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Takahashi K, Mizukami M, Watanabe H, Kuroda MM, Shimizu Y, Nakajima T, Mutsuzaki H, Kamada H, Tokeji K, Hada Y, Koseki K, Yoshikawa K, Nakayama T, Iwasaki N, Kawamoto H, Sankai Y, Yamazaki M, Matsumura A, Marushima A. Feasibility and safety study of wearable cyborg Hybrid Assistive Limb for pediatric patients with cerebral palsy and spinal cord disorders. Front Neurol 2023; 14:1255620. [PMID: 38020664 PMCID: PMC10656736 DOI: 10.3389/fneur.2023.1255620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroki Watanabe
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Takashi Nakajima
- Department of Neurology, National Hospital Organization Niigata National Hospital, Kashiwazaki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kayo Tokeji
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Tomohiro Nakayama
- Department of Pediatric, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Nobuaki Iwasaki
- Department of Pediatric Neurology, Tsuchiura Rehabilitation Hospital, Tsuchiura, Japan
| | - Hiroaki Kawamoto
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Matsumura
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
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Kuroda MM, Iwasaki N, Mutsuzaki H, Yoshikawa K, Takahashi K, Nakayama T, Nakayama J, Takeuchi R, Mataki Y, Ohguro H, Tomita K. Benefits of a Wearable Cyborg HAL (Hybrid Assistive Limb) in Patients with Childhood-Onset Motor Disabilities: A 1-Year Follow-Up Study. Pediatr Rep 2023; 15:215-226. [PMID: 36976724 PMCID: PMC10057157 DOI: 10.3390/pediatric15010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Rehabilitation robots have shown promise in improving the gait of children with childhood-onset motor disabilities. This study aimed to investigate the long-term benefits of training using a wearable Hybrid Assistive Limb (HAL) in these patients. Training using a HAL was performed for 20 min a day, two to four times a week, over four weeks (12 sessions in total). The Gross Motor Function Measure (GMFM) was the primary outcome measure, and the secondary outcome measures were gait speed, step length, cadence, 6-min walking distance (6MD), Pediatric Evaluation of Disability Inventory, and Canadian Occupational Performance Measure (COPM). Patients underwent assessments before the intervention, immediately after the intervention, and at 1-, 2-, 3-month and 1-year follow-ups. Nine participants (five males, four females; mean age: 18.9 years) with cerebral palsy (n = 7), critical illness polyneuropathy (n = 1), and encephalitis (n = 1) were enrolled. After training using HAL, GMFM, gait speed, cadence, 6MD, and COPM significantly improved (all p < 0.05). Improvements in GMFM were maintained one year after the intervention (p < 0.001) and in self-selected gait speed and 6MD three months after the intervention (p < 0.05). Training using HAL may be safe and feasible for childhood-onset motor disabilities and may maintain long-term improvements in motor function and walking ability.
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Affiliation(s)
- Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Nobuaki Iwasaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Tomohiro Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Junko Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Yuki Mataki
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan
| | - Haruka Ohguro
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ibaraki 300-0331, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
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Moll F, Kessel A, Bonetto A, Stresow J, Herten M, Dudda M, Adermann J. Safety and Feasibility of Robot-assisted Gait Training in Adults with Cerebral Palsy in an Inpatient Setting - an Observational Study. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2023; 35:1-16. [PMID: 36817800 PMCID: PMC9918396 DOI: 10.1007/s10882-023-09895-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To investigate the safety and feasibility of six sessions of Hybrid Assistive Limb (HAL) robot-assisted gait training (RAGT) integrated into an inpatient therapy concept and their influence on walking speed and gait parameters in adult CP patients. METHODS Eleven subjects (male = 8, female = 3, mean age: 23 years and 2 months, ± 4.5 years) with spastic CP underwent six 20-minute RAGT sessions with the HAL during an 11-day hospital stay. Additionally, physiotherapy, physician-performed manual medicine, massage and exercise therapy were provided. Pre- (T1) and post- (T2) intervention assessments were: 10-metre walking test (10MWT), 6-minute walking test (6MWT), Gross Motor Function Measure (GMFM-88) and lower extremities passive range of motion (pROM). RESULTS All subjects completed the study. No adverse events were noted. Walking speed in the 10MWT test increased from 32.5 s (± 24.5 s) at T1 to 27.5 s (± 21.4 s) at T2, without significance. Slight, but non-significant improvements were detected in the 6MWT, GMFM and pROM. Confounding factors did not significantly affect the results. Conclusion: Intensive therapy including HAL training leads to non-significant improvements. Further studies with more patients and longer intervention time could provide further insights into the RAGT therapy of adult patients with CP. Registration DRKS-ID: DRKS00020275.
