Effectiveness of virtual reality and robotic-assisted therapy for upper limb rehabilitation in spinal cord injury: a narrative review
DOI:
https://doi.org/10.69133/aoth.v77i2.539Keywords:
spinal cord injury; virtual reality; robotic rehabilitation; upper limbAbstract
Spinal cord injury is a complex neurological condition that impairs upper limb function and independence in activities of daily living. In recent years, robotic-assisted therapy and virtual reality (VR) have appeared as promising approaches in upper limb rehabilitation. This study presents a condensed narrative review of the current literature on the effectiveness of these technologies on the upper limb rehabilitation in individuals with spinal cord injury.
The findings of this review demonstrate that both robotic and VR interventions may improve motor function, strength, and functional independence in upper limbs. However, results remain inconsistent, with several studies reporting no significant differences between the study groups and suggesting that benefits may not be attributable only to technological interventions.
Overall, while these technologies appear safe and promising, further high-quality studies are required to establish their clinical effectiveness.
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References
1. World Health Organization. Spinal cord injury [Internet]. Geneva: World Health Organization; 2024 [cited 2026 Apr 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury
2. Cieza A. The international spinal cord injury survey and the learning health system for spinal cord injury. Am J Phys Med Rehabil. 2017;96:S1.
3. Bickenbach JE, Officer A. International perspectives on spinal cord injury. Copenhagen: World Health Organization, European Observatory on Health Systems and Policies; 2013.
4. Bennett J, Das JM, Emmady PD. Spinal cord injuries [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2026 Apr 21]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560721/
5. National Institute of Neurological Disorders and Stroke. Spinal cord injury [Internet]. Bethesda (MD): National Institute of Neurological Disorders and Stroke; 2022 [cited 2026 Apr 21]. Available from: https://www.ninds.nih.gov/health-information/disorders/spinal-cord-injury
6. Clark WE, Sivan M, O’Connor RJ. Evaluating the use of robotic and virtual reality rehabilitation technologies to improve function in stroke survivors: a narrative review. J Rehabil Assist Technol Eng. 2019;6:205566831986355.
7. Drigas A, Sideraki A. Brain neuroplasticity leveraging virtual reality and brain–computer interface technologies. Sensors (Basel). 2024;24(17):5725.
8. Nas K. Rehabilitation of spinal cord injuries. World J Orthop. 2015;6(1):8.
9. Maciejasz P, Eschweiler J, Gerlach-Hahn K, Jansen-Troy A, Leonhardt S. A survey on robotic devices for upper limb rehabilitation. J Neuroeng Rehabil. 2014;11(1):3.
10. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):225–39.
11. Lim DY, Hwang DM, Cho KH, Moon CW, Ahn SY. A fully immersive virtual reality method for upper limb rehabilitation in spinal cord injury. Ann Rehabil Med. 2020;44(4):311–9.
12. Prasad S, Aikat R, Labani S, Khanna N. Efficacy of virtual reality in upper limb rehabilitation in patients with spinal cord injury: a pilot randomized controlled trial. Asian Spine J. 2018;12(5):927–34.
13. Dimbwadyo-Terrer I, Trincado-Alonso F, de los Reyes-Guzmán A, Aznar MA, Alcubilla C, Pérez-Nombela S. Upper limb rehabilitation after spinal cord injury: a treatment based on a data glove and an immersive virtual reality environment. Disabil Rehabil Assist Technol. 2015;11(6):462–7.
14. Dimbwadyo-Terrer I, Gil-Agudo A, Segura-Fragoso A, de los Reyes-Guzmán A, Trincado-Alonso F, Piazza S. Effectiveness of the virtual reality system Toyra on upper limb function in people with tetraplegia: a pilot randomized clinical trial. Biomed Res Int. 2016;2016:1–12.
15. Crosbie J, Lennon S, McGoldrick M, McNeill M, McDonough S. Virtual reality in the rehabilitation of the arm after hemiplegic stroke: a randomized controlled pilot study. Clin Rehabil. 2012;26(9):798–806.
16. Gil-Agudo A, Dimbwadyo-Terrer I, Peñasco-Martín B, de los Reyes-Guzmán A, Bernal-Sahún A, Berbel-García A. Experiencia clínica de la aplicación del sistema de realidad TOyRA en la neuro-rehabilitación de pacientes con lesión medular. Rehabilitacion (Madr). 2012;46(1):41–8.
17. Gijbels D, Lamers I, Kerkhofs L, Alders G, Knippenberg E, Feys P. The Armeo Spring as training tool to improve upper limb functionality in multiple sclerosis: a pilot study. J Neuroeng Rehabil. 2011;8(1):39.
18. Biffi E, Maghini C, Cairo B, Beretta E, Peri E, Altomonte D. Movement velocity and fluidity improve after Armeo®Spring rehabilitation in children affected by acquired and congenital brain diseases: an observational study. Biomed Res Int. 2018;2018:1–8.
