Training with a gravity-balanced exoskeleton robot to improve upper limb and daily function in patients with tetraplegia

Objective Patients with tetraplegia experience significant limitations in upper extremity function, restricting the performance of activities of daily living (ADL). Herein, we evaluated the effects of upper extremity training using an exoskeleton robot device, in the form of mobile arm support (MAS), on functional recovery and ADL performance. Design This preliminary study employed a one-group pre-post-test design and used a Wilmington robotic exoskeleton for training. The training comprised six sessions conducted three times per week over a 2-week period. Assessments were conducted using the manual muscle test, range of motion (ROM), upper extremity functional index (UEFI), and efficiency of assistive technology and services (EATS-6D). Twenty participants were enrolled. Results The participants demonstrated significant improvements in muscle strength across shoulder and elbow flexion. Regarding ROM, significant improvements were observed in all areas except for shoulder internal rotation and elbow flexion. The UEFI results indicated no significant differences in the difficulty of performing most tasks. The EATS-6D showed some improvement in task performance difficulty; however, they were not significant. Conclusion A gravity-balanced exoskeleton robot effectively improved the upper extremity muscle strength and ROM in patients with tetraplegia. MAS devices can be utilized to assist in upper extremity function and training in patients with tetraplegia.