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Affiliation(s)
- Fabian Moll
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Axel Kessel
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
| | - Anna Bonetto
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
| | - Johanna Stresow
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
| | - Monika Herten
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Marcel Dudda
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Hufelandstraße 55, 45147 Essen, Germany
| | - Jens Adermann
- Klinik für Manuelle Therapie Hamm (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
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Moll F, Kessel A, Bonetto A, Stresow J, Herten M, Dudda M, Adermann J. Use of Robot-Assisted Gait Training in Pediatric Patients with Cerebral Palsy in an Inpatient Setting-A Randomized Controlled Trial. SENSORS (BASEL, SWITZERLAND) 2022; 22:9946. [PMID: 36560316 PMCID: PMC9783925 DOI: 10.3390/s22249946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Robot-assisted gait training (RAGT) provides a task-based support of walking using exoskeletons. Evidence shows moderate, but positive effects in the therapy of patients with cerebral palsy (CP). This study investigates the impact of RAGT on walking speed and gait parameters in pediatric CP patients. Thirty subjects (male = 23; female = 7), with a mean age of 13.0 ± 2.5 (9-17) years, and with spastic CP, were recruited. The intervention group (n = 15) underwent six 20-minute RAGT sessions with the Hybrid Assistive Limb (HAL) during an 11-day hospital stay. Additionally, a therapy concept including physiotherapy, physician-performed manual medicine, massage and exercise therapy was provided. The control group (n = 15) was treated with the therapy concept only. The outcome was based on a 10-Metre Walking Test (10MWT), 6-Minute Walking Test (6MWT), Gross Motor Function Measure (GMFM-88) and lower extremities passive range of motion. The intervention group achieved a mean increase in walking speed in the 10MWT (self-selected walking speed SSW) of 5.5 s (p = 0.378). There were no significant differences between the groups in the 10MWT (max) (p = 0.123) and the 6MWT (p = 0.8). Changes in the GMFM (total) and in the dimension standing and walking, running and jumping (D + E) showed clinically relevant significant results (p = 0.002 and p = 0.046). RAGT as a supplement to an inpatient therapy stay appears to have a positive, yet not significant impact on the gait parameters of pediatric CP patients as well as motivating them to practice walking. Further studies with adapted study designs are needed to evaluate different influencing factors.
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Affiliation(s)
- Fabian Moll
- Klinik für Manuelle Therapie (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Axel Kessel
- Klinik für Manuelle Therapie (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
| | - Anna Bonetto
- Klinik für Manuelle Therapie (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
| | - Johanna Stresow
- Klinik für Manuelle Therapie (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
| | - Monika Herten
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Marcel Dudda
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Jens Adermann
- Klinik für Manuelle Therapie (Hospital for Pain Management), Ostenalle 83, 59071 Hamm, Germany
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Liu W, Hu Y, Li J, Chang J. Effect of Virtual Reality on Balance Function in Children With Cerebral Palsy: A Systematic Review and Meta-analysis. Front Public Health 2022; 10:865474. [PMID: 35548088 PMCID: PMC9081327 DOI: 10.3389/fpubh.2022.865474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
Virtual Reality (VR) therapy is popular in treating children with Cerebral Palsy (CP) as a new technology for rehabilitation. Nevertheless, no substantial evidence supporting VR therapy promotion has been developed to date. This study aimed to investigate the effects of VR therapy on balance in children with CP. We conducted a systematic search in PubMed and Web of Science (updated to December 30, 2021). The systematic review and meta-analysis included all randomized controlled trials that included children with CP. A total of 18 RCT studies were eligible for inclusion in the systematic review, and meta-analysis was performed on 16 of them. Results showed that the VR intervention was beneficial for balance (SMD 0.47 [95% CI, SD 0.28, 0.66]). We concluded that VR therapy interventions for children with CP have positive effects. However, cautious implementation is needed in clinical applications.
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Affiliation(s)
- Wei Liu
- School of Physical Education, Xuzhou Kindergarten Teachers College, Xuzhou, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Yuanyan Hu
- School of Mathematics and Statistics, Yunlin Normal University, Yunlin, China
| | - Junfeng Li
- Ministry of Sports, Shandong Technology and Business University, Yantai, China
- *Correspondence: Junfeng Li
| | - Jindong Chang
- Institute of Motor Quotient, Southwest University, Chongqing, China
- Jindong Chang
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Yasunaga Y, Koizumi R, Toyoda T, Koda M, Mamizuka N, Sankai Y, Yamazaki M, Miura K. Biofeedback Physical Therapy With the Hybrid Assistive Limb (HAL) Lumbar Type for Chronic Low Back Pain: A Pilot Study. Cureus 2022; 14:e23475. [PMID: 35495003 PMCID: PMC9038590 DOI: 10.7759/cureus.23475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Objective There are many treatments for chronic low back pain, including various medications, exercise therapy, orthotics, and surgery, but no treatment is definitive. We hypothesized that biofeedback therapy using the hybrid assistive limb (HAL) lumbar type would have some immediate effects on chronic low back pain. The purpose of this pilot study was to assess whether immediate changes in low back pain and hip flexibility and any other adverse events would occur following the HAL biofeedback physical therapy. Methods This was a single-center, pilot, prospective, single-arm study of outpatient biofeedback physical therapy using the HAL lumbar type for patients with chronic low back pain. Patients underwent a 10-minute biofeedback physical therapy (lumbar flexion-extension, sit-to-stand, and squat) with the HAL lumbar type (in one session). The visual analog scale (VAS) score of low back pain during lumbar flexion, extension, lateral bending, and rotation was evaluated. The finger-to-floor distance (FFD), straight leg raising test (SLR), and the Thomas test were measured to assess hip flexibility. Results All 35 participants (14 men and 21 women) (100%) conducted a biofeedback HAL therapy session using the HAL lumbar type. No participant had deterioration of low back pain. No adverse events occurred. After the biofeedback therapy using the HAL lumbar type, SLR demonstrated a significant positive change with large effect size and sufficient power. Lumbar VAS during lumbar flexion and extension and FFD showed a significant positive change with medium effect size and adequate power. Conclusions Biofeedback therapy using the HAL lumbar type is an option for intervention in chronic low back pain.
