Purpose We evaluated improvements in gait after using the Hybrid Assistive Limb (HAL®) exoskeleton robot in a patient with late-onset neurological deterioration of lower extremity function after undergoing thoracic spine surgery for a myelopathy due to ossification of the ligamentum flavum. Case Presentation A 70-year-old man participated in ten 20 min sessions of HAL intervention, twice weekly for five weeks. The effects of each HAL session were evaluated based on changes in performance on the 10 m walk test (10 MWT), lower limb kinematics quantified from motion capture, and the activation ratio of the gastrocnemius, measured before and after the intervention. Muscle activity was recorded using surface electromyography and synchronized to measured kinematics. The HAL intervention improved gait speed and step length, with an increase in the hip flexion angle during the swing phase and a decrease in the activation ratio of the gastrocnemius. The modified Ashworth scale improved from 1+ to 1 and International Standards for Neurological and Functional Classification of Spinal Cord Injury motor scores from 34 to 49. Conclusion Intervention using the HAL exoskeleton robot may be an effective method to improve functional ambulation in patients with chronic spinal disorders.

Upper extremity dysfunction after stroke affects quality of life. Focusing on the shoulder joint, we investigated the safety and effectiveness of rehabilitation using a shoulder joint hybrid assistive limb (HAL). Eight patients with chronic stroke and upper extremity functional disability were enrolled and used a shoulder joint HAL, which assisted shoulder movement based on the user’s intention, through myoelectric activation of the shoulder flexor. Ten training sessions of 30–40 min each were performed to assist voluntary movement of upper limb elevation on the affected side through triggering the deltoid muscle. All patients completed the interventions without shoulder pain. Surface electromyography evaluation indicated post-intervention improvement in coordinated movement of the affected upper extremity. Significant improvements in voluntary and passive shoulder joint range of motion were obtained after the intervention, suggesting improvement in shoulder muscle strength. A significant decrease in the modified Ashworth scale and improvements in functional scores in the upper limb were also observed. Along with safe use for our study patients, the shoulder HAL provided appropriate motor learning benefits. Improvements in shoulder joint function and whole upper limb function were observed, suggesting that HAL could be an optimal treatment method.

Upper limb dysfunction after stroke is one of the most serious functional disorders, and adequate functional recovery is often not expected. Although various studies have been conducted on effective rehabilitation for upper limb dysfunction, active rehabilitation such as repetitive training of upper limb elevation has not been sufficiently conducted yet because the shoulder joint is highly unstable and the appearance of pain is easily observed. In this study, we performed right shoulder joint elevation training in a seated position using a single-joint hybrid assistive limb (HAL) in a 54-year-old female with right hemiplegia after a stroke. Her right upper limb function improved as follows: passive and active range of motion (ROM) of shoulder flexion, from 105° to 115° and from 65° to 105°, respectively; manual muscle test (MMT), from 2 to 4; box and block test of the right hand, from 1 to 8; right grip strength, from less than 5 to 7.4 kg; and action research arm test (ARAT) total scores, from 10 to 20. No adverse events including shoulder pain were seen. According to the result of the pilot study, HAL may be an effective rehabilitation tool for upper limb dysfunction after stroke.