Research Article
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The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals with Spinal Cord Injury

Year 2024, Volume: 8 Issue: 3, 580 - 589, 30.09.2024
https://doi.org/10.30621/jbachs.1407163

Abstract

Purpose: To investigate the effect of assistive robotic technologies on quality of life, functional independence, and perceived fatigue level in individuals with spinal cord injury (SCI).
Material and Methods: This research involved a cohort of 25 patients who had been diagnosed with SCI. To assess their progress, clinical assessments were administered both at the commencement and completion of a six-week robotic rehabilitation treatment regimen. The evaluations encompassed the use of the Spinal Cord Independence Measure (SCIM III) to measure their performance in daily living activities and mobility. Additionally, the quality of life was assessed using the World Health Organization Quality of Life Scale – Short Form (WHOQOL-BREF) scale, while the levels of fatigue experienced during rehabilitation were gauged using the Modified Borg Scale (RPE).
Results: The participants' average age and BMI were 40.72±1.28 kg/m2 and 23.43±0.57 year. Statistically significant differences were found in self-care (p=0.006) and mobility (p=0.004) values of SCIM III scale compared to pretreatment values. WHOQOL-BREF General health status, Physical health, Psychological, Social relations and Environment sub-parameters all showed statistically significant differences compared to pre-treatment values (p<0.001). There was a significant decrease in the RPE value to determine the level of fatigue during exertion in robotic walking training (p<0.001).
Conclusion: Assisted robotic rehabilitation approaches increased individual independence, quality of life and reduced fatigue during exertion in Individuals with SCI. We think that assisted robotic approaches applied in addition to traditional rehabilitation provide additional benefits in increasing the level of independence and quality of life of individuals with SCI in daily life and reducing fatigue during exertion.

Ethical Statement

The study received ethical clearance from the Bakirkoy Dr. Sadi Guest Training And Research Hospital Clinical Research Ethics Committee as specified in the authorization decision dated 19.06.2017 and reference number 2017-06-24.

