Abstract
The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on “Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin” (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury.
Highlights
Spinal cord injury (SCI) represents one of the most disabling neurological conditions by complete or incomplete damage to the spinal cord with resulting detrimental consequences in motor, sensitive, and visceral controls [1,2,3,4].The prevalence of SCIs widely varies among countries, ranging from 13.0 per million to 163.4 per million people [5]
11 papers [25,26,27,28,29,30,31,32,33,34,35] were included in the qualitative synthesis (PRISMA flow diagram was depicted by Figure 1): five case series [25,26,27,28,29], one parallel-group controlled trial [30], two Randomized Controlled Trial (RCT) [31,34], two systematic reviews [32,33] and one longitudinal intervention study [35]
The studies included in this systematic review were published from 2012 [25] to 2020 [35], covering several Nations from all over the world; more in detail, seven studies were from the Americas, two from Europe, and two from Asia (Republic of Korea [31,34])
Summary
Spinal cord injury (SCI) represents one of the most disabling neurological conditions by complete or incomplete damage to the spinal cord with resulting detrimental consequences in motor, sensitive, and visceral controls [1,2,3,4].The prevalence of SCIs widely varies among countries, ranging from 13.0 per million to 163.4 per million people [5]. Spinal cord injury (SCI) represents one of the most disabling neurological conditions by complete or incomplete damage to the spinal cord with resulting detrimental consequences in motor, sensitive, and visceral controls [1,2,3,4]. SCIs might arise from mechanical damages (i.e., contusions, compressions or lacerations of the spinal cord) or non-traumatic events (e.g., degenerative cervical myelopathies, cancers, infections, intervertebral disc diseases, etc.) [6,7]. High-level spinal cord lesions could lead subjects to a high disability, considering the loss of arms and hands function related to detrimental consequences of functional impairment, reduced independence in activities of daily living (ADL), and a poor HealthRelated Quality of Life (HRQoL) [1,2,7,8]. Rehabilitation might play a crucial role in the arm and hand functional recovery of patients affected by SCI, with a large variety of therapeutic options currently adopted. [7,9] It has been recently proposed that repetitive, task-specific, functional training could be considered effective in improving upper limb functions, even potentially interacting with the self-repair capacity of the spinal cord [10,11]
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