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Wu K, Pan HH, Lin CH. Robotic exoskeletons and total knee arthroplasty: The future of knee rehabilitation and replacement - A meta-analysis. Medicine (Baltimore) 2024; 103:e37876. [PMID: 38669435 PMCID: PMC11049723 DOI: 10.1097/md.0000000000037876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Exoskeletons can play a crucial role in post-TKA rehabilitation by accelerating recovery, improving mobility, and reducing further injury risk. This meta-analysis evaluated the effectiveness of exoskeletons in post-total knee replacement (TKR) rehabilitation. DESIGN Comprehensive searches were conducted on PubMed, OVID Medline, Cochrane Collaboration Library, and Embase (period: database inception to March 2023). Randomized controlled trials enrolling patients who underwent TKR and studies examining the effect of robot-assisted rehabilitation on physical function and pain outcomes were eligible for inclusion. Eight studies (302 patients) were thus included. RESULTS Exoskeletons significantly improved active range of motion (ROM) (SMD: 10.98, 95% confidence interval (CI): 7.81-14.16, P < .001), passive ROM (SMD: 4.11, 95% CI: 1.02-7.20, P = .009), Hospital for Special Surgery scores (SMD: 7.78, 95% CI: 5.87-9.68, P < .00001), and hospital stay length (SMD: -3.19, 95% CI: -4 to -2.38, P < .00001) compared with conventional rehabilitation. Active and passive ROM improvements suggest that exoskeletons aid knee function restoration and mobility post-TKR, whereas Hospital for Special Surgery score improvements support exoskeleton use in TKR rehabilitation. A shorter hospital stay was an important finding which could potentially reduce healthcare costs and improve outcomes. CONCLUSION Despite the inclusion of a limited number of studies, our findings suggest that exoskeletons can enhance post-TKR rehabilitation outcomes and improve quality of life. Robot-assisted rehabilitation may be effective following TKR. Further research should confirm these findings.
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Affiliation(s)
- Karl Wu
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
- Department of Materials and Textiles, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Hsiang Hung Pan
- Department of Education, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chun Hung Lin
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
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Maeda T, Sasaki E, Kasai T, Igarashi S, Wakai Y, Sasaki T, Tsuda E, Ishibashi Y. Therapeutic effect of knee extension exercise with single-joint hybrid assistive limb following total knee arthroplasty: a prospective, randomized controlled trial. Sci Rep 2024; 14:3889. [PMID: 38365932 PMCID: PMC10873320 DOI: 10.1038/s41598-024-53891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
The single-joint hybrid assistive limb (HAL-SJ), an exoskeletal robotic suit, offers functional improvement. In this prospective randomized controlled trial, we investigated the therapeutic effects of knee extension exercises using the HAL-SJ after total knee arthroplasty (TKA). Seventy-six patients with knee osteoarthritis were randomly assigned to HAL-SJ or conventional physical therapy (CPT) groups. The HAL-SJ group underwent exercise using the HAL-SJ for 10 days postoperatively, in addition to CPT; the CPT group underwent only CPT. Pain intensity and active and passive knee extension angles were evaluated preoperatively and on postoperative days 1-10 and weeks 2 and 4. Performance tests and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were evaluated preoperatively and at postoperative weeks 2 and 4. Statistical analysis showed that the HAL-SJ group significantly improved active and passive knee extension angles compared with the CPT group. The HAL-SJ group showed immediate improvement in active knee extension angle through day 5. There were no significant differences in results between the performance tests and KOOS. Knee extension exercises with the HAL-SJ improved knee pain and the angle of extension in the acute phase after TKA.
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Affiliation(s)
- Takaya Maeda
- Department of Rehabilitation, Hirosaki Memorial Hospital, 59-1, Sakaizekinishida, Hirosaki, Aomori, Japan.