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Morioka H, Hirayama T, Sugisawa T, Murata K, Shibukawa M, Ebina J, Sawada M, Hanashiro S, Nagasawa J, Yanagihashi M, Uchi M, Kawabe K, Washizawa N, Ebihara S, Nakajima T, Kano O. Robot-assisted training using hybrid assistive limb ameliorates gait ability in patients with amyotrophic lateral sclerosis. J Clin Neurosci 2022; 99:158-163. [PMID: 35279589 DOI: 10.1016/j.jocn.2022.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Harumi Morioka
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Takehisa Hirayama
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Tatsuki Sugisawa
- Department of Rehabilitation Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Kiyoko Murata
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Mari Shibukawa
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Junya Ebina
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Masahiro Sawada
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Sayori Hanashiro
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Junpei Nagasawa
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Masaru Yanagihashi
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Masayuki Uchi
- Department of Rehabilitation Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Kiyokazu Kawabe
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Naohiro Washizawa
- Nutrition Therapy Center, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Takashi Nakajima
- Niigata National Hospital, National Hospital Organization, 3-52 Akasaka Kashiwazaki City, Niigata 945-8585, Japan
| | - Osamu Kano
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan.
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Suzuki H, Imajo Y, Funaba M, Nishida N, Sakamoto T, Sakai T. Current Concepts of Neural Stem/Progenitor Cell Therapy for Chronic Spinal Cord Injury. Front Cell Neurosci 2022; 15:794692. [PMID: 35185471 PMCID: PMC8850278 DOI: 10.3389/fncel.2021.794692] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic spinal cord injury (SCI) is a devastating condition that results in major neurological deficits and social burden. It continues to be managed symptomatically, and no real therapeutic strategies have been devised for its treatment. Neural stem/neural progenitor cells (NSCs/NPCs) being used for the treatment of chronic SCI in experimental SCI models can not only replace the lost cells and remyelinate axons in the injury site but also support their growth and provide neuroprotective factors. Currently, several clinical studies using NSCs/NPCs are underway worldwide. NSCs/NPCs also have the potential to differentiate into all three neuroglial lineages to regenerate neural circuits, demyelinate denuded axons, and provide trophic support to endogenous cells. This article explains the challenging pathophysiology of chronic SCI and discusses key NSC/NPC-based techniques having the greatest potential for translation over the next decade.
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Okawara H, Tashiro S, Sawada T, Sugai K, Matsubayashi K, Kawakami M, Nori S, Tsuji O, Nagoshi N, Matsumoto M, Nakamura M. Neurorehabilitation using a voluntary driven exoskeletal robot improves trunk function in patients with chronic spinal cord injury: a single-arm study. Neural Regen Res 2022; 17:427-432. [PMID: 34269219 PMCID: PMC8463976 DOI: 10.4103/1673-5374.317983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Body weight-supported treadmill training with the voluntary driven exoskeleton (VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level (six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral (right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee (IRB No. 20150355-3) on September 26, 2017.
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Affiliation(s)
- Hiroki Okawara
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Syoichi Tashiro
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Sawada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Sugai
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Matsubayashi
- Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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10
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Giraldo-Pedroza A, Lee WCC, Lam WK, Coman R, Alici G. A Wearable Biofeedback Device to Increase Gait Swing Time Could Have Positive Effects on Gait among Older Adults. SENSORS (BASEL, SWITZERLAND) 2021; 22:s22010102. [PMID: 35009646 PMCID: PMC8747130 DOI: 10.3390/s22010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 05/14/2023]
Abstract
Older adults walk with a shorter stride length, reduced hip range of motion (ROM) and higher cadence. These are signs of reductions in walking ability. This study investigated whether using a wireless smart insole system that monitored and provided biofeedback to encourage an extension of swing time could increase stride length and hip flexion, while reducing the cadence. Seven older adults were tested in this study, with and without the biofeedback device, in an outdoor environment. Gait analysis was performed by using GaitRite system and Xsens MVN. Repeated measures analysis demonstrated that with biofeedback, the swing time increased by 6.45%, stride length by 4.52% and hip flexion by 14.73%, with statistical significance. It also decreased the cadence significantly by 5.5%. This study has demonstrated that this smart insole system modified positively the studied gait parameters in older adults and has the potential to improve their walking ability.
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Affiliation(s)
- Alexandra Giraldo-Pedroza
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; (A.G.-P.); (G.A.)
- Applied Mechatronics and Biomedical Engineering Research (AMBER) Group, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Winson Chiu-Chun Lee
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; (A.G.-P.); (G.A.)
- Applied Mechatronics and Biomedical Engineering Research (AMBER) Group, University of Wollongong, Wollongong, NSW 2522, Australia
- Correspondence: (W.C.-C.L.); (W.-K.L.)
| | - Wing-Kai Lam
- Li Ning Sports Science Research Center, Beijing 101111, China
- Department of Kinesiology, Shenyang Sport University, Shenyang 110102, China
- Correspondence: (W.C.-C.L.); (W.-K.L.)
| | - Robyn Coman
- School of Health and Society, Faculty of Arts, Social Sciences & Humanities, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Gursel Alici
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; (A.G.-P.); (G.A.)
