Clinical efficacy of upper limb robotic therapy in cervical spinal cord injured patients: A randomized control trial

Abstract

The efficacy of upper limb robotic therapy (UERs) in cervical SCI patients is relatively limited. With a better understanding of the effect of UER in cervical SCI patients, development of therapy programs with more adequate dosing, method, and safe protocols along with valid assessment tools will be possible in the future. This study evaluates the potential effects of (exoskeleton type) UER in cervical SCI patients using a randomized controlled design. Study patients were randomly allocated to the robotic therapy (RT) or occupational therapy (OT) groups. Both groups received 5 sessions of therapy per week for 4 weeks (both received OT with additional 30 minutes respectively of RT [using the Armeo Power] and OT). Outcome measures were modified Medical Research Council (mMRC) scale motor strength score and Korean Spinal Cord Independence Measurement version III (KSCIM-III) score changes. Measurements were performed twice (baseline and therapy termination). A total of 30 individuals with cervical SCI were included, with 15 patients in each group. At therapy termination, C6, C7, T1 key muscle score, and the sum of C5–T1 key muscle score increased in the RT group. Increase in C7 and T1 was higher in the RT than OT group. Among (KSCIM-III) sub-categories, use of toilet, mobility, and the total score increased in the RT group. Improvement in mobility in bed and action to prevent pressure sores, mobility indoor, and total score were higher in the RT group. This is a randomized control trial that investigated the effects of upper-limb exo-skeletal RT in SCI patients. With upper limb RT, cervical SCI patients showed some improvements in muscle power and KSCIM-III scores. For better C7, T1 key muscle power and related functional recovery, upper limb RT seems to be a feasible option. Superiority over one therapy could not be determined in this study.