Evaluation of feasibility and clinical utility of computer assisted robotic devices for upper limb therapy for patients with cervical level spinal cord injuries

Brief name: Use of Tyromotion Diego robotics Participants are consenting patients with a cervical level spinal cord injury who have been cleared by their consultant for the study, in acute care. Delivery of the protocol will be done by two occupational therapists and two researchers who have all been trained in the use of the Tyromotion Diego equipment. Procedure: 1. All patients with SCI are reviewed by OT when first admitted to the ward. At this stage, the OT will assess each patient to determine eligibility. If eligible, written consent for patient to participate to be provided by patient’s spinal rehabilitation consultant. 2. If eligible, the purpose and methodology of the trial will be discussed with the patient. The patient will then be provided with a participant information statement. Patient to provide informed written consent. 3. Patient assessed using the following assessments: - Canadian Occupational Performance Measure (COPM) - Spinal Cord Independence Measure (SCIM) - manual muscle testing of upper limb - goniometer range of motion (ROM) testing of upper limb - spasticity testing (Modified Ashworth Scale) - visual analogue pain scale - visual analogue fatigue scale - proprioception assessment - Tyromotion assessment of muscle strength and ROM. This will take approximately 2 x 1 hour sessions. 4. The Tyromotion Diego is a bi-lateral sling to support both upper limbs. Patients are seated in their wheelchairs and their arms are strapped in to the slings, and the robotics function removes gravity and allows assisted movement of the upper limbs in a number of directions. The Diego also records accurate ranges of motion at the shoulder and elbow, and the robotics function can be adjusted to provide less assistance as the patient progresses. 5. For the following 4.25 weeks, patient will have upper limb standard therapy and Tyromotion upper limb therapy timetabled. A diary will be kept with patient’s attendance noted, as well as activities participated in, exercises/games completed, functional tasks completed, number of repetitions and resistance settings/assistance provided. Standard upper limb therapy sessions will be scheduled for maximum 2 x 1 hour sessions per week (or up to patient’s tolerance). Sessions will be based on the patient’s functional goals and will be split with 30 minutes of upper limb exercises and 30 minutes application to functional tasks. - Tyromotion upper limb sessions will be scheduled for 3 x 1 hour sessions per week (1 hour per day in the AM). This will include 10 min set-up, 30 min of exercises with patient facing the computer screen. Games selected will be impairment oriented and games chosen specifically based on pathology. The patient will commence at the easiest level to allow the patient to master the game, then as the patient succeeds at each level, graded upwards in challenge. Exercises will focus on bilateral shoulder/elbow work. Time spent on each game will be recorded. The patient will then engage in 20 minutes of exercises facing away from Diego. This will include a function feeding/reach task which is bilateral task oriented. Time taken to complete tasks will be noted. Exercises will be selected based on the patient’s functional goals. The intervention will be delivered by an occupational therapist with experience in spinal cord injury management, face to face.