{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:19:49Z","timestamp":1790871589028,"version":"4.1.0"},"reference-count":54,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Rehabil Assist Technol"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Technology-assisted and robotic rehabilitation methods are increasingly used in neurorehabilitation. Still, scarce evidence exists on their effects on upper extremity functioning after spinal cord injury, especially at the chronic stage.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The present study aims to evaluate the effects of a 6-week intervention focusing on technology-assisted upper extremity rehabilitation in adults 1-8 years after incomplete cervical spinal cord injury.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this pilot randomized controlled crossover trial, 20 participants (10 men, 34\u201073 y of age) were recruited by mail and randomized into 2 sequences (AB: n=10 and BA: n=10). All participants received a 6-week rehabilitation intervention in Period 1 or Period 2, with a 4-week washout period in between. The intervention was delivered 3 times a week for 6 weeks (18 sessions) by occupational therapists specialized in spinal cord injuries. Each 1-hour therapy session included a minimum of 30 minutes of technology-assisted upper extremity rehabilitation using interactive and task-specific AMADEO, DIEGO, or PABLO devices. Other occupational therapy activities were allowed to complete the 1-hour therapy session. The effects of the 6-week rehabilitation intervention were compared with 6 weeks of no intervention, and the analyses were based on paired data. Each participant served as their own control. Hand and arm function were evaluated using the Action Research Arm Test, the American Spinal Injury Association\u2013Upper Extremity Motor Score (ASIA-UEMS), grip strength, pinch strength, and the Spinal Cord Independence Measure\u2013Self Report. Rehabilitation goal attainment was evaluated by the Goal Attainment Scale. Face-to-face assessments were conducted at baseline, after Period 1, after Period 2, and at 6 months, except for the Goal Attainment Scale, which was used at the beginning and immediately after the rehabilitation intervention.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The effects of the rehabilitation intervention compared to no intervention were statistically insignificant, except for the ASIA-UEMS (median change 1, IQR 0\u20102 point versus 0, IQR \u22122 to 0 point) in participants in sequence BA (n=7) who received the rehabilitation intervention during Period 2 (\n P<\/jats:italic>\n =.04). The rehabilitation intervention showed good feasibility and tolerability in adults with incomplete cervical spinal cord injury. Of 20 participants (median age 62, IQR 58\u201066 y), 19 enrolled in the study, and 17 completed at least 80% of the rehabilitation sessions. Fourteen out of 16 participants included in the final analysis attained their rehabilitation goals. The goals were mainly focusing on \u201cfine hand use\u201d and \u201chand and arm use\u201d related to self-care and domestic life.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Results of this pilot study suggest that technology-assisted upper extremity rehabilitation provided by occupational therapists is safe and has potential for broader clinical use in adults with incomplete cervical spinal cord injury. The rehabilitation intervention showed good feasibility and positive outcomes in rehabilitation goal attainment. This study was left unpowered, and the results need to be confirmed in a larger randomized controlled trial.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/78091","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T15:00:08Z","timestamp":1756220408000},"page":"e78091-e78091","source":"Crossref","is-referenced-by-count":4,"title":["Effects of Technology-Assisted Rehabilitation After Spinal Cord Injury: Pilot Randomized Controlled Crossover Trial"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6900-5270","authenticated-orcid":false,"given":"Mia Maria","family":"Kilkki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9043-6550","authenticated-orcid":false,"given":"Joonas","family":"Poutanen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8854-208X","authenticated-orcid":false,"given":"Kari","family":"Kauranen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7023-2235","authenticated-orcid":false,"given":"Jari","family":"Arokoski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7069-6643","authenticated-orcid":false,"given":"Sinikka","family":"Hiekkala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"issue":"21","key":"R1","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.1097\/BRS.0000000000004417","article-title":"Spinal cord injury: the global incidence, prevalence, and disability from the global burden of disease study 2019","volume":"47","author":"Ding","journal-title":"Spine (Phila Pa 1986)"},{"key":"R2","volume":"37","author":"Koskinen","journal-title":"Suomen L\u00e4\u00e4k\u00e4rilehti"},{"key":"R3","unstructured":"Bickenbach J Officer A Shakespeare T von Groote P . International perspectives on spinal cord injury. World Health Organization. 