Feasibility and safety study of wearable cyborg Hybrid Assistive Limb for pediatric patients with cerebral palsy and spinal cord disorders.

Introduction: The wearable cyborg Hybrid Assistive Limb (HAL) is the world's first cyborg-type wearable robotic device, and it assists the user's voluntary movements and facilitates muscle activities. However, since the minimum height required for using the HAL is 150 cm, a smaller HAL (2S size) has been newly developed for pediatric use. This study aimed to (1) examine the feasibility and safety of a protocol for treatments with HAL (2S size) in pediatric patients and (2) explore the optimal method for assessing the efficacy of HAL. Methods: This clinical study included seven pediatric patients with postural and motor function disorders, who received 8-12 sessions of smaller HAL (2S size) treatment. The primary outcome was the Gross Motor Function Measure-88 (GMFM-88). The secondary outcomes were GMFM-66, 10-m walk test, 2- and 6-min walking distances, Canadian Occupational Performance Measure (COPM), a post-treatment questionnaire, adverse events, and device failures. Statistical analyses were performed using the paired samples t-test or Wilcoxon signed-rank test. Results: All participants completed the study protocol with no serious adverse events. GMFM-88 improved from 65.51 ± 21.97 to 66.72 ± 22.28 (p = 0.07). The improvements in the secondary outcomes were as follows: GMFM-66, 53.63 ± 11.94 to 54.96 ± 12.31, p = 0.04; step length, 0.32 ± 0.16 to 0.34 ± 0.16, p = 0.25; 2-MWD, 59.1 ± 57.0 to 62.8 ± 63.3, p = 0.54; COPM performance score, 3.7 ± 2.0 to 5.3 ± 1.9, p = 0.06; COPM satisfaction score, 3.3 ± 2.1 to 5.1 ± 2.1, p = 0.04. Discussion: In this exploratory study, we applied a new size of wearable cyborg HAL (2S size), to children with central nervous system disorders. We evaluated its safety, feasibility, and identified an optimal assessment method for multiple treatments. All participants completed the protocol with no serious adverse events. This study suggested that the GMFM would be an optimal assessment tool for validation trials of HAL (2S size) treatment in pediatric patients with posture and motor function disorders.

Safety and Feasibility Study of the Medical Care Pit Walking Support System for Rehabilitation of Acute Stroke Patients.

Stroke rehabilitation with mechanical assistance improves outcomes by facilitating repetition and relieving the care burden of therapy staff. Here, we tested the Medical Care Pit (MCP) walking assistance training device in the rehabilitation of eight acute stroke patients (median age 60.7 ± 16.3 years) who had recently suffered ischemic (three) or hemorrhagic (five) stroke (14.1 ± 6.5 days). Patients received standard rehabilitation approximately 5 days per week (weekdays only), plus MCP therapy twice a week, totaling four MCP sessions over 2 weeks. Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Functional Ambulation Category (FAC), and other gait-associated parameters were measured. Over the 10.5 ± 1.6 days of therapy, MCP qualitatively assisted in gait analysis and real-time patient feedback while independent walking scores significantly improved (FAC 2.2 ± 0.8 to 3.1 ± 1.3, p = 0.020). FMA-LE scores also slightly improved but not to significance (p = 0.106). Objective burden on patients, as measured by modified Borg scale, was significantly improved (2.7 ± 1.6 to 2.0 ± 1.6, p = 0.014). In terms of questionnaires, anxiety scores for the physical therapist regarding gait training and falling with MCP significantly decreased (3.8 ± 2.3 to 1.0 ± 1.6; p = 0.027 and 3.1 ± 2.2 to 0.8 ± 1.3; p = 0.045) from the first to fourth sessions. Taken together, MCP, in addition to the usual rehabilitation program, was effective in gait rehabilitation for independent walking and relieved burdens on the patients. Such walking support systems may be an important part of acute stroke rehabilitation.

Gait improvement with wearable cyborg HAL trunk unit for parkinsonian patients: five case reports.

