Abstract
Objective: The aim of this study was to review the literature on clinical applications of the Hybrid Assistive Limb system for gait training.Methods: A systematic literature search was conducted using Web of Science, PubMed, CINAHL and clinicaltrials.gov and additional search was made using reference lists in identified reports. s were screened, relevant articles were reviewed and subject to quality assessment.Results: Out of 37 studies, 7 studies fulfilled inclusion criteria. Six studies were single group studies and 1 was an explorative randomized controlled trial. In total, these studies involved 140 participants of whom 118 completed the interventions and 107 used HAL for gait training. Five studies concerned gait training after stroke, 1 after spinal cord injury (SCI) and 1 study after stroke, SCI or other diseases affecting walking ability. Minor and transient side effects occurred but no serious adverse events were reported in the studies. Beneficial effects on gait function variables and independence in walking were observed.Conclusions: The accumulated findings demonstrate that the HAL system is feasible when used for gait training of patients with lower extremity paresis in a professional setting. Beneficial effects on gait function and independence in walking were observed but data do not allow conclusions. Further controlled studies are recommended.
Highlights
Normal gait depends on the functional integrity and interactions in sensory-motor neural networks at spinal and supraspinal levels (Bowden et al, 2013)
Studies differed in terms of aim, design, duration of intervention, patients/diagnosis, setting and participant characteristics as well as allocation, randomization, blinding and outcome measures
No study provides conclusive data on the effects of gait training with Hybrid Assistive Limb system (HAL) as compared to other training and the risk of confounding and bias was considered high, the experiences of training with HAL and the responses that were observed will be useful in the design of further studies
Summary
Normal gait depends on the functional integrity and interactions in sensory-motor neural networks at spinal and supraspinal levels (Bowden et al, 2013). This complex system may be disturbed in many neurological conditions such as stroke or spinal cord injury (SCI) resulting in limited mobility and impaired gait function, which are major challenges in neuro rehabilitation. A recent Cochrane review concluded that electromechanically assisted gait training in combination with physiotherapy after stroke increases the odds of achieving independent walking and most so when applied for severely impaired patients in the first 3 months after stroke (Mehrholz et al, 2013) but less clear after SCI (Mehrholz et al, 2012)
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