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

Abstract

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

Gait Training Using a Hip-Wearable Robotic Exoskeleton After Total Knee Arthroplasty: A Case Report

“… 15 However, there are few reports demonstrating the effect of RAT in postoperative rehabilitation after TKA. 16 , 17 The Honda Walking Assist ® (HWA; Honda Motor Co., Ltd., Tokyo, Japan) is a wearable robotic device that assists with gait training. It has a simple mechanism and is lightweight and easy to wear ( Figure 1A ).…”

Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report

“…It actuates the electric motors embedded in the hips and knees of its exoskeleton in real time, amplifying bioelectric activation of the relevant muscles which are detected using surface electrodes attached on the hip and knee muscles. Previous studies using HAL for myelopathy (10)(11)(12), spinal cord injury (13)(14)(15)(16)(17), and post-surgery rehabilitation after total knee arthroplasty (18) reported improvement of walking ability after HAL training.…”

Successful Use of the Hybrid Assistive Limb for Care Support to Reduce Lumbar Load in a Simulated Patient Transfer

“…It can provide interactive motion according to the wearer's voluntary motor drive. Various types of HALs, such as those for lower limbs, for single joints, and for lumbar support, have been used for musculoskeletal and neurological disorders, including cerebral infarction, spinal cord injury, myelopathy, and osteoarthritis [13][14][15]. The HAL for Care Support substitutes hip joint motion for trunk motion and assists hip joint extension, which thereby reduces the lumbar load during lifting.…”