This paper proposes an algorithm to estimate human intentions related with walking in order to comfortably and safely support a paraplegia patient's walk. A robot suit "HAL" has been developed for an enhancement of healthy person's activities and for support of physically challenged person's daily life. Assisting method based on bioelectrical signals such as myoelectricity successfully supports healthy person's walking. These bioelectrical signals, however, cannot be measured properly from a paraplegia patient. Therefore another interface that can estimate patients' intentions without any manual controller are desired for robot control since a manual controller deprives a patient of his/her hands' freedom. Estimation of patients' intentions contributes to support not only comfortably but also safely, because an inconformity between the robot suit motion and the patient motion results in his/her stumbling or falling. The proposed algorithm, therefore, estimates patient's intentions from a floor reaction force reflecting patient's weight shift during walking and standing. The effectiveness of this algorithm is investigated through experiments on a paraplegia patient who has a sensory paralysis on both legs, especially his left leg. We show that HAL supports patient's walk properly, estimating his intentions based on floor reaction force.
BackgroundIntensive task specific training early after stroke may enhance beneficial neuroplasticity and functional recovery. Impaired gait after hemiparetic stroke remains a challenge that may be approached early after stroke by use of novel technology. The aim of the study was to investigate the safety and feasibility of the exoskeleton Hybrid Assistive Limb (HAL) for intensive gait training as part of a regular inpatient rehabilitation program for hemiparetic patients with severely impaired gait early after stroke.MethodsEligible were patients until 7 weeks after hemiparetic stroke. Training with HAL was performed 5 days per week by the autonomous and/or the voluntary control mode offered by the system. The study protocol covered safety and feasibility issues and aspects on motor function, gait performance according to the 10 Meter Walking Test (10MWT) and Functional Ambulation Categories (FAC), and activity performance.ResultsEight patients completed the study. Median time from stroke to inclusion was 35 days (range 6 to 46). Training started by use of the autonomous HAL mode in all and later switched to the voluntary mode in all but one and required one or two physiotherapists. Number of training sessions ranged from 6 to 31 (median 17) and walking time per session was around 25 minutes. The training was well tolerated and no serious adverse events occurred. All patients improved their walking ability during the training period, as reflected by the 10MWT (from 111.5 to 40 seconds in median) and the FAC (from 0 to 1.5 score in median).ConclusionsThe HAL system enables intensive training of gait in hemiparetic patients with severely impaired gait function early after stroke. The system is safe when used as part of an inpatient rehabilitation program for these patients by experienced physiotherapists.
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
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