Improvement of walking ability during postoperative rehabilitation with the hybrid assistive limb after total knee arthroplasty: A randomized controlled study

Tanaka, Yohei; Oka, Hiroyuki; Nakayama, Shinichi; Ueno, Takaaki; Matsudaira, Ko; Miura, Toshiki; Tanaka, Kihachiro; Tanaka, Sakae

doi:10.1177/2050312117712888

Cited by 23 publications

(35 citation statements)

References 34 publications

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“… 11 , 12 Recently, the effects of using robotics for walking exercises have been examined, 13 - 15 and exoskeletal robotic exercises have been proposed for patients who have undergone TKA to improve postoperative knee function and walking ability. 16 - 19 However, several of these devices are heavy and have a strong exoskeleton mechanism to provide lower leg support because they are intended to be used during repetitive walking exercises for severely paralyzed patients. As patients after TKA surgery do not have severe paralysis, these exoskeleton-type robotic devices may not be efficient in clinical settings because of the large scale of the devices and time it takes to fit them.…”

Section: Introductionmentioning

confidence: 99%

Early Recovery of Walking Ability in Patients After Total Knee Arthroplasty Using a Hip-Wearable Exoskeleton Robot: A Case-Controlled Clinical Trial

Koseki

Mutsuzaki

Yoshikawa

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: The Honda Walking Assist (HWA) is a hip-wearable exoskeleton robot for gait training that assists in hip flexion and extension movements to guide hip joint movements during gait. This study aimed to evaluate the effects of walking exercises with HWA in patients who underwent total knee arthroplasty (TKA). Materials and Methods: This study involved 10 patients (11 knees) in the HWA group and 11 patients (11 knees) in the control group who underwent conventional physical therapy. The patients assigned to the HWA group underwent a total of 17-20 gait training sessions, each lasting approximately 20 min from week 1 to 5 following TKA. Self-selected walking speed (SWS), maximum walking speed (MWS), range of motion (ROM), knee extension and flexion torque, and Western Ontario and McMaster Universities Osteoarthritis Index subscales of pain (WOMAC-p) and physical function (WOMAC-f) scores were measured preoperatively, at 2, 4, and 8 weeks following TKA. Results: Interventions were successfully completed in all patients, with no severe adverse events. A significant difference was noted in the time × group interaction effect between preoperative and week 2 SWS and MWS. Regarding knee function, there was a significant difference in the time × group interaction between preoperative and week 2 active ROM extension; however, no significant difference in knee torque, WOMAC-p, and WOMAC-f scores were observed. In the between-group post hoc analysis, WOMAC-f in the HWA group was higher than that in the control group at week 8. Discussion: Although the control group showed a temporary reduction in SWS and MWS 2 weeks after TKA, the HWA group did not. These results suggest that HWA intervention promotes early improvement in walking ability after TKA. Conclusions: The gait training using HWA was safe and feasible and could be effective for the early improvement of walking ability in TKA patients.

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Section: Introductionmentioning

confidence: 99%

Early Recovery of Walking Ability in Patients After Total Knee Arthroplasty Using a Hip-Wearable Exoskeleton Robot: A Case-Controlled Clinical Trial

Koseki

Mutsuzaki

Yoshikawa

et al. 2021

Geriatr Orthop Surg Rehabil

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“…RAGT improved gait independence in stroke and cerebral palsy patients and improved motor function [ 8 , 9 ]. The investigators found the effectiveness of RAGT in patients with musculoskeletal injuries such as knee osteoarthritis [ 10 , 11 ]. Few previous studies have reported the use of RAGT in other musculoskeletal diseases, and there are no clear guidelines regarding the application of RAGT.…”

Section: Introductionmentioning

confidence: 99%

Effects of Robot-Assisted Gait Training in Patients with Burn Injury on Lower Extremity: A Single-Blind, Randomized Controlled Trial

