Feasibility of technology-assisted task-oriented skill training of the upper extremity in persons with a cervical spinal cord injury: a pilot study

Arm hand skilled performance plays a major role in the rehabilitation of
persons with a cervical spinal cord injury (C-SCI). A small improvement may
have major impact on the level of independence and the quality of life. To
improve arm hand skilled performance and taking into account the importance of
client-centred therapy, a task-oriented client centred training module was
developed for C-SCI. Results demonstrate a substantial improvement in arm hand
skilled performance. However, patients report that repetitive training may not
be challenging enough. Technology assisted training, which is known to improve
motivation and to be more challenging for patients might solve this problem.
Additionally, technology supported training offers the opportunity to training
without the help of therapists.

Last year a pilot study was done training persons with stroke to improve arm
hand skilled performance using a Haptic Master. The Haptic Master, enables
persons to train daily activities by *themselves*. The Haptic Master consists
of :1) a computer screen with information, 2) a individual tailored training
program for arm and hand, 3) a robot arm which may help persons to move their
arm.
This project will assess the feasibility of the technology assisted training
using the Haptic Master in persons with C-SCI.

The aim of this project is to assess the feasibility of the technology assisted
training to improve arm hand skilled performance using the Haptic Master in
persons with C-SCI.
Research questions:
Is it feasible to train persons with a C-SCI with a technology supported
program for 6 weeks, aimed at the improvement of arm hand skilled performance?
What is the order of magnitude as to possible short-term effects of such
training on arm hand function and arm hand skilled performance in persons with
a C-SCI?
What is the order of magnitude as to possible long-term effects of such
training on arm hand function and arm hand skilled performance in persons with
a C-SCI?

This feasibility study will be used to set up a randomised clinical trial that
will assess the benefits of technology supported training on arm hand skilled
performance in persons with C-SCI.

This is a prospective study in which it is expected that 6 persons with a
C-SCI, who have finished their rehabilitation longer than 1 year will
participate. The participants will be trained using an Haptic Master aimed at
improving their arm hand skilled performance. A baseline measurement will be
taken before the start of the training, an intermittent measurement after 4
weeks, a measurement directly after finishing the training and a follow-up
measurement at 6 months after finishing the training. The feasibility and the
order of magnitude of improvement on arm hand skilled performance will be
evaluated on the shorter and longer term.

Data analysis:
To answers the different research questions, data of the different measurement
moments will be compared. Data will be analysed descriptively.

Plan of Action:
In the preparatory phase, participants will be recruited and de training
program will be finalised. In the second phase, 6 participants will be measured
and trained. In the 3th phase, data will be analysed and in the last phase the
results will be reported.

The intervention consists of an 6 weeks technology supported task oriented
training to improve arm hand skilled performance, in which there will be
trained 4x a week; 2x 30* a day with 30* rest in between. The training will be
given by an occupational therapist in which the Haptic Master will be used.

The training consists of several movements in various directions performed by
the participant from a sitting position. The burden is 4 times a week for 1. 5
hour per day for a period of 6 weeks. The risks are equivalent to (or even less
than) the risk in normal daily life activities.