Feasibility of Neurorehabilitation Using a Hybrid Assistive Limb for Patients Who Underwent Spine Surgery

Yatsugi, Aya; Morishita, Takashi; Fukuda, Hiroyuki; Kotani, Naoya; Yagi, Kenji; Abe, Hiroshi; Shiota, Etsuji; Inoue, Takeshi

doi:10.1155/2018/7435746

Cited by 7 publications

(22 citation statements)

References 42 publications

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“…From the standing point, we consider that the disturbance of the central pattern generator (CPG) in the spinal cord exists in common among frailty patients. Repetitive sensory feedback from HAL training may activate the central nervous system (CNS) and possibly induce neuroplasticity in the spinal cord level to facilitate functional recovery in the disused neuronal networks (20) (Figure 7).…”

Section: Discussionmentioning

confidence: 99%

Biofeedback Core Exercise Using Hybrid Assistive Limb for Physical Frailty Patients With or Without Parkinson's Disease

et al. 2020

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Introduction: Elderly people often exhibit "frailty," and motor dysfunction occurs. Several studies have reported about the relationship between motor dysfunction and frailty in Parkinson's disease (PD). This study aimed to test whether the core exercise using the hybrid assistive limb lumbar type for care support (HAL-CB02) may improve the motor functions in frailty patients with or without PD and to explore the optimal patient selection from the frailty cohort. Materials and Methods: We recruited 16 frailty patients (PD = 8; non-PD = 8). The participants performed core exercise and squats using HAL-CB02 for five sessions a week. Outcome measures were 10-m walking test, step length, timed up-and-go test, 30-s chair stand test, and visual analog scale. Evaluation was conducted at baseline, post-exercise, and 1-and 3-month follow-ups. Results: Both PD and non-PD patients showed significant improvement in all evaluation items post-exercise. Moreover, no significant difference was found in the improvement value between the two groups. Conclusions: Our results suggest that biofeedback exercise with HAL-CB02 is a safe and promising treatment for frailty patients. Motor dysfunction in PD patients may be partly due to physical frailty, and biofeedback exercise with HAL-CB02 is proposed as a treatment option.

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Section: Discussionmentioning

confidence: 99%

Biofeedback Core Exercise Using Hybrid Assistive Limb for Physical Frailty Patients With or Without Parkinson's Disease

et al. 2020

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“…Ekso device effects were analyzed in 20 studies [40][41][42][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64], ReWalk ones in 14 studies [12,43,44,[65][66][67][68][69][70][71][72][73][74][75], Indego ones in 4 [45][46][47]76], HAL and Rex devices respectively were analyzed in 2 [77,78] and 1 studies [79]. Ekso studies were conducted on individuals with subacute (N = 2 [49,53]) and chronic (N = 12 [40-42, 50, 51, 54-60]) lesions.…”

Section: Interventionmentioning

confidence: 99%

“…Indego device effects were analyzed in 4 studies [45][46][47]76], that enrolled individuals with chronic lesion (N = 1) [76], mixed TSI (N = 1) [46]; while 2 [45,47] studies did not specify the TSI. The 2 HAL studies focused exclusively on individuals with subacute SCI [77,78], while the single Rex study assessed only individuals with chronic TSI [79].…”

Section: Interventionmentioning

confidence: 99%

“…All studies, except one [75], employed kinematic analyses but they varied on the measures considered. Besides kinematics, also other instrumental measures were occasionally employed, trunk angle oscillation was assessed in 2 studies [70,77] and vertical ground reaction forces in a single one [75]. Quite surprisingly, only 3 of the included studies used clinical scales, such as WISCI II scale alone (N = 2) or in association with the modified Gait Abnormality Rating Scale (GARS-M) (N = 1).…”

Section: Walking Domainmentioning

confidence: 99%

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Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review

