## 4 Discussion  
This study has successfully analyzed the effectiveness of the Armeo Spring exoskeleton in improving the performance of subjects with cervical SCI in completing ADL.  
Although there are numerous research papers on the Armeo Spring [10; 11; 12; 13; 14; 15; 16; 17; 18; 19; 20; 21; 22; 23; 24; 25; 26; 27], very few have focused on analyzing the effectiveness of the device with the idea of detecting findings on the outcomes of UE-RT versus UE-CT. These studies were focused on non-neurological subjects with proximal humeral fracture and surgical treatment [42] and subjects with UE impairments after neurological pathologies such as stroke [43] and cerebral palsy [22]. However, studies carried out on SCI are still scarce compared to these neurological pathologies.  
Thus, the only full report on the effectiveness of this device in subacute cervical SCI was published by [PERSON] et al., marking a major breakthrough in SCI research. In that study, there was no independent control group that did not receive treatment with the exoskeleton and the authors found few functional benefits in limbs that received Armeo Spring treatment compared to limbs that did not receive treatment with the exoskeleton [13]. For this reason, the experimental protocol in this paper was designed to address some of  
\begin{table}
\begin{tabular}{l c} \hline \hline
**Question** & **Mean (SD)** \\ \hline Q1. The ARMEO was enjoyable to use. & 6.4 (0.8) \\ \hline Q2. It was easy to understand how to use the ARMEO. & 6.8 (0.4) \\ \hline Q3. The games increased your motivation to perform & 6.0 (1.2) \\ your exercises. & \\ \hline Q4. You would be comfortable using the ARMEO with only & 4.6 (1.9) \\ minimal supervision by a therapist. & \\ \hline Q5. You felt that the ARMEO training was an effective for & 5.3 (1.2) \\ rehabilitation as your usual rehabilitation sessions with a therapist. & \\ \hline Q6. The ARMEO was helpful for tracking the progress of & 6.4 (0.9) \\ your rehabilitation. & \\ \hline Q7. The length of the sessions was appropriate & 6.8 (0.4) \\ \hline Q8. The number of sessions per week was appropriate & 6.7 (0.4) \\ \hline Q9. You felt that the ARMEO exercises were more relevant to & 4.3 (1.0) \\ activities in your daily life than conventional rehabilitation. & \\ \hline Q10. You think that the ADL drinking game enriches the therapy & 6.7 (0.6) \\ proposed by ARMEO & 6.7 (0.6) \\ \hline Q11. You find this game useful for ADL training & 6.6 (0.7) \\ \hline Q12. You would use the ARMEO in your free time if it was & 5.8 (1.6) \\ available to you. & \\ \hline Q13. You preferred the ARMEO training to & 4.3 (1.5) \\ conventional rehabilitation. & \\ \hline Q14. The ARMEO is appropriate for someone with your level & 6.7 (0.8) \\ of lesion. & \\ \hline Q15. The ARMEO is appropriate for someone with your type of & 6.4 (1.2) \\ injury (that is, AIS A, B, C or D) & \\ \hline AIS, ASIA Impairment Scale. & \\ \hline \hline \end{tabular}
\end{table}
Table 4: Results related to the subject discharge questionnaire for patients within the intervention group. Results are shown with mean score and standard deviation for each question.  
the shortcomings of this previous study and an independent control group that did not receive exoskeleton therapy was included in the study, thus increasing the sample size.  
On the other hand, scientific evidence from one of the most recently published reviews suggests that robotic therapy may not benefit basic ADL more than usual care or no treatment [29]. Therefore, this paper focuses on the possible improvement of robotic therapy in ADL, incorporating within the UL-RT experimental sessions the ADL of drinking, designed for this purpose.