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Shigesato Igarashi
- Department of Rehabilitation, Hirosaki Memorial Hospital, 59-1, Sakaizekinishida, Hirosaki, Aomori, Japan
| | - Yuji Wakai
- Department of Orthopedic Surgery, Hirosaki Memorial Hospital, Hirosaki, Japan
| | - Tomoyuki Sasaki
- Department of Orthopedic Surgery, Hirosaki Memorial Hospital, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Mawarikado Y, Sakata A, Inagaki Y, Shirai D, Tatsumi K, Nogami K, Tanaka Y, Kido A, Shima M. Single-facility study of the effectiveness of rehabilitation therapy using wearable hybrid assistive limb for patients with bleeding disorders: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e076153. [PMID: 37984952 PMCID: PMC10660193 DOI: 10.1136/bmjopen-2023-076153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Haemophilic arthropathy, a serious complication of haemophilia, results from recurrent joint bleeding, causing progressive joint damage and severely impacting patient quality of life. Rehabilitation therapy (RT) effectively addresses declining physical function due to joint degradation, but pain during RT can hinder its success. Therefore, an effective pain-alleviating treatment method is required. The single-joint hybrid assistive limb (HAL-SJ), a powered exoskeleton, measures bioelectric potential during muscle contraction and provides motorised support, potentially alleviating pain. OBJECTIVE This study outlines our protocol for a randomised, prospective, single-blind (evaluator) trial aimed to investigate the effects of HAL-SJ on pain reduction during RT, kinesiophobia and other physical functions in patients with haemophilia. METHODS AND ANALYSIS This two-group comparison intervention study will include 24 male patients aged 12-85 years diagnosed with a bleeding disorder necessitating RT for pain and physical function improvement. The primary outcome measures pain changes during the first and second RT session in patients receiving HAL-SJ-assisted RT compared with traditional RT without HAL-SJ. The secondary outcomes include kinesiophobia (Japanese version of the Tampa Scale for Kinesiophobia), standing position gait (zebris FDM-T treadmill), range of motion (manual goniometer) and body surface temperature (infrared thermography camera) during the study period of up to 3 months or until the end of 10 RTs. RT intensity remains below that required to move the affected joint against gravity, given HAL-SJ's muscular support. The follow-up period extends to 1 month after the last RT. Intergroup study variables are compared by an unpaired t-test or Mann-Whitney test. Intragroup comparisons of secondary outcomes are analysed by a paired t-test or Wilcoxon signed-rank test. ETHICS AND DISSEMINATION This study was approved by the accreditation committee of Nara Medical University Hospital. The study results will disseminate through publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER jRCTs052220076.
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Affiliation(s)
- Yuya Mawarikado
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
| | - Asuka Sakata
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
| | - Yusuke Inagaki
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Shirai
- Department of Medical Technology Center, Nara Medical University Hospital, Kashiwara, Nara, Japan
| | - Kohei Tatsumi
- Advanced Medical Science of Thrombosis and Hemostasis, Nara Medical University, Kashihara, Nara, Japan
| | - Keiji Nogami
- Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Midori Shima
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
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Cai L, Liu Y, Wei Z, Liang H, Liu Y, Cui M. Robot-assisted rehabilitation training improves knee function and daily activity ability in older adults following total knee arthroplasty. Res Nurs Health 2023; 46:203-209. [PMID: 36504201 DOI: 10.1002/nur.22290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
To evaluate the effects of robot-assisted rehabilitation training on knee function and the daily activity ability of older adults following total knee arthroplasty (TKA). Eighty-eight patients who underwent TKA were randomly assigned to a robot-assisted rehabilitation or traditional therapy group. The patients in the control group were treated with traditional manual rehabilitation therapy, while the patients in the experimental group were subjected to the robot-assisted rehabilitation program. Range of motion of the knee joint, Hospital for Special Surgery Knee Rating Score, and the modified Barthel Index were assessed on the first or second day after TKA (preintervention) and the discharge day (postintervention). Additionally, the length of hospital stay and related hospitalization expenses of the two groups were collected on the discharge day. Improvements in the active range of motion (p < 0.001), passive range of motion (p = 0.001), Hospital for Special Surgery Knee Rating Score (p < 0.001), and modified Barthel Index score (p = 0.004) were significantly better in the robot-assisted rehabilitation group than in the traditional therapy group. Interestingly, the length of hospital stay in the experimental group (9 days) was shorter than that in the control group (13 days), and the total cost of hospitalization was lower (p = 0.002). The robot-assisted rehabilitation training program is an effective intervention that significantly improves the daily activity ability and knee function of older adults following TKA.
