The effectiveness of robotic-assisted upper limb rehabilitation to improve upper limb function in patients with cervical spinal cord injuries: a systematic literature review

Frontiers in Neurology, 2023 · DOI: 10.3389/fneur.2023.1126755 · Published: August 9, 2023

Assistive Technology Neurology Rehabilitation

Simple Explanation

Spinal Cord Injury (SCI) damages pathways, leading to changes in sensation, motor function, strength, and body function. Cervical SCI (cSCI) causes severe upper limb (UL) impairments, increasing falls risk and limiting independence. Robotic therapy (RT) is a new treatment for people with cervical spinal cord injuries (cSCI). The review explores evidence and studies regarding the effectiveness of RT for individuals with cSCI in improving UL function. The review of 7 articles involving 87 patients found mixed evidence regarding the effectiveness of RT to improve upper limb function in participants with cSCI. RT was shown to be safe, feasible, and reduces active therapist time.

Study Duration

Specified articles published from January 2010 to January 2022

Participants

87 patients (74 males and 13 females)

Evidence Level

Systematic Literature Review

Key Findings

1
Four out of seven studies demonstrated statistically significant improvements in outcome measurements on UL function and strength after RT.
2
The fully portable robotic glove showed significant average object manipulation improvement and upper limb lift force.
3
Small improvements in muscle strength and SCIM-III scores in RT group, but no statistically significant differences.

Research Summary

This review was based on 7 studies that met the inclusion criteria. Among four out of these seven studies, participants with cSCIs demonstrated significant improvements in UL function, strength, grasping, and overall motor function with the implementation of RT as a primary intervention. The findings from this review suggested that Allied Health Professionals (AHPs) should implement RT alongside conventional therapy as part of their rehabilitation program. This can be implemented by instructing participants to perform UL functional exercises with the use of upper extremity robots providing resistance and movement assistance to the affected limb This scoping review provided an overview of evidence relevant to the effectiveness of AHP-prescribed RT in improving UL function for individuals with cSCI. Among the three seemingly average quality studies, it showed no significant effects on treatment outcomes.

Practical Implications

Clinical Practice

AHPs should consider implementing RT alongside conventional therapy for cSCI rehabilitation to improve UL function.

Research

Further research is needed on the long-term effects, cost-effectiveness, and optimal protocols for UL RT in cSCI rehabilitation.

Device Design

Future robotic devices should be cost-effective, quick to setup, and allow multi-joint training to enhance accessibility and usability for AHPs and service users.

Study Limitations

1
Inclusion of only studies published in English may have excluded relevant research.
2
Small sample sizes and lack of control groups in some studies limit the generalizability of results.
3
Limited RCT and experimental studies restrict the identification of cause-and-effect relationships.

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