Supporting Institution

none

References

  • Fang CY, Tsai JL, Li GS, Lien AS, Chang YJ. Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis. Biomed Res Int 2020;2020:2102785.
  • Tamburella F, Lorusso M, Tramontano M, Fadlun S, Masciullo M, Scivoletto G. Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review. Journal of NeuroEngineering and Rehabilitation 2022;19(1):27.
  • Boakye M, Leigh BC, Skelly AC. Quality of life in persons with spinal cord injury: comparisons with other populations. J Neurosurg Spine 2012;17(1 Suppl):29-37.
  • Trgovcevic S, Milicevic M, Nedovic G, Jovanic G. Health Condition and Quality of Life in Persons with Spinal Cord Injury. Iran J Public Health 2014;43(9):1229-38.
  • van Leeuwen CM, Post MW, van der Woude LH, de Groot S, Smit C, van Kuppevelt D, et al. Changes in life satisfaction in persons with spinal cord injury during and after inpatient rehabilitation: adaptation or measurement bias? Qual Life Res 2012;21(9):1499-508.
  • Pirrera A, Meli P, De Dominicis A, Lepri A, Giansanti D. Assistive Technologies and Quadriplegia: A Map Point on the Development and Spread of the Tongue Barbell Piercing. Healthcare (Basel) 2022;11(1).
  • Clark WE, Sivan M, O’Connor RJ. Evaluating the use of robotic and virtual reality rehabilitation technologies to improve function in stroke survivors: A narrative review. Journal of Rehabilitation and Assistive Technologies Engineering. 2019;6:2055668319863557.
  • Palermo AE, Maher JL, Baunsgaard CB, Nash MS. Clinician-Focused Overview of Bionic Exoskeleton Use After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2017;23(3):234-44.
  • Lajeunesse V, Vincent C, Routhier F, Careau E, Michaud F. Exoskeletons' design and usefulness evidence according to a systematic review of lower limb exoskeletons used for functional mobility by people with spinal cord injury. Disability and Rehabilitation: Assistive Technology 2016;11(7):535-47.
  • Athanasiou A, Klados MA, Pandria N, Foroglou N, Kavazidi KR, Polyzoidis K, et al. A Systematic Review of Investigations into Functional Brain Connectivity Following Spinal Cord Injury. Frontiers in Human Neuroscience 2017;11.
  • Vibhuti n, Kumar N, Kataria C. Efficacy assessment of virtual reality therapy for neuromotor rehabilitation in home environment: a systematic review. Disability and Rehabilitation: Assistive Technology 2023;18(7):1200-20.
  • Dobkin BH. Spinal and supraspinal plasticity after incomplete spinal cord injury: correlations between functional magnetic resonance imaging and engaged locomotor networks. Prog Brain Res 2000;128:99-111.
  • Winchester P, McColl R, Querry R, Foreman N, Mosby J, Tansey K, et al. Changes in Supraspinal Activation Patterns following Robotic Locomotor Therapy in Motor-Incomplete Spinal Cord Injury. Neurorehabilitation and neural repair 2005;19(4):313-24.
  • Nam KY, Kim HJ, Kwon BS, Park J-W, Lee HJ, Yoo A. Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: a systematic review. Journal of NeuroEngineering and Rehabilitation 2017;14(1):24.
  • Maulden S, Gassaway J, Horn S, Smout R, DeJong G. Timing of Initiation of Rehabilitation After Stroke. Archives of physical medicine and rehabilitation. 2006;86:S34-S40.
  • Jezernik S, Colombo G, Keller T, Frueh H, Morari M. Robotic orthosis lokomat: a rehabilitation and research tool. Neuromodulation 2003;6(2):108-15.
  • Catz A, Itzkovich M. Spinal Cord Independence Measure: comprehensive ability rating scale for the spinal cord lesion patient. Journal of rehabilitation research and development 2007;44(1):65-8.
  • Kesiktas N, Paker N, Bugdayci D, Sencan S, Karan A, Muslumanoglu L. Turkish adaptation of Spinal Cord Independence Measure — version III. International Journal of Rehabilitation Research 2012;35(1).
  • Syed SA, Cheema A, Abdullah M, Chaudhry M, Baig ZF. Assessment of Quality of Life in Haemodialysis Patients using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) Questionnaire. Pakistan Armed Forces Medical Journal 2023;73(SUPPL-1):S234-8.