Cybernic treatment involves the generation of an interactive bio-feedback loop between an individual's nervous system and the worn cyborg Hybrid Assistive Limb (HAL); this treatment has been applied for several intractable neuromuscular disorders. Thus, it is of interest to determine its potential for parkinsonian patients. This study confirmed the feasibility of using a HAL trunk unit to improve parkinsonian gait disturbance. HAL establishes functional and physical synchronization with the wearer by providing lateral cyclic forces to the chest in the form of somatosensory and motor cues. To confirm the feasibility of its use for improving parkinsonian gait disturbances, we conducted experiments with three Parkinson's disease patients and two patients with progressive supranuclear palsy. During the experiments, the immediate effect of the intervention was assessed; all participants exhibited improvements in gait disturbance while wearing the HAL unit, and this improvement effect persisted without the HAL unit in two participants. Afterward, based on the assessment, we conducted a continuous intervention for one participant. In this intervention, the number of steps in the final experiment was significantly decreased compared with the initial state. These findings suggest that the proposed method is an option for treating parkinsonian patients to generate somatosensory and motor cues.

Effects of cardiac rehabilitation with motion assistance from a wearable cyborg hybrid assistive limb on patients with chronic heart failure: a randomized controlled trial with a one-year follow-up.

[Purpose] We have recently reported that using a wearable cyborg hybrid assistive limb improved the isometric knee extensor muscle strength of patients with chronic heart failure. Here, we investigated the long-term effects of a lumbar-type hybrid assistive limb for patients with chronic heart failure. [Participants and Methods] A total of 28 hospitalized patients with chronic heart failure (mean age, 73.1 ± 13.8 years) were randomly assigned to two groups: the hybrid assistive limb group or the control group, in which they performed a sit-to-stand exercise with or without the hybrid assistive limb, respectively. The cardiac rehabilitation therapy included this intervention, which was performed as many times as possible for 5-30 minutes per day for 6-10 days. Clinical assessments like lower-limb muscle strength, walking ability, etc., were measured before and after the intervention. Cardiac events were followed up for up to a year after discharge. [Results] No adverse events occurred during the study period in either group. In terms of long-term effects, the incidence of cardiac events was 23% and 45% in the hybrid assistive limb and the control groups, respectively. [Conclusion] Hybrid assistive limb-assisted exercise therapy may be a safe and feasible cardiac rehabilitation tool in patients with chronic heart failure. The lumbar-type wearable cyborg hybrid assistive limb may have a positive effect on heart failure prognosis by adding long-term exercise therapy.

Staged treatment protocol for gait with hybrid assistive limb in the acute phase of patients with stroke.

Hybrid Assistive Limb (HAL) is a wearable human assistant cyborg-type robot that helps lower-leg movement based on bioelectrical signals detected from the voluntary movement of the person wearing it. In this study, we developed a novel staged HAL treatment protocol for patients with acute stroke. The Regain Program for Gait with HAL (RPG-HAL) was formulated in four steps, based on the severity of limb paralysis. Twenty-one patients with acute stroke received a combination treatment of RPG-HAL and conventional rehabilitation. The feasibility and safety of RPG-HAL were evaluated based on changes in physical function and activities of daily living (ADL). RPG-HAL yielded improvement in gait speed, cadence, step length, and functional ambulation category (FAC). The effect size was >0.8 in all measurements. FAC (1.90) and Barthel Index (BI) (1.92) exhibited the highest scores. Twelve out of 14 patients with FAC 0 before RPG-HAL reached the upper FAC. Thus, earlier intervention using RPG-HAL as improving physical function, ADL, and gait ability in patients with stroke.

Gait Evaluation with Bioelectrical Signal Patterns during Cybernic Treatment.

