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Disability and Rehabilitation: Assistive Technology Volume 13, 2018 - Issue 7
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Review Article

Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review

Hardeep SinghToronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; ;Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; View further author information
,
Janelle UngerToronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; ;Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; View further author information
,
José ZariffaToronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; ;Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; ;Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; ORCID Iconhttp://orcid.org/0000-0002-8842-745XView further author information
ORCID Icon,
Maureen PakoshToronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; View further author information
,
Susan JaglalToronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; ;Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; ;Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; ;Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; View further author information
,
B. Catharine CravenToronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; ;Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; ;Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaView further author information
&
Kristin E. MusselmanToronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; ;Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; ;Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Correspondence[email protected]
ORCID Iconhttp://orcid.org/0000-0001-8336-8211View further author information
ORCID Icon show all
Pages 704-715 | Received 24 Aug 2017, Accepted 05 Jan 2018, Published online: 15 Jan 2018
 
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Abstact

Purpose: To provide an overview of the feasibility and outcomes of robotic-assisted upper extremity training for individuals with cervical spinal cord injury (SCI), and to identify gaps in current research and articulate future research directions.

Materials and methods: A systematic search was conducted using Medline, Embase, PsycINFO, CCTR, CDSR, CINAHL and PubMed on June 7, 2017. Search terms included 3 themes: (1) robotics; (2) SCI; (3) upper extremity. Studies using robots for upper extremity rehabilitation among individuals with cervical SCI were included. Identified articles were independently reviewed by two researchers and compared to pre-specified criteria. Disagreements regarding article inclusion were resolved through discussion. The modified Downs and Black checklist was used to assess article quality. Participant characteristics, study and intervention details, training outcomes, robot features, study limitations and recommendations for future studies were abstracted from included articles.

Results: Twelve articles (one randomized clinical trial, six case series, five case studies) met the inclusion criteria. Five robots were exoskeletons and three were end-effectors. Sample sizes ranged from 1 to 17 subjects. Articles had variable quality, with quality scores ranging from 8 to 20. Studies had a low internal validity primarily from lack of blinding or a control group. Individuals with mild-moderate impairments showed the greatest improvements on body structure/function and performance-level measures. This review is limited by the small number of articles, low-sample sizes and the diversity of devices and their associated training protocols, and outcome measures.

Conclusions: Preliminary evidence suggests robot-assisted interventions are safe, feasible and can reduce active assistance provided by therapists.

    Implications for rehabilitation

  • Robot-assisted upper extremity training for individuals with cervical spinal cord injury is safe, feasible and can reduce hands-on assistance provided by therapists.

  • Future research in robotics rehabilitation with individuals with spinal cord injury is needed to determine the optimal device and training protocol as well as effectiveness.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Craig H. Neilsen Foundation under Grant [440070]; and Ontario Neurotrauma Foundation under Grant [2013-SCI-RECOV2–974] to KEM. SJ is supported by the Toronto Rehabilitation Institute-University Health Network Chair at the University of Toronto.

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