title: Wilmington robotic exoskeleton: a novel device to maintain arm improvement in muscular disease.
abstract: BACKGROUND
  Upper-extremity movement is limited in individuals with muscular weakness. This paper describes a novel, articulated upper-extremity orthosis, the Wilmington Robotic Exoskeleton (WREX), which helps people overcome this movement deficit.
  
  
  METHODS
  This prospective, case-controlled study involved an ambulatory patient with arthrogryposis multiplex congenita and 2 nonambulatory patients with spinal muscular atrophy type II. The WREX uses elastic bands to negate the effects of gravity; it allows a person with neuromuscular weakness to move their arm in 3 dimensions. The WREX can be fixed on a brace for ambulatory patients and on the wheelchair for nonambulatory patients. Assessment was performed through motion analysis (with and without the WREX), clinical examination, and qualitative questionnaire.
  
  
  RESULTS
  Motion analysis showed a marked improvement in upper-extremity function with the WREX. The questionnaire illustrated enhanced functionality with the WREX including self-feeding, fine motor control, and use of a television remote control. Enhanced functionality resulted in improved quality of life by increasing participation in school, raising self-esteem, and increasing social interaction. Two unexpected outcomes were increased security with trunk inclination and amelioration of the effects of contractures.
  
  
  CONCLUSIONS
  The WREX provided an increase in functionality and improved the quality of life of the patients. The device has become an integral part of the lives of the 3 patients.
  
  
  METHODS
  Level III in Therapeutic Studies-Investigating the Results of Treatment.
authors.affiliation: Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA. trahman@nemours.org
authors.forename: Thierry
authors.initials: T
authors.lastname: Haumont
authors.forename: Tariq
authors.initials: T
authors.lastname: Rahman
authors.forename: Whitney
authors.initials: W
authors.lastname: Sample
authors.forename: Marilyn
authors.initials: M
authors.lastname: M King
authors.forename: Chris
authors.initials: C
authors.lastname: Church
authors.forename: John
authors.initials: J
authors.lastname: Henley
authors.forename: Shanmuga
authors.initials: S
authors.lastname: Jayakumar
mesh_terms: D000293:Adolescent; D001176:Arthrogryposis / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D004867:Equipment Design; D005081:Exercise Therapy / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006112:Gravitation; D006801:Humans; D008297:Male; D009989:Orthotic Devices; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology*; D012371:Robotics / Q000295:instrumentation*; D014897:Spinal Muscular Atrophies of Childhood / Q000503:physiopathology / Q000534:rehabilitation*; D013813:Therapy, Computer-Assisted / Q000295:instrumentation