A Consecutive 25-Week Program of Gait Training, Using the Alternating Hybrid Assistive Limb (HAL®) Robot and Conventional Training, and Its Effects on the Walking Ability of a Patient with Chronic Thoracic Spinal Cord Injury: A Single Case Reversal Design.

Background and Objectives: In this study, we examined the effect of a consecutive 25-week gait training program, consisting of 5-week alternating phases of Hybrid Assistive Limb (HAL)-assisted robot gait training and conventional gait training, on the walking ability of a 50-year-old man with a chronic thoracic spinal cord injury (SCI). Materials and Methods: Clinical features of this patient's paraplegia were as follows: neurological level, T7; American Spinal Cord Injury Association Impairment Scale Score, C; Lower Extremity Motor Score, 20 points; Berg Balance Scale score, 15 points; and Walking Index for Spinal Cord Injury, 6 points. The patient completed a 100 m walk, under close supervision, using a walker and bilateral ankle-foot orthoses. The intervention included two phases: phase A, conventional walking practice and physical therapy for 5 weeks, and phase B, walking using the HAL robot (3 d/week, 30 min/session), combined with conventional physical therapy, for 5 weeks. A consecutive A-B-A-B-A sequence was used, with a 5-week duration for each phase. Results: The gait training intervention increased the maximum walking speed, cadence, and 2-min walking distance, as well as the Berg Balance and Walking Index for Spinal Cord Injury from 15 to 17 and 6 to 7, respectively. Walking speed, stride length, and cadence improved after phase A (but not B). Improved standing balance was associated with measured improvements in measured gait parameters. Conclusion: The walking ability of patients with a chronic SCI may be improved, over a short period by combining gait training, using HAL-assisted and conventional gait training and physical therapy.

Adjusting Assistance Commensurates with Patient Effort During Robot-Assisted Upper Limb Training for a Patient with Spasticity After Cervical Spinal Cord Injury: A Case Report.

Limited evidence is available on optimal patient effort and degree of assistance to achieve preferable changes during robot-assisted training (RAT) for spinal cord injury (SCI) patients with spasticity. To investigate the relationship between patient effort and robotic assistance, we performed training using an electromyography-based robotic assistance device (HAL-SJ) in an SCI patient at multiple settings adjusted to patient effort. In this exploratory study, we report immediate change in muscle contraction patterns, patient effort, and spasticity in a 64-year-old man, diagnosed with cervical SCI and with American Spinal Injury Association Impairment Scale C level and C4 neurological level, who underwent RAT using HAL-SJ from post-injury day 403. Three patient effort conditions (comfortable, somewhat hard, and no-effort) by adjusting HAL-SJ's assists were set for each training session. Degree of effort during flexion and extension exercise was assessed by visual analog scale, muscle contraction pattern by electromyography, modified Ashworth scale, and maximum elbow extension and flexion torques, immediately before and after each training session, without HAL-SJ. The amount of effort during training with the HAL-SJ at each session was evaluated. The degree of effort during training can be set to three effort conditions as we intended by adjusting HAL-SJ. In sessions other than the no-effort setting, spasticity improved, and the level of effort was reduced immediately after training. Spasticity did not decrease in the training session using HAL-SJ with the no-effort setting, but co-contraction further increased during extension after training. Extension torque was unchanged in all sessions, and flexion torque decreased in all sessions. When performing upper-limb training with HAL-SJ in this SCI patient, the level of assistance with some effort may reduce spasticity and too strong assistance may increase co-contraction. Sometimes, a patient's effort may be seemingly unmeasurable; hence, the degree of patient effort should be further measured.

Gait Training Using the Honda Walking Assistive Device® in a Patient Who Underwent Total Hip Arthroplasty: A Single-Subject Study.