Cybernic treatment with a wearable cyborg Hybrid Assistive Limb for medical use (Medical HAL) improves ambulatory function in patients with progressive neuromuscular diseases. The progress of cybernic treatment is evaluated based on the change in the patient's walking distance and walking speed over a certain treatment period. However, evaluation methods to capture temporal changes in gait functions during each therapy are required for more effective evaluation in clinical practice. Because the patients' muscular activities are measured with each trial of cybernic treatment, bioelectrical signals (BES) of lower limb muscles measured by Medical HAL may aid in evaluating the wearers' gait functions. Thus, this study proposed a method to quantify the BES patterns of patients during cybernic treatment and compared them with the BES patterns of healthy personnel for evaluation, which confirmed the correlation between the BES pattern and the patients' gait abilities. First, we obtained a reference BES pattern from the BES of three healthy personnel during walking using Medical HAL. Second, we calculated the similarity between the reference BES pattern of the healthy personnel and the patient's BES pattern using derivative dynamic time warping (DDTW), which quantified the patients' BES patterns based on their shape. Third, we investigated the correlation between patients' DDTW of BES patterns during cybernic treatment and 2-minute walking distances. The correlation coefficient between the patients was -0.83 (p < 0.01) and that within patients was -0.38 (p < 0.05), indicating a significant BES pattern relationship between walking with Medical HAL and gait abilities. Conclusively, the similarity between the BES patterns of healthy personnel and patients calculated using DDTW might be applied to the evaluation of patients' gait functions. The ability to assess the gait function with data measured during cybernic treatment would provide understandings of the patient's functional changes over time.

Basic study of epileptic seizure detection using a single-channel frontal EEG and a pre-trained ResNet.

Epilepsy is a neurological disorder that causes sudden seizures due to abnormal excitation of neurons in the brain. Approximately 30 % of patients cannot control their seizures using medication. In addition, since seizures can occur anywhere and at any time, caregivers must always be with the patient. Various researchers have developed seizure detection methods using multichannel EEG to improve the quality of life of patients and caregivers. However, the large size of the measurement device impedes transportation. We believe that a portable measurement device with a small number of channels is suitable for detecting seizures in daily life. Therefore, we need a system that can detect seizures using a small number of channels. The purpose of this research is to develop a seizure detection algorithm using a single-channel frontal EEG and to confirm its basic performance. We used EEG signals from a single electrode position (Fp1-F7, Fp2-F8), which is a bipolar derivation of the frontal region. We segmented the EEG using a 2 s sliding window with 50 % overlap and converted the segments into images. After preprocessing, we fine-tuned ResNet18, pre-trained on ImageNet, and developed an ensemble classification method. In the experiments with 10 epileptic patients (3 - 19 years old) registered in the CHB-MIT scalp EEG database, the results showed that the average sensitivity was 88.73 %, the average specificity was 98.98 %, and the average detection latency time was 7.39 s. In conclusion, the developed algorithm was validated as sufficiently accurate to detect epileptic seizures.Clinical Relevance- This establishes an image recognition algorithm that can detect epileptic seizures using a single- channel frontal EEG.

Effects of Cardiac Rehabilitation With Lumbar-Type Hybrid Assistive Limb on Muscle Strength in Patients With Chronic Heart Failure　- A Randomized Controlled Trial.

BACKGROUND: Aiming to establish an effective tool in new cardiac rehabilitation programs, we investigated the use of a lumbar-type hybrid assistive limb (HAL) in patients with heart failure (HF) who had difficulty in walking at the usual speed of healthy subjects (≈80 m/min).Methods and Results:We randomly assigned 28 HF patients (age, 73.1±13.8 years) to perform a sit-to-stand exercise with or without HAL. The sit-to-stand exercise was repeated as many times as possible as cardiac rehabilitation therapy over a period of 6-10 days. We measured 5 parameters before and after the completion of cardiac rehabilitation: B-type natriuretic peptide, Short Physical Performance Battery (SPPB), 6-min walking distance (6MWD), 30-s chair-stand test (CS-30), and isometric knee extensor muscle strength. The SPPB and 6MWD were significantly improved, and the CS-30 score was somewhat improved, after the exercise therapy in both the HAL and non-HAL groups. The knee extensor muscle strength improved significantly in the HAL group (0.29±0.11 to 0.35±0.11 kgf/kg, P<0.01), but showed no change in the non-HAL group (0.35±0.11 to 0.35±0.13 kgf/kg, P=0.40). CONCLUSIONS: The improved knee extensor muscle strength in the HAL group suggests that the lumbar-type HAL may be an effective tool for cardiac rehabilitation in HF patients with frailty, which is a predictor of poor prognosis in HF.

