A single-subject study of robotic upper limb training in the subacute phase for four persons with cervical spinal cord injury

Spinal Cord Series and Cases, 2019 · DOI: https://doi.org/10.1038/s41394-019-0170-3 · Published: May 1, 2019

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This study investigates whether robotic training can improve arm and hand function in people with spinal cord injuries. The researchers compared standard occupational therapy to robotic training using a device called Armeo Spring. Four participants with cervical spinal cord injuries (C4-C7, AIS A-C) participated in the study. They completed 11 sessions of robotic training, and their progress was measured using several tests and questionnaires. The study found that most participants showed some improvement in arm and hand function and activities of daily living after robotic training. The participants generally enjoyed the robotic training and found it motivating.

Study Duration

Six-week

Participants

Four participants (C4–7, AIS A-C)

Evidence Level

Level 4: Single-subject design

Key Findings

1
All of the participants exhibited an increase in assessments of upper limb function (GRASSP-total) right side (0.4%–61.2%), and all except for one participant (−8%) showed an increase on their left side (20.9%–106.2%).
2
Three out of four participants had improvements in ADL function SCIM-III (ranging from 5.6% to 46.7%).
3
The participants enjoyed the exercise, and found it motivating and relevant to their injury (median ranged from 3.5 to 6.5 on a 0–7 scale).

Research Summary

This study explored the impact of robotic training on upper limb function, ADL, and training experience in subacute tetraplegic inpatients using a single-subject design. The results showed that most participants experienced improvements in upper limb function and ADL independence, although the study could not definitively attribute these improvements solely to the robotic intervention. Participants generally found the robotic training enjoyable and relevant to their injury, suggesting its potential as a supplemental treatment to standard training.

Practical Implications

Robotic therapy as adjunct

Robotic training can be an encouraging supplemental treatment to standard training in rehabilitation hospitals for persons with cervical SCI.

Repetitive training

Robotic training facilitates high numbers of repetitions, potentially leading to better outcomes.

Motivation and engagement

Robotic training can motivate patients and make them more engaged in their rehabilitation.

Study Limitations

1
Small sample size (four participants) limits generalizability.
2
Lack of a control group makes it difficult to definitively attribute improvements to the robotic intervention.
3
The natural recovery process after SCI might have influenced the results.

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