Factors Leading to Improved Gait Function in Patients with Subacute or Chronic Central Nervous System Impairments Who Receive Functional Training with the Robot Suit Hybrid Assistive Limb

Abstract

The factors that lead to the improvement of gait function in patients with diseases of the central nervous system (CNS) who use a hybrid assistive limb (HAL) are not yet fully understood. The purpose of the present study was to analyze these factors to determine the prognosis of the patients’ gait function. Patients whose CNS disease was within 180 days since onset were designated as the subacute-phase patients, and patients whose disease onset had occurred more than 180 days previously were designated as chronic-phase patients. Fifteen subacute-phase patients and 15 chronic-phase patients were given HAL training. The study analyzed how post-training walking independence in these patients was affected by the following factors: age, disease, lesion area, lower limb function, balance, period until the start of training, number of training sessions, additional rehabilitation, higher-order cognitive dysfunction, HAL model, and the use of a non-weight-bearing walking-aid. In subacute-phase patients, walking independence was related to lower limb function (rs = 0.35). In chronic-phase patients, there was a statistically significant correlation between post-training walking independence and balance (rs = 0.78). In addition, in patients with a severe motor dysfunction that was accompanied by inattention and global cognitive dysfunction, little improvement occurred, even with double-leg model training, because they had difficulty wearing the device. The results demonstrated that the factors that improved walking independence post HAL training differed between patients with subacute- and chronic-stage CNS diseases. The findings may serve as valuable information for future HAL training of patients with CNS diseases.

A Randomized and Controlled Crossover Study Investigating the Improvement of Walking and Posture Functions in Chronic Stroke Patients Using HAL Exoskeleton – The HALESTRO Study (HAL-Exoskeleton STROke Study)

“…Less relevant, Yoshimoto et al (2015) used the single leg version of the HAL robot suit (Kawamoto et al, 2009). Recently, it has been discussed how far single leg type is more suitable for patients with medium to low functional impairment and the double leg type is recommended for patients with severe functional impairment (indicated by FAC ≤ 1) (Nishimura et al, 2018). Studies investigating the efficiency of both types have not been performed yet.…”

Self-perceived functioning and disability after randomized conventional and electromechanically-assisted gait training in subacute stroke: A 6 months follow-up

“…Notably, as in our study the HAL group in their study received more therapy time in total. In contrast, other (single group) studies suggest that increase in walking speed [86] and improved independence in walking [90] after HAL training are less in patients with more severe hemiparesis (as assessed by Brunnström or FMA-LE) in the acute phase after stroke and in subacute stage after diseases in the central nervous system resulting in lower limb motor paresis. In Study II, patients had a FMA-LE motor score at T1 that were corresponding to a severe hemiparesis, yet improvements in independence in walking and walking speed were found, but without between-group differences.…”

“…At present, several studies have explored the use of HAL for gait training in different stages after stroke [77][78][79][80][81][82][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101]. The studies differ in terms of aim, design, duration of intervention, diagnosis, setting, and patient characteristics as well as allocation, randomization, blinding and outcome measures.…”

“…Ten studies [78,79,81,82,91,92,94,98,100,101] report on a positive impact on walking speed after HAL training, however all except three [82,92,100] were single group studies. Two studies have found improvements in walking endurance [81,91], one in balance [79], and two studies report increased level of independence in walking according to the Functional Ambulation Category [90,91], however all are single group studies.…”