19. Adomavičienė A, Daunoravičienė K, Kubilius R, Varžaitytė L, Raistenskis J. Influence of new technologies on post-stroke rehabilitation: a comparison of Armeo Spring to the Kinect system. Medicina (Kaunas). 2019;55(4):E98.
20. Gueye T, Dedkova M, Rogalewicz V, Grunerova-Lippertova M, Angerova Y. Early post-stroke rehabilitation for upper limb motor function using virtual reality and exoskeleton: equally efficient in older patients. Neurol Neurochir Pol. 2021;55(1):91–6.
21. Lozano-Berrio V, Alcobendas-Maestro M, Perales-Gómez R, Pérez-Borrego Y, Gil-Agudo A, Polonio-López B. Can robotic therapy improve performance in activities of daily living? A randomized controlled trial in sub-acute spinal cord injured patients. Appl Sci. 2024;14(18):8478.
22. García-Alén L, Kumru H, Castillo-Escario Y, Benito-Penalva J, Medina-Casanovas J, Gerasimenko Y. Transcutaneous cervical spinal cord stimulation combined with robotic exoskeleton rehabilitation for the upper limbs in subjects with cervical SCI: clinical trial. Biomedicines. 2023;11(2):589.
23. Lozano-Berrio V, Alcobendas-Maestro M, Polonio-López B, Gil-Agudo A, de la Peña-González A, de los Reyes-Guzmán A. The impact of robotic therapy on the self-perception of upper limb function in cervical spinal cord injury: a pilot randomized controlled trial. Int J Environ Res Public Health. 2022;19(10):6321.
24. Zariffa J, Kapadia N, Kramer JLK, Taylor P, Alizadeh-Meghrazi M, Zivanovic V. Feasibility and efficacy of upper limb robotic rehabilitation in a subacute cervical spinal cord injury population. Spinal Cord. 2012;50(3):220–6.
25. Zariffa J, Kapadia N, Kramer JLK, Taylor PJ, Alizadeh-Meghrazi M, Zivanovic V. Effect of a robotic rehabilitation device on upper limb function in a sub-acute cervical spinal cord injury population. Spinal Cord. 2011;49(6):687–93.
26. Kim J, Lee BS, Lee HJ, Kim HR, Cho DY, Lim JE. Clinical efficacy of upper limb robotic therapy in people with tetraplegia: a pilot randomized controlled trial. Spinal Cord. 2018;57(1):49–57.
27. Moggio L, de Sire A, Marotta N, Demeco A, Ammendolia A. Exoskeleton versus end-effector robot-assisted therapy for finger-hand motor recovery in stroke survivors: systematic review and meta-analysis. Top Stroke Rehabil. 2021;28(8):631–45.
28. Harvey L, Batty J, Jones R, Crosbie J. Hand function of C6 and C7 tetraplegics 1–16 years following injury. Spinal Cord. 2001;39(1):37–43.
29. Yozbatiran N, Francisco GE. Robot-assisted therapy for the upper limb after cervical spinal cord injury. Phys Med Rehabil Clin N Am. 2019;30(2):367–84.
30. Frullo JM, Elinger J, Pehlivan AU, Fitle K, Nedley K, Francisco GE. Effects of assist-as-needed upper extremity robotic therapy after incomplete spinal cord injury: a parallel-group controlled trial. Front Neurorobot. 2017;11:29.
31. Yozbatiran N, Keser Z, Davis M, Stampas A, O’Malley MK, Cooper-Hay C. Transcranial direct current stimulation (tDCS) of the primary motor cortex and robot-assisted arm training in chronic incomplete cervical spinal cord injury: a proof-of-concept sham-randomized clinical study. NeuroRehabilitation. 2016;39(3):401–11.
32. Kowalczewski J, Chong SL, Galea M, Prochazka A. In-home tele-rehabilitation improves tetraplegic hand function. Neurorehabil Neural Repair. 2011;25(5):412–22.
33. Kilkki MM, Poutanen J, Kauranen K, Arokoski J, Hiekkala S. Effects of technology-assisted rehabilitation after spinal cord injury: a pilot randomized controlled crossover trial. JMIR Rehabil Assist Technol. 2025.
34. Osuagwu BAC, Timms S, Peachment R, Dowie S, Thrussell H, Cross S. Home-based rehabilitation using a soft robotic hand glove device leads to improvement in hand function in people with chronic spinal cord injury: a pilot study. J Neuroeng Rehabil. 2020;17(1):40.
35. Cappello L, Meyer JT, Galloway KC, Peisner JD, Granberry R, Wagner DA. Assisting hand function after spinal cord injury with a fabric-based soft robotic glove. J Neuroeng Rehabil. 2018;15(1):59.
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