The Effectiveness Of Single Joint Hybrid Assistive Limb (HAL-SJ) Robotic Exoskeleton Therapy In Improving Functional Outcomes Among Workers With Wrist Fractures: A Randomized Controlled Trial

INTERVENTION: The HAL is a hybrid control system that consists of a ‘Cybernic Voluntary Control (Bio‐Cybernic Control)’ and ‘Cybernic Autonomous Control (Cybernic Robot Control)’. The cybernic control system can provide suitable physical support to wearers with various conditions including both healthy persons and physically challenged persons by using the two types of algorithms as complementary controls. The Cybernic Voluntary Control provides physical supports/actions according to the operator’s voluntary intention caused by the bioelectrical signals including muscle activity. The power units of HAL generate power assist torque by amplifying the wearer’s own joint torque estimated from his/her bioelectrical signals, and the support motions are consequently controlled. Bioelectrical signals, including myoelectricity, are useful and reliable information to estimate a human’s motion intentions because the signals are measured just before corresponding visible muscle activities. Thus, the wearer receives physical support directly by an unconscious interface using the bioelectrical signals. In contrary, the Cybernic Autonomous Control autonomously provides a desired functional motion generated according to the wearer’s body constitution, conditions, and purposes of motion support During the intervention session, the participant will perform repetitions of different wrist movements such as extension, flexion, supination and pronation whilst assisted by a robot arm which receives feedback from the bioelectrical signals generated by the muscle movement. The researcher is a certified HAL‐SJ operator accredited by Cyberdyne Inc. and is competent to conduct the robotic intervention for the intervention group. Participants will be selected based on the in CONDITION: Wrist Fractures; ; Wrist Fractures Injuries and Accidents ‐ Fractures Musculoskeletal ‐ Other muscular and skeletal disorders PRIMARY OUTCOME: Primary outcome: Difference in term of functional level between the intervention and control groups; ; Instrument: Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure[At baseline and 4 weeks after the commencement of the intervention] Difference in pain levels assessed with Visual Analogue Scale[At baseline and 4 weeks after the commencement of the intervention] Primary outcome: Difference in term of work readiness between the intervention and control group; ; Instrument: Lam Assessment on Stages of Employment Readiness (LASER) [At baseline and 4 weeks after commencement of the intervention] SECONDARY OUTCOME: Hand dexterity assessed with Block and Box Test[At baseline and 4 weeks after the commencement of the intervention] Difference in range of motion assessed with goniometer[At baseline and 4 weeks after the commencement of the intervention] Difference in grip strength assessed with a hand dynamometer[At baseline and 4 weeks after the commencement of the intervention] Difference in pinch strength assessed with pinch gauge[At baseline and 4 weeks after the commencement of the intervention] Hand dexterity assessed with Purdue Pegboard[At baseline and 4 weeks after the commencement of the intervention] INCLUSION CRITERIA: a. SOCSO insured Malaysian workers who are on medical leave; have not returned to work; and receiving rehabilitation program at SOCSO Tun Razak Rehabilitation Centre, Melaka b. Wrist fracture involving individual or combined distal radius, distal ulna, distal radioulnar, radiocarpal joint c. Extraarticular fracture, partial articular fracture, and/or complete articular fracture