- Applied Mechatronics and Biomedical Engineering Research (AMBER) Group, University of Wollongong, Wollongong, NSW 2522, Australia
- ARC Centre of Excellence for Electromaterials Science, University of Wollongong Innovation Campus, North Wollongong, NSW 2500, Australia
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11
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Sarajchi M, Al-Hares MK, Sirlantzis K. Wearable Lower-Limb Exoskeleton for Children With Cerebral Palsy: A Systematic Review of Mechanical Design, Actuation Type, Control Strategy, and Clinical Evaluation. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2695-2720. [PMID: 34910636 DOI: 10.1109/tnsre.2021.3136088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Children with a neurological disorder such as cerebral palsy (CP) severely suffer from a reduced quality of life because of decreasing independence and mobility. Although there is no cure yet, a lower-limb exoskeleton (LLE) has considerable potential to help these children experience better mobility during overground walking. The research in wearable exoskeletons for children with CP is still at an early stage. This paper shows that the number of published papers on LLEs assisting children with CP has significantly increased in recent years; however, no research has been carried out to review these studies systematically. To fill up this research gap, a systematic review from a technical and clinical perspective has been conducted, based on the PRISMA guidelines, under three extended topics associated with "lower limb", "exoskeleton", and "cerebral palsy" in the databases Scopus and Web of Science. After applying several exclusion criteria, seventeen articles focused on fifteen LLEs were included for careful consideration. These studies address some consistent positive evidence on the efficacy of LLEs in improving gait patterns in children with CP. Statistical findings show that knee exoskeletons, brushless DC motors, the hierarchy control architecture, and CP children with spastic diplegia are, respectively, the most common mechanical design, actuator type, control strategy, and clinical characteristics for these LLEs. Clinical studies suggest ankle-foot orthosis as the primary medical solution for most CP gait patterns; nevertheless, only one motorized ankle exoskeleton has been developed. This paper shows that more research and contribution are needed to deal with open challenges in these LLEs.
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Brinkemper A, Aach M, Grasmücke D, Jettkant B, Rosteius T, Dudda M, Yilmaz E, Schildhauer TA. Improved Physiological Gait in Acute and Chronic SCI Patients After Training With Wearable Cyborg Hybrid Assistive Limb. Front Neurorobot 2021; 15:723206. [PMID: 34512302 PMCID: PMC8426634 DOI: 10.3389/fnbot.2021.723206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
In recent years robotic devices became part of rehabilitation offers for patients suffering from Spinal Cord Injury (SCI) and other diseases. Most scientific publications about such devices focus on functional outcome. The aim of this study was to verify whether an improvement in physiological gait can be demonstrated in addition to the functional parameters after treatment with neurological controlled HAL® Robot Suit. Fifteen subjects with acute (<12 months since injury, n = 5) or chronic (>12 months since injury, n = 10) incomplete paraplegia (AIS B, n = 0/AIS C, n = 2/AIS D, n = 8) or complete paraplegia (AIS A, n = 5) with zones of partial preservation participated. Subjects underwent a body weight supported treadmill training for five times a week over 12 weeks using HAL®. At baseline and at the end of the study a gait analysis was performed and additional functional parameters such as 10-Meter-Walk-Test, Timed-Up-and-Go-Test, 6-Minutes-Walk-Test, and WISCI II score were collected. Results were evaluated for whole group and individually for acute and chronic subgroups. All functional parameters improved. Differences were also found in physiological parameters such as phases of gait cycle and accompanied by significant improvement in all spatiotemporal and gait phase parameters. The presented study shows signs that an improvement in physiological gait can be achieved in addition to improved functional parameters in patients with SCI after completing 12-week training with HAL®. Trial Registration: DRKS, DRKS00020805. Registered 12 February 2020—Retrospectively registered, https://www.drks.de/DRKS00020805.
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Affiliation(s)
- Alexis Brinkemper
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Mirko Aach
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Dennis Grasmücke
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Birger Jettkant
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thomas Rosteius
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Marcel Dudda
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Emre Yilmaz
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
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13
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Kuroda MM, Mutsuzaki H, Yoshikawa K, Ohguro H, Nobuaki I. Gait training using a hybrid assistive limb after botulinum toxin treatment for cerebral palsy: a case report. J Phys Ther Sci 2021; 33:499-504. [PMID: 34177115 PMCID: PMC8219601 DOI: 10.1589/jpts.33.499] [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] [Received: 02/08/2021] [Accepted: 03/26/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Hybrid Assistive Limb® (HAL; Cyberdyne, Tsukuba, Japan) is a wearable robot that assists patients based on their voluntary movements. We report gait training with HAL after botulinum toxin treatment for spasticity of the lower limb in cerebral palsy (CP). [Participant and Methods] The participant was a 36 year-old male with spastic diplegia due to periventricular leukomalacia, with Gross Motor Function Classification System (GMFCS) level II. HAL training was performed in 20-minute sessions (3 sessions/week for 4 weeks). The outcome measures were range of motion, spasticity, walking ability, muscle strength, gross motor function measure (GMFM), Canadian Occupational Performance Measure (COPM), and Pediatric Evaluation of Disability Inventory measured before, immediately after, and one, two, and three months after HAL training. [Results] No adverse events were observed during training. After the HAL intervention, gait speed, step length, cadence, 6-min walking distance (6MD), knee extension strength, GMFM, and COPM increased, and Physiological Cost Index declined. Three months post-intervention, gait speed, step length, cadence, 6MD, and GMFM remained higher than those observed within the first two months. [Conclusion] Gait training with HAL can be a safe and feasible method for patients with CP who undergo botulinum toxin treatment to improve walking ability and motor function.
