Improved motor performance in chronic spinal cord injury following upper-limb robotic training.
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.
Non-invasive Brain Stimulation and Human Motor Control Laboratory, Burke Medical Research Institute, White Plains, NY, USA. mcortes@burke.org
Mar
M
Cortes
Jessica
J
Elder
Avrielle
A
Rykman
Lynda
L
Murray
Manuel
M
Avedissian
Argyrios
A
Stampas
Gary W
GW
Thickbroom
Alvaro
A
Pascual-Leone
Hermano Igo
HI
Krebs
Josep
J
Valls-Sole
Dylan J
DJ
Edwards
D000293:Adolescent; D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009044:Motor Cortex / Q000503:physiopathology; D011782:Quadriplegia / Q000534:rehabilitation; D020127:Recovery of Function; D012371:Robotics / Q000379:methods* / Q000592:standards; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D050781:Transcranial Magnetic Stimulation; D034941:Upper Extremity / Q000503:physiopathology*