Article

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.

Langue : ANGLAIS