Improvement of Walking Ability Using Hybrid Assistive Limb Training in a Patient with Severe Thoracic Myelopathy caused by Ossification of the Posterior Longitudinal Ligament - A Case Report

Kuzuhara, Shigeki; Abe, Tetsuya

doi:10.4172/2165-7939.s7-003

Cited by 11 publications

(17 citation statements)

References 8 publications

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“…Therefore, our HAL intervention resulted in considerable functional improvement for our patient. This way, the gait improvement observed in the current case after HAL intervention indicates a new possibility of HAL: modification of gait to achieve improvement of daily activities in patients with limited balance ability because of neurological disorder, making comparison to effectiveness of gait training in the rather severe cases reported in previous reports [ 12 – 15 , 25 ].…”

Section: Resultssupporting

confidence: 59%

“…HAL has unique operation system in using user's neuromuscular activities, compared to other rehabilitation robots such as Lokomat [ 4 ] (Hocoma, Switzerland), LOPES [ 5 ], or ReWalk (Robotics, Israel) [ 6 ], which are powered exoskeleton robots with angular sensors in the joints and pelvis and foot force-pressure sensors. Effective gait training outcomes using HAL have been reported in patients with chronic stroke [ 7 – 9 ] and spinal cord injury [ 9 – 12 ], as well as in patients following surgery for spinal myelopathy of the thoracic spine due to ossification of the posterior longitudinal ligament (OLF) [ 13 – 15 ]. We previously reported the effect for recovery of muscle activity during motion using HAL for chronic spinal cord injury [ 12 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Hybrid Assistive Limb Intervention in a Patient with Late Neurological Deterioration after Thoracic Myelopathy Surgery due to Ossification of the Ligamentum Flavum

Taketomi

Shimizu

Kadone

et al. 2018

Case Reports in Orthopedics

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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.

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Section: Resultssupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Hybrid Assistive Limb Intervention in a Patient with Late Neurological Deterioration after Thoracic Myelopathy Surgery due to Ossification of the Ligamentum Flavum

Taketomi

Shimizu

Kadone

et al. 2018

Case Reports in Orthopedics

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“…Such information is processed and used by the exoskeleton to assist the patient during gait training. In previous studies where HAL was used in neurologic patients with gait disturbances, improvement in clinical scores, and walking performance, such as elongation of the stride length and increment of gait speed, was found (Kawamoto et al, 2013 ; Sakakima et al, 2013 ; Fujii et al, 2016 ; Kubota et al, 2016 ; Sczesny-Kaiser et al, 2017 ). A group of stroke patients treated with HAL improved their sit-to-stand movements thanks to the increment of the forward tilt angle (Kasai and Takeda, 2016 ).…”

Section: Introductionmentioning

confidence: 93%

Reshaping of Gait Coordination by Robotic Intervention in Myelopathy Patients After Surgery

et al. 2018

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The Ossification of the Posterior Longitudinal Ligament (OPLL) is an idiopathic degenerative spinal disease which may cause motor deficit. For patients presenting myelopathy or severe stenosis, surgical decompression is the treatment of choice; however, despite adequate decompression residual motor impairment is found in some cases. After surgery, there is no therapeutic approach available for this population. The Hybrid Assistive Limb® (HAL) robot suit is a unique powered exoskeleton designed to predict, support, and enhance the lower extremities performance of patients using their own bioelectric signals. This approach has been used for spinal cord injury and stroke patients where the walking performance improved. However, there is no available data about gait kinematics evaluation after HAL therapy. Here we analyze the effect of HAL therapy in OPLL patients in acute and chronic stages after decompression surgery. We found that HAL therapy improved the walking performance for both groups. Interestingly, kinematics evaluation by the analysis of the elevation angles of the thigh, shank, and foot by using a principal component analysis showed that planar covariation, plane orientation, and movement range evaluation improved for acute patients suggesting an improvement in gait coordination. Being the first study performing kinematics analysis after HAL therapy, our results suggest that HAL improved the gait coordination of acute patients by supporting the relearning process and therefore reshaping their gait pattern.

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“…Gait training with the HAL has been reported to improve gait ability in patients with chronic stroke (Kawamoto et al, 2013 ; Nilsson et al, 2014 ; Wall et al, 2015 ), chronic SCI (Aach et al, 2014 ; Sczesny-Kaiser et al, 2015 ; Wall et al, 2015 ; Ikumi et al, 2017 ; Shimizu et al, 2017b ), and postoperative thoracic ossification of the posterior longitudinal ligament (Sakakima et al, 2013 ; Kubota et al, 2016 , 2017 ; Fujii et al, 2017 ) in terms of gait speed, step length, and clinical functional evaluation.…”

Section: Introductionmentioning

confidence: 99%

Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury

et al. 2017

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Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20–67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60–90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings suggest that upper-limb-triggered HAL ambulation is a safe and feasible option for rehabilitation in patients with complete quadri/paraplegia caused by chronic SCI.

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Improvement of Walking Ability Using Hybrid Assistive Limb Training in a Patient with Severe Thoracic Myelopathy caused by Ossification of the Posterior Longitudinal Ligament - A Case Report

Cited by 11 publications

References 8 publications

Hybrid Assistive Limb Intervention in a Patient with Late Neurological Deterioration after Thoracic Myelopathy Surgery due to Ossification of the Ligamentum Flavum

Hybrid Assistive Limb Intervention in a Patient with Late Neurological Deterioration after Thoracic Myelopathy Surgery due to Ossification of the Ligamentum Flavum

Reshaping of Gait Coordination by Robotic Intervention in Myelopathy Patients After Surgery

Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury

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