title: Assisted movement with proprioceptive stimulation reduces impairment and restores function in incomplete spinal cord injury.
abstract: OBJECTIVE
  To test whether treatment with assisted movement with enhanced sensation (AMES) using vibration to the antagonist muscle would reduce impairments and restore upper limb function in people with incomplete tetraplegia.
  
  
  METHODS
  Prospective, pre-post study.
  
  
  METHODS
  Laboratory and rehabilitation hospital.
  
  
  METHODS
  We recruited 15 arms from 10 individuals (8 men; mean age, 40.5 y; mean years postspinal cord injury [SCI], 3) with chronic, incomplete tetraplegia.
  
  
  METHODS
  Two or three 20-minute sessions per week over 9 to 13 weeks (25 sessions total) on the AMES device, which combines repeated movement with targeted vibration to the antagonist muscle.
  
  
  METHODS
  Strength and active motion tests on the AMES device; International Standards for the Neurological Classification of SCI (ISNCSCI) motor and sensory examinations; Modified Ashworth Scale (MAS); grasp and release test (GRT); Van Lieshout Test (VLT); and Capabilities of Upper Extremity questionnaire (CUE).
  
  
  RESULTS
  The AMES strength test scores improved significantly in metacarpophalangeal flexion (P=.024) and extension (P=.007) and wrist flexion (P=.001) and extension (P<.000). The AMES active motion scores improved in the hand (P=.001) and wrist (P=.001). The MAS and ISNCSCI scores remained unchanged, whereas the GRT scores increased (P=.025). Post hoc analysis showed a trend from pre- to posttreatment (P=.068) and a significant change from pretreatment to 3-month follow-up (P=.046). There was no significant change in the VLT (P=.951) or the CUE (P=.164). Five of the 10 participants reported a return of sensation to the digits after the first, second, or third treatment session.
  
  
  CONCLUSIONS
  People with chronic, incomplete tetraplegia may experience improvements in impairments and function after treatment on a device combining assisted movement and proprioceptive stimulation. Further investigation is warranted.
authors.affiliation: Crawford Research Institute, Shepherd Center, Atlanta, GA. Electronic address: Deborah_backus@shepherd.org.
authors.forename: Deborah
authors.initials: D
authors.lastname: Backus
authors.affiliation: Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR; AMES Technology Inc, Portland, OR.
authors.forename: Paul
authors.initials: P
authors.lastname: Cordo
authors.affiliation: Post-Acute SCI Rehabilitation, Shepherd Center, Atlanta, GA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gillott
authors.affiliation: Crawford Research Institute, Shepherd Center, Atlanta, GA.
authors.forename: Casey
authors.initials: C
authors.lastname: Kandilakis
authors.affiliation: Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: Motomi
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Neurological Surgery, Oregon Health & Science University, Portland, OR.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Raslan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005385:Fingers / Q000503:physiopathology; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000503:physiopathology; D008875:Middle Aged; D009068:Movement; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology; D026201:Musculoskeletal Manipulations; D011434:Proprioception / Q000502:physiology*; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D020127:Recovery of Function; D012677:Sensation; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation; D014732:Vibration / Q000627:therapeutic use; D014953:Wrist / Q000503:physiopathology; D055815:Young Adult
keywords: Feedback, sensory; Proprioceptive feedback; Rehabilitation; Spinal cord injuries; Upper extremity