Effect of robot-assisted hand therapy on hand functions and quality of life in patients with spinal cord injury: Randomised kontrolled trial

Objective: Improving hand functions in spinal cord injury patients is important to facilitate daily living activities. Robot-assisted therapy is a treatment method consisting of exercises performed with the help of a computer program and a mechanical device. Robot-assisted therapy offers high-intensity, frequently repeated and functional treatment. This study aimed to evaluate the effectiveness of robot-assisted hand therapy on hand functions and quality of life in patients with spinal cord injuries. Materials and Methods: In our study, 41 patients aged 18-65 who applied to Afyonkarahisar Health Sciences University Physical Medicine and Rehabilitation clinic for rehabilitation between 15.11.2021-15.05.2023 and who developed tetraplegia after spinal cord injury were evaluated. Of the 38 patients who met the inclusion criteria, the data of 30 patients who completed the study were examined. Demographic data of the patients were recorded. The patients were randomly divided into two groups: robot-assisted therapy group and conventional therapy group. An exercise program consisting of passive and active assistive joint range of motion exercises, strengthening exercises and task-oriented exercises was applied to the conventional therapy group for 30 minutes for both hands. In addition to this treatment, the robot-assisted hand therapy group received robot-assisted treatment with a hand-finger robot for 30 minutes on each hand, 5 days a week. Continuous passive joint range of motion, active assistive exercises and game programs were used in robotic rehabilitation. Both groups received a total of 30 treatment sessions, 5 days a week for 6 weeks. Evaluation parameters included Sollerman Hand Function Test and Box Block test for dexterity, dynamometer for hand grip strength and finger pinch strength; Functional Independence Scale and Spinal Cord Injury Independence Scale III for activity limitation; SF-36 Quality of Life Scale was used for social participation. Evaluations were made before treatment (T0) and after treatment (T1). SPSS 25.0 program was used in statistical analysis and p value <0.05 was considered significant. Results: Of the 30 patients evaluated; there were 2 women (13.3%) and 13 men (86.7%) in the robot-assisted therapy group, and 1 woman (6.7%) and 14 men (93.3%) in the conventional therapy group (p = 0.543). In both groups, a significant improvement was found in the Upper Extremity Motor Score, Sollerman Hand Function Test, Box and Block Test for the left hand, Spinal Cord Independence Measure-III self-care, mobility and total score, Functional İndependence Measure self-care and total score after treatment (p < 0.05). Additionally, in the robot-assisted hand therapy group, a significant improvement was found in the box and block test for the right hand, grip strength for the left hand, fingertip, lateral and palmar pinch strength for the left hand, fingertip pinch strength for the right hand, Functional İndependence Measure transfer subparameter and SF-36 emotional role limitation after treatment (p<0.05). In the evaluation of hand functions with Sollerman Hand Function Test and Box and Block Test, while the groups were similar at the beginning, higher scores were detected in the robot-assisted hand therapy group compared to the conventional therapy group after the treatment (p<0.05). In the evaluation of activity limitation with the Spinal Cord Injury Independence Scale III, the groups were similar at the beginning, higher scores were detected in the self-care subparameter in the robot-assisted hand therapy group compared to the conventional therapy group after treatment (p<0.05). Conclusion: Robot-assisted hand therapy added to conventional therapy in tetraplegic patients with spinal cord injury improves hand functions and quality of life. Key words: Spinal cord injuries, tetraplegia, hand rehabilitation, robotic rehabilitation, hand functions, quality of life