A single-subject study of robotic upper limb training in the subacute phase for four persons with cervical spinal cord injury

STUDY DESIGN: Single-subject design, standard training (“B”) compared with Robotic training (“C”). OBJECTIVES: To explore the impact of robotic training on upper limb function, activities of daily living (ADL) and training experience in subacute tetraplegic inpatients. SETTING: Inpatient subacute Norwegian spinal cord injury (SCI) unit. METHODS: Four participants (C4–7, AIS A-C) completed 11 sessions of robotic training using a passive robotic exoskeleton (Armeo Spring®). Descriptive statistics and visual analyses were used for comparing standard occupational therapy and robotic training. Outcome measures included the Spinal Cord Independence Measure (SCIM-III), the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), and a questionnaire. RESULTS: All of the participants exhibited an increase in assessments of upper limb function (GRASSP-total) right side (0.4%–61.2%), and all except for one participant (−8%) showed an increase on their left side (20.9%–106.2%). Three out of four participants had improvements in ADL function SCIM-III (ranging from 5.6% to 46.7%). Results demonstrated improvements during the robotic intervention period in five out of 28 measurements. The participants enjoyed the exercise, and found it motivating and relevant to their injury (median ranged from 3.5 to 6.5 on a 0–7 scale). CONCLUSIONS: Three out of four participants improved upper limb function and ADL independence, but the study could not confirm that improvements were due to the robotic intervention. The participants enjoyed the robotic training and found it relevant to their injury.