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Affiliation(s)
- Libai Cai
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yanjin Liu
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zexu Wei
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Hao Liang
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Yangyang Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Miaoran Cui
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Koseki K, Takahashi K, Yamamoto S, Yoshikawa K, Abe A, Mutsuzaki H. Use of Robot-Assisted Ankle Training in a Patient with an Incomplete Spinal Cord Injury: A Case Report. J Funct Morphol Kinesiol 2023; 8:jfmk8010031. [PMID: 36976128 PMCID: PMC10054573 DOI: 10.3390/jfmk8010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
Rehabilitation interventions are crucial in promoting neuroplasticity after spinal cord injury (SCI). We provided rehabilitation with a single-joint hybrid assistive limb (HAL-SJ) ankle joint unit (HAL-T) in a patient with incomplete SCI. The patient had incomplete paraplegia and SCI (neurological injury height: L1, ASIA Impairment Scale: C, ASIA motor score (R/L) L4:0/0, S1:1/0) following a rupture fracture of the first lumbar vertebra. The HAL-T consisted of a combination of ankle plantar dorsiflexion exercises in the sitting position, knee flexion, and extension exercises in the standing position, and stepping exercises in the standing position with HAL assistance. The plantar dorsiflexion angles of the left and right ankle joints and electromyograms of the tibialis anterior and gastrocnemius muscles were measured and compared using a three-dimensional motion analyzer and surface electromyography before and after HAL-T intervention. Phasic electromyographic activity was developed in the left tibialis anterior muscle during plantar dorsiflexion of the ankle joint after the intervention. No changes were observed in the left and right ankle joint angles. We experienced a case in which intervention using HAL-SJ induced muscle potentials in a patient with a spinal cord injury who was unable to perform voluntary ankle movements due to severe motor-sensory dysfunction.
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Affiliation(s)
- Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Satoshi Yamamoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Atsushi Abe
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
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Kruppa C, Benner S, Brinkemper A, Aach M, Reimertz C, Schildhauer TA. [New technologies and robotics]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:9-18. [PMID: 36515725 DOI: 10.1007/s00113-022-01270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/15/2022]
Abstract
The development of increasingly more complex computer and electromotor technologies enables the increasing use and expansion of robot-assisted systems in trauma surgery rehabilitation; however, the currently available devices are rarely comprehensively applied but are often used within pilot projects and studies. Different technological approaches, such as exoskeletal systems, functional electrical stimulation, soft robotics, neurorobotics and brain-machine interfaces are used and combined to read and process the communication between, e.g., residual musculature or brain waves, to transfer them to the executing device and to enable the desired execution.Currently, the greatest amount of evidence exists for the use of exoskeletal systems with different modes of action in the context of gait and stance rehabilitation in paraplegic patients; however, their use also plays a role in the rehabilitation of fractures close to the hip joint and endoprosthetic care. So-called single joint systems are also being tested in the rehabilitation of functionally impaired extremities, e.g., after knee prosthesis implantation. At this point, however, the current data situation is still too limited to be able to make a clear statement about the use of these technologies in the trauma surgery "core business" of rehabilitation after fractures and other joint injuries.For rehabilitation after limb amputation, in addition to the further development of myoelectric prostheses, the current development of "sentient" prostheses is of great interest. The use of 3D printing also plays a role in the production of individualized devices.Due to the current progress of artificial intelligence in all fields, ground-breaking further developments and widespread application possibilities in the rehabilitation of trauma patients are to be expected.
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Affiliation(s)
- Christiane Kruppa
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Bochum, Deutschland.
| | - Sebastian Benner
- BG Service- und Rehabilitationszentrum, BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt am Main, Deutschland
| | - Alexis Brinkemper
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Mirko Aach
- Chirurgische Klinik und Poliklinik, Abteilung für Rückenmarkverletzte, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Christoph Reimertz
- BG Service- und Rehabilitationszentrum, BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt am Main, Deutschland
| | - Thomas A Schildhauer
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Bochum, Deutschland
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Mrotzek SJ, Ahmadi S, von Glinski A, Brinkemper A, Aach M, Schildhauer TA, Cibura C. Rehabilitation during early postoperative period following total knee arthroplasty using single-joint hybrid assistive limb as new therapy device: a randomized, controlled clinical pilot study. Arch Orthop Trauma Surg 2022; 142:3941-3947. [PMID: 34783882 PMCID: PMC9596552 DOI: 10.1007/s00402-021-04245-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The first weeks after total knee arthroplasty (TKA) are crucial for the functional outcome. To improve knee mobility, a continuous passive motion (CPM) motor rail is commonly used during in-hospital rehabilitation. The single-joint hybrid assistive limb (HAL-SJ) is a new therapy device. The aim of the study was to improve patients' range of motion (ROM), mobility, and satisfaction using the active-assistive support of the HAL-SJ. MATERIALS AND METHODS Between 09/2017 and 10/2020, 34 patients, who underwent TKA and matched the inclusion criteria, were randomized into study (HAL-SJ) and control (CPM) group. Treatment began after drain removal and was carried out until discharge. Primary outcome parameters were raised pre- and postoperatively and included the Oxford knee score (OKS), visual analog scale (VAS), and acquired range of motion. Furthermore complications caused by the device were recorded. RESULTS OKS increased in both groups postoperatively, but only significantly in the HAL-SJ group. Postoperative pain improved in both groups without significant differences. Flexion improvement was significant in both groups between days 3/7 and 8 weeks postoperatively. We did not encounter any complications related to HAL-SJ. CONCLUSIONS In conclusion, use of the HAL-SJ during rehabilitation in the early postoperative period after TKA was safe without disadvantages compared to the control group and seems to have advantages in terms of daily life impairment.
