Improved motor performance in chronic spinal cord injury following upper-limb robotic training

被引:39
作者
Cortes, Mar [1 ,2 ,9 ,10 ]
Elder, Jessica [1 ,3 ]
Rykman, Avrielle [1 ]
Murray, Lynda [1 ]
Avedissian, Manuel [1 ]
Stampa, Argyrios [4 ]
Thickbroom, Gary W. [5 ]
Pascual-Leone, Alvaro [6 ,7 ]
Krebs, Hermano Igo [8 ]
Valls-Sole, Josep [9 ,10 ]
Edwards, Dylan J. [1 ,2 ,5 ,6 ]
机构
[1] Cornell Univ, Coll Med, Burke Med Res Inst, Noninvas Brain Stimulat & Human Motor Control Lab, White Plains, NY 10605 USA
[2] Cornell Univ, Neurol & Neurosci Dept, Ithaca, NY 14853 USA
[3] Cornell Univ, Biostat & Epidemiol Dept, Ithaca, NY 14853 USA
[4] Burke Rehabil Hosp, White Plains, NY USA
[5] Univ Western Australia, Ctr Neuromuscular & Neurol Disorders, Nedlands, WA 6009, Australia
[6] Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Berenson Allen Ctr Noninvas Brain Stimulat, Boston, MA 02215 USA
[7] Univ Autonoma Barcelona, Guttmann Univ Inst Neurorehabil, E-08193 Barcelona, Spain
[8] MIT, Newman Lab Biomech & Human Rehabil, Cambridge, MA 02139 USA
[9] Univ Barcelona, Hosp Clin, Dept Neurol, EMG, Barcelona, Spain
[10] Univ Barcelona, Hosp Clin, Dept Neurol, Motor Control Unit, Barcelona, Spain
关键词
Spinal cord injury; transcranial magnetic stimulation; robotic training; kinematics; INDIVIDUALS; REHABILITATION; PLASTICITY;
D O I
10.3233/NRE-130928
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: 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 radians, post 1.03 +/- 0.08 radians, 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.
引用
收藏
页码:57 / 65
页数:9
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