning

The findings emphasize the importance of incorporating motor learning and control principles in rehabilitation interventions to restore sensorimotor-related spinal networks.

Study Limitations

1
Single-subject design limits the generalizability of the findings.
2
Lack of a control group makes it difficult to isolate the specific effects of TruST-intervention.
3
EMG responses were highly variable within and across study sessions.

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