Cybernic treatment with wearable cyborg Hybrid Assistive Limb (HAL) improves ambulatory function in patients with slowly progressive rare neuromuscular diseases: a multicentre, randomised, controlled crossover trial for efficacy and safety (NCY-3001).

BACKGROUND: Rare neuromuscular diseases such as spinal muscular atrophy, spinal bulbar muscular atrophy, muscular dystrophy, Charcot-Marie-Tooth disease, distal myopathy, sporadic inclusion body myositis, congenital myopathy, and amyotrophic lateral sclerosis lead to incurable amyotrophy and consequent loss of ambulation. Thus far, no therapeutic approaches have been successful in recovering the ambulatory ability. Thus, the aim of this trial was to evaluate the efficacy and safety of cybernic treatment with a wearable cyborg Hybrid Assistive Limb (HAL, Lower Limb Type) in improving the ambulatory function in those patients. RESULTS: We conducted an open-label, randomised, controlled crossover trial to test HAL at nine hospitals between March 6, 2013 and August 8, 2014. Eligible patients were older than 18 years and had a diagnosis of neuromuscular disease as specified above. They were unable to walk for 10 m independently and had neither respiratory failure nor rapid deterioration in gait. The primary endpoint was the distance passed during a two-minute walk test (2MWT). The secondary endpoints were walking speed, cadence, and step length during the 10-m walk test (10MWT), muscle strength by manual muscle testing (MMT), and a series of functional measures. Adverse events and failures/problems/errors with HAL were also evaluated. Thirty patients were randomly assigned to groups A or B, with each group of 15 receiving both treatments in a crossover design. The efficacy of a 40-min walking program performed nine times was compared between HAL plus a hoist and a hoist only. The final analysis included 13 and 11 patients in groups A and B, respectively. Cybernic treatment with HAL resulted in a 10.066% significantly improved distance in 2MWT (95% confidence interval, 0.667-19.464; p = 0.0369) compared with the hoist only treatment. Among the secondary endpoints, the total scores of MMT and cadence at 10MWT were the only ones that showed significant improvement. The only adverse effects were slight to mild myalgia, back pain, and contact skin troubles, which were easily remedied. CONCLUSIONS: HAL is a new treatment device for walking exercise, proven to be more effective than the conventional method in patients with incurable neuromuscular diseases. TRIAL REGISTRATION: JMACTR, JMA-IIA00156.

Exercise training using hybrid assistive limb (HAL) lumbar type for locomotive syndrome: a pilot study.

BACKGROUND: With a rapidly aging population in Japan, locomotive syndrome is becoming an increasingly serious social problem. Exercise therapy using the lumbar type HAL, which is a wearable robot suit that can assist voluntary hip joint motion, would be expected to cause some beneficial effects for people with locomotive syndrome. The purpose of this study was to assess whether the deterioration of low back pain and any other adverse events would occur following HAL exercise therapy. Moreover, the changes of motor ability variables were evaluated. METHODS: We enrolled 33 participants (16 men, 17 women) with locomotive syndrome in this study. They received exercise training (sit-to-stand, lumbar flexion-extension, and gait training) with HAL (in total 12 sessions). We assessed the change of low back pain (lumbar VAS). More than 50% and 25 mm increase compared to baseline was defined as adverse events. One-leg standing time (OLST), 10-m walking test (10MWT), Timed Up and Go test (TUG), 1-min sit-to-stand test (1MSTS), FIM mobility scores and EQ-5D were measured. RESULTS: Of the 33 participants, 32 (16 men, 16 women) (97.0%) completed all 12 exercise training sessions using the lumbar type HAL. One woman aged 82 years withdrew because of right upper limb pain after the second session regardless of the use of HAL. There was no participant who had deterioration of low back pain. Any other adverse events including external injuries and/or falling, skin disorders, uncontrollable cardiovascular or respiratory disorders, and other health disorders directly related to this exercise therapy did not occur. Several outcome measures of motion ability including OLST, TUG and 1MSTS, EQ VAS and lumbar pain improved significantly after this HAL training. CONCLUSIONS: Almost all patients with locomotive syndrome completed this exercise training protocol without any adverse events related to HAL. Furthermore, balance function variables including OLST, TUG and 1MSTS improved after this HAL exercise therapy even though mobility function variables including 10MWT and FIM mobility scores did not show any significant change. These findings suggest that the exercise therapy using the lumbar type HAL would be one of the options for the intervention in locomotive syndrome.

