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

Shimizu, Yoshiki; Kadone, Hideki; Kuzuhara, Shigeki; Suzuki, Kenji; Abe, Tetsuya; Ueno, Tomoyuki; Soma, Yuichiro; Sankai, Yoshiyuki; Hada, Yasushi; Yamazaki, Masashi

doi:10.3389/fnins.2017.00649

Cited by 24 publications

(17 citation statements)

References 34 publications

(56 reference statements)

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“…It was also noted by Verma et al ( 2012 ) that the adult human brain is capable of reorganization after stroke and can be manipulated with movement stimuli involving lower limbs. Shimizu et al ( 2017 ) showed that recovery of neuromuscular activity is possible even in patients with chronic complete spinal cord injury with quadri/paraplegia. They used HAL to allow patients to trigger voluntary ambulation with residual muscle activations in their arms.…”

Section: Discussionmentioning

confidence: 99%

Lateral Symmetry of Synergies in Lower Limb Muscles of Acute Post-stroke Patients After Robotic Intervention

et al. 2018

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Gait disturbance is commonly associated with stroke, which is a serious neurological disease. With current technology, various exoskeletons have been developed to provide therapy, leading to many studies evaluating the use of such exoskeletons as an intervention tool. Although these studies report improvements in patients who had undergone robotic intervention, they are usually reported with clinical assessment, which are unable to characterize how muscle activations change in patients after robotic intervention. We believe that muscle activations can provide an objective view on gait performance of patients. To quantify improvement of lateral symmetry before and after robotic intervention, muscle synergy analysis with Non-Negative Matrix Factorization was used to evaluate patients' EMG data. Eight stroke patients in their acute phase were evaluated before and after a course of robotic intervention with the Hybrid Assistive Limb (HAL), lasting over 3 weeks. We found a significant increase in similarity between lateral synergies of patients after robotic intervention. This is associated with significant improvements in gait measures like walking speed, step cadence, stance duration percentage of gait cycle. Clinical assessments [Functional Independence Measure-Locomotion (FIM-Locomotion), FIM-Motor (General), and Fugl-Meyer Assessment-Lower Extremity (FMA-LE)] showed significant improvements as well. Our study shows that muscle synergy analysis can be a good tool to quantify the change in neuromuscular coordination of lateral symmetry during walking in stroke patients.

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Section: Discussionmentioning

confidence: 99%

Lateral Symmetry of Synergies in Lower Limb Muscles of Acute Post-stroke Patients After Robotic Intervention

et al. 2018

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“…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 ). Additionally, spinal cord injury patients showed improvement in their spasticity (Ikumi et al, 2016 ), recovery of lower limb muscle activities (Shimizu et al, 2017 ), reduction of neuropathic pain (Cruciger et al, 2016 ) and normalization of cortical excitability and cortical plasticity (Sczesny-Kaiser et al, 2017 ). However, there is no available data about gait kinematics evaluation after HAL therapy.…”

Section: Introductionmentioning

confidence: 99%

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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“…There are some reports on neural activity changes by HAL in recent literature: brain activity changes in the primary motor cortex of subacute stroke patients immediately after using HAL (81), cortical excitability changes in the primary somatosensory cortex of spinal cord injury patients after 3 months of training (16), muscle synergy changes in the lower limbs of stroke patients (50), segmental coordination changes in in the lower limbs of myelopathy patients after surgery for thoracic OPLL (11), and activation in some muscles of chronic spinal cord injury patients during and after HAL training (17).…”

Section: Discussionmentioning

confidence: 99%

“…It actuates the electric motors embedded in the hips and knees of its exoskeleton in real time, amplifying bioelectric activation of the relevant muscles which are detected using surface electrodes attached on the hip and knee muscles. Previous studies using HAL for myelopathy (10)(11)(12), spinal cord injury (13)(14)(15)(16)(17), and post-surgery rehabilitation after total knee arthroplasty (18) reported improvement of walking ability after HAL training.…”

Section: Introductionmentioning

confidence: 94%

“…Since HAL assists activity-based joint motion during locomotion and, hence, assists in providing coherent sensory input to the spinal cord through assistance of actual performance of the motion intended by the neural system, we think that HAL can provide an effective method for the recovery of gait after spinal cord disorder. Actually, gait improvement after training using HAL has been reported for patients after spinal cord injury (references cited above), among which, Shimizu et al (17) reported reactivation in some of the paralyzed muscles of chronic spinal cord injury patients during walking with HAL. Compressive myelopathy and spinal cord injury are both spinal cord disorders leading to disturbance or impairment of gait, the difference being that the former is caused by chronic degeneration while the latter is caused by acute injury.…”

Section: Introductionmentioning

confidence: 99%

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Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report

et al. 2020

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Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.

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

Cited by 24 publications

References 34 publications

Lateral Symmetry of Synergies in Lower Limb Muscles of Acute Post-stroke Patients After Robotic Intervention

Lateral Symmetry of Synergies in Lower Limb Muscles of Acute Post-stroke Patients After Robotic Intervention

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

Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report

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