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Affiliation(s)
- Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Ibaraki 300-0394, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Haruka Ohguro
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Iwasaki Nobuaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
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14
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Effectiveness of powered exoskeleton use on gait in individuals with cerebral palsy: A systematic review. PLoS One 2021; 16:e0252193. [PMID: 34038471 PMCID: PMC8153467 DOI: 10.1371/journal.pone.0252193] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 05/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background Cerebral palsy (CP) is a leading cause of childhood disability. The motor impairments of individuals with CP significantly affect the kinematics of an efficient gait pattern. Robotic therapies have become increasingly popular as an intervention to address this. Powered lower limb exoskeletons (PoLLE) are a novel form of robotic therapy that allow the individual to perform over-ground gait training and yet its effectiveness for CP is unknown. Purpose To determine the effectiveness of PoLLE use on gait in individuals with CP. Method A systematic search of eight electronic databases was conducted in March 2020. Studies included children (0–18 years) and or adults (18+ years) diagnosed with CP who used a PoLLE for gait training. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement, with the methodology registered with PROSPERO (CRD42020177160). A modified version of the McMaster critical review form for quantitative studies was used to assess the methodological quality. Due to the heterogeneity of the included studies, a descriptive synthesis using the National Health & Medical Research Council (NHMRC) FORM framework was undertaken. Results Of the 2089 studies screened, ten case series and three case studies met the inclusion criteria highlighting the current evidence base is emerging and low level. A range of PoLLEs were investigated with effectiveness measured by using a number of outcome measures. Collectively, the body of evidence indicates there is some consistent positive evidence on the effectiveness of PoLLE in improving gait in individuals with CP, with minimal adverse effects. While this is a positive and encouraging finding for an emerging technology, methodological concerns also need to be acknowledged. Conclusion With rapidly evolving technology, PoLLEs could play a transformative role in the lives of people impacted by CP. Ongoing research is required to further strengthen the evidence base and address current methodological concerns.
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15
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Nakatsu D, Matsui M, Yonenobu Y, Toyooka K, Inoue K, Saito T. [A case study of a patient with myotonic dystrophy type 1 whose gait disturbance was improved by gait training with hybrid assistive limbs]. Rinsho Shinkeigaku 2021; 61:368-372. [PMID: 34011806 DOI: 10.5692/clinicalneurol.cn-001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A Japanese woman first noticed dysarthria at the age of 23. She visited a hospital at the age of 32 and was diagnosed as having myotonic dystrophy clinically. She was diagnosed genetically as having myotonic dystrophy type 1 at 47 years old with 160-270 CTG repeats on the DMPK gene. At the age of 48, she needed non-invasive positive pressure ventilation because of hypoxia at night. Her gait function also deteriorated. She could not stand up from the supine position by herself. However, when she stood, she could walk without a cane for a short distance. She was admitted to our hospital to receive rehabilitation against progressive gait disturbance at the age of 53. She received gait training with hybrid assistive limb® (HAL®). We evaluated some parameters such as walking distance of 2-minute walk test (2MWT), gait speed /cadence/stride length of 10-meter walk test (10MWT), before and just after the course. The first course was performed in September 2017 and the second was done in May 2018 so the interval was about six months. After two courses of HAL® gait training, the distance on the 2-minute walk test increased from 111 m to 154 m, the average speed and the cadence of 10MWT improved from 2.01 m/s to 2.78 m/s and from 2.21 steps/s to 3.05 steps/s respectively. The score of the muscular disability quality of life (QOL) rating scale was also improved. The factors including "defecation," "breathing," and "ADL" suggest that the patient's physical abilities improved and she could move easily. Other factors such as "hope", "activity" and "human relationship" suggest that patient's mood improved after the HAL® training.It was suggested that HAL® gait training could improve QOL as well as gait function in patients with progressive neuromuscular disorder.
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Affiliation(s)
- Daisuke Nakatsu
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center
| | - Misa Matsui
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center
| | - Yuki Yonenobu
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center
| | - Keiko Toyooka
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center
| | - Kimiko Inoue
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center.,Department of Rehabilitation medicine, National Hospital Organization Osaka Toneyama Medical Center
| | - Toshio Saito
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center.,Division of Child Neurology, Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center
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16
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Effect of the Hybrid Assistive Limb on the Gait Pattern for Cerebral Palsy. ACTA ACUST UNITED AC 2020; 56:medicina56120673. [PMID: 33297300 PMCID: PMC7762323 DOI: 10.3390/medicina56120673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/06/2023]
Abstract
Background and objectives: Cerebral palsy (CP) is the most frequent childhood motor disability. Achieving ambulation or standing in children with CP has been a major goal of physical therapy. Recently, robot-assisted gait training using the Hybrid Assistive Limb® (HAL) has been effective in improving walking ability in patients with CP. However, previous studies have not examined in detail the changes in gait pattern after HAL training for patients with spastic CP, including gait symmetry. This study aimed to evaluate the immediate effect of HAL training on the walking ability and the changes in gait pattern and gait symmetry in patients with spastic CP. Materials and Methods: We recruited 19 patients with spastic CP (13 male and six female; mean age, 15.7 years). Functional ambulation was assessed using the 10-Meter Walk Test and gait analysis in the sagittal plane before and after a single 20-min HAL intervention session. Results: The walking speed and stride length significantly increased after HAL intervention compared to the pre-intervention values. Two-dimensional gait analysis showed improvement in equinus gait, increase in the flexion angle of the swing phase in the knee and hip joints, and improvement in gait symmetry. Immediate improvements in the walking ability and gait pattern were noted after HAL training in patients with spastic CP. Conclusions: The symmetry of the joint angle of the lower limb, including the trunk, accounts for the improvement in walking ability after HAL therapy.
