Abstract
Most patients with thoracic ossification of the posterior longitudinal ligament (OPLL) exhibit delayed recovery of gait dysfunction after spinal injury. The hybrid assistive limb (HAL) is a new robot suit controlling knee and hip joint motion by detecting very weak bioelectric signals on the surface of the skin. This study is to report the feasibility and benefits of patient-assistive HAL walking rehabilitation for facilitating locomotor function after spinal surgery. The patient was a 60-year-old woman with thoracic OPLL, and her motor and sensory paralyses did not improve after spinal surgery, indicating severe impairment in the paretic legs. The subject underwent 6 HAL sessions per week for 8 weeks, consisting of a standing and sitting exercise and walking on the ground with HAL. Clinical outcomes were evaluated before and after HAL training and 1 year after surgery. The subject improved considerably as a result of HAL training. Subsequently, her walking ability recovered rapidly, and she was able to walk unaided six months after surgery. This case study suggests that HAL training is a feasible and effective option to facilitating locomotor function and the early HAL training with physiotherapy may enhance motor recovery of patients with residual paralysis after surgery.
Highlights
Decompression is the primary treatment for patients with compressive myelopathy due to thoracic ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), but surgical outcomes vary
No studies have attempted to clarify the feasibility of rehabilitation with hybrid assistive limb (HAL) for patients with residual paralysis after spinal decompression for thoracic OPLL or OLF. This case was markedly improved locomotor function by training with HAL, recovery did not start until 7 weeks after spinal decompression of thoracic OPLL
At 1 year after surgery, she was able to walk independently with a Tcane. This case report describes the feasibility of facilitating locomotor functions with HAL training for patients with residual paralysis after spinal surgery
Summary
Decompression is the primary treatment for patients with compressive myelopathy due to thoracic ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), but surgical outcomes vary. Studies of postoperative clinical outcomes of thoracic OPLL indicate that most patients exhibit delayed recovery of motor weakness in the lower limbs and gait dysfunction after surgery [1, 2]. The robot suit hybrid assistive limb (HAL) is a new robot suit to assist voluntary control of knee and hip joint motion by detecting very weak bioelectric signals on the surface of the skin [7]. No studies have attempted to clarify the feasibility of rehabilitation with HAL for patients with residual paralysis after spinal decompression for thoracic OPLL or OLF. This case was markedly improved locomotor function by training with HAL, recovery did not start until 7 weeks after spinal decompression of thoracic OPLL. We report a case of patient-assistive HAL walking rehabilitation from an early stage for facilitating locomotor functions for patients with severe residual paralysis
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