Improvement and sustainability of walking ability with hybrid assistive limb training in a patient with cerebral palsy after puberty: a case report

Abstract

[Purpose] Cerebral palsy is one of the most common causes of childhood physical disability affecting motor development. Gait training with a wearable-robot, such as the Hybrid Assistive Limb, has been reported to improve gait ability in patients with chronic motor disabilities; however, there are no reports concerning the sustained improvement of walking ability with its use in patients with cerebral palsy. We present our observations for the use of Hybrid Assistive Limb gait training in a postpubescent cerebral palsy patient. [Participant and Methods] A 17-year-old male with spastic cerebral palsy could only ambulate slightly using a crouch gait posture and with the aid of a walker. Hybrid Assistive Limb training was performed thrice weekly for 4 weeks (total of 12 sessions) along with concurrent daily physical therapy. The follow-up period was 7 months after the intervention. [Results] The intervention resulted in improvements in the patient’s gait speed, proportion of the stance phase in a gait cycle, step length, and the flexion angle of the knees at initial contact and during late stance phase, which was sustained for 7 months following the intervention. [Conclusion] Our observations suggest that Hybrid Assistive Limb training may effectively improve and sustain walking ability even among postpubescent cerebral palsy patients who have a decreased walking ability.

Effectiveness of powered exoskeleton use on gait in individuals with cerebral palsy: A systematic review

“…With the exception of Lerner, Damiano and Bulea [ 32 ] who did not report any change, all the other eight studies found improvements in step length. Four studies [ 41 , 43 – 45 ] had a statistically significant increase in step length, while three studies [ 31 , 39 , 42 ] did not support their findings with statistical significance. Matsuda et al [ 47 ] found a non-statistically significant increase in step length for both self-selected walking speed (P = 0.078) and maximum walking speed (P = 0.739) in participants using the HAL exoskeleton.…”

“…While most of the included studies scored well for criterion two [ 31 – 34 , 39 , 41 – 48 ] and criterion 14 [ 31 – 34 , 39 , 41 – 45 , 47 , 48 ], there were a number of methodological concerns. These included measurement bias due to lack of psychometrically sound outcome measures [ 31 – 33 , 39 , 41 – 48 ], co-intervention bias [ 31 – 33 , 39 , 42 , 43 , 47 , 48 ] and lack of appropriate analytical methods [ 31 , 39 , 42 , 48 ]. While the lack of blinding of the participants, therapists and measures increases the risk of placebo, Hawthorne effect and measurement bias, given the nature of the intervention, these biases could not be entirely avoidable.…”

“…Four studies [ 41 , 43 , 44 , 47 ] had session durations of 20 minutes. Three studies [ 39 , 42 , 48 ] had session durations of 60 minutes. Mileti et al [ 45 ] and Bayon et al [ 31 ] had session durations of 30 minutes and approximately 75 minutes, respectively.…”

“…Two studies [ 33 , 34 ] did not report on session duration at all. Nakagawa et al [ 39 ] included 10 minutes of single-leg extension-flexion motion and standing and seated exercises as pre-training into their study design. Study duration ranged from 1 day [ 34 , 41 , 44 – 46 ] to 8–12 weeks [ 32 ].…”

“…Ten studies reported an increase in mean velocity as a result of the intervention. Of these studies, findings from five studies [ 33 , 41 , 43 , 44 , 47 ] were statistically significant while five studies [ 31 , 34 , 39 , 42 , 48 ] did not report data on statistical significance. There was no difference in mean velocity in the remaining three studies [ 32 , 45 , 46 ].…”