Feasibility and efficacy of upper limb robotic rehabilitation in a subacute cervical spinal cord injury population

Study design: Multi-center pilot study. Objectives: To investigate the use of an upper limb robotic rehabilitation device (Armeo Spring, Hocoma AG, Switzerland) in a subacute cervical spinal cord injury (SCI) population. Setting: Two Canadian inpatient rehabilitation centers. Methods: Twelve subjects (motor level C4-C6, ASIA Impairment Scale A-D) completed the training, which consisted of 16.1 +/- 4.6 sessions over 5.2 +/- 1.4 weeks. Two types of outcomes were recorded: (1) feasibility of incorporating the device into an inpatient rehabilitation program (compliance with training schedule, reduction in therapist time required and subject questionnaires) and (2) efficacy of the robotic rehabilitation for improving functional outcomes (Graded and Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), action research arm test, grip dynamometry and range of motion). Results: By the end of the training period, the robot-assisted training was shown to require active therapist involvement for 25 +/- 11% (mean +/- s.d.) of the total session time. In the group of all subjects and in a subgroup composed of motor-incomplete subjects, no statistically significant differences were found between intervention and control limbs for any of the outcome measures. In a subgroup of subjects with partial hand function at baseline, the GRASSP-Sensibility component showed a statistically significant increase (6.0 +/- 1.6 (mean +/- s.e.m.) point increase between baseline and discharge for the intervention limbs versus 1.9 +/- 0.9 points for the control limbs). Conclusion: The pilot results suggest that individuals with some preserved hand function after SCI may be better candidates for rehabilitation training using the Armeo Spring device. Spinal Cord (2012) 50, 220-226; doi:10.1038/sc.2011.104; published online 13 September 2011