BACKGROUND AND OBJECTIVES: The Honda Walking Assistive device® (HWA) is a light and easywearable robot device for gait training, which assists patients' hip flexion and extension movementsto guide hip joint movements during gait. However, the safety and feasibility of robot-assisted gaittraining after total hip arthroplasty (THA) remains unclear. Thus, we aimed to evaluate the safetyand feasibility of this gait training intervention using HWA in a patient who underwent THA. MATERIALS AND METHODS: The patient was a 76-year-old woman with right hip osteoarthritis. Gaittraining using HWA was implemented for 20 sessions in total, five times per week from 1 week to5 weeks after THA. Self-selected walking speed (SWS), step length (SL), cadence, timed up and go(TUG), range of motion (ROM) of hip extension, and hip abduction and extension torque weremeasured preoperatively, and at 1 (pre-HWA), 2, 3, 4, 5 (post-HWA), and 10 weeks (follow-up) afterTHA. The gait patterns at SWS without HWA were measured by using three-dimensional (3D) gaitanalysis and an integrated electromyogram (iEMG). RESULTS: The patient completed 20 gait trainingsessions with no adverse event. Hip abduction torque at the operative side, hip extension torque,SWS, SL, and cadence were higher at post-HWA than at pre-HWA. In particular, SWS, TUG, andhip torque were remarkably increased 3 weeks after THA and improved to almost the same levelsat follow-up. Maximum hip extension angle and hip ROM during gait were higher at post-HWAthan at pre-HWA. Maximum and minimum anterior pelvic tilt angles were lower at post-HWA thanat pre-HWA. The iEMG of the gluteus maximus and gluteus medius in the stance phase were lowerat post-HWA than preoperatively and at pre-HWA. CONCLUSIONS: In this case, the gait training usingHWA was safe and feasible, and could be effective for the early improvement of gait ability, hipfunction, and gait pattern after THA.

Safety and efficacy of robotic elbow training using the upper limb single-joint hybrid assistive limb combined with conventional rehabilitation for bilateral obstetric brachial plexus injury with co-contraction: a case report.

[Purpose] Obstetric brachial plexus injuries are accompanied by co-contractions due to misdirection of regenerated nerve fibers. The result is inhibition of arm movement necessary for activities of daily living. Rehabilitation is important to prevent joint contracture and muscle atrophy in such cases. A single-joint hybrid assistive limb is a new wearable robot that can assist in elbow joint motion by detecting muscle action potentials on the upper limb surface. Inhibiting co-contractions due to obstetric brachial plexus injuries with this device may help with performance of activities of daily living. This study aimed to evaluate the safety and efficacy of using a single-joint hybrid assistive limb combined with conventional rehabilitation in a patient with obstetric brachial plexus injuries. [Participant and Methods] A 40-year-old male with bilateral obstetric brachial plexus injuries and co-contractions of the biceps and deltoid underwent rehabilitation training using the single-joint hybrid assistive limb 3 times a week for 12 sessions (4 weeks) in both upper limbs. [Results] The patient completed all 12 sessions of training using the single-joint hybrid assistive limb with no adverse events. Improvements in flexion strength in the left elbow, active flexion range of motion in both elbows, and functional tests in the right arm were observed. [Conclusion] Elbow training using the newly developed single-joint hybrid assistive limb combined with conventional rehabilitation can be performed without severe adverse events and may improve muscle strength, range of motion, and arm functions in adults with obstetric brachial plexus injuries and bilateral co-contractions of the deltoid and biceps muscles.

Association between Obesity and Short-Term Patient-Reported Outcomes following Total Knee Arthroplasty: A Retrospective Cohort Study in Japan.

Background: This study investigated the association between obesity and short-term patient-reported outcomes after total knee arthroplasty (TKA). Methods: The primary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index's (WOMAC) pain and function scores. Data were collected preoperatively and 2 and 4 weeks after surgery. Patients were stratified into three groups based on body mass index (BMI): normal weight (BMI < 24.99 kg/m2), overweight (25 ≤ BMI < 29.99 kg/m2), and obese (BMI ≥ 30 kg/m2). The associations between BMI and the WOMAC pain and function scores were assessed using generalized linear mixed models. Results: Among the 102 patients (median age: 75.0, women [85.3%]), 29.4%, 48.0%, and 22.5% were normal weight, overweight, and obese, respectively. The mean pain and function scores at baseline were similar across the BMI-stratified groups (p = 0.727 and 0.277, respectively). The pain score significantly improved 2 weeks post-surgery (p = 0.001). The function score improved significantly 4 weeks post-surgery (p < 0.001). The group and group-by-time interaction effects lacked statistical significance. Conclusions: All patients statistically and clinically showed relevant pain reduction and functional improvement shortly after TKA, irrespective of their obesity status. These data may help healthcare professionals discuss the expectations of pain amelioration and functional improvement with TKA candidates.

