Improved motor performance in chronic spinal cord injury following upper-limb robotic training

Issue title: Robot-Assisted Therapy: A Clinical Perspective

Guest editors: Hermano Igo Krebs

Article type: Research Article

Authors: Cortes, Mar^{a; b; i; *} | Elder, Jessica^{a; c} | Rykman, Avrielle^a | Murray, Lynda^a | Avedissian, Manuel^a | Stampas, Argyrios^d | Thickbroom, Gary W.^e | Pascual-Leone, Alvaro^{f; g} | Krebs, Hermano Igo^h | Valls-Sole, Josepⁱ | Edwards, Dylan J.^{a; b; e; f}

Affiliations: [a] Non-invasive Brain Stimulation and Human Motor Control Laboratory, Burke Medical Research Institute, White Plains, NY, USA | [b] Neurology and Neuroscience Department, Cornell University, NY, USA | [c] Biostatistics and Epidemiology Department, Cornell University, NY, USA | [d] The Burke Rehabilitation Hospital, White Plains, NY, USA | [e] Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, Western Australia, Australia | [f] Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA | [g] Guttmann University Institute for Neurorehabilitation, Universitat Autonoma de Barcelona, Barcelona, Spain | [h] Newman Laboratory for Biomechanics and Human Rehabilitation, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA | [i] EMG and Motor Control Unit, Neurology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain

Correspondence: [*] Address for correspondence: Mar Cortes, Non-invasive Brain Stimulation and Human Motor Control Laboratory, Burke Medical Research Institute, White Plains, NY, USA. E-mail: [email protected]

Abstract: Background:Recovering upper-limb motor function has important implications for improving independence of patients with tetraplegia after traumatic spinal cord injury (SCI). Objective:To evaluate the feasibility, safety and effectiveness of robotic-assisted training of upper limb in a chronic SCI population. Methods:A total of 10 chronic tetraplegic SCI patients (C4 to C6 level of injury, American Spinal Injury Association Impairment Scale, A to D) participated in a 6-week wrist-robot training protocol (1 hour/day 3 times/week). The following outcome measures were recorded at baseline and after the robotic training: a) motor performance, assessed by robot-measured kinematics, b) corticospinal excitability measured by transcranial magnetic stimulation (TMS), and c) changes in clinical scales: motor strength (Upper extremity motor score), pain level (Visual Analog Scale) and spasticity (Modified Ashworth scale). Results:No adverse effects were observed during or after the robotic training. Statistically significant improvements were found in motor performance kinematics: aim (pre 1.17 ± 0.11 raduans, post 1.03 ± 0.08 raduans, p = 0.03) and smoothness of movement (pre 0.26 ± 0.03, post 0.31 ± 0.02, p = 0.03). These changes were not accompanied by changes in upper-extremity muscle strength or corticospinal excitability. No changes in pain or spasticity were found. Conclusions:Robotic-assisted training of the upper limb over six weeks is a feasible and safe intervention that can enhance movement kinematics without negatively affecting pain or spasticity in chronic SCI. In addition, robot-assisted devices are an excellent tool to quantify motor performance (kinematics) and can be used to sensitively measure changes after a given rehabilitative intervention.

Keywords: Spinal cord injury, transcranial magnetic stimulation, robotic training, kinematics

DOI: 10.3233/NRE-130928

Journal: NeuroRehabilitation, vol. 33, no. 1, pp. 57-65, 2013