2013. URL: https:\/\/www.who.int\/publications\/i\/item\/international-perspectives-on-spinal-cord-injury [Accessed 17-09-2025]"},{"issue":"10","key":"R4","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1089\/neu.2004.21.1371","article-title":"Targeting recovery: priorities of the spinal cord-injured population","volume":"21","author":"Anderson","journal-title":"J Neurotrauma"},{"issue":"21","key":"R5","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1089\/neu.2016.4423","article-title":"Functional priorities in persons with spinal cord injury: using discrete choice experiments to determine preferences","volume":"33","author":"Lo","journal-title":"J Neurotrauma"},{"issue":"9","key":"R6","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1038\/sj.sc.3101638","article-title":"Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics","volume":"42","author":"Snoek","journal-title":"Spinal Cord"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-018-0383-x","article-title":"Rehabilitation robots for the treatment of sensorimotor deficits: a neurophysiological perspective","volume":"15","author":"Gassert","journal-title":"J Neuroeng Rehabil"},{"issue":"9 Suppl 2","key":"R8","doi-asserted-by":"publisher","first-page":"S189","DOI":"10.1016\/j.pmrj.2018.07.011","article-title":"Robotic and sensor technology for upper limb rehabilitation","volume":"10","author":"Jakob","journal-title":"PM R"},{"issue":"3","key":"R9","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1007\/s13311-018-0642-3","article-title":"Robotic rehabilitation and spinal cord injury: a narrative review","volume":"15","author":"Mekki","journal-title":"Neurotherapeutics"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.jht.2015.11.006","article-title":"Robot training for hand motor recovery in subacute stroke patients: a randomized controlled trial","volume":"29","author":"Orihuela-Espina","journal-title":"J Hand Ther"},{"issue":"7","key":"R11","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1080\/17483107.2018.1425747","article-title":"Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review","volume":"13","author":"Singh","journal-title":"Disabil Rehabil Assist Technol"},{"issue":"8","key":"R12","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1177\/0269215511431473","article-title":"Individual finger synchronized robot-assisted hand rehabilitation in subacute to chronic stroke: a prospective randomized clinical trial of efficacy","volume":"26","author":"Hwang","journal-title":"Clin Rehabil"},{"issue":"10 Suppl 1","key":"R13","doi-asserted-by":"publisher","first-page":"S171","DOI":"10.1097\/PHM.0000000000000815","article-title":"Robot-assisted training of arm and hand movement shows functional improvements for incomplete cervical spinal cord injury","volume":"96","author":"Francisco","journal-title":"Am J Phys Med Rehabil"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/0269215514536411","article-title":"Effects of training on upper limb function after cervical spinal cord injury: a systematic review","volume":"29","author":"Lu","journal-title":"Clin Rehabil"},{"issue":"12","key":"R15","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11121630","article-title":"Upper limb robotic rehabilitation for patients with cervical spinal cord injury: a comprehensive review","volume":"11","author":"Morone","journal-title":"Brain Sci"},{"issue":"2","key":"R16","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.pmr.2018.12.008","article-title":"Robot-assisted therapy for the upper limb after cervical spinal cord injury","volume":"30","author":"Yozbatiran","journal-title":"Phys Med Rehabil Clin N Am"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1038\/s41393-018-0190-z","article-title":"Clinical efficacy of upper limb robotic therapy in people with tetraplegia: a pilot randomized controlled trial","volume":"57","author":"Kim","journal-title":"Spinal Cord"},{"issue":"10","key":"R18","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19106321","article-title":"The impact of robotic therapy on the self-perception of upper limb function in cervical spinal cord injury: a pilot randomized controlled trial","volume":"19","author":"Lozano-Berrio","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"R19","doi-asserted-by":"publisher","first-page":"445","DOI":"10.5535\/arm.2019.43.4.445","article-title":"Effects of combined upper limb robotic therapy in patients with tetraplegic spinal cord injury","volume":"43","author":"Jung","journal-title":"Ann Rehabil Med"},{"issue":"3","key":"R20","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1038\/sc.2011.104","article-title":"Feasibility and efficacy of upper limb robotic rehabilitation in a subacute cervical spinal cord injury population","volume":"50","author":"Zariffa","journal-title":"Spinal