Joo

Lee

Cho

et al. 2020

JCM

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This study investigated the effects of robot-assisted gait training (RAGT) on gait function in burn patients. Briefly, 40 burn patients were randomly divided into an RAGT group or a conventional training (CON) group. SUBAR® (Cretem, Korea) is a wearable robot with a footplate that simulates normal gait cycles. The RAGT group underwent 30 min of robot-assisted training using SUBAR® with 30 min of conventional physiotherapy once a day, 5 days a week for 12 weeks. Patients in the CON group received 30 min of overground gait training and range-of-motion (ROM) exercises twice a day for 5 days a week for 12 weeks. The RAGT group and the CON group underwent 60 min of training per day. The intervention frequency and duration did not differ between the RAGT group and the CON group. The main outcomes were functional ambulatory category (FAC); 6-min walking test (6MWT); visual analogue scale (VAS) during gait movement; ROM; and isometric forces of bilateral hip, knee, and ankle muscles before and after 12 weeks of training. The results of the VAS, FAC, and 6MWT (8.06 ± 0.66, 1.76 ± 0.56, and 204.41 ± 85.60) before training in the RAGT group improved significantly (4.41 ± 1.18, 4.18 ± 0.39, and 298.53 ± 47.75) after training (p < 0.001, p < 0.001, and p < 0.001). The results of the VAS, FAC, and 6MWT (8.00 ± 1.21, 1.75 ± 0.58, and 220.94 ± 116.88) before training in the CON group improved significantly (5.00 ± 1.03, 3.81 ± 1.05, and 272.19 ± 110.14) after training (p < 0.001, p < 0.001, and p = 0.05). There were differences in the improvement of results of the VAS, FAC, and 6MWT between groups after training, but they were not statistically significant (p = 0.23, p = 0.14, and p = 0.05). The isometric strengths of the right hip extensor (p = 0.02), bilateral knee flexor (p = 0.04 in the right, and p = 0.001 in the left), bilateral knee extensor (p = 0.003 in the right, and p = 0.002 in the left), bilateral ankle dorsiflexor (p = 0.04 in the right, and p = 0.02 in the left), and bilateral ankle plantarflexor (p = 0.001 in the right, and p = 0.008 in the left) after training were significantly improved compared with those before training in the RAGT group. The ROMs of the right knee extension (p = 0.03) and bilateral ankle plantarflexion (p = 0.008 in the right, and p = 0.03 in the left) were significantly improved compared with measurements before training in the RAGT. There were no significant differences of the isometric strengths and ROMs of the bilateral hip, knee, and ankle muscles after training in the CON group. There were significant improvements in the isometric strengths of the left knee flexor (p = 0.01), left ankle dorsiflexor (p = 0.01), and left ankle plantarflexor (p = 0.003) between the two groups. The results suggested that RAGT is effective to facilitate early recovery of muscles strength after a burn injury. This is the first study to evaluate the effectiveness of RAGT in patients with burns compared with those receiving conventional training. The absence of complications in burn patients provides an opportunity to enlarge the application area of RAGT.

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“…The study by Tanaka et al [ 23 ] has been the only randomized controlled trial that compared the lower limb function between groups of patients who underwent training with HAL and conventional therapy after TKA. Although actual measured values were not described in the article, an immediate improvement within 1 week was observed with the use of HAL.…”

Section: Introductionmentioning

confidence: 99%

Training with Hybrid Assistive Limb for walking function after total knee arthroplasty

et al. 2018

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BackgroundThe Hybrid Assistive Limb (HAL, CYBERDYNE) is a wearable robot that provides assistance to patients while walking, standing, and performing leg movements based on the intended movement of the wearer. We aimed to assess the effect of HAL training on the walking ability, range of motion (ROM), and muscle strength of patients after total knee arthroplasty (TKA) for osteoarthritis and rheumatoid arthritis, and to compare the functional status after HAL training to the conventional training methods after surgery.MethodsNine patients (10 knees) underwent HAL training (mean age 74.1 ± 5.7 years; height 150.4 ± 6.5 cm; weight 61.2 ± 8.9 kg), whereas 10 patients (11 knees) underwent conventional rehabilitation (mean age 78.4 ± 8.0 years; height 150.5 ± 10.0 cm; weight 59.1 ± 9.8 kg). Patients underwent HAL training during 10 to 12 (average 14.4 min a session) sessions over a 4-week period, 1 week after TKA. There was no significant difference in the total physical therapy time including HAL training between the HAL and control groups. Gait speed, step length, ROM, and muscle strength were evaluated.ResultsThe nine patients completed the HAL training sessions without adverse events. The walking speed and step length in the self-selected walking speed condition, and the walking speed in the maximum walking speed condition were greater in the HAL group than in the control group at 4 and 8 weeks (P < 0.05). The step length in the maximum walking speed condition was greater in the HAL group than in the control group at 2, 4, and 8 weeks (P < 0.05). The extension lag and knee pain were lower in the HAL group than in the control group at 2 weeks (P < 0.05). The muscle strength of knee extension in the HAL group was greater than that in the control group at 8 weeks (P < 0.05).ConclusionHAL training after TKA can improve the walking ability, ROM, and muscle strength compared to conventional physical therapy for up to 8 weeks after TKA. Since the recovery of walking ability was earlier in the HAL group than in the control group and adverse events were not observed in this pilot study, HAL training after TKA can be considered a safe and effective rehabilitation intervention.Trial registrationUMIN, UMIN000017623. Registered 19 May 2015

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Improvement of walking ability during postoperative rehabilitation with the hybrid assistive limb after total knee arthroplasty: A randomized controlled study

Cited by 23 publications

References 34 publications

Early Recovery of Walking Ability in Patients After Total Knee Arthroplasty Using a Hip-Wearable Exoskeleton Robot: A Case-Controlled Clinical Trial

Early Recovery of Walking Ability in Patients After Total Knee Arthroplasty Using a Hip-Wearable Exoskeleton Robot: A Case-Controlled Clinical Trial

Effects of Robot-Assisted Gait Training in Patients with Burn Injury on Lower Extremity: A Single-Blind, Randomized Controlled Trial

Training with Hybrid Assistive Limb for walking function after total knee arthroplasty

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