Use of Robot-Assisted Ankle Training in a Patient with an Incomplete Spinal Cord Injury: A Case Report.

Rehabilitation interventions are crucial in promoting neuroplasticity after spinal cord injury (SCI). We provided rehabilitation with a single-joint hybrid assistive limb (HAL-SJ) ankle joint unit (HAL-T) in a patient with incomplete SCI. The patient had incomplete paraplegia and SCI (neurological injury height: L1, ASIA Impairment Scale: C, ASIA motor score (R/L) L4:0/0, S1:1/0) following a rupture fracture of the first lumbar vertebra. The HAL-T consisted of a combination of ankle plantar dorsiflexion exercises in the sitting position, knee flexion, and extension exercises in the standing position, and stepping exercises in the standing position with HAL assistance. The plantar dorsiflexion angles of the left and right ankle joints and electromyograms of the tibialis anterior and gastrocnemius muscles were measured and compared using a three-dimensional motion analyzer and surface electromyography before and after HAL-T intervention. Phasic electromyographic activity was developed in the left tibialis anterior muscle during plantar dorsiflexion of the ankle joint after the intervention. No changes were observed in the left and right ankle joint angles. We experienced a case in which intervention using HAL-SJ induced muscle potentials in a patient with a spinal cord injury who was unable to perform voluntary ankle movements due to severe motor-sensory dysfunction.

Gait training using a wearable robotic hip device for incomplete spinal cord injury: A preliminary study.

CONTEXT/OBJECTIVE: To explore changes in gait functions for patients with chronic spinal cord injury (SCI) before and after standard rehabilitation and rehabilitation with a wearable hip device, explore the utility of robot-assisted gait training (RAGT), and evaluate the safety and dose of RAGT. DESIGN: Single-arm, open-label, observational study. SETTING: A rehabilitation hospital. PARTICIPANTS: Twelve patients with SCI. INTERVENTIONS: Standard rehabilitation after admission in the first phase. RAGT for two weeks in the second phase. OUTCOME MEASURES: Self-selected walking speed (SWS), step length, cadence, and the 6-minute walking distance were the primary outcomes. Walking Index for SCI score, lower extremity motor score, and spasticity were measured. Walking abilities were compared between the two periods using a generalized linear mixed model (GLMM). Correlations between assessments and changes in walking abilities during each period were analyzed. RESULTS: After standard rehabilitation for 66.1 ± 36.9 days, a period of 17.6 ± 3.3 days of RAGT was safely performed. SWS increased during both periods. GLMM showed that the increase in cadence was influenced by standard rehabilitation, whereas the limited step length increase was influenced by RAGT. During RAGT, the increase in step length was related to an increase in hip flexor function. CONCLUSIONS: Gait speed in patients with SCI increased after rehabilitation, including RAGT, in the short-term. This increase was associated with improved muscle function in hip flexion at the start of RAGT.Trial Registration: This study was registered with the UMIN Clinical Trials Registry (UMIN-CTR; UMIN000042025).

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.

Robot-Assisted Ankle Rehabilitation Using the Hybrid Assistive Limb for Children after Equinus Surgery: A Report of Two Cases.

After equinus corrective surgery, repetitive exercises for ankle dorsiflexion and plantar flexion are crucial during rehabilitation. The single-joint Hybrid Assistive Limb (HAL-SJ) is an advanced exoskeletal robotic device with a control system that uses bioelectrical signals to assist joint motion in real time and demonstrates joint torque assistance with the wearer's voluntary movement. We present two cases of robot-assisted ankle rehabilitation after equinus surgery using the HAL-SJ in children. Case 1 was an 8-year-old boy, whereas case 2 was a 6-year-old boy. When they were allowed to walk without braces, training with the HAL-SJ was performed postoperatively for 20 min per session a total of eight times (2-4 sessions per week). Assessments were performed before and after HAL-SJ training. During gait analysis, case 1 had improved joint angles during the stance phase on the operated side; however, case 2 had improved joint angles during the stance and swing phases. The co-activation index values of the medial gastrocnemius and tibialis anterior muscles, which were high before training, decreased after training and approached the standard value. The HAL-SJ may provide systematic feedback regarding voluntary ankle dorsiflexion and plantar flexion and is considered to have motor learning effects.