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

STUDY DESIGN: Prospective experimental study in humans. PURPOSE: To determine whether the hybrid assistive limb (HAL) for Care Support can reduce lumbar load during a patient transfer. OVERVIEW OF LITERATURE: The prevalence of work-related low back pain (LBP) among nurses is high. In particular, transferring patients poses a high risk for LBP due to the large lumbar load. Attempts to reduce the lumbar load are crucial to avoid the risk of LBP. Therefore, we investigated the effects of the HAL for Care Support. METHODS: Nineteen volunteers (16 men, three women) lifted a 60-kg doll from a seated position to a standing position. The first transfer was performed without the HAL for Care Support, and the second was performed with the HAL for Care Support assistive robot. We evaluated transfer performance, the visual analog scale (VAS) score for lumbar fatigue, and electromyogram analyses of the trunk and hip. RESULTS: Four participants (two men, two women) succeeded with the HAL for Care Support even though they were unable to perform the task without it. The mean lumbar fatigue VAS score for all participants without the HAL for Care Support was 62 mm, while that with it was 43 mm. With lumbar assistance from the HAL for Care Support, subjective lumbar fatigue during the transfer decreased significantly. A power analysis indicated adequate statistical power to detect a difference in the VAS score for lumbar fatigue (0.99). The activity of the left gluteus maximus alone increased significantly during transfers with the HAL for Care Support. No adverse events occurred during use of the HAL for Care Support for transfers. CONCLUSIONS: The HAL for Care Support was able to reduce lumbar load in a simulated patient transfer.

Development of a Tendon-Driven Wearable Assist System for Thumb Motion of Hand Paralysis.

Thumb movement is very important for object gripping. However, when a cerebrovascular disorder or spinal cord injury causes hand paralysis, which impairs the motor function of the fingers, it becomes impossible to flex and extend the fingers and to move the thumb to the opposition position; this makes it difficult to grip objects in daily life. Several assistive devices have been developed for people with hand paralysis. However, they only assist flexion/extension of the thumb, narrow the type of grip by fixing the thumb position, or have large sizes and weights due to using links and frames to assist thumb adduction and opposition. They are not effective for daily use. Thumb motion assistance that does not hinder the degree of freedom of the thumb is important for gripping objects in everyday life. In this study, we developed a wearable ring and a fingertip-cap that assist two-degree-of-freedom thumb motion by means of a tendon-drive based on the hand's anatomy; the feasibility of the device is confirmed through basic experiments, in which the device was evaluated by a hand in a weakened state. It was confirmed that opposing movement and flexion/extension motion of the thumb were possible. In addition, we confirmed that it was possible to grip thin objects by using only thumb motion assistance. In conclusion, we developed a tendon-driven thumb motion assistive device using a ring-shaped component and confirmed the feasibility of this system to support the opposition/reposition and flexion/extension motions of the thumb.

[Traumatic Intercostal Lung Hernia Repaired by Video-assisted Thoracoscopic Surgery;Report of a Case].

The 40-year-old male patient was raced to our hospital complaining respiratory difficulty after hitting his left chest at a handle when falling down from a bicycle. Fracture of 5th left rib and partial lung prolapsed intercostally out of the thorax was observed by computed tomography (CT). Due to exacerbated pneumothorax and pneumoderma recognized 12 hours later by CT with the lung remained incarcerated, a surgery was conducted. Camera port was placed from 8th intercostal part at left midaxillary line. The left lung was partially incarcerated from ruptured intercostal part of fractured 5th rib. Adding a working port from 7th intercostal part at the posterior axillary line, the incarcerated lung was thoracoscopically reduced. The thoracoscopic surgery was completed by fixing the rib outside the thoracic wall with 2-0 nylon suture without partial resection of the lung. The patient was discharged on day 7 with satisfactory progress. Thoracoscopic approach is effective for traumatic intercostal lung hernia.

Weight-Supported Walking Assist Device for Knee Osteoarthritis Patients.

