Intensive Gait Treatment Using a Robot Suit Hybrid Assistive Limb in Acute Spinal Cord Infarction: Report of Two Cases

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2017.1372059 · Published: May 1, 2019

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

Spinal cord infarction can lead to walking difficulties due to muscle weakness and sensory issues. Current treatments are limited to conventional rehabilitation. This study explores the use of a robotic suit, the Hybrid Assistive Limb (HAL), to improve walking in individuals with recent spinal cord infarction. Two patients with incomplete paralysis participated in gait treatment with HAL, in addition to standard physical therapy. The HAL suit is designed to assist voluntary movement of the hip and knee joints by detecting weak bioelectrical signals from the skin. The study found improvements in various measures, including motor skills, walking ability, gait speed, and joint angles, in both patients. The use of HAL may enable more intensive gait training without worsening muscle stiffness.

Study Duration

Not specified

Participants

Two individuals with incomplete paraplegia due to acute spinal cord infarction

Evidence Level

Case Series

Key Findings

1
Both participants showed improvements in Lower Extremity Motor Score (LEMS), Walking Index for Spinal Cord Injury (WISCI II), comfortable gait speed (CGS), stride, cadence, Barthel Index (BI), Functional Independence Measure (FIM), modified Rankin Scale (mRS), and joint angles after HAL treatment.
2
One participant experienced decreased spasticity in the gastrocnemius muscle, as measured by the Modified Ashworth Scale (MAS).
3
Gait treatment using HAL is feasible and safe in the early stage after SCI.

Research Summary

This study investigated the effect of gait treatment using the Hybrid Assistive Limb (HAL) on individuals with acute spinal cord infarction (SCI). Two patients with incomplete paraplegia participated in the study, receiving gait treatment with HAL in addition to conventional physical therapy. The results showed improvements in several clinical outcome measures, including motor skills, walking ability, gait speed, and joint angles, in both participants. HAL facilitated intensive gait treatment in people during the acute phase after SCI. The authors concluded that gait treatment using HAL may be beneficial for paraplegic, non-ambulatory individuals with acute SCI and that HAL may be useful for intensive gait treatment without increasing spasticity. Further studies are needed to compare HAL treatment with conventional physical therapy alone.

Practical Implications

Rehabilitation strategy

HAL can be considered as a therapeutic tool to improve gait ability in non-ambulatory individuals after acute SCI.

Intensive gait training

HAL can provide the means for intensive gait treatment without increasing spasticity.

Assistive technology

The study suggests that robotic-assisted gait treatment may facilitate recovery of motor function and gait ability in the early stages after SCI.

Study Limitations

1
Small sample size of only two cases.
2
Lack of a control group to eliminate the effects of conventional physical therapy and spontaneous recovery.
3
The study design is a case series, which limits the ability to draw broad conclusions.

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