Gait training of subacute stroke patients using a hybrid assistive limb: a pilot study

Abstract

Purpose To determine whether gait training with a hybrid assistive limb (HAL) as an exoskeleton robotic device was safe and could increase functional mobility and gait ability in subacute stroke patients. Methods The participants were eight patients with post-stroke hemiparesis whose walking impairment and gait recovery curves had plateaued. The intervention program was gait training using HAL and a walker for 20 min daily 5 days a week for 5 weeks. The 10-m maximum walking speed (MWS), self-selected walking speed (SWS) and 2-min-walk test (2MT) without HAL were used as primary outcome measures to determine the effects of training. The Berg Balance Scale (BBS), Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA) and functional ambulation category (FAC) were assessed as secondary outcomes. These measures were assessed before and after the 5-week intervention program and were analyzed statistically using a paired t-test. Results All eight participants completed the intervention program with no adverse events. There were significant increases in MWS, SWS and 2MT. BBS, FMA and FAC also increased, but not significantly. Conclusion The new HAL exoskeleton robotic device was efficient and safe for improving motor function and gait in patients in the subacute stage after stroke. Implications for Rehabilitation Gait training using HAL will improve gait ability of individuals with post stroke. The HAL achieve intensive gait training without increase spasticity and abnormal gait pattern.

Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

“…In contrast to studies with patients with SCI, studies with post-stroke patients assessed the gait performance, without wearing exoskeleton, after training with the exoskeleton and compared the results with the baseline measurements. In general, we found that the degree of mobility improvement was not as substantial as with the studies focusing on SCI patients: 12 out of 16 studies analyzing gait speed reported an improvement [37,47,87,102,[105][106][107][108][109][110][111][112], and only 3 out of 9 studies analyzing Flugl-Meyer scores reported an improvement [102,109,112]. Regarding the group of studies focusing on other pathologies, 4 out of 7 studies analyzing outcome measures related to gait speed reported an improvement [36,86,113,114].…”

Effects of Gait Treatment With a Single-Leg Hybrid Assistive Limb System After Acute Stroke: A Non-randomized Clinical Trial

“…In an exploratory study, Yoshikawa et al (2016) suggested that HAL treatment in cases of sub-acute stroke may enhance the walking speed by changing the walking pattern and asymmetry ratio in the late recovery stage. Mizukami et al (2017) also argued that, if gait treatment with HAL can be started early, walking with an appropriate pattern can be improved and patients can avoid acquiring an incorrect or compensatory walking pattern. Early intensive HAL treatment may contribute not only to improved independent walking but also to improved walking patterns.…”

Effects of gait training using the Hybrid Assistive Limb® in recovery-phase stroke patients: A 2-month follow-up, randomized, controlled study

“…Several studies have investigated the effects of locomotion training using HAL ® for stroke patients (Kawamoto et al, 2013;Nilsson, Vreede, Häglund, Kawamoto, Sankai, & Borg, 2014;Watanabe, Tanaka, Inuta, Saitou, & Yanagi, 2014;Mizukami et al, 2016). Kawamoto et al (2013) reported that the dependent ambulatory levels (FAC 2-3 with chronic stroke) showed significant differences in comfortable walking speed between before and after a total of 16 HAL ® training sessions.…”

“…During locomotor training, the patients walked on a floor and were harnessed in a mobile suspension system. Mizukami et al (2016) discussed that the harness walker system enabled patients to walk continuously without risk of falling. Therefore, the use of mobile suspension system played an important role in enhancing the HAL ® training effect.…”