The need for research

The loss of hand function is considered by SCI individuals as one of the most devastating consequences of their injury.  Many daily living tasks such as feeding, bathing and dressing become difficult without the normal function of the hands.  Intricate movements which may be taken for granted but are required for various object manipulations are impaired with people with tetraplegia.  These impairments of hand function significantly reduce independence making an individual reliant on a caregiver even for the most basic activity of daily living.

SMSR-funded research

Assessment of a robotic exoskeleton for upper limb rehabilitation in people with Spinal Cord Injury (SCI)

Led by the University of Liverpool and involving patients at the Queen Elizabeth National Spinal Injury Unit in Glasgow and the National Spinal Injuries Centre in Stoke Mandeville.

With limited or no hand function, people with tetraplegia can become completely reliant on family and carers for their most basic needs. Research shows, however, that robotic rehabilitation can promote the reorganisation of circuitries in the brain and thus augment upper limb functionality.

This two-year study will test the only portable and commercially available robotic device (‘exoskeleton’) for the first time on people with incomplete tetraplegia. It has already been used successfully for arm rehabilitation by people with stroke and brachial plexus injuries who had reached a plateau with traditional rehabilitation. The team will assess the advantages and limitations of this device using two groups of patients – an intervention group (that will undergo rehabilitation using the exoskeleton in addition to the traditional rehabilitation programme) and a control group that will receive traditional rehabilitation only. If the team finds that this portable device improves upper limb mobility, it will offer patients the opportunity to self-manage at home and ease the burden of SCI.

Update May 2023:  The start of the study was delayed due to COVID restrictions and delays with ethical and regulatory approval, but is now in a position to go ahead. In the background the team have received training on the equipment and made the necessary preparations with partners. Patient recruitment is soon to begin at the three sites - Oswestry, Glasgow and Stoke Mandeville.

PhD project: Using Virtual Reality for Upper Limb Rehabilitation in acute Spinal Cord Injury (SCI)

Led by Glasgow Caledonian University, with inpatients at Queen Elizabeth National Spinal Injuries Unit in Glasgow.

The aim of this exciting three-year project is to explore the role of virtual reality (VR) as a form of assistive technology to improve upper limb function in people with acute/sub-acute tetraplegia following SCI. The most common type of spinal cord injury is incomplete tetraplegia, which results from injury to the vertebrae in the neck, and accounts for almost half of all SCIs.
The lead researcher will apply his experience in serious game design to design, test and evaluate the feasibility of VR games in improving hand and arm function in this patient group. Earlier studies suggest that VR Training can improve motor and aerobic function as well as balance, and reduce pain. Users also found VR training much more motivating and engaging than conventional therapy. However, the number of studies and data is limited, and so far, there have been no studies evaluating its use in the acute phase following SCI, when there is most potential for recovery.

Update May 2023: PhD student Andrew Goodsell has carried out an extensive literature review around the topic, has run 7 focus groups, and begun development of a bespoke suite of VR games. Over the coming months, these will be further developed in collaboration with patients and therapists before being tested in a randomised controlled feasibility study.