  • Fidaner H, Fidaner C, Elbi H, Eser E, Göker E. Yaşam kalitesinin ölçülmesi, WHOQOL-100 ve WHOQOL-BREF. 3P Dergisi 1999;7:5-13.
  • Borg G. Borg's perceived exertion and pain scales: Human kinetics; 1998.
  • Hwang S, Kim HR, Han ZA, Lee BS, Kim S, Shin H, et al. Improved Gait Speed After Robot-Assisted Gait Training in Patients With Motor Incomplete Spinal Cord Injury: A Preliminary Study. Ann Rehabil Med 2017;41(1):34-41.
  • Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863.
  • Geigle PR, Kallins M. Exoskeleton-assisted walking for people with spinal cord injury. Archives of physical medicine and rehabilitation 2017;98(7):1493-5.
  • Shin JC, Kim JY, Park HK, Kim NY. Effect of Robotic-Assisted Gait Training in Patients With Incomplete Spinal Cord Injury Arm 2014;38(6):719-25.
  • Faulkner J, Martinelli L, Cook K, Stoner L, Ryan-Stewart H, Paine E, et al. Effects of robotic-assisted gait training on the central vascular health of individuals with spinal cord injury: A pilot study. The journal of spinal cord medicine 2021;44(2):299-305.
  • Morone G, Pirrera A, Iannone A, Giansanti D. Development and Use of Assistive Technologies in Spinal Cord Injury: A Narrative Review of Reviews on the Evolution, Opportunities, and Bottlenecks of Their Integration in the Health Domain. Healthcare 2023;11(11):1646.
  • Alashram AR, Annino G, Padua E. Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat. J Clin Neurosci 2021;91:260-9. Benedicto A, Foresti A, Fernandes M, Miri A, Lopes E, Souza R. Functional independence analysis in persons with spinal cord injury. Fisioterapia em Movimento 2022;35.
  • Çinar Ç, Yildirim MA, Öneş K, Gökşenoğlu G. Effect of robotic-assisted gait training on functional status, walking and quality of life in complete spinal cord injury. Int J Rehabil Res 2021;44(3):262-8.
  • Platz T, Gillner A, Borgwaldt N, Kroll S, Roschka S. Device-Training for Individuals with Thoracic and Lumbar Spinal Cord Injury Using a Powered Exoskeleton for Technically Assisted Mobility: Achievements and User Satisfaction. BioMed Research International 2016;2016:8459018.
  • Baunsgaard CB, Nissen UV, Brust AK, Frotzler A, Ribeill C, Kalke YB, et al. Exoskeleton gait training after spinal cord injury: An exploratory study on secondary health conditions. J Rehabil Med 2018;50(9):806-13.
  • Dobkin BH, Busza A. Upper Extremity Robotic-Assisted Rehabilitation: Results Not Yet Robust. Stroke 2023;54(6):1474-6.
  • Mekki M, Delgado AD, Fry A, Putrino D, Huang V. Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review. Neurotherapeutics 2018;15(3):604-17.
  • Hu X, Lu J, Wang Y, Pang R, Liu J, Gou X, et al. Effects of a lower limb walking exoskeleton on quality of life and activities of daily living in patients with complete spinal cord injury: A randomized controlled trial. Technol Health Care 2024;32(1):243-53.
  • Sale P, Russo EF, Russo M, Masiero S, Piccione F, Calabrò RS, et al. Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report. BMC Neurology 2016;16(1):12.
  • Corbianco S, Cavallini G, Dini M, Franzoni F, D’Avino C, Gerini A, et al. Energy cost and psychological impact of robotic-assisted gait training in people with spinal cord injury: effect of two different types of devices. Neurological Sciences 2021;42(8):3357-66.
  • McIntosh K, Charbonneau R, Bensaada Y, Bhatiya U, Ho C. The Safety and Feasibility of Exoskeletal-Assisted Walking in Acute Rehabilitation After Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation 2020;101(1):113-20.
  • Escalona MJ, Brosseau R, Vermette M, Comtois AS, Duclos C, Aubertin-Leheudre M, et al. Cardiorespiratory demand and rate of perceived exertion during overground walking with a robotic exoskeleton in long-term manual wheelchair users with chronic spinal cord injury: A cross-sectional study. Annals of Physical and Rehabilitation Medicine 2018;61(4):215-23.
Year 2024, Volume: 8 Issue: 3, 580 - 589, 30.09.2024
https://doi.org/10.30621/jbachs.1407163