Knee osteoarthritis patients have pain in their knee and it can become difficult to walk depending on the progress of symptoms. After performing chondrocyte implantation, it is necessary to reduce the load on the knee joint until the implanted cartilage is integrated. The purposes of this study were to develop a device that enables the user to walk and reduced the weight on the knee joint and to confirm basic performance of the device through experiments. The device was composed of a seat for supporting the body weight of the user, a prosthetic knee, and the floor reaction force sensor shoes. Experiments were conducted to confirm the basic performance of the device. As a result, an able-bodied participant who wore the device was able to walk while unloading two-thirds of their body weight onto their knee. As a result of gait analysis, it was found that the gait did not change significantly even when the device was worn.

Feasibility and safety of Robot Suit HAL treatment for adolescents and adults with cerebral palsy.

To investigate whether Robot Suit HAL treatment (HAL-T) is safe and feasible for gait disorders in adolescents and adults with cerebral palsy (CP). We tested HAL-T in adolescents and adults with bilateral spastic CP (four men, four women; mean age: 18.2 years). Three participants were classified as level III under the Gross Motor Function Classification System (GMFCS), and five were classified as level IV. The participants underwent HAL-T twice per week for 4 weeks. The outcome measures, which were assessed before and after HAL-T, included comfortable gait speed (CGS), step length (SL), cadence, and GMFCS level. Adverse events were noted. All participants completed the HAL-T sessions despite some mild adverse events occurring. The mean increases in CGS, SL, and cadence were 0.19 ±â€¯0.14 m/s (p = 0.006), 0.09 ±â€¯0.08 m (p = 0.020), and 18.0 ±â€¯15.9 steps/min (p = 0.015), respectively. HAL-T is safe and feasible for gait disorders in patients with CP. HAL-T can significantly improve CGS, SL, and cadence and may be effective for improving walking ability in adolescents and adults with CP.

Efficacy of Cardiac Rehabilitation with Assistance from Hybrid Assistive Limb in Patients with Chronic Heart Failure: Protocol for a Randomized Controlled Study.

The hybrid assistive limb (HAL) provides motion assistance based on bioelectrical signals detected on the skin surface when muscle forces are generated. The lumbar-type HAL is expected to expand the therapeutic options for severe cardiac patients who have difficulty in moving on their own legs. We aim to compare the efficacy of exercise therapy performed with assistance from a lumbar-type HAL versus conventional training (sit-to-stand exercise without HAL) in patients with chronic heart failure. This investigation will be a randomized, nonblinded, controlled study. Sixty patients who satisfy the criteria to receive cardiac rehabilitation therapy under the Japanese national insurance system will be enrolled at the University of Tsukuba Hospital. Participants randomly assigned to 2 groups (HAL group and conventional group) at a 1:1 allocation ratio will perform exercise therapy either with HAL or without HAL for 5-30 min once a day for 6-10 days. Outcome parameters will be measured just before and after the completion of the exercise therapy and at 1 year after hospital discharge. The primary outcomes will be the heart rate, blood pressure, subjective ratings of exercise intensity during exercise (Borg scale), number of days from the start of exercise therapy to independent walking and to discharge, and prognosis (mortality and cardiovascular events) over the 1-year period after discharge. The secondary outcomes will be the assessment of heart failure severity, brain natriuretic peptide, grip strength, thigh muscle thickness, isometric knee extensor strength, standing ability, 10-meter walking speed, 6-min walking distance, short physical performance battery, and adverse events. Unpaired t tests will be used for baseline assessments and outcome measures. This is the first randomized controlled study to examine the efficacy and feasibility of lumbar-type HAL in patients with chronic heart failure. If the results confirm beneficial effects in the outcomes of patients with heart failure, this study will add more evidence in support of the use of the lumbar-type HAL as an effective tool in new cardiac rehabilitation programs.

Effects of a lumbar-type hybrid assistive limb on cardiopulmonary burden during squat exercise in healthy subjects.

