Upper Limb Robotic Rehabilitation for Patients with Cervical Spinal Cord Injury: A Comprehensive Review

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.

The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb—Promising Results from a Pilot Study

“…In the present day, as stroke is a socio-economic burden and there are many therapeutic possibilities for dealing with motor impairments and post-stroke disabilities, most current studies focus on developing improved rehabilitation therapies for those stroke survivors. A few studies focus on RAT in multiple sclerosis [ 25 , 26 ] or spinal cord injuries [ 27 , 28 , 29 ]. However, this study, even if small, included patients with upper limb impairments caused by neurological disorders other than stroke.…”

Reference theories and future perspectives on robot-assisted rehabilitation in people with neurological conditions: A scoping review and recommendations from the Italian Consensus Conference on Robotics in Neurorehabilitation (CICERONE)

“…Results from the Consensus has promoted a large exchange of views, fostering all the people involved to share different perspectives and needs. To date, the CICERONE Consensus promoted important evidence on the impact of robotics in stroke (Calabrò, Sorrentino, et al, 2021;Morone, Palomba, et al, 2021), multiple sclerosis (Bowman et al, 2021;, Parkinson's disease (Carmignano et al, 2022;Picelli et al, 2021) and spinal cord injury (Morone, de Sire, et al, 2021). The dissemination of the CICERONE Consensus results is a contribute to national and international perspectives on how to improve functional outcomes of patients living with neurological conditions.…”

Treatment of the Paretic Hand with a Robotic Glove Combined with Physiotherapy in a Patient Suffering from Traumatic Tetraparesis: A Case Report

“…SCIs have the greatest impact on the bio-psycho-social condition of the person. In fact, the loss of neuromotor skills, sensitivity, and vegetative functions cause the loss or decrease in autonomy in performing activities of daily living (ADLs), influencing the autonomy in everyday life in the psychological, socio-economic, and work aspects, as well as the social–health costs related to the pathological condition itself, with a greater degree of disability the greater the lesion [ 1 , 5 , 6 ].…”