Cord"},{"issue":"26","key":"R21","doi-asserted-by":"publisher","DOI":"10.3389\/fnbot.2017.00026","article-title":"Effects of assist-as-needed upper extremity robotic therapy after incomplete spinal cord injury: a parallel-group controlled trial","volume":"11","author":"Frullo","journal-title":"Front Neurorobot"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.2196\/44484","article-title":"Technology-assisted cognitive motor dual-task rehabilitation in chronic age-related conditions: systematic review","volume":"25","author":"Tuena","journal-title":"J Med Internet Res"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.2196\/57227","article-title":"A participatory model for cocreating accessible rehabilitation technology for stroke survivors: user-centered design approach","volume":"11","author":"Kerr","journal-title":"JMIR Rehabil Assist Technol"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.2196\/46619","article-title":"An intensive exercise program using a technology-enriched rehabilitation gym for the recovery of function in people with chronic stroke: usability study","volume":"10","author":"Kerr","journal-title":"JMIR Rehabil Assist Technol"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.2196\/45993","article-title":"Examining usability, acceptability, and adoption of a self-directed, technology-based intervention for upper limb rehabilitation after stroke: cohort study","volume":"10","author":"Broderick","journal-title":"JMIR Rehabil Assist Technol"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.2196\/54095","article-title":"Advances in the application of AI robots in critical care: scoping review","volume":"26","author":"Li","journal-title":"J Med Internet Res"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4378","article-title":"CONSORT 2010 statement: extension to randomised crossover trials","volume":"366","author":"Dwan","journal-title":"BMJ"},{"issue":"4","key":"R28","doi-asserted-by":"publisher","first-page":"293","DOI":"10.4097\/kja.21165","article-title":"Considerations for crossover design in clinical study","volume":"74","author":"Lim","journal-title":"Korean J Anesthesiol"},{"issue":"6","key":"R29","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1179\/107902611X13186000420242","article-title":"Reference for the 2011 revision of the international standards for neurological classification of spinal cord injury","volume":"34","author":"Kirshblum","journal-title":"J Spinal Cord Med"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1177\/1545968307305353","article-title":"A standardized approach to performing the action research arm test","volume":"22","author":"Yozbatiran","journal-title":"Neurorehabil Neural Repair"},{"issue":"4","key":"R31","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1097\/00004356-198112000-00001","article-title":"A performance test for assessment of upper limb function in physical rehabilitation treatment and research","volume":"4","author":"Lyle","journal-title":"Int J Rehabil Res"},{"issue":"6","key":"R32","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1080\/16501970600803252","article-title":"Validation of the action research arm test using item response theory in patients after stroke","volume":"38","author":"Koh","journal-title":"J Rehabil Med"},{"issue":"3","key":"R33","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1080\/165019701750165916","article-title":"The responsiveness of the action research arm test and the Fugl-Meyer assessment scale in chronic stroke patients","volume":"33","author":"van der Lee","journal-title":"J Rehabil Med"},{"issue":"11","key":"R34","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1038\/sj.sc.3101067","article-title":"Inter-rater reliability of the 1992 international standards for neurological and functional classification of incomplete spinal cord injury","volume":"38","author":"Jonsson","journal-title":"Spinal Cord"},{"key":"R35","unstructured":"International Standards for Neurological Classification of SCI (ISNCSCI) worksheet. The American Spinal Injury Association. 2019. URL: https:\/\/asia-spinalinjury.org\/international-standards-neurological-classification-sci-isncsci-worksheet [Accessed 25-09-2025]"},{"issue":"4","key":"R36","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1016\/j.jht.2015.04.004","article-title":"Reliability of maximal grip strength measurements and grip strength recovery following a stroke","volume":"28","author":"Bertrand","journal-title":"J Hand Ther"},{"issue":"12","key":"R37","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1038\/sj.sc.3100504","article-title":"SCIM--spinal cord independence measure: a new disability scale for patients with spinal cord lesions","volume":"35","author":"Catz","journal-title":"Spinal Cord"},{"issue":"1-21","key":"R38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10790268.2025.2477364","article-title":"Patient-reported outcome measures for assessing functioning, disability, and health of people with spinal cord injury\u2014a scoping