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17
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Continuous Finite-Time Torque Control for Flexible Assistance Exoskeleton with Delay Variation Input. ROBOTICA 2020. [DOI: 10.1017/s0263574720000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
SUMMARYAccurate torque control is a critical issue in the compliant human–robot interaction scenario, which is, however, challenging due to the ever-changing human intentions, input delay, and various disturbances. Even worse, the performances of existing control strategies are limited on account of the compromise between precision and stability. To this end, this paper presents a novel high-performance torque control scheme without compromise. In this scheme, a new nonlinear disturbance observer incorporated with equivalent control concept is proposed, where the faster convergence and stronger anti-noise capability can be obtained simultaneously. Meanwhile, a continuous fractional power control law is designed with an iteration method to address the matched/unmatched disturbance rejection and global finite-time convergence. Moreover, the finite-time stability proof and prescribed control performance are guaranteed using constructed Lyapunov function with adding power integrator technique. Both the simulation and experiments demonstrate enhanced control accuracy, faster convergence rate, perfect disturbance rejection capability, and stronger robustness of the proposed control scheme. Furthermore, the evaluated assistance effects present improved gait patterns and reduced muscle efforts during walking and upstair activity.
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18
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Dropped Head Syndrome Attenuation by Hybrid Assistive Limb: A Preliminary Study of Three Cases on Cervical Alignment during Walking. ACTA ACUST UNITED AC 2020; 56:medicina56060291. [PMID: 32545567 PMCID: PMC7353901 DOI: 10.3390/medicina56060291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022]
Abstract
Background and Objectives: Dropped head syndrome (DHS) is characterized by apparent neck extensor muscle weakness and difficulty in extending the neck to raise the head against gravity. DHS affects forward vision and eating behavior, and hence impairs quality of life. However, standardized treatment of DHS has not yet been established. The purpose of this preliminary study is to seek for a possibility of effective non-surgical, conservative treatment for DHS, by applying a robotic treatment. Materials and Methods: A wearable exoskeleton type robot suit hybrid assistive limb (HAL) was applied to three patients with DHS. A course of HAL treatment included 10 sessions of gait training using HAL. One session lasted about an hour. Case 1 completed the course twice, the first time in two weeks (one session per day) and second time in 10 months (one session per month). Case 2 and Case 3 completed the course once in 10 weeks (one session per week) and in 6 months (one session per 2.5 weeks), respectively. Immediate and lasting effects of HAL on the reduction of cervical sagittal vertical alignment (SVA) during gait was evaluated using a motion capture system. Results: Case 1 showed improvement of cervical alignment during gait after the HAL courses of both different frequencies. Case 2 did not show improvement of cervical alignment during gait. Case 3 showed improvement of cervical kyphosis but not of cervical sagittal alignment during gait. Conclusions: The results of the preliminary study suggest that gait training using HAL may be an effective option of conservative treatment for a part of DHS patients. They also suggest that a lack of immediate effects on the cervical alignment and a lack of ability to perform compensatory trunk motion may indicate a non-responding patient. Generalization of the results requires further research with more cases.
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Nakagawa S, Mutsuzaki H, Mataki Y, Endo Y, Matsuda M, Yoshikawa K, Kamada H, Iwasaki N, Yamazaki M. Safety and immediate effects of Hybrid Assistive Limb in children with cerebral palsy: A pilot study. Brain Dev 2020; 42:140-147. [PMID: 31704189 DOI: 10.1016/j.braindev.2019.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Early intervention is effective for developing motor ability and preventing contractures and deformities in patients with cerebral palsy (CP). Gait training using the newly developed Hybrid Assistive Limb (HAL) shows promise as an intervention to prevent deterioration in walking ability and deformities in pediatric CP patients. The purpose of this pilot study was to examine the safety and immediate effects on walking ability after gait training using the HAL in pediatric CP patients. METHODS Nineteen patients (six females, 13 males; mean age 8.5 years; mean height 120.5 cm; mean weight 23.2 kg) were enrolled. The Gross Motor Functional Classification Scale level was I in two patients, II in two, III in eight, and IV in seven. The HAL was used for a single session of gait training. The primary outcome was safety of the HAL for use in pediatric CP patients. The secondary outcome was the immediate effect after gait training with HAL, evaluated by passive range of motion (ROM) and gait parameters, including gait speed (m/s), step length (cm), and cadence (step/min). RESULTS All 19 patients were able to carry out the gait training without any severe adverse events. Significant improvements were observed for mean internal/external rotation and abduction angles of the hip joint, and ankle dorsiflexion angles (n = 19). Significant improvements were observed for mean gait speed and step length based on expansion of the hip flexion-extension range (n = 11). CONCLUSION Gait training using the HAL is safe and can produce immediate improvements in ROM and walking ability in pediatric patients with CP.
