Pilot study of locomotion improvement using hybrid assistive limb in chronic stroke patients

Abstract

BackgroundLocomotor training using robots is increasingly being used for rehabilitation to reduce manpower and the heavy burden on therapists, and the effectiveness of such techniques has been investigated. The robot suit Hybrid Assistive Limb (HAL) has been developed to rehabilitate or support motor function in people with disabilities. The HAL provides motion support that is tailored to the wearer’s voluntary drive. We performed a pilot clinical trial to investigate the feasibility of locomotor training using the HAL in chronic stroke patients, and to examine differences between two functional ambulation subgroups.MethodsSixteen stroke patients in the chronic stage participated in this study. All patients were trained with the HAL over 16 sessions (20–30 min/day within 2 days/week). Primary outcomes were walking speed, cadence, and number of steps recorded during a 10-meter walk test (10MWT). Berg balance scale (BBS) and timed up and go (TUG) were also measured. All outcome measures were evaluated without wearing HAL assistance before and after the intervention in all patients as well as in the dependent ambulatory and independent ambulatory subgroups.ResultsAll participants completed the intervention with no adverse events. Gait speed, cadence, number of steps during the 10MWT, and BBS increased significantly from 0.41 m/s to 0.45 m/s (P = 0.031), from 68.6 steps/min to 72.0 steps/min (P = 0.020), from 37.5 steps to 33.1 steps (P = 0.017), and from 40.6 to 45.4 (P = 0.004) respectively. The TUG test score improved, although this difference was not statistically significant. The findings in the dependent ambulatory subgroup primarily contributed to the significant differences observed in the group as a whole.ConclusionsThis pilot study showed that locomotor training using the HAL is feasible for chronic stroke patients. Randomized controlled trials are now required to demonstrate the effectiveness of HAL-based rehabilitation over conventional therapies.Trial registrationUMIN000002969

Gait training in subacute non-ambulatory stroke patients using a full weight-bearing gait-assistance robot: A prospective, randomized, open, blinded-endpoint trial

“…Robotic devices for gait training are classified into end-effector [18,19], exoskeletal [20,21], and robotic arm control systems [22][23][24][25]. The gait-assistance robot (GAR) is a robotic arm control system that consists of four robotic arms that control the thighs and legs automatically and independently, thigh cuffs, leg apparatuses, a control panel, a power generator, lights for the foot pressure biofeedback system, and a treadmill ( Fig.…”

Sustained effects of once-a-week gait training with hybrid assistive limb for rehabilitation in chronic stroke: case study

“…Unlike other robotic devices that provide automatic passive motion generated by a robot7 ) , HAL receives and interprets muscle activity, enabling the user to control movements; this facilitates motor learning. Previous studies on patients with chronic stroke used HAL training, twice a week in total 16 sessions, and indicated benefits in restitution of walking function8, 9 ) . Furthermore, a subgroup analysis by Kawamoto et al indicated that the dependent, not independent, ambulator significantly improved walking function8 ) .…”

“…Previous studies on patients with chronic stroke used HAL training, twice a week in total 16 sessions, and indicated benefits in restitution of walking function8, 9 ) . Furthermore, a subgroup analysis by Kawamoto et al indicated that the dependent, not independent, ambulator significantly improved walking function8 ) . Although there are an increasing number of studies supporting the effectiveness of HAL in restoring walking function in hemiparetic stroke subjects8,9,10 ) , appropriate training protocol detailing the frequency of training or the training speed remains unestablished.…”

“…Furthermore, a subgroup analysis by Kawamoto et al indicated that the dependent, not independent, ambulator significantly improved walking function8 ) . Although there are an increasing number of studies supporting the effectiveness of HAL in restoring walking function in hemiparetic stroke subjects8,9,10 ) , appropriate training protocol detailing the frequency of training or the training speed remains unestablished. Additionally, there are no reports on the follow-up data after gait training with HAL.…”

Affective Touch and Low Power Artificial Muscles for Rehabilitative and Assistive Wearable Soft Robotics

“…Wearable robotics may be helpful in providing enhanced and automatic rehabilitation and assistance. Conventional rigid robotics, such as exoskeletons, have set the bar for 'wearable' physical rehab and assist devices [1] [2]. Unfortunately the limitations of rigid robots and their underlying reliance on geared motors and rigid metals and plastics reduces the adaptability and comfort of these devices and elevates their cost and complexity.…”