RiceWrist Robotic Device for Upper Limb Training: Feasibility Study and Case Report of Two Tetraplegic Persons with Spinal Cord Injury

Regaining upper extremity function is the primary concern of persons with tetraplegia caused by spinal cord injury (SCI). Robotic rehabilitation has been inadequately tested and underutilized in rehabilitation of the upper extremity in the SCI population. Given the acceptance of robotic train ing in stroke rehabilitation and SCI gait training, coupled with recent evidence that the spinal cord, like the brain, demonstrates plasticity that can be enhanced by repetitive movement training such as that available with robotic devices, it is probable that robotic upper ext remity train ing of persons with SCI could be clin ically beneficial. The primary goal of th is pilot study was to test the feasibility of using a novel robotic device –the RiceWrist Exoskeletonfor rehabilitation of the upper limbs (UL) of two tetraplegic persons with incomplete SCI. Two pilot experiments were conducted. Experiment 1was the first novel attempt to admin ister treatment with the RiceWrist. The left UL of a tetraplegic subject was treated during seven therapy sessions. The subject’s feedback and the investigator’s observations were used to enhance the robotic device and the corresponding graphical-interface. In Experiment 2, a second tetraplegic subject underwent 10 three-hour train ing sessions admin istered by a physical therapist. Smoothness factor (FS) –a new measure developed in Experiment 1was used as the primary outcome to test the subject’s performance before and after the training. The RiceWrist was modified accord ing to the feedback obtained in Experiment 1. Thereafter, the device was successfully administered for upper limb training of the tetraplegic individual. Noticeable improvements in FS were observed for the stronger arm of the subject who completed 10 sessions of train ing. Improvements were also observed in the subject’s hand according to the Jebsen-Taylor Hand Function Test. Results from this study suggest a potential application of the RiceWrist for rehabilitation of SCI individuals and offer valuable in formation regard ing development of UL robotic devices for this population.