The robotic Trunk-Support-Trainer (TruST) to measure and increase postural workspace during sitting in people with spinal cord injury

Abstract

Study design

Cross-sectional study.

Objectives

To measure and expand the sitting workspace of participants with spinal cord injury (SCI) with the Trunk-Support-Trainer (TruST).

Setting

Columbia University.

Methods

TruST is a motorized-cable belt placed around the torso. Participants performed maximal trunk excursions along eight directions, radiating in a star-shape, to define their seated postural limits and workspace area (cm2). TruST was configured to apply “assist-as-needed” forces when the trunk moved beyond these postural limits. Kinematics were collected to examine trunk control. The clinical features of the sample (n = 5) were documented by neurological injury, dynamometry, the American Spinal Injury Association Impairment Scale, and Spinal Cord Independence Measure-III.

Results

Statistical significance was examined with paired t-tests. TruST successfully recreated the postural limits of participants and expanded their active sitting workspace (Mean: 123.3 ± SE: 42.8 cm2, p < 0.05). Furthermore, participants improved their trunk excursions to posterior (Mean: 5.1 ± SE: 0.8 cm, p < 0.01), right (Mean: 3.1 ± SE: 1.1 cm, p < 0.05), and left (Mean: 5.0 ± SE: 1.7 cm, p = 0.05) directions with TruST-force field.

Conclusions

TruST can accurately define and expand the active seated workspace of people with SCI during volitional trunk movements. The capacity of TruST to deliver continuous force-feedback at the user’s postural limits opens new frontiers to implement motor learning-based paradigms to retrain functional sitting in people with SCI.

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Fig. 1: To the right, the robotic trunk-support-trainer (TruST) device with cables attached to the belt (B) and routed through the pulleys down to the motors (M) on the frame.
Fig. 2: Area of active seated postural control in sitting measured with the postural star-sitting test via the Trunk-Support-Trainer (TruST).

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Acknowledgements

The authors want to thank Lawrence Harding PT, Wheeling Forward, and all the participants for their valuable collaboration in this research. This study was funded by NYS research funding, DOH01-C31290GG, Dr. Sunil K. Agrawal principal investigator.

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Correspondence to Sunil Agrawal.

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Santamaria, V., Luna, T., Khan, M. et al. The robotic Trunk-Support-Trainer (TruST) to measure and increase postural workspace during sitting in people with spinal cord injury. Spinal Cord Ser Cases 6, 1 (2020). https://doi.org/10.1038/s41394-019-0245-1

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