Effectiveness of Acute Phase Hybrid Assistive Limb Rehabilitation in Stroke Patients Classified by Paralysis Severity

Abstract

The purpose of the present study was to investigate the effectiveness of acute phase hybrid assistive limb (HAL) rehabilitation training for patients after stroke by measuring the difference in the severity of paralysis. Fifty-three acute stroke patients were enrolled in this prospective cohort study. HAL training was administered about twice per week, and the mean number of sessions was 3.9 ± 2.7. The walking training was performed on a treadmill with individually adjustable body weight support and speed and there was a 10-m walk test (10MWT) before and after each session. Assessment at baseline and at endpoint consisted of the Glasgow Coma Scale (GCS), Revised Hasegawa’s Dementia Scale (HDS-R), Brunnstrom stage (Brs), Functional Independence Measure (FIM), Barthel index (BI), and 10MWT. We measured these assessments at the first walking training session and at the end of the final training session without the HAL. To evaluate the feasibility of training with the HAL, the outcome measures of BI, FIM, and speed and number of steps of 10MWT were compared before and after training using a paired Wilcoxon’s signed-rank test in different Brs. Except for Brs IV, the Brs III or higher subgroups displayed significant amelioration in BI, and the Brs III subgroup displayed significant amelioration in FIM. The Brs V and VI subgroups displayed significant amelioration in 10-m walking speed and steps. In acute phase rehabilitation after stroke, it is thought that the HAL is more effective for patients with less lower-limb paralysis, such as Brs III or higher.

A randomized controlled study incorporating an electromechanical gait machine, the Hybrid Assistive Limb, in gait training of patients with severe limitations in walking in the subacute phase after stroke

“…In these studies, the groups were small (n = 6-12) and the assessors were not blinded. A study with a larger sample (n = 53) [47] suggested that improvements in walking speed after HAL training in the acute phase after stroke are less in patients with severe hemiparesis compared to those with less severe hemiparesis, but that study did not compare HAL training to conventional rehabilitation. Further studies with sufficient statistical power are needed to address the question about who will benefit from HAL training based on their initial level of dependence in walking.…”

Self-perceived functioning and disability after randomized conventional and electromechanically-assisted gait training in subacute stroke: A 6 months follow-up

“…Notably, as in our study the HAL group in their study received more therapy time in total. In contrast, other (single group) studies suggest that increase in walking speed [86] and improved independence in walking [90] after HAL training are less in patients with more severe hemiparesis (as assessed by Brunnström or FMA-LE) in the acute phase after stroke and in subacute stage after diseases in the central nervous system resulting in lower limb motor paresis. In Study II, patients had a FMA-LE motor score at T1 that were corresponding to a severe hemiparesis, yet improvements in independence in walking and walking speed were found, but without between-group differences.…”

“…At present, several studies have explored the use of HAL for gait training in different stages after stroke [77][78][79][80][81][82][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101]. The studies differ in terms of aim, design, duration of intervention, diagnosis, setting, and patient characteristics as well as allocation, randomization, blinding and outcome measures.…”

“…no control group is applied) [77-79, 81, 84-88, 90, 91, 94, 95, 99, 101], one is a case study [98], five studies have a control group (but did not use strict randomization) [82,89,92,97,100] and two are randomized controlled trials [80,93,96]. The studies include one [98,99] to 53 [86] patients with stroke who performed HAL training. The total number of HAL sessions range from 1 [87] to 31 [88] and with a total mean of approximately 11 sessions, using HAL 2-3 times per week with durations of ≥20 minutes (net walking time) per session.…”

Interactive Bio-feedback Therapy Using Hybrid Assistive Limbs for Motor Recovery after Stroke: Current Practice and Future Perspectives

“…We next retrospectively reviewed the clinical data of 53 acute stroke patients who underwent neurorehabilitation using either the HAL-BL or HAL-SL between November 2011 and May 2014 to determine the cases where HAL treatment was effective for ambulatory training. 18 , 19) In this previous report, we classified the included patients according to Brunnstrom stage severity and evaluated the activities of daily living (ADL) and motor performance. For patients Brunnstrom stage III or higher, improvements were seen in the Barthel index, functional independence measure (FIM), and the 10-m walking test (10MWT).…”