Tamburella

Lorusso

Tramontano

et al. 2022

J NeuroEngineering Rehabil

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Overground powered lower limb exoskeletons (EXOs) have proven to be valid devices in gait rehabilitation in individuals with spinal cord injury (SCI). Although several articles have reported the effects of EXOs in these individuals, the few reviews available focused on specific domains, mainly walking. The aim of this systematic review is to provide a general overview of the effects of commercial EXOs (i.e. not EXOs used in military and industry applications) for medical purposes in individuals with SCI. This systematic review was conducted following the PRISMA guidelines and it referred to MED-LINE, EMBASE, SCOPUS, Web of Science and Cochrane library databases. The studies included were Randomized Clinical Trials (RCTs) and non-RCT based on EXOs intervention on individuals with SCI. Out of 1296 studies screened, 41 met inclusion criteria. Among all the EXO studies, the Ekso device was the most discussed, followed by ReWalk, Indego, HAL and Rex devices. Since 14 different domains were considered, the outcome measures were heterogeneous. The most investigated domain was walking, followed by cardiorespiratory/metabolic responses, spasticity, balance, quality of life, human–robot interaction, robot data, bowel functionality, strength, daily living activity, neurophysiology, sensory function, bladder functionality and body composition/bone density domains. There were no reports of negative effects due to EXOs trainings and most of the significant positive effects were noted in the walking domain for Ekso, ReWalk, HAL and Indego devices. Ekso studies reported significant effects due to training in almost all domains, while this was not the case with the Rex device. Not a single study carried out on sensory functions or bladder functionality reached significance for any EXO. It is not possible to draw general conclusions about the effects of EXOs usage due to the lack of high-quality studies as addressed by the Downs and Black tool, the heterogeneity of the outcome measures, of the protocols and of the SCI epidemiological/neurological features. However, the strengths and weaknesses of EXOs are starting to be defined, even considering the different types of adverse events that EXO training brought about. EXO training showed to bring significant improvements over time, but whether its effectiveness is greater or less than conventional therapy or other treatments is still mostly unknown. High-quality RCTs are necessary to better define the pros and cons of the EXOs available today. Studies of this kind could help clinicians to better choose the appropriate training for individuals with SCI.

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“…Three types of HAL (lower limb type, single-joint type, lumbar type) are currently being attempted for rehabilitation. There are a number of studies of postoperative rehabilitation using the HAL lower limb type for myelopathy [8,9], cerebral palsy [10], and knee osteoarthritis [11,12]. Rehabilitation using the HAL single-joint type after surgery for knee osteoarthritis has also been reported [13,14].…”

Section: Introductionmentioning

confidence: 99%

Early Postoperative Rehabilitation Using the Hybrid Assistive Limb (HAL) Lumbar Type in Patients With Hip Fracture: A Pilot Study

Fujikawa¹,

Takahashi²,

Shinohara³

et al. 2022

Cureus

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Objective: To extend life expectancy after surgery, patients with hip fractures need to improve their mobility quickly through postoperative rehabilitation. Voluntary hip joint motion supported by the hybrid assistive limb (HAL) lumbar type, an exoskeleton robot suit characterized by its ability to detect the wearer's intentions through the bioelectrical signals and assist hip extension motions at an optimal timing, may be effective to improve mobility in patients with hip joint dysfunction after surgery. We aimed to introduce rehabilitation using the HAL lumbar type in the early period after hip fracture surgery.Methods: Patients who underwent internal fixation for hip fracture at a single institution were prospectively enrolled. They received early postoperative rehabilitation (forward and backward bending of the lumbar spine, pelvic tilt forward and backward, standing up, and squatting) using the HAL lumbar type (six times a week for 15 min per session). Five-times-sit-to-stand (FTSS) and timed-up-and-go (TUG) tests were conducted at baseline before HAL rehabilitation (pre-HAL) and after the HAL rehabilitation (post-HAL) intervention.Results: We enrolled 14 patients (one man, 13 women) in this study. There were no adverse events, and all patients were able to complete the entire rehabilitation program. Post-HAL FTSS showed significant improvement compared with pre-HAL and had a large effect size of 1.81 (95% CI = 0.93 to 2.66) and sufficient power.Conclusions: Robotic rehabilitation with HAL lumbar type could be introduced without adverse events, even in the early postoperative period following surgery for hip fracture. Further study is needed to develop an appropriate rehabilitation protocol using the HAL lumbar type.

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Feasibility of Neurorehabilitation Using a Hybrid Assistive Limb for Patients Who Underwent Spine Surgery

Cited by 7 publications

References 42 publications

Biofeedback Core Exercise Using Hybrid Assistive Limb for Physical Frailty Patients With or Without Parkinson's Disease

Biofeedback Core Exercise Using Hybrid Assistive Limb for Physical Frailty Patients With or Without Parkinson's Disease

Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review

Early Postoperative Rehabilitation Using the Hybrid Assistive Limb (HAL) Lumbar Type in Patients With Hip Fracture: A Pilot Study

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