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Kubota S, Kadone H, Shimizu Y, Watanabe H, Koda M, Sankai Y, Yamazaki M. Feasibility and Efficacy of the Newly Developed Robotic Hybrid Assistive Limb Shoulder Exercises in Patients with C5 Palsy during the Acute Postoperative Phase. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1496. [PMID: 37629786 PMCID: PMC10456926 DOI: 10.3390/medicina59081496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Although postoperative C5 palsy is a frequent complication of cervical spine surgery, no effective therapeutic rehabilitation approach has been established for postoperative C5 palsy. The purpose of this study was to find evidence confirming the effectiveness and feasibility of robotic Hybrid Assistive Limb (HAL) shoulder exercises for C5 palsy. Materials and Methods: In this before-after, uncontrolled case series clinical study, we performed a mean of 11.7 shoulder training sessions using a shoulder HAL immediately after the onset of C5 palsy in seven shoulders of six patients who developed postoperative C5 palsy and had difficulty raising their shoulder during the acute postoperative phase of cervical spine surgery. Shoulder HAL training was introduced as early as possible after evaluating the general condition of all inpatients who developed C5 palsy. Patients underwent shoulder abduction training using shoulder HAL on an inpatient and outpatient basis at 2-week or 1-month intervals. Adverse events associated with shoulder HAL training were investigated. The shoulder abduction angle and power without the shoulder HAL were evaluated before shoulder HAL usage, at every subsequent session, and upon completion of all sessions. Results: Severe adverse events due to shoulder HAL training were not reported. After completion of all shoulder HAL sessions, all patients showed improved shoulder elevation, while shoulder abduction angle and power improved over time. Conclusions: Shoulder elevation training with HAL in patients in the acute stage of postoperative C5 palsy has the potential to demonstrate improvement in shoulder joint function with a low risk of developing severe adverse events.
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Affiliation(s)
- Shigeki Kubota
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan; (M.K.); (M.Y.)
| | - Hideki Kadone
- Center for Innovating Medicine and Engineering (CIME), University of Tsukuba, Ibaraki 305-0821, Japan;
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan;
| | - Hiroki Watanabe
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan;
| | - Masao Koda
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan; (M.K.); (M.Y.)
| | - Yoshiyuki Sankai
- Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki 305-8573, Japan;
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan; (M.K.); (M.Y.)
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Development of a New Ankle Joint Hybrid Assistive Limb. Medicina (B Aires) 2022; 58:medicina58030395. [PMID: 35334571 PMCID: PMC8955947 DOI: 10.3390/medicina58030395] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/18/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022] Open
Abstract
Foot and ankle disabilities (foot drop) due to common peroneal nerve palsy and stroke negatively affect patients’ ambulation and activities of daily living. We developed a novel robotics ankle hybrid assistive limb (HAL) for patients with foot drop due to common peroneal nerve palsy or stroke. The ankle HAL is a wearable exoskeleton-type robot that is used to train plantar and dorsiflexion and for voluntary assistive training of the ankle joint of patients with palsy using an actuator, which is placed on the lateral side of the ankle joint and detects bioelectrical signals from the tibialis anterior (TA) and gastrocnemius muscles. Voluntary ankle dorsiflexion training using the new ankle HAL was implemented in a patient with foot drop due to peroneal nerve palsy after lumbar surgery. The time required for ankle HAL training (from wearing to the end of training) was approximately 30 min per session. The muscle activities of the TA on the right were lower than those on the left before and after ankle HAL training. The electromyographic wave of muscle activities of the TA on the right was slightly clearer than that before ankle HAL training in the resting position immediately after ankle dorsiflexion. Voluntary ankle dorsiflexion training using the novel robotics ankle HAL was safe and had no adverse effect in a patient with foot drop due to peroneal nerve palsy.
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Matsuda D, Kubota S, Akinaga Y, Yasunaga Y, Sankai Y, Yamazaki M. Ankle dorsiflexion training with a newly developed Hybrid Assistive Limb for a patient with foot drop caused by common peroneal nerve palsy: a case report. J Phys Ther Sci 2022; 34:410-415. [PMID: 35527842 PMCID: PMC9057677 DOI: 10.1589/jpts.34.410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] An ankle disorder (foot drop) caused by common peroneal nerve palsy or
cerebrovascular accident (stroke) interferes with patients’ ability to walk and hinders in
activities of daily living. A new robotic ankle, the Hybrid Assistive Limb, has been
developed for the treatment of foot drop caused by common peroneal nerve palsy or sequelae
of stroke. The purpose in this study was to report and examine the efficacy and
feasibility of a case who was treated with voluntary ankle dorsiflexion training with the
ankle Hybrid Assistive Limb. [Participant and Method] A 60-year-old man with foot drop due
to peroneal nerve palsy that occurred without a contributory cause was treated via ankle
dorsiflexion training with the use of a new robotic ankle, the “Ankle Hybrid Assistive
Limb”. [Results] Following total ankle rehabilitation training with the Ankle Hybrid
Assistive Limb, improvements in ankle dorsiflexor strength, gait, and sensory function of
the lower leg and foot were observed. [Conclusion] The newly developed ankle Hybrid
Assistive Limb could be an effective training tool for foot drop caused by common peroneal
nerve palsy.