review","volume":"5","author":"Nuuttila","journal-title":"J Spinal Cord Med"},{"issue":"1","key":"R39","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1038\/sc.2012.87","article-title":"Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III)","volume":"51","author":"Fekete","journal-title":"Spinal Cord"},{"issue":"5","key":"R40","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-2839","article-title":"Sound psychometric properties of the Swedish version of the Spinal Cord Independence Measure Self-Report","volume":"53","author":"J\u00f6rgensen","journal-title":"J Rehabil Med"},{"issue":"9","key":"R41","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1177\/0269215506070793","article-title":"Goal setting as an outcome measure: a systematic review","volume":"20","author":"Hurn","journal-title":"Clin Rehabil"},{"issue":"3","key":"R42","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.rehab.2013.02.002","article-title":"Goal attainment scaling in rehabilitation: a literature-based update","volume":"56","author":"Krasny-Pacini","journal-title":"Ann Phys Rehabil Med"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.2340\/jrm.v55.6498","article-title":"Goal attainment scaling in rehabilitation: an educational review providing a comprehensive didactical tool box for implementing goal attainment scaling","volume":"55","author":"Bard-Pondarr\u00e9","journal-title":"J Rehabil Med"},{"issue":"1","key":"R44","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.apmr.2015.08.424","article-title":"Proposed criteria for appraising goal attainment scales used as outcome measures in rehabilitation research","volume":"97","author":"Krasny-Pacini","journal-title":"Arch Phys Med Rehabil"},{"issue":"2","key":"R45","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1136\/ejhpharm-2019-002040","article-title":"Goal attainment scaling to facilitate person-centred, medicines-related consultations","volume":"28","author":"Clarkson","journal-title":"Eur J Hosp Pharm"},{"issue":"6","key":"R46","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1007\/BF01530764","article-title":"Goal attainment scaling: a general method for evaluating comprehensive community mental health programs","volume":"4","author":"Kiresuk","journal-title":"Community Ment Health J"},{"key":"R47","unstructured":"Kiresuk TJ Smith A Cardillo J . Goal Attainment Scaling: Applications, Theory, and Measurement. Lawrence Erlbaum Associates, Inc; 1994."},{"issue":"4","key":"R48","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1177\/0269215508101742","article-title":"Goal attainment scaling (GAS) in rehabilitation: a practical guide","volume":"23","author":"Turner-Stokes","journal-title":"Clin Rehabil"},{"issue":"5","key":"R49","doi-asserted-by":"publisher","first-page":"574","DOI":"10.3109\/09638288.2016.1145258","article-title":"Refinements of the ICF linking rules to strengthen their potential for establishing comparability of health information","volume":"41","author":"Cieza","journal-title":"Disabil Rehabil"},{"key":"R50","unstructured":"ICF: International Classification of Functioning, Disability and Health. World Health Organization; 2001:299. ISBN: 9241545429"},{"issue":"29","key":"R51","doi-asserted-by":"publisher","DOI":"10.1038\/s41394-019-0170-3","article-title":"A single-subject study of robotic upper limb training in the subacute phase for four persons with cervical spinal cord injury","volume":"5","author":"S\u00f8rensen","journal-title":"Spinal Cord Ser Cases"},{"issue":"1","key":"R52","doi-asserted-by":"publisher","first-page":"57","DOI":"10.3233\/NRE-130928","article-title":"Improved motor performance in chronic spinal cord injury following upper-limb robotic training","volume":"33","author":"Cortes","journal-title":"NeuroRehabilitation"},{"issue":"23","key":"R53","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11233055","article-title":"Technology-assisted upper limb therapy (TAULT): evaluation of clinical practice at a specialised centre for spinal cord injury in Switzerland","volume":"11","author":"Kuchen","journal-title":"Healthcare (Basel)"},{"issue":"2","key":"R54","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1080\/10790268.2022.2161867","article-title":"ICF-linking and psychometric properties of upper extremity mobility outcome measures in spinal cord injury\u2014a scoping review","volume":"47","author":"Poutanen","journal-title":"J Spinal Cord Med"}],"container-title":["JMIR Rehabilitation and Assistive Technologies"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/rehab.jmir.org\/2025\/1\/e78091","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:10:34Z","timestamp":1782843034000},"score":1,"resource":{"primary":{"URL":"https:\/\/rehab.jmir.org\/2025\/1\/e78091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,2]]},"references-count":54,"URL":"https:\/\/doi.org\/10.2196\/78091","relation":{},"ISSN":["2369-2529"],"issn-type":[{"value":"2369-2529","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,2]]},"article-number":"v12i21e78091"}}