Abstract

References

  • Fang CY, Tsai JL, Li GS, Lien AS, Chang YJ. Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis. Biomed Res Int 2020;2020:2102785.
  • Tamburella F, Lorusso M, Tramontano M, Fadlun S, Masciullo M, Scivoletto G. Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review. Journal of NeuroEngineering and Rehabilitation 2022;19(1):27.
  • Boakye M, Leigh BC, Skelly AC. Quality of life in persons with spinal cord injury: comparisons with other populations. J Neurosurg Spine 2012;17(1 Suppl):29-37.
  • Trgovcevic S, Milicevic M, Nedovic G, Jovanic G. Health Condition and Quality of Life in Persons with Spinal Cord Injury. Iran J Public Health 2014;43(9):1229-38.
  • van Leeuwen CM, Post MW, van der Woude LH, de Groot S, Smit C, van Kuppevelt D, et al. Changes in life satisfaction in persons with spinal cord injury during and after inpatient rehabilitation: adaptation or measurement bias? Qual Life Res 2012;21(9):1499-508.
  • Pirrera A, Meli P, De Dominicis A, Lepri A, Giansanti D. Assistive Technologies and Quadriplegia: A Map Point on the Development and Spread of the Tongue Barbell Piercing. Healthcare (Basel) 2022;11(1).
  • Clark WE, Sivan M, O’Connor RJ. Evaluating the use of robotic and virtual reality rehabilitation technologies to improve function in stroke survivors: A narrative review. Journal of Rehabilitation and Assistive Technologies Engineering. 2019;6:2055668319863557.
  • Palermo AE, Maher JL, Baunsgaard CB, Nash MS. Clinician-Focused Overview of Bionic Exoskeleton Use After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2017;23(3):234-44.
  • Lajeunesse V, Vincent C, Routhier F, Careau E, Michaud F. Exoskeletons' design and usefulness evidence according to a systematic review of lower limb exoskeletons used for functional mobility by people with spinal cord injury. Disability and Rehabilitation: Assistive Technology 2016;11(7):535-47.
  • Athanasiou A, Klados MA, Pandria N, Foroglou N, Kavazidi KR, Polyzoidis K, et al. A Systematic Review of Investigations into Functional Brain Connectivity Following Spinal Cord Injury. Frontiers in Human Neuroscience 2017;11.
  • Vibhuti n, Kumar N, Kataria C. Efficacy assessment of virtual reality therapy for neuromotor rehabilitation in home environment: a systematic review. Disability and Rehabilitation: Assistive Technology 2023;18(7):1200-20.
  • Dobkin BH. Spinal and supraspinal plasticity after incomplete spinal cord injury: correlations between functional magnetic resonance imaging and engaged locomotor networks. Prog Brain Res 2000;128:99-111.
  • Winchester P, McColl R, Querry R, Foreman N, Mosby J, Tansey K, et al. Changes in Supraspinal Activation Patterns following Robotic Locomotor Therapy in Motor-Incomplete Spinal Cord Injury. Neurorehabilitation and neural repair 2005;19(4):313-24.
  • Nam KY, Kim HJ, Kwon BS, Park J-W, Lee HJ, Yoo A. Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: a systematic review. Journal of NeuroEngineering and Rehabilitation 2017;14(1):24.
  • Maulden S, Gassaway J, Horn S, Smout R, DeJong G. Timing of Initiation of Rehabilitation After Stroke. Archives of physical medicine and rehabilitation. 2006;86:S34-S40.
  • Jezernik S, Colombo G, Keller T, Frueh H, Morari M. Robotic orthosis lokomat: a rehabilitation and research tool. Neuromodulation 2003;6(2):108-15.
  • Catz A, Itzkovich M. Spinal Cord Independence Measure: comprehensive ability rating scale for the spinal cord lesion patient. Journal of rehabilitation research and development 2007;44(1):65-8.
  • Kesiktas N, Paker N, Bugdayci D, Sencan S, Karan A, Muslumanoglu L. Turkish adaptation of Spinal Cord Independence Measure — version III. International Journal of Rehabilitation Research 2012;35(1).
  • Syed SA, Cheema A, Abdullah M, Chaudhry M, Baig ZF. Assessment of Quality of Life in Haemodialysis Patients using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) Questionnaire. Pakistan Armed Forces Medical Journal 2023;73(SUPPL-1):S234-8.
  • Fidaner H, Fidaner C, Elbi H, Eser E, Göker E. Yaşam kalitesinin ölçülmesi, WHOQOL-100 ve WHOQOL-BREF. 3P Dergisi 1999;7:5-13.
  • Borg G. Borg's perceived exertion and pain scales: Human kinetics; 1998.
  • Hwang S, Kim HR, Han ZA, Lee BS, Kim S, Shin H, et al. Improved Gait Speed After Robot-Assisted Gait Training in Patients With Motor Incomplete Spinal Cord Injury: A Preliminary Study. Ann Rehabil Med 2017;41(1):34-41.
  • Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863.
  • Geigle PR, Kallins M. Exoskeleton-assisted walking for people with spinal cord injury. Archives of physical medicine and rehabilitation 2017;98(7):1493-5.
  • Shin JC, Kim JY, Park HK, Kim NY. Effect of Robotic-Assisted Gait Training in Patients With Incomplete Spinal Cord Injury Arm 2014;38(6):719-25.
  • Faulkner J, Martinelli L, Cook K, Stoner L, Ryan-Stewart H, Paine E, et al. Effects of robotic-assisted gait training on the central vascular health of individuals with spinal cord injury: A pilot study. The journal of spinal cord medicine 2021;44(2):299-305.
  • Morone G, Pirrera A, Iannone A, Giansanti D. Development and Use of Assistive Technologies in Spinal Cord Injury: A Narrative Review of Reviews on the Evolution, Opportunities, and Bottlenecks of Their Integration in the Health Domain. Healthcare 2023;11(11):1646.
  • Alashram AR, Annino G, Padua E. Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat. J Clin Neurosci 2021;91:260-9. Benedicto A, Foresti A, Fernandes M, Miri A, Lopes E, Souza R. Functional independence analysis in persons with spinal cord injury. Fisioterapia em Movimento 2022;35.
  • Çinar Ç, Yildirim MA, Öneş K, Gökşenoğlu G. Effect of robotic-assisted gait training on functional status, walking and quality of life in complete spinal cord injury. Int J Rehabil Res 2021;44(3):262-8.
  • Platz T, Gillner A, Borgwaldt N, Kroll S, Roschka S. Device-Training for Individuals with Thoracic and Lumbar Spinal Cord Injury Using a Powered Exoskeleton for Technically Assisted Mobility: Achievements and User Satisfaction. BioMed Research International 2016;2016:8459018.
  • Baunsgaard CB, Nissen UV, Brust AK, Frotzler A, Ribeill C, Kalke YB, et al. Exoskeleton gait training after spinal cord injury: An exploratory study on secondary health conditions. J Rehabil Med 2018;50(9):806-13.
  • Dobkin BH, Busza A. Upper Extremity Robotic-Assisted Rehabilitation: Results Not Yet Robust. Stroke 2023;54(6):1474-6.
  • Mekki M, Delgado AD, Fry A, Putrino D, Huang V. Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review. Neurotherapeutics 2018;15(3):604-17.
  • Hu X, Lu J, Wang Y, Pang R, Liu J, Gou X, et al. Effects of a lower limb walking exoskeleton on quality of life and activities of daily living in patients with complete spinal cord injury: A randomized controlled trial. Technol Health Care 2024;32(1):243-53.
  • Sale P, Russo EF, Russo M, Masiero S, Piccione F, Calabrò RS, et al. Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report. BMC Neurology 2016;16(1):12.
  • Corbianco S, Cavallini G, Dini M, Franzoni F, D’Avino C, Gerini A, et al. Energy cost and psychological impact of robotic-assisted gait training in people with spinal cord injury: effect of two different types of devices. Neurological Sciences 2021;42(8):3357-66.
  • McIntosh K, Charbonneau R, Bensaada Y, Bhatiya U, Ho C. The Safety and Feasibility of Exoskeletal-Assisted Walking in Acute Rehabilitation After Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation 2020;101(1):113-20.
  • Escalona MJ, Brosseau R, Vermette M, Comtois AS, Duclos C, Aubertin-Leheudre M, et al. Cardiorespiratory demand and rate of perceived exertion during overground walking with a robotic exoskeleton in long-term manual wheelchair users with chronic spinal cord injury: A cross-sectional study. Annals of Physical and Rehabilitation Medicine 2018;61(4):215-23.
There are 38 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Research Article
Authors

