A Consecutive 25-Week Program of Gait Training, Using the Alternating Hybrid Assistive Limb (HAL®) Robot and Conventional Training, and its Effects on the Walking Ability of a Patient with Chronic Thoracic Spinal Cord Injury: A Single Case Reversal Design

Abstract

Background and Objectives: In this study, we examined the effect of a consecutive 25-week gait training program, consisting of 5-week alternating phases of Hybrid Assistive Limb (HAL)-assisted robot gait training and conventional gait training, on the walking ability of a 50-year-old man with a chronic thoracic spinal cord injury (SCI). Materials and Methods: Clinical features of this patient’s paraplegia were as follows: neurological level, T7; American Spinal Cord Injury Association Impairment Scale Score, C; Lower Extremity Motor Score, 20 points; Berg Balance Scale score, 15 points; and Walking Index for Spinal Cord Injury, 6 points. The patient completed a 100 m walk, under close supervision, using a walker and bilateral ankle-foot orthoses. The intervention included two phases: phase A, conventional walking practice and physical therapy for 5 weeks, and phase B, walking using the HAL robot (3 d/week, 30 min/session), combined with conventional physical therapy, for 5 weeks. A consecutive A-B-A-B-A sequence was used, with a 5-week duration for each phase. Results: The gait training intervention increased the maximum walking speed, cadence, and 2-min walking distance, as well as the Berg Balance and Walking Index for Spinal Cord Injury from 15 to 17 and 6 to 7, respectively. Walking speed, stride length, and cadence improved after phase A (but not B). Improved standing balance was associated with measured improvements in measured gait parameters. Conclusion: The walking ability of patients with a chronic SCI may be improved, over a short period by combining gait training, using HAL-assisted and conventional gait training and physical therapy.

Improved Physiological Gait in Acute and Chronic SCI Patients After Training With Wearable Cyborg Hybrid Assistive Limb

“…Our data supports findings of previous studies reporting of improvements in terms of spatiotemporal gait parameters and joint angles during the gait cycle after HAL R treatment (Kanazawa et al, 2019;Watanabe et al, 2019). However, presented data only shows statistical significance and not necessarily clinical significance as no comparison was made with minimal clinically important difference values for this population.…”

“…Consequently studies should not only focus on functional outcomes but also on physiology when assessing the rehabilitation progress. Hence, several studies evaluated gait parameter changes after HAL R treatment and found improvements, for example in patients after Stroke (Tanaka et al, 2019), in groups of patients with cerebral palsy (Matsuda et al, 2018;Mataki et al, 2020) and in case reports of patients with SCI (Kanazawa et al, 2019;Watanabe et al, 2019). Investigations in larger groups of people living with SCI are missing.…”

Current Concepts of Neural Stem/Progenitor Cell Therapy for Chronic Spinal Cord Injury

“…Recently, gait training using the Alternating Hybrid Assistive Limb (HAL R ) Robot was reported. By combining gait training using HAL-assisted and conventional gait training with physical therapy, the ability of patients with a chronic SCI to walk may be improved over a short period (Sczesny-Kaiser et al, 2015;Shimizu et al, 2017;Matsuda et al, 2018;Kanazawa et al, 2019). The potential for gait training using HAL to improve the ability of patients with chronic severe incomplete tetraplegic SCI to walk was also shown.…”