Weight Change during the Early Phase of Convalescent Rehabilitation after Stroke as a Predictor of Functional Recovery: A Retrospective Cohort Study.

It has been reported that weight gain at discharge compared with admission is associated with improved activities of daily living in convalescent rehabilitation (CR) patients with low body mass index. Here, we investigated whether weight maintenance or gain during the early phase of CR after stroke correlates with a better functional recovery in patients with a wide range of BMI values. We conducted this retrospective cohort study in a CR ward of our hospital and included adult stroke patients admitted to the ward from January 2014 to December 2018. After ~1 month of hospitalization, the patients were classified into weight loss and weight maintenance or gain (WMG) groups based on the Global Leadership Initiative on Malnutrition criteria for weight. We adopted the motor functional independence measure (FIM) gain as the primary outcome. The motor FIM gain tended to be greater in the WMG group but without statistical significance. However, multiple regression analysis showed that WMG was significantly and positively associated with motor FIM gain. In conclusion, weight maintenance or gain in patients during the early phase of CR after stroke may be considered as a predictor of their functional recovery, and nutritional management to prevent weight loss immediately after the start of rehabilitation would contribute to this.

Effect of Training With the Hybrid Assistive Limb on Gait Cycle Kinematics After Total Knee Arthroplasty.

INTRODUCTION: Reportedly, wearable robots, such as the hybrid assistive limb (HAL), are effective in the functional recovery of various locomotor disabilities, including disrupted walking, restricted range of motion, and muscle weakness. However, the effect of walking exercises with a HAL on the kinematic and kinetic variables of lower limb joint function is not yet fully understood. Therefore, the purpose of this study was to elucidate the effect of HAL on the kinematic and kinetic variables of lower limb function in patients 5 weeks after total knee arthroplasty (TKA). MATERIALS AND METHODS: Nine patients (ten knees) in the HAL training group and nine patients (nine knees) in the control group underwent TKA. HAL training was initiated 1-5 weeks after TKA, and general rehabilitation was performed in the control group. Gait analysis was performed on each patient using a motion analysis system at 5 weeks after TKA. We compared the effects of the joint angles of the walking cycle between groups, and investigated the effect of the walking cycle's joint angles on step length. RESULTS: In the HAL group, the odds ratio of hip extension was as large as 1.741, while that of knee swing was as large as 1.501. These 2 variables were significant between the 2 groups. Knee swing and varus significantly affected step length. CONCLUSIONS: Our results suggest that training by wearing HAL after TKA increased the mobility of the knee and hip joints during early postoperative walking, and that walking ability was improved by increasing the step length.

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

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.

Gait Training after Stroke with a Wearable Robotic Device: A Case Report of Further Improvements in Walking Ability after a Recovery Plateau.

BACKGROUND: Conventional rehabilitation is known to improve walking ability after stoke, but its effectiveness is often limited. Recent studies have shown that gait training combining conventional rehabilitation and robotic devices in stroke patients provides better results than conventional rehabilitation alone, suggesting that gait training with a robotic device may lead to further improvements in the walking ability recovered by conventional rehabilitation. Therefore, the aim of this report was to highlight the changes in kinematic and electromyographic data recorded during walking before and after gait training with the Honda Walking Assist Device® (HWAT) in a male patient whose walking speed had reached a recovery plateau under conventional rehabilitation. CASE: The patient was a 42-year-old man with severe hemiplegia caused by right putaminal hemorrhage. He underwent conventional rehabilitation for 20 weeks following the onset of stroke, after which his walking speed reached a recovery plateau. Subsequently, we added robotic rehabilitation using HWAT to his regular rehabilitation regimen, which resulted in improved step length symmetry and gait endurance. We also noted changes in muscle activity patterns during walking. DISCUSSION: HWAT further improved the walking ability of a patient who had recovered with conventional rehabilitation; this improvement was accompanied by changes in muscle activity patterns during walking. The improvement in gait endurance exceeded the smallest meaningful change in stroke patients, suggesting that this improvement represented a noticeable enhancement in the quality of life in relation to mobility in the community. Further clinical trials are needed to confirm the results of the present case study.

The Progress of the Gait Impairment and Brain Activation in a Patient with Post-stroke Hemidystonia.

