Effects of Technology-Assisted Rehabilitation After Spinal Cord Injury: Pilot Randomized Controlled Crossover Trial.

Background: Technology-assisted and robotic rehabilitation methods are increasingly used in neurorehabilitation. Still, scarce evidence exists on their effects on upper extremity functioning after spinal cord injury, especially at the chronic stage. Objective: The present study aims to evaluate the effects of a 6-week intervention focusing on technology-assisted upper extremity rehabilitation in adults 1-8 years after incomplete cervical spinal cord injury. Methods: In this pilot randomized controlled crossover trial, 20 participants (10 men, 34-73 y of age) were recruited by mail and randomized into 2 sequences (AB: n=10 and BA: n=10). All participants received a 6-week rehabilitation intervention in Period 1 or Period 2, with a 4-week washout period in between. The intervention was delivered 3 times a week for 6 weeks (18 sessions) by occupational therapists specialized in spinal cord injuries. Each 1-hour therapy session included a minimum of 30 minutes of technology-assisted upper extremity rehabilitation using interactive and task-specific AMADEO, DIEGO, or PABLO devices. Other occupational therapy activities were allowed to complete the 1-hour therapy session. The effects of the 6-week rehabilitation intervention were compared with 6 weeks of no intervention, and the analyses were based on paired data. Each participant served as their own control. Hand and arm function were evaluated using the Action Research Arm Test, the American Spinal Injury Association-Upper Extremity Motor Score (ASIA-UEMS), grip strength, pinch strength, and the Spinal Cord Independence Measure-Self Report. Rehabilitation goal attainment was evaluated by the Goal Attainment Scale. Face-to-face assessments were conducted at baseline, after Period 1, after Period 2, and at 6 months, except for the Goal Attainment Scale, which was used at the beginning and immediately after the rehabilitation intervention. Results: The effects of the rehabilitation intervention compared to no intervention were statistically insignificant, except for the ASIA-UEMS (median change 1, IQR 0-2 point versus 0, IQR -2 to 0 point) in participants in sequence BA (n=7) who received the rehabilitation intervention during Period 2 (P=.04). The rehabilitation intervention showed good feasibility and tolerability in adults with incomplete cervical spinal cord injury. Of 20 participants (median age 62, IQR 58-66 y), 19 enrolled in the study, and 17 completed at least 80% of the rehabilitation sessions. Fourteen out of 16 participants included in the final analysis attained their rehabilitation goals. The goals were mainly focusing on "fine hand use" and "hand and arm use" related to self-care and domestic life. Conclusions: Results of this pilot study suggest that technology-assisted upper extremity rehabilitation provided by occupational therapists is safe and has potential for broader clinical use in adults with incomplete cervical spinal cord injury. The rehabilitation intervention showed good feasibility and positive outcomes in rehabilitation goal attainment. This study was left unpowered, and the results need to be confirmed in a larger randomized controlled trial.