Use of an arm weight-bearing combined with upper-limb reaching apparatus to facilitate motor paralysis recovery in an incomplete spinal cord injury patient: a single case report

Abstract

[Purpose] Training using an arm weight-bearing device combined with upper-limb reaching apparatus to facilitate motor paralysis recovery, named the "Reaching Robot", as well as Repetitive Facilitation Exercise were applied to a patient with severe impairment of the shoulder and elbow due to incomplete spinal cord injury and the effects were examined. [Subjects and Methods] A 66-year-old man with incomplete spinal cord injury participated in an upper extremity rehabilitation program involving a Reaching Robot. The program was comprised of active motor suspension, continuous low amplitude neuromuscular electrical stimulation and functional vibratory stimulation, as well as Repetitive Facilitation Exercise combined with continuous low amplitude neuromuscular electrical stimulation. This protocol used a crossover design following an A₁-B₁-A₂-B₂. "A" consisted of 2 weeks of Repetitive Facilitation Exercise, and "B" consisted of 2 weeks of Reaching Robot training. [Results] Improvements were observed after all sessions. Active range of motion for shoulder flexion improved after 2 weeks of Reaching Robot sessions only. There were no adverse events. [Conclusion] Reaching Robot training for severe paretic upper-extremity after incomplete spinal cord injury was a safe and effective treatment. Reaching Robot training may be useful for rehabilitation of paretic upper-extremity after incomplete spinal cord injury.

Keywords: Incomplete spinal cord injury; Reaching Robot training; Repetitive Facilitation Exercise.

Fig. 2.

Components of the Reaching Robot training system. a. Reaching: (1) start-button, (2) target-button, (3) suspension wire;. b. CNMES device: (1) ITO ESPURGE, (2) electrode pads (50 mm × 50mm);. c. FVS device: 33 mm long × 15 mm wide × 7 mm high).

Fig 3.

Reaching Robot training and motor improvement on SIAS Knee-mouth test a) The patient during Reaching Robot training. b) SIAS Knee-mouth test before treatment. c) SIAS Knee-mouth test after 12 weeks of upper extremity training using Reaching Robot and RFE. SIAS: Stroke Impairment Assessment Set; RFE: Repetitive Facilitation Exercise

Fig 4.

Time course of changes in evaluation scores after sessions A₁, B₁, A₂, B₂. Figure 1 shows improvement in upper extremity function on SIAS, Active ROMs, STEF and MAS. Upper extremity function improved on all outcome measures except MAS of the wrist flexor. Active ROMs for shoulder flexion improved only after B1 and B2. SIAS: Stroke Impairment Assessment Set; Active ROMs: Active range of motion; MAS, Modified Ashworth Scale; STEF: Simple Test for Evaluating Hand Function

Fig. 1.

Experimental procedure during the 12-week study period. Before and after each of the two-week sessions (A₁, B₁, A₂, B₂), motor function, spasticity and the ability to manipulate objects were evaluated by SIAS, Active ROMs, MAS and STEF. RFE: Repetitive Facilitation Exercise; Robot: Reaching Robot training; pre: pretest; SIAS: Stroke Impairment Assessment Set; Active ROMs: Active range of motion; MAS: Modified Ashworth Scale; STEF: Simple Test for Evaluating Hand Function