OBJECTIVE: We explore the effects of body weight-supported (BWS) treadmill training, including the change of cortical activation, on a patient with post-stroke hemidystonia. PATIENT: The patient was a 71-year-old man with left thalamus hemorrhage. His motor symptoms indicated slight impairment. There was no overactive muscle contraction in the supine, sitting, or standing positions. During his gait, the right initial contact was the forefoot, and his right knee showed an extension thrust pattern. These symptoms suggested that he had post-stroke hemidystonia. METHODS: The patient performed BWS treadmill training 14 times over 3 weeks. The effects of the BWS training were assessed by a step-length analysis, electromyography and functional magnetic resonance imaging (fMRI). RESULTS: The patient's nonparetic step length was extended significantly in the Inter-BWS (p<0.001) and Post-BWS (p=0.025) periods compared to the Pre-BWS session. The excessive muscle activity of the right gastrocnemius medialis in the swing phase was decreased at the Inter-BWS, Post-BWS, and follow-up compared to the Pre-BWS session. The peak timing difference of the bilateral tibialis anterior muscle became significant (p<0.05) on the first day of the intervention. The fMRI revealed that the cortical areas activated by the motor task converged through the intervention (p<0.05, family-wise error corrected). CONCLUSION: These results suggest that there was improvement of the patient's symptoms of post-stroke hemidystonia due to changes in the brain activity during voluntary movement after BWS intervention. Body weight-supported treadmill training may thus be an effective treatment for patients with poststroke hemidystonia.

Gait Training Using a Wearable Robotic Device for Non-Traumatic Spinal Cord Injury: A Case Report.

INTRODUCTION: We aimed to report the clinical evaluation results of gait training with the Honda Walking Assist Device® (HWAT) in a patient with spinal cord injury (SCI). PATIENTS AND METHODS: A 63-year-old male with SCI (grade D on the American Spinal Injury Association Impairment Scale) underwent 20 HWAT sessions over 4 weeks. The self-selected walking speed (SWS), mean step length, cadence, 6-minute walking test (6MWT), Walking Index for SCI score, SCI Functional Ambulation Inventory gait score, American Spinal Injury Association Impairment Scale grade, neurological level, upper and lower extremity motor scores, modified Ashworth Scale, Penn Spasm Frequency Scale, and Spinal Cord Independence Measure version III were measured on admission, at the start of HWAT, at 2 and 4 weeks post-HWAT, and at discharge. Three-dimensional kinematic gait analysis and electromyographic assessments were performed before and after HWAT. RESULTS: The patient safely completed 20 HWAT sessions. We found improvements above the clinically meaningful difference in SWS and 6MWT as well as increased hip extension, ankle plantar- and dorsi-flexion range of motion and increased hip extensor, abductor, adductor, and ankle plantar flexor muscle activity. DISCUSSION: The SWS improved more markedly during the HWAT intervention, exceeding the minimal clinically important difference (0.10 to 0.15 m/s) in walking speed for people with SCI until discharge. Moreover, the 6MWT results at 2 weeks after the start of HWAT exceeded the cutoff value (472.5 m) for community ambulation and remained at a similar value at discharge. CONCLUSION: The walking distance (6MWT) and the walking speed (SWS) both demonstrated clinically important improvements following 20 treatment sessions which included HWAT.

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

The Honda Walking Assist® (HWA) is a light and easy wearable robot device for gait training, which assists patients' hip flexion and extension movements to guide hip joint movements during gait. However, the safety and feasibility of gait training with HWA after total knee arthroplasty (TKA) remains unclear. Thus, we aimed to evaluate the safety and feasibility of this gait training intervention using HWA for a patient who underwent TKA. The patient was a 76-year-old female who underwent a left TKA. Gait training using HWA was conducted for 18 sessions in total, from 1 to 5 weeks after TKA. To verify the recovery process after TKA surgery, knee function parameters and walking ability were measured at pre-TKA and 1, 2, 4, and 8 weeks after TKA. The gait patterns at self-selected walking speed (SWS) without HWA at pre- and 5 weeks after TKA were measured by using 3-dimensional (3D) gait analysis. The patient completed a total of 18 gait training interventions with HWA without any adverse complications such as knee pain and skin injury. The postoperative knee extension range of motion (ROM), knee extension torque, SWS, and maximum walking speed were remarkably improved. Regarding gait kinematic parameters, though this patient had a characteristic gait pattern with decreased knee ROM (called stiff knee gait) preoperatively, the knee flexion angle at 5 weeks after TKA showed knee flexion movement at loading response phase (LR; called double knee action), increased knee ROM during gait, and increased knee flexion angle at swing phase. In this case, the gait training using HWA was safe and feasible, and could be effective for the early improvement of gait ability, hip function, and gait pattern after TKA.