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Affiliation(s)
- Silvia J Mrotzek
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Shahir Ahmadi
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Alexander von Glinski
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Alexis Brinkemper
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Mirko Aach
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Charlotte Cibura
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Yoo JI, Oh MK, Lee SU, Lee CH. Robot-assisted rehabilitation for total knee or hip replacement surgery patients: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30852. [PMID: 36221411 PMCID: PMC9543030 DOI: 10.1097/md.0000000000030852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study was performed to update the current evidence and evaluate the effects of robot-assisted rehabilitation (RAR) in comparison with conventional rehabilitation (CR) in patients following total knee (TKR) or hip replacements (THR). METHODS PubMed Central, OVID Medline, Cochrane Collaboration Library, and EMBASE for a comprehensive search for all relevant studies, from database inception to July 2022. The following inclusion criteria were used to determine eligibility for studies: randomized and matched controlled trials recruiting men and women who underwent TKR and THR; and studies examining the effect of RAR on outcome measures of physical function and pain. RESULTS A total of 9 studies (230 patients) were included in this review and 4 were included in the meta-analysis. The meta-analysis of 2 studies showed that Hybrid Assistive Limb (HAL) training for 5 days, significantly improved pain measured on a visual analogue scale, compared to CR in patients following TKR (SMD = 1.05, 95% confidence interval [Cl] 0.39-1.71). Heterogeneity for I2 value was lower than moderate (tau^2 = 0.0121; I2 = 5%; P = .30). There were 2 studies that assessed self-selected walking speed. The meta-analysis of these studies showed that HAL training was significantly superior to CR in patients following TKR (SMD = 48.70, 95% Cl -50.53 to 147.94) at 2 months. A high heterogeneity was detected (P < .01; I2 = 97%). CONCLUSION The result of this systematic review and meta-analysis suggest that RAR may be an effective treatment in TKR and THR patients. However, high-quality studies are needed to verify the long-term effect on their recovery.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
- Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
- *Correspondence: Chang Han Lee, Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju 52727, Korea (e-mail: )
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Robot-Assisted Ankle Rehabilitation Using the Hybrid Assistive Limb for Children after Equinus Surgery: A Report of Two Cases. Pediatr Rep 2022; 14:338-351. [PMID: 35997418 PMCID: PMC9397056 DOI: 10.3390/pediatric14030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
After equinus corrective surgery, repetitive exercises for ankle dorsiflexion and plantar flexion are crucial during rehabilitation. The single-joint Hybrid Assistive Limb (HAL-SJ) is an advanced exoskeletal robotic device with a control system that uses bioelectrical signals to assist joint motion in real time and demonstrates joint torque assistance with the wearer's voluntary movement. We present two cases of robot-assisted ankle rehabilitation after equinus surgery using the HAL-SJ in children. Case 1 was an 8-year-old boy, whereas case 2 was a 6-year-old boy. When they were allowed to walk without braces, training with the HAL-SJ was performed postoperatively for 20 min per session a total of eight times (2-4 sessions per week). Assessments were performed before and after HAL-SJ training. During gait analysis, case 1 had improved joint angles during the stance phase on the operated side; however, case 2 had improved joint angles during the stance and swing phases. The co-activation index values of the medial gastrocnemius and tibialis anterior muscles, which were high before training, decreased after training and approached the standard value. The HAL-SJ may provide systematic feedback regarding voluntary ankle dorsiflexion and plantar flexion and is considered to have motor learning effects.
