Reliability of movement workspace measurements in a passive arm orthosis used in spinal cord injury rehabilitation

Abstract

BackgroundRobotic and non-robotic training devices are increasingly being used in the rehabilitation of upper limb function in subjects with neurological disorders. As well as being used for training such devices can also provide ongoing assessments during the training sessions. Therefore, it is mandatory to understand the reliability and validity of such measurements when used in a clinical setting. The aim of this study was to evaluate the reliability of movement measures as assessed in the Armeo Spring system for the eventual application to the rehabilitation of patients suffering from cervical spinal cord injury (SCI).MethodsReliability (intra- and inter-rater reliability) of the movement workspace (representing multiple ranges of movement) and the influence of varying seating conditions (5 different chair conditions) was assessed in twenty control subjects. In eight patients with cervical SCI the test-retest reliability (tested twice on the same day by the same rater) was assessed as well as a correlation of the movement workspace to retrieve self-care items as scored by the spinal cord independence measure (SCIM 3).ResultsAnalysis of workspace measures in control subjects revealed intra-class correlation coefficients (ICC) ranging from 0.747 to 0.837 for the intra-rater reliability and from 0.661 to 0.855 for the inter-rater reliability. Test-retest analysis in SCI patients showed a similar high reliability with ICC = 0.858. Also the reliability of the movement workspace between different seating conditions was good with ICCs ranging from 0.844 to 0.915. The movement workspace correlated significantly with the SCIM3 self-care items (p < 0.05, rho = 0.72).ConclusionThe upper limb movement workspace measures assessed in the Armeo Spring device revealed fair to good clinical reliability. These findings suggest that measures retrieved from such a training device can be used to monitor changes in upper limb function over time. The correlation between the workspace measures and SCIM3 self-care items indicates that such measures might also be valuable to document the progress of clinical rehabilitation, however further detailed studies are required.

Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

“…In particular, cortical reorganization and associated functional motor recovery, key factors in neurologic rehabilitation (Rudhe et al, 2012), after virtual reality in patients with chronic stroke are documented also by fMRI (Jang et al, 2005). In addition, these devices are able to support the patient's arm weight during therapy (O'Dell et al, 2009), thus allowing individuals unable to lift their arm sufficiently against gravity to be treated.…”

Impact of Non-Robotic Assisted Therapy for Improvement of Mobility of Paretic Upper Extremity Caused by Cerebral Palsy Compared to Classical Kinesiotherapy

“…As well as being used for training such devices can also provide ongoing assessments during the training sessions. Therefore, it is mandatory to understand the reliability and validity of such measurements when used in a clinical setting [13]. We consent, therefore, started using non-robotic Armeo ® equipment in our rehabilitation center.…”

Feasibility of an Exoskeleton‐Based Interactive Video Game System for Upper Extremity Burn Contractures

“…Also, positioning of the subject in the device is a potential reliability limitation. Previous work with the same device in a nonburn population demonstrated reliable tracking of movements with different seating positions [17]; this issue was mitigated by use of a consistent positioning protocol consistent with manufacturer recommendations. Lastly, this feasibility study did not include detailed information of the burn injury (ie, time since burn, duration of hospital stay, location, type, and number of surgeries) as this was considered outside the scope of the study design; future studies of efficacy should consider including additional burn related data.…”

“…The system is an adjustable arm orthosis with demonstrated feasibility in the stroke [14], spinal cord injury [15], and multiple sclerosis [16] populations. Previous research has demonstrated reliability of the system in a nonburn population [17]. When using the system, one's upper extremity is fit onto the device with Velcro straps at the forearm and upper arm ( Figure 1).…”