Gait training using the Honda Walking Assist Device® for individuals with transfemoral amputation: A report of two cases.

BACKGROUND: Independent walking is important for individuals who have undergone lower limb amputation. Recently, robot-assisted gait training has been widely used for individuals with abnormal gait. However, no study has evaluated the effect of the Honda Walking Assist Device® (HWA) on the gait of patients who have undergone transfemoral (TF) amputation. OBJECTIVE: This study aimed to investigate the safety, feasibility, and effect of gait training using the HWA for individuals who underwent lower limb amputation. METHODS: This study included two elderly patients who underwent TF amputation due to a nontraumatic reason. Gait training interventions using the HWA were performed for a week (5 training sessions). Self-selected walking speed (SWS), step length, cadence, hip kinematic parameters, and symmetricity of single support time ratios during SWS were measured before and after the HWA interventions. RESULTS: SWS, step length, cadence, and hip angle range improved after the HWA interventions in both patients. Symmetricity of single support time ratios and maximum hip extension angle improved in patient 1, but not in patient 2. There were no adverse events in either patient. CONCLUSIONS: Gait training using the HWA was safe and effective for improving the gait of two TF amputees.

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

BACKGROUND: The 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. METHODS: Nine 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. RESULTS: The 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). CONCLUSION: HAL 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 REGISTRATION: UMIN, UMIN000017623 . Registered 19 May 2015.

Gait training of subacute stroke patients using a hybrid assistive limb: a pilot study.

Purpose To determine whether gait training with a hybrid assistive limb (HAL) as an exoskeleton robotic device was safe and could increase functional mobility and gait ability in subacute stroke patients. Methods The participants were eight patients with post-stroke hemiparesis whose walking impairment and gait recovery curves had plateaued. The intervention program was gait training using HAL and a walker for 20 min daily 5 days a week for 5 weeks. The 10-m maximum walking speed (MWS), self-selected walking speed (SWS) and 2-min-walk test (2MT) without HAL were used as primary outcome measures to determine the effects of training. The Berg Balance Scale (BBS), Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA) and functional ambulation category (FAC) were assessed as secondary outcomes. These measures were assessed before and after the 5-week intervention program and were analyzed statistically using a paired t-test. Results All eight participants completed the intervention program with no adverse events. There were significant increases in MWS, SWS and 2MT. BBS, FMA and FAC also increased, but not significantly. Conclusion The new HAL exoskeleton robotic device was efficient and safe for improving motor function and gait in patients in the subacute stage after stroke. Implications for Rehabilitation Gait training using HAL will improve gait ability of individuals with post stroke. The HAL achieve intensive gait training without increase spasticity and abnormal gait pattern.

Gait training with Hybrid Assistive Limb enhances the gait functions in subacute stroke patients: A pilot study.

BACKGROUND: The robotic Hybrid Assistive Limb (HAL) provides motion according to the wearer's voluntary activity. HAL training effects on walking speed and capacity have not been clarified in subacute stroke. OBJECTIVES: To determine improvement in walking ability by HAL and the most effective improvement measure for use in future large-scale trials. METHODS: Sixteen first-ever hemiplegic stroke patients completed at least 20 sessions over 5 weeks. Per session, the experimental group received no more than 20 min of gait training with HAL (HT) and 40 min of conventional physiotherapy, whereas the control group received at least 60 min of conventional physiotherapy. Primary outcome was maximum walking speed (MWS). RESULTS: The change in MWS from baseline at week 5 was 11.6±10.6 m/min (HAL group) and 2.2±4.1 m/min (control group) (adjusted mean difference = 9.24 m/min, 95% confidence interval 0.48-18.01, P = 0.040). In HAL subjects there were significant increases in Self-selected walking speed (SWS; a secondary outcome) and in step length (a secondary outcome) at MWS and SWS compared with controls. CONCLUSIONS: HT improved walking speed in hemiplegic sub-acute stroke patients. In future, randomized controlled trials are needed to confirm the utility of HT.