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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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Fujikawa T, Takahashi S, Shinohara N, Mashima N, Koda M, Takahashi H, Yasunaga Y, Sankai Y, Yamazaki M, Miura K. Early Postoperative Rehabilitation Using the Hybrid Assistive Limb (HAL) Lumbar Type in Patients With Hip Fracture: A Pilot Study. Cureus 2022; 14:e22484. [PMID: 35371681 PMCID: PMC8943782 DOI: 10.7759/cureus.22484] [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: 02/22/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: To extend life expectancy after surgery, patients with hip fractures need to improve their mobility quickly through postoperative rehabilitation. Voluntary hip joint motion supported by the hybrid assistive limb (HAL) lumbar type, an exoskeleton robot suit characterized by its ability to detect the wearer’s intentions through the bioelectrical signals and assist hip extension motions at an optimal timing, may be effective to improve mobility in patients with hip joint dysfunction after surgery. We aimed to introduce rehabilitation using the HAL lumbar type in the early period after hip fracture surgery. Methods: Patients who underwent internal fixation for hip fracture at a single institution were prospectively enrolled. They received early postoperative rehabilitation (forward and backward bending of the lumbar spine, pelvic tilt forward and backward, standing up, and squatting) using the HAL lumbar type (six times a week for 15 min per session). Five-times-sit-to-stand (FTSS) and timed-up-and-go (TUG) tests were conducted at baseline before HAL rehabilitation (pre-HAL) and after the HAL rehabilitation (post-HAL) intervention. Results: We enrolled 14 patients (one man, 13 women) in this study. There were no adverse events, and all patients were able to complete the entire rehabilitation program. Post-HAL FTSS showed significant improvement compared with pre-HAL and had a large effect size of 1.81 (95% CI = 0.93 to 2.66) and sufficient power. Conclusions: Robotic rehabilitation with HAL lumbar type could be introduced without adverse events, even in the early postoperative period following surgery for hip fracture. Further study is needed to develop an appropriate rehabilitation protocol using the HAL lumbar type.
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Koseki K, Mutsuzaki H, Yoshikawa K, Iwai K, Hashizume Y, Nakazawa R, Kohno Y. Early Recovery of Walking Ability in Patients After Total Knee Arthroplasty Using a Hip-Wearable Exoskeleton Robot: A Case-Controlled Clinical Trial. Geriatr Orthop Surg Rehabil 2021; 12:21514593211027675. [PMID: 34262793 PMCID: PMC8243097 DOI: 10.1177/21514593211027675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: The Honda Walking Assist (HWA) is a hip-wearable exoskeleton robot for gait
training that assists in hip flexion and extension movements to guide hip
joint movements during gait. This study aimed to evaluate the effects of
walking exercises with HWA in patients who underwent total knee arthroplasty
(TKA). Materials and Methods: This study involved 10 patients (11 knees) in the HWA group and 11 patients
(11 knees) in the control group who underwent conventional physical therapy.
The patients assigned to the HWA group underwent a total of 17-20 gait
training sessions, each lasting approximately 20 min from week 1 to 5
following TKA. Self-selected walking speed (SWS), maximum walking speed
(MWS), range of motion (ROM), knee extension and flexion torque, and Western
Ontario and McMaster Universities Osteoarthritis Index subscales of pain
(WOMAC-p) and physical function (WOMAC-f) scores were measured
preoperatively, at 2, 4, and 8 weeks following TKA. Results: Interventions were successfully completed in all patients, with no severe
adverse events. A significant difference was noted in the time × group
interaction effect between preoperative and week 2 SWS and MWS. Regarding
knee function, there was a significant difference in the time × group
interaction between preoperative and week 2 active ROM extension; however,
no significant difference in knee torque, WOMAC-p, and WOMAC-f scores were
observed. In the between-group post hoc analysis, WOMAC-f in the HWA group
was higher than that in the control group at week 8. Discussion: Although the control group showed a temporary reduction in SWS and MWS 2
weeks after TKA, the HWA group did not. These results suggest that HWA
intervention promotes early improvement in walking ability after TKA. Conclusions: The gait training using HWA was safe and feasible and could be effective for
the early improvement of walking ability in TKA patients.
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Affiliation(s)
- Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Koichi Iwai
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Yuko Hashizume
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Ryo Nakazawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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