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Affiliation(s)
- Shogo Nakagawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan; Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan; Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Yusuke Endo
- Department of Physical Therapy, Faculty of Health Science, Health Science University, Japan
| | - Mayumi Matsuda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan.
| | - Nobuaki Iwasaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Japan; Department of Pediatrics, Ibaraki Prefectural University of Health Sciences, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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20
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Nakagawa S, Mutsuzaki H, Mataki Y, Endo Y, Kamada H, Yamazaki M. Improvement and sustainability of walking ability with hybrid assistive limb training in a patient with cerebral palsy after puberty: a case report. J Phys Ther Sci 2019; 31:633-637. [PMID: 31528000 PMCID: PMC6698460 DOI: 10.1589/jpts.31.633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/05/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Cerebral palsy is one of the most common causes of childhood physical
disability affecting motor development. Gait training with a wearable-robot, such as the
Hybrid Assistive Limb, has been reported to improve gait ability in patients with chronic
motor disabilities; however, there are no reports concerning the sustained improvement of
walking ability with its use in patients with cerebral palsy. We present our observations
for the use of Hybrid Assistive Limb gait training in a postpubescent cerebral palsy
patient. [Participant and Methods] A 17-year-old male with spastic cerebral palsy could
only ambulate slightly using a crouch gait posture and with the aid of a walker. Hybrid
Assistive Limb training was performed thrice weekly for 4 weeks (total of 12 sessions)
along with concurrent daily physical therapy. The follow-up period was 7 months after the
intervention. [Results] The intervention resulted in improvements in the patient’s gait
speed, proportion of the stance phase in a gait cycle, step length, and the flexion angle
of the knees at initial contact and during late stance phase, which was sustained for 7
months following the intervention. [Conclusion] Our observations suggest that Hybrid
Assistive Limb training may effectively improve and sustain walking ability even among
postpubescent cerebral palsy patients who have a decreased walking ability.
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Affiliation(s)
- Shogo Nakagawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.,Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yusuke Endo
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, 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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21
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Nakagawa S, Mutsuzaki H, Mataki Y, Endo Y, Matsuda M, Yoshikawa K, Kamada H, Yamazaki M. Newly developed hybrid assistive limb for pediatric patients with cerebral palsy: a case report. J Phys Ther Sci 2019; 31:702-707. [PMID: 31528013 PMCID: PMC6698473 DOI: 10.1589/jpts.31.702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The effect of fitness training on improving walking ability in cerebral palsy
is controversial. However, gait training with a wearable robot (hybrid assistive limb) has
been reported to improve gait ability in patients with cerebral palsy. For pediatric
patients, a smaller, lighter-weight hybrid assistive limb has been newly developed. We
describe the immediate effect of this newly developed smaller hybrid assistive limb on the
gait ability of a pediatric patient with cerebral palsy and examine its safety and
feasibility. [Participant and Methods] An 11-year-old male with spastic cerebral palsy
(height, 130 cm; weight, 29.0 kg) who could ambulate using an elbow crutch participated in
this study. A single session of hybrid assistive limb training comprising pre-exercise of
the hip and knee joints and walking for 20 minutes was conducted. [Results] The
intervention immediately improved his gait speed, stride length, and cadence according to
the 10-m walking test. Co-contraction of agonist/antagonist muscles during walking
improved, and the flexion angle of the right hip during the swing phase increased, which
resulted in symmetry of movement of both legs. [Conclusion] Gait training using the new,
smaller hybrid assistive limb for a pediatric patient was safe and feasible, and the newly
developed hybrid assistive limb has the potential to immediately improve walking ability
even among young children with cerebral palsy.
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Affiliation(s)
- Shogo Nakagawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.,Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Japan.,Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Yusuke Endo
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Mayumi Matsuda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, 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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22
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Endo Y, Mutsuzaki H, Mizukami M, Yoshikawa K, Kobayashi Y, Yozu A, Mataki Y, Nakagawa S, Iwasaki N, Yamazaki M. Long-term sustained effect of gait training using a hybrid assistive limb on gait stability via prevention of knee collapse in a patient with cerebral palsy: a case report. J Phys Ther Sci 2018; 30:1206-1210. [PMID: 30214126 PMCID: PMC6127483 DOI: 10.1589/jpts.30.1206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/22/2018] [Indexed: 11/26/2022] Open
Abstract
[Purpose] The hybrid assistive limb was developed to improve the kinematics and muscle
activity in patients with neurological and orthopedic conditions. The purpose of the
present study was to examine the long-term sustained effect of gait training using a
hybrid assistive limb on gait stability, kinematics, and muscle activity by preventing
knee collapse in a patient with cerebral palsy. [Participant and Methods] A 17 year-old
male with cerebral palsy performed gait training with a hybrid assistive limb 12 times in
4 weeks. After completion of 12 sessions of hybrid assistive limb training, monthly
follow-up was conducted for 8 months. The improvement was assessed on the basis of joint
angle and muscle activity during gait. [Results] The degree of knee collapse observed at
baseline was improved at 8-month follow-up. Regarding muscle activity, electromyography
revealed increased activation of the vastus lateralis at 8-month follow-up. Moreover, the
hip and knee angles were expanded during gait. In particular, the knee extension angle at
heel contact was increased at 8 months after follow-up. [Conclusion] Gait training with a
hybrid assistive limb provided improvement of gait stability such as kinematics and muscle
activity in a patient with cerebral palsy. The improved gait stability through prevention
of knee collapse achieved with hybrid assistive limb training sustained for 8 months.