Abdurrahim Yıldız 0000-0002-6049-0705

Rüstem Mustafaoğlu 0000-0001-7030-0787

Nur Kesiktaş 0000-0002-3937-9973

Publication Date September 30, 2024
Submission Date December 19, 2023
Acceptance Date July 3, 2024
Published in Issue Year 2024 Volume: 8 Issue: 3

Cite

APA Yıldız, A., Mustafaoğlu, R., & Kesiktaş, N. (2024). The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals with Spinal Cord Injury. Journal of Basic and Clinical Health Sciences, 8(3), 580-589. https://doi.org/10.30621/jbachs.1407163
AMA Yıldız A, Mustafaoğlu R, Kesiktaş N. The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals with Spinal Cord Injury. JBACHS. September 2024;8(3):580-589. doi:10.30621/jbachs.1407163
Chicago Yıldız, Abdurrahim, Rüstem Mustafaoğlu, and Nur Kesiktaş. “The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals With Spinal Cord Injury”. Journal of Basic and Clinical Health Sciences 8, no. 3 (September 2024): 580-89. https://doi.org/10.30621/jbachs.1407163.
EndNote Yıldız A, Mustafaoğlu R, Kesiktaş N (September 1, 2024) The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals with Spinal Cord Injury. Journal of Basic and Clinical Health Sciences 8 3 580–589.
IEEE A. Yıldız, R. Mustafaoğlu, and N. Kesiktaş, “The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals with Spinal Cord Injury”, JBACHS, vol. 8, no. 3, pp. 580–589, 2024, doi: 10.30621/jbachs.1407163.
ISNAD Yıldız, Abdurrahim et al. “The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals With Spinal Cord Injury”. Journal of Basic and Clinical Health Sciences 8/3 (September 2024), 580-589. https://doi.org/10.30621/jbachs.1407163.
JAMA Yıldız A, Mustafaoğlu R, Kesiktaş N. The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals with Spinal Cord Injury. JBACHS. 2024;8:580–589.
MLA Yıldız, Abdurrahim et al. “The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals With Spinal Cord Injury”. Journal of Basic and Clinical Health Sciences, vol. 8, no. 3, 2024, pp. 580-9, doi:10.30621/jbachs.1407163.
Vancouver Yıldız A, Mustafaoğlu R, Kesiktaş N. The Effect of Assistive Robotic Technologies on Quality of Life and Functional Independence in Individuals with Spinal Cord Injury. JBACHS. 2024;8(3):580-9.