Treadmill Training with HAL Exoskeleton—A Novel Approach for Symptomatic Therapy in Patients with Limb-Girdle Muscular Dystrophy—Preliminary Study

Abstract

Purpose: Exoskeletons have been developed for rehabilitation of patients with walking impairment due to neurological disorders. Recent studies have shown that the voluntary-driven exoskeleton HAL® (hybrid assistive limb) can improve walking functions in spinal cord injury and stroke. The aim of this study was to assess safety and effects on walking function of HAL® supported treadmill therapy in patients with limb-girdle muscular dystrophy (LGMD).Materials and Methods: Three LGMD patients received 8 weeks of treadmill training with HAL® 3 times a week. Outcome parameters were 10-meter walk test (10 MWT), 6-minute walk test, and timed-up-and-go test (TUG). Parameters were assessed pre and post training and 6 weeks later (follow-up).Results: All patients completed the therapy without adverse reactions and reported about improvement in endurance. Improvements in outcome parameters after 8 weeks could be demonstrated. Persisting effects were observed after 6 weeks for the 10 MWT and TUG test (follow-up).Conclusions: HAL® treadmill training in LGMD patients can be performed safely and enables an intensive highly repetitive locomotor training. All patients benefitted from this innovative method. Upcoming controlled studies with larger cohorts should prove its effects in different types of LGMD and other myopathies.

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

“…The HAL has been reported to be a feasible tool for some types of neuromuscular disorders (Kawamoto et al, 2013 ; Kubota et al, 2013 , 2017 ; Sakakima et al, 2013 ; Aach et al, 2014 ; Nilsson et al, 2014 ; Sczesny-Kaiser et al, 2015 , 2017 ; Wall et al, 2015 ; Fujii et al, 2017 ; Ikumi et al, 2017 ; Shimizu et al, 2017b ) and to improve ambulation in patients with chronic SCI (Aach et al, 2014 ; Sczesny-Kaiser et al, 2015 ; Wall et al, 2015 ; Ikumi et al, 2017 ; Kubota et al, 2017 ; Shimizu et al, 2017b ). HAL is able to detect very weak neuromuscular activities, if any, using its surface electrodes and to provide motion assistance.…”

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

“…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 ).…”

Effects of Gait Treatment With a Single-Leg Hybrid Assistive Limb System After Acute Stroke: A Non-randomized Clinical Trial

“…A single-leg version of HAL can give active and intensive support to the gait pattern when rehabilitating a patient after acute stroke (Nilsson et al, 2014). By assisting the knee and hip joints on the paretic side, HAL can increase the frequency or duration of gait treatment a patient can undergo in a single treatment session and over a fixed period (Sczesny-Kaiser et al, 2017). In the present study, the actual walking distance was significantly higher in the HAL group than in the CGT group, implying that more repetitions of the walking motion were possible.…”