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Affiliation(s)
- Yusuke Endo
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Yasuto Kobayashi
- Department of Sport Management, Faculty of Business and Public Administration, Sakushin Gakuin University, Japan
| | - Arito Yozu
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Shogo Nakagawa
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Nobuaki Iwasaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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23
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Matsuda M, Iwasaki N, Mataki Y, Mutsuzaki H, Yoshikawa K, Takahashi K, Enomoto K, Sano K, Kubota A, Nakayama T, Nakayama J, Ohguro H, Mizukami M, Tomita K. Robot-assisted training using Hybrid Assistive Limb® for cerebral palsy. Brain Dev 2018; 40:642-648. [PMID: 29773349 DOI: 10.1016/j.braindev.2018.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The Hybrid Assistive Limb® (HAL®, CYBERDYNE) is a wearable robot that provides assistance to a patient while they are walking, standing, and performing leg movements based on the wearer's intended movement. The effect of robot-assisted training using HAL® for cerebral palsy (CP) is unknown. Therefore, we assessed the effect of robot-assisted training using HAL® on patients with CP, and compared walking and gross motor abilities between pre-intervention and post-intervention. METHODS Six subjects with CP were included (mean age: 16.8 years; range: 13-24 years; Gross Motor Function Classification System levels II-IV: n = 1, 4, 1). Robot-assisted training using HAL® were performed 2-4 sessions per week, 20 min per session, within a 4 weeks period, 12 times in total. Outcome measures included gait speed, step length, cadence, single-leg support per gait cycle, hip and knee joint angle in stance, and swing phase per gait cycle, 6-minute walking distance (6 MD), physiological cost index (PCI), knee-extension strength, and Gross Motor Function Measure (GMFM). RESULTS There were significant increases in self-selected walking speed (SWS), cadence during SWS and maximum walking speed (MWS), single-leg support per gait cycle, hip joint angle in the swing phase, 6 MD, and GMFM. In contrast, gait speed during MWS, step length during SWS and MWS, hip and knee joint angle in the stance phase, knee joint angle in the swing phase, PCI, and knee-extension strength generally improved, but not significantly. CONCLUSION Robot-assisted training using HAL® may improve walking and gross motor abilities of patients with CP.
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Affiliation(s)
- Mayumi Matsuda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan; Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan.
| | - Nobuaki Iwasaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan; Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Japan; Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Keiko Enomoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kumiko Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Aoi Kubota
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Tomohiro Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Junko Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Haruka Ohguro
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Masafumi Mizukami
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan; Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan; Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan; Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
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24
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Takahashi K, Mutsuzaki H, Mataki Y, Yoshikawa K, Matsuda M, Enomoto K, Sano K, Kubota A, Mizukami M, Iwasaki N, Yamazaki M. Safety and immediate effect of gait training using a Hybrid Assistive Limb in patients with cerebral palsy. J Phys Ther Sci 2018; 30:1009-1013. [PMID: 30154591 PMCID: PMC6110229 DOI: 10.1589/jpts.30.1009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to determine the safety and immediate effect of a single
training session with the Hybrid Assistive Limb (CYBERDYNE) on walking ability in patients
with cerebral palsy. [Participants and Methods] This study included 20 patients with
cerebral palsy (15 males, 5 females, mean age 15.0 ± 6.3 years; 19 with spastic cerebral
palsy, 1 with athetoid cerebral palsy; Gross Motor Function Classification System level I:
4, II: 3, III: 9, and IV: 4). Participants completed a single 20-minute gait training
session using the Hybrid Assistive Limb. The safety and immediate effect were evaluated.
The immediate outcomes were gait speed and mean step length, and cadence before and after
training. [Results] Two participants were excluded because they were not tall enough to
use the Hybrid Assistive Limb. Eighteen participants performed the training. There were no
serious adverse events during the training. Since 14 participants were able to walk on
their own, walking evaluations were performed before and after training. Statistically
significant improvements were observed in gait speed and mean step length. [Conclusion]
Gait training using the Hybrid Assistive Limb is safe for patients with cerebral palsy and
can produce immediate effects on walking ability in ambulatory patients with cerebral
palsy.
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Affiliation(s)
- Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hirotaka Mutsuzaki
- Center of Medical Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan.,Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Mayumi Matsuda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Keiko Enomoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kumiko Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Aoi Kubota
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Nobuaki Iwasaki
- Center of Medical Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan.,Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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Yoshikawa K, Mutsuzaki H, Sano A, Koseki K, Fukaya T, Mizukami M, Yamazaki M. Training with Hybrid Assistive Limb for walking function after total knee arthroplasty. J Orthop Surg Res 2018; 13:163. [PMID: 29970139 PMCID: PMC6029050 DOI: 10.1186/s13018-018-0875-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4773 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0331, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, Japan.
| | - Ayumu Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4773 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0331, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4773 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0331, Japan
| | - Takashi Fukaya
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, 6-8-33 Manabe, Tsuchiura, Ibaraki, 300-0051, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, 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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