The lumbar-type Hybrid Assistive Limb (HAL) is expected to expand the possibilities of exercise therapy for severe cardiac patients who have difficulty in moving on their own legs. We investigated whether motion assistance from HAL during squat exercise could effectively reduce the cardiopulmonary burden in healthy subjects. Twelve healthy subjects (33 ±â€¯11 years) performed squat exercise for 3 consecutive minutes at a repetition rate of 20 squats per minute with and without assistance from a lumbar-type HAL. The oxygen uptake (VO2), carbon dioxide output (VCO2), minute ventilation (VE), and the Borg Scale were monitored during exercise. VO2 (930 ±â€¯207 vs 992 ±â€¯169 mL/min, p < 0.05) and the Borg Scale rating (12.8 ±â€¯1.1 vs 13.7 ±â€¯0.8, p < 0.05) at the end of exercise were significantly lower when HAL was used. When 2 subjects who regularly perform high-intensity exercise for more than 10 h per week were excluded from the analyses, VO2, VCO2, VE, and the Borg Scale were significantly lower when HAL was used. Our results demonstrate that the lumbar-type HAL significantly reduces cardiopulmonary burden during squat exercise in healthy subjects. The effects were especially striking in sedentary subjects. Further studies on cardiac patients are expected to establish a new cardiac rehabilitation program using HAL.

Intensive Gait Treatment Using a Robot Suit Hybrid Assistive Limb in Acute Spinal Cord Infarction: Report of Two Cases.

CONTEXT: Spinal cord infarction (SCI) causes gait disturbance because of paresis, spasticity, and sensory disturbance of the lower limbs. There is no effective medical treatment for SCI, and conventional rehabilitation alone is the main approach to helping individuals work toward independent walking. The aim of this study was to evaluate the effect of gait treatment using the Hybrid Assistive Limb (HAL) on acute SCI. FINDINGS: A 61-year-old female and a 62-year-old male with incomplete paraplegia participated in this study. Our study participants received gait treatment with HAL 3-4 times per week, with a total of 7-8 sessions (20 min), in addition to conventional physical therapy. The American Spinal Injury Association Impairment Scale, Lower Extremity Motor Score (LEMS), Modified Ashworth Scale (MAS), the Walking Index for Spinal Cord Injury (WISCI II), comfortable gait speed (CGS), stride, cadence, Barthel Index (BI), Functional Independence Measure (FIM), modified Rankin Scale (mRS), joint angles, and adverse effects were assessed prior to HAL treatment and post-HAL treatment. HAL facilitated intensive gait treatment in people during the acute phase after SCI. Improvements in LEMS, WISCI II, CGS, stride, cadence, BI, FIM, mRS, and joint angles were observed in both study participants. Furthermore, decreased spasticity in the gastrocnemius muscle was found in one participant as assessed by MAS. CONCLUSION: Gait treatment using HAL may be beneficial for paraplegic, non-ambulatory individuals with acute SCI. HAL may be useful for intensive gait treatment without increasing spasticity.

Walking ability following hybrid assistive limb treatment for a patient with chronic myelopathy after surgery for cervical ossification of the posterior longitudinal ligament.

CONTEXT: The hybrid assistive limb (HAL) (the wearable robot) can assist kinesis during voluntary control of hip and knee joint motion by detecting the wearer's bioelectric signals on the surface of their skin. The purpose of this study was to report on walking ability following the wearable robot treatment in a patient with chronic myelopathy after surgery for cervical ossification of the posterior longitudinal ligament (OPLL). FINDINGS: The patient was a 66-year-old woman with cervical OPLL who was able to ambulate independently with the aid of bilateral crutches. The wearable robot treatment was received once every 2 weeks for ten sessions beginning approximately 14 years after surgery. Improvements were observed in gait speed (BL 22.5; post 46.7 m/min), step length (BL 0.36; post 0.57 m), and cadence (BL 61.9; post 81.6 m/min) based on a 10-m walk test and a 2-minute walk test (BL 63.4; post 103.7 m) assessing total walking distance. The improvements in walking ability were maintained after the wearable robot treatment for 6 months. CONCLUSION: We report the functional recovery in the walking ability of a patient with chronic cervical myelopathy following the wearable robot treatment, suggesting that as a rehabilitation tool, the wearable robot has the potential to effectively improve functional ambulation in chronic cervical myelopathy patients whose walking ability has plateaued, even many years after surgery.