Effects of Long-term Hybrid Assistive Limb Use on Gait in Patients with Amyotrophic Lateral Sclerosis.

Objective To assess the long-term effects of hybrid assistive limb (HAL) treatment on gait in patients with amyotrophic lateral sclerosis (ALS). Methods Three courses of treatment with HAL were administered to three women with ALS. Each course had a four- to five-week duration, during which the treatment was performed nine times, with a rest period of at least two months between each course. Gait ability (2-minutes-walk and 10-m-walk tests), ALS Functional Rating Scale-Revised, and respiratory function tests were performed before and after each treatment course. Patients Patients diagnosed with ALS, according to the updated Awaji criteria, by board-certified neurologists in the Department of Neurology and Department of Rehabilitation Medicine, Toho University Omori Faculty of Medicine between January and December 2019 were recruited. Results The average time from the start to the end of the 3 courses was 319.7±33.7 days. A multiple regression analysis was performed for the 2-minutes-walk and 10-m-walk tests, using the baseline value, each participant's ID, and time point as covariates. Changes after each course were considered outcomes. Following the 3 treatment courses, the 2-minutes walk distance improved by 16.61 m (95% confidence interval, -9.33-42.54) compared with the baseline value, but this improvement was not statistically significant (p=0.21). However, cadence significantly improved by 1.30 steps (95% confidence interval, 0.17-2.42; p=0.02). Conclusion Long-term, repetitive HAL treatments may help patients with ALS maintain their gait.

Robot-assisted training using hybrid assistive limb ameliorates gait ability in patients with amyotrophic lateral sclerosis.

OBJECTIVE: The Hybrid Assistive Limb (HAL; CYBERDYNE, Inc., Japan) is a wearable robot device that provides effective gait assistance according to voluntary intention by detecting weak bioelectrical signals of neuromuscular activity on the surface of the skin. We used HAL for patients with amyotrophic lateral sclerosis (ALS) to determine whether HAL training had an effect on their gait ability. METHODS: We conducted a single-center, single-arm, observational study. Patients with ALS underwent HAL training once per day (20-40 min per session) for 9-10 days for at least 4 weeks. Gait ability was evaluated using the 2-minute walk test, the 10-meter walk test without the assistance of HAL, and activities of daily living (ADL) using the Barthel Index and Functional Independence Measures before and after a full course of HAL training. RESULTS: There were no dropouts or adverse events during the observation period. Gait function improved after HAL training. The 2-minute walk test revealed a mean gait distance of 73.87 m (36.65) at baseline and 89.9m (36.70) after HAL training (p = 0.004). The 10-meter walk test showed significantly improved cadence, although gait speed, step length on the 10-m walk, or ADL measurements did not change significantly. CONCLUSIONS: Although HAL is not a curative treatment for ALS, our data suggest that HAL may be effective in ameliorating and preserving gait ability in patients with ALS.

[Feasibility of cardiopulmonary rehabilitation in patients with idiopathic pulmonary arterial hypertension treated with intravenous prostacyclin infusion therapy].

OBJECTIVES: To evaluate cardiopulmonary rehabilitation in patients with idiopathic pulmonary arterial hypertension who had severe heart failure. METHODS: The subjects comprised 11 men and 13 women aged 5 to 37 years old with idiopathic pulmonary arterial hypertension, who received cardiopulmonary rehabilitation following the start of continuous intravenous prostacyclin administration between January 1999 and September 2003. Fifteen patients were categorized in New York Heart Association (NYHA) functional class-III and 9 were class-IV on admission. Patients received cardiopulmonary rehabilitation consisting of breathing exercise, training of upper extremity muscles, gait training, bicycle ergometer training, and treadmill walking for 30 to 60 min per day, 5 days a week. Cardiothoracic ratio, NYHA class, heart rate, pulse oximeter saturation, plasma levels of human atrial natriuretic peptide and brain natriuretic peptide, tricuspid regurgitation, and right ventricular myocardial index (RV Tei index) were evaluated by echocardiography, lower extremity muscle strength, ambulation ability, Barthel index, and 6-minute walking distance at the beginning and end of cardiopulmonary rehabilitation. RESULTS: The average period of cardiopulmonary rehabilitation was 6.7 weeks. There was no deterioration in cardiothoracic ratio, human atrial natriuretic peptide, brain natriuretic peptide levels, tricuspid regurgitation, RV Tei index and pulse oximeter saturation. The results also showed decreased heart rate at rest (p = 0.007), and improved NYHA class (p = 0.010), lower extremity strength (p < 0.001), ambulation ability (p < 0.001), Barthel index (p < 0.001), and 6-minute walking distance (p = 0.001). CONCLUSIONS: Cardiopulmonary rehabilitation is safe and effective for idiopathic pulmonary arterial hypertension patients in NYHA class-III and IV during intravenous prostacyclin infusion without deterioration of cardiac functions, despite the conventional contraindication.