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Affiliation(s)
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | | | - Yoshihiro Yasunaga
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yoshiyuki Sankai
- Faculty of Engineering, Information and Systems, University of Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Taketomi M, Shimizu Y, Kadone H, Hada Y, Yamazaki M. Hybrid Assistive Limb Intervention for Hemiplegic Shoulder Dysfunction Due to Stroke. Cureus 2021; 13:e19827. [PMID: 34963844 PMCID: PMC8702387 DOI: 10.7759/cureus.19827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Abstract
Upper limb dysfunction after stroke is one of the most serious functional disorders, and adequate functional recovery is often not expected. Although various studies have been conducted on effective rehabilitation for upper limb dysfunction, active rehabilitation such as repetitive training of upper limb elevation has not been sufficiently conducted yet because the shoulder joint is highly unstable and the appearance of pain is easily observed. In this study, we performed right shoulder joint elevation training in a seated position using a single-joint hybrid assistive limb (HAL) in a 54-year-old female with right hemiplegia after a stroke. Her right upper limb function improved as follows: passive and active range of motion (ROM) of shoulder flexion, from 105° to 115° and from 65° to 105°, respectively; manual muscle test (MMT), from 2 to 4; box and block test of the right hand, from 1 to 8; right grip strength, from less than 5 to 7.4 kg; and action research arm test (ARAT) total scores, from 10 to 20. No adverse events including shoulder pain were seen. According to the result of the pilot study, HAL may be an effective rehabilitation tool for upper limb dysfunction after stroke.
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Affiliation(s)
- Masakazu Taketomi
- Doctoral Program in Clinical Science Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, JPN
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, JPN
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
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Kubota S, Kadone H, Shimizu Y, Takahashi H, Koda M, Miura K, Watanabe H, Suzuki K, Hada Y, Sankai Y, Yamazaki M. Robotic Shoulder Rehabilitation With the Hybrid Assistive Limb in a Patient With Delayed Recovery After Postoperative C5 Palsy: A Case Report. Front Neurol 2021; 12:676352. [PMID: 34594290 PMCID: PMC8477042 DOI: 10.3389/fneur.2021.676352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/30/2021] [Indexed: 12/04/2022] Open
Abstract
C5 palsy is a serious complication that may occur after cervical spine surgery; however, standard procedures for shoulder rehabilitation for patients with postoperative C5 palsy have not yet been established. We used a wearable robot suit Hybrid Assistive Limb (HAL) in a patient with delayed recovery after postoperative C5 palsy and conducted shoulder abduction training with the HAL. A 62-year-old man presented with weakness in his left deltoid muscle 2 days after cervical spine surgery. He experienced great difficulty in elevating his left arm and was diagnosed with postoperative C5 palsy. Seven months after surgery, shoulder abduction training with a HAL was initiated. In total, 23 sessions of shoulder HAL rehabilitation were conducted until 26 months after surgery. His shoulder abduction angle and power improved at every HAL session, and he was able to fully elevate his arm without any compensatory movement after the 23rd session, suggesting that the HAL is a useful tool for shoulder rehabilitation in patients with postoperative C5 palsy. We employed shoulder HAL training for a patient with delayed recovery from postoperative C5 palsy and achieved complete restoration of shoulder function. We believe that the HAL-based training corrected the erroneous motion pattern of his paralyzed shoulder and promoted errorless motor learning for recovery. Our collective experience suggests that shoulder HAL training could be an effective therapeutic tool for patients with postoperative C5 palsy.
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Affiliation(s)
- Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideki Kadone
- Center for Innovating Medicine and Engineering (CIME), University of Tsukuba Hospital, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroki Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kenji Suzuki
- Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Kubota S, Kadone H, Shimizu Y, Koda M, Miura K, Takahashi H, Watanabe H, Marushima A, Hada Y, Sankai Y, Yamazaki M. Adjustment effect during shoulder abduction training with the Hybrid Assistive Limb in a patient with postoperative C5 palsy. J Clin Neurosci 2021; 88:197-204. [PMID: 33992184 DOI: 10.1016/j.jocn.2021.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
Standard shoulder rehabilitation procedures for patients with postoperative C5 palsy have not yet been established. We applied a wearable robot suit hybrid assistive limb (HAL) for a patient with postoperative C5 palsy and conducted shoulder abduction training with HAL. A 65-year-old woman was diagnosed with postoperative C5 palsy after undergoing cervical spine surgery. Five days after surgery, shoulder abduction training with HAL was initiated. The shoulder abduction angle and power and trapezius and deltoid activities were evaluated. Ten rehabilitation sessions were conducted until 82 days after surgery. Shoulder abduction training was safely and effectively performed from the first session. Her shoulder abduction angle and power improved at every session, and she could fully elevate her arm without any compensatory motion after the 10th session. Shoulder HAL training suppressed the muscular activity of the trapezius and activated that of the deltoid, especially in the earlier stages of rehabilitation. Moreover, it had an adjustment effect for obtaining normal shoulder motion, which might have promoted smoother arm elevation using errorless motor learning. These findings suggest that HAL is a useful tool for shoulder rehabilitation in patients with postoperative C5 palsy.
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Affiliation(s)
- Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
| | - Hideki Kadone
- Center for Innovating Medicine and Engineering (CIME), University of Tsukuba Hospital, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroki Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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