Robotic training and kinematic analysis of arm and hand after incomplete spinal cord injury: A case study

Regaining upper extremity function is the primary concern of persons with tetraplegia caused by spinal cord injury (SCI). Robotic rehabilitation has been inadequately tested and underutilized in rehabilitation of the upper extremity in the SCI population. Given the acceptance of robotic training in stroke rehabilitation and SCI gait training, coupled with recent evidence that the spinal cord, like the brain, demonstrates plasticity that can be catalyzed by repetitive movement training such as that available with robotic devices, it is probable that robotic upper-extremity training of persons with SCI could be clinically beneficial. The primary goal of this pilot study was to test the feasibility of using a novel robotic device for the upper extremity (RiceWrist) and to evaluate robotic rehabilitation using the RiceWrist in a tetraplegic person with incomplete SCI. A 24-year-old male with incomplete SCI participated in 10 sessions of robot-assisted therapy involving intensive upper limb training. The subject successfully completed all training sessions and showed improvements in movement smoothness, as well as in the hand function. Results from this study provide valuable information for further developments of robotic devices for upper limb rehabilitation in persons with SCI.

[1]  E. Field-Fote,et al.  Functional and Corticomotor Changes in Individuals With Tetraplegia Following Unimanual or Bimanual Massed Practice Training With Somatosensory Stimulation: A Pilot Study , 2010, Journal of neurologic physical therapy : JNPT.

[2]  W. Rymer,et al.  Spastic hypertonia: mechanisms and measurement. , 1989, Archives of physical medicine and rehabilitation.

[3]  R. Davoodi,et al.  Switching curve control of functional electrical stimulation assisted rowing exercise in paraplegia , 2003, Medical and Biological Engineering and Computing.

[4]  H.I. Krebs,et al.  Robot-Aided Neurorehabilitation: A Robot for Wrist Rehabilitation , 2007, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[5]  D. Hoffman,et al.  Step-tracking movements of the wrist in humans. I. Kinematic analysis , 1986, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[6]  H. V. van Hedel,et al.  Upper Extremity Function in Persons with Tetraplegia: Relationships Between Strength, Capacity, and the Spinal Cord Independence Measure , 2009, Neurorehabilitation and neural repair.

[7]  Hermano Igo Krebs,et al.  A robot for wrist rehabilitation , 2001, 2001 Conference Proceedings of the 23rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[8]  H.I. Krebs,et al.  Wrist rehabilitation following stroke: initial clinical results , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[9]  A. Wernig,et al.  Maintenance of locomotor abilities following Laufband (treadmill) therapy in para- and tetraplegic persons: follow-up studies , 1998, Spinal Cord.

[10]  Maarten J. IJzerman,et al.  Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics , 2004, Spinal Cord.

[11]  E. Field-Fote,et al.  Massed Practice versus Massed Practice with Stimulation: Effects on Upper Extremity Function and Cortical Plasticity in Individuals with Incomplete Cervical Spinal Cord Injury , 2005, Neurorehabilitation and neural repair.

[12]  P. Dario,et al.  Assessing Mechanisms of Recovery During Robot-Aided Neurorehabilitation of the Upper Limb , 2008, Neurorehabilitation and neural repair.

[13]  R L Lieber,et al.  Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury , 2009, Spinal Cord.

[14]  Corwin Boake,et al.  Normalized Movement Quality Measures for Therapeutic Robots Strongly Correlate With Clinical Motor Impairment Measures , 2010, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[15]  Imre Cikajlo,et al.  Universal Haptic Drive: A Robot for Arm and Wrist Rehabilitation , 2010, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[16]  Ranu Jung,et al.  Activity-dependent plasticity in spinal cord injury. , 2008, Journal of rehabilitation research and development.

[17]  M.K. O'Malley,et al.  Design of a haptic arm exoskeleton for training and rehabilitation , 2006, IEEE/ASME Transactions on Mechatronics.

[18]  Roberta Klatzky,et al.  Visual feedback distortion in a robotic environment for hand rehabilitation , 2008, Brain Research Bulletin.

[19]  Marcia K. O'Malley,et al.  Validation of a smooth movement model for a human reaching task , 2009, 2009 IEEE International Conference on Rehabilitation Robotics.

[20]  Hanson Rw,et al.  Sexual loss in relation to other functional losses for spinal cord injured males. , 1976 .

[21]  R. Waters,et al.  Motor and sensory recovery following incomplete tetraplegia. , 1994, Archives of physical medicine and rehabilitation.

[22]  Martin E. Schwab,et al.  Plasticity of motor systems after incomplete spinal cord injury , 2001, Nature Reviews Neuroscience.

[23]  C. Burgar,et al.  Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. , 2002, Archives of physical medicine and rehabilitation.

[24]  M. Jannink,et al.  Systematic review of the effects of exercise therapy on the upper extremity of patients with spinal-cord injury , 2009, Spinal Cord.

[25]  H. F. Machiel van der Loos,et al.  Development of robots for rehabilitation therapy: the Palo Alto VA/Stanford experience. , 2000, Journal of rehabilitation research and development.

[26]  N. Yozbatiran,et al.  Robotic training and clinical assessment of forearm and wrist movements after incomplete spinal cord injury: A case study , 2011, 2011 IEEE International Conference on Rehabilitation Robotics.

[27]  Neville Hogan,et al.  Impedance Control: An Approach to Manipulation , 1984, 1984 American Control Conference.

[28]  R W Hanson,et al.  Sexual loss in relation to other functional losses for spinal cord injured males. , 1976, Archives of physical medicine and rehabilitation.

[29]  J. McGuire,et al.  Beyond Ashworth. Electrophysiologic quantification of spasticity. , 1998, Physical medicine and rehabilitation clinics of North America.