Improved Physiological Gait in Acute and Chronic SCI Patients After Training With Wearable Cyborg Hybrid Assistive Limb

Abstract

In recent years robotic devices became part of rehabilitation offers for patients suffering from Spinal Cord Injury (SCI) and other diseases. Most scientific publications about such devices focus on functional outcome. The aim of this study was to verify whether an improvement in physiological gait can be demonstrated in addition to the functional parameters after treatment with neurological controlled HAL® Robot Suit. Fifteen subjects with acute (<12 months since injury, n = 5) or chronic (>12 months since injury, n = 10) incomplete paraplegia (AIS B, n = 0/AIS C, n = 2/AIS D, n = 8) or complete paraplegia (AIS A, n = 5) with zones of partial preservation participated. Subjects underwent a body weight supported treadmill training for five times a week over 12 weeks using HAL®. At baseline and at the end of the study a gait analysis was performed and additional functional parameters such as 10-Meter-Walk-Test, Timed-Up-and-Go-Test, 6-Minutes-Walk-Test, and WISCI II score were collected. Results were evaluated for whole group and individually for acute and chronic subgroups. All functional parameters improved. Differences were also found in physiological parameters such as phases of gait cycle and accompanied by significant improvement in all spatiotemporal and gait phase parameters. The presented study shows signs that an improvement in physiological gait can be achieved in addition to improved functional parameters in patients with SCI after completing 12-week training with HAL®.Trial Registration: DRKS, DRKS00020805. Registered 12 February 2020—Retrospectively registered, https://www.drks.de/DRKS00020805.

Robotic rehabilitation therapy using Hybrid Assistive Limb (HAL) for patients with spinal cord lesions: a narrative review

“…Brinkemper et al. [8] reported that HAL walking rehabilitation promoted improvement of physiological gait in addition to functional improvement. They showed improvement in physiological parameters such as phases of the gait cycle and significant improvement in all spatiotemporal and gait phase parameters induced by HAL walking rehabilitation.…”

Benefits of a Wearable Cyborg HAL (Hybrid Assistive Limb) in Patients with Childhood-Onset Motor Disabilities: A 1-Year Follow-Up Study

“…Unlike other robots, movement occurs in response to the wearer’s voluntary drive. The effects of training with HAL as an intervention strategy to improve walking performance have been reported in patients with gait disorders of different etiologies for several years [ 17 , 18 , 19 , 20 , 21 ]. In adult patients with stroke and spinal cord injury, improvements in gait speed, step length, cadence, walking endurance, and functional parameters were shown [ 17 , 18 , 19 , 20 , 21 ]; however, HAL is not labeled for use for CP, and this remains investigational.…”

“…The effects of training with HAL as an intervention strategy to improve walking performance have been reported in patients with gait disorders of different etiologies for several years [ 17 , 18 , 19 , 20 , 21 ]. In adult patients with stroke and spinal cord injury, improvements in gait speed, step length, cadence, walking endurance, and functional parameters were shown [ 17 , 18 , 19 , 20 , 21 ]; however, HAL is not labeled for use for CP, and this remains investigational. Even when a patient with CP can walk, if the patient continues to walk with an abnormal gait peculiar to CP, such as an equinus or crouching gait, the joints and soft tissues become very stressed.…”

Safety and Feasibility of a Novel Exoskeleton for Locomotor Rehabilitation of Subjects With Spinal Cord Injury: A Prospective, Multi-Center, and Cross-Over Clinical Trial

“…The advent of exoskeletal robotic technology can benefit the spinal cord injury population in three ways: (1) extensive repetitions of walking can help them improve and regain their walking ability, (2) the need for medical manual labor can be reduced, making extensive walking training feasible and even shortening the course of treatment, and (3) complications can be reduced, such as reduced pain, spasticity, osteoporosis and improved cardiorespiratory, lower urinary tract and bowel function (Esquenazi et al, 2012 ; Kolakowsky-Hayner, 2013 ; Benson et al, 2015 ; Stampacchia et al, 2016 ; Chun et al, 2019 ; Jang et al, 2019 ; Alashram et al, 2021 ; Brinkemper et al, 2021 ; Shackleton et al, 2021 ; Williams et al, 2021 ; Garnier-Villarreal et al, 2022 ).…”