Feasibility of Neurorehabilitation Using a Hybrid Assistive Limb for Patients Who Underwent Spine Surgery.

Aya Yatsugi,Hiroyuki Fukuda,Kenji Yagi,Etsuji Shiota,Takashi Morishita,Tooru Inoue,Naoya Kotani,Hiroshi Abe

doi:10.1155/2018/7435746

Abstract

Recent studies of robotic rehabilitation have demonstrated its efficacy for neurological disorders. However, few studies have used the Hybrid Assistive Limb (HAL) during the early postoperative stage of spine disorders. We aimed to evaluate the safety and efficacy of HAL treatment during the early postoperative period for spine disorder patients. We retrospectively identified patients who underwent spine surgery and who could complete HAL treatment. We evaluated the 10-m walking test (10MWT), the modified Gait Abnormality Rating Scale (GARS-M), Barthel Index (BI), and the walking index for spinal cord injury II (WISCI II) score results before and after robotic rehabilitation. Clinical outcomes were compared after treatment. We included nine patients with various spine problems. After HAL treatment, the speed during the 10MWT significantly improved from 64.1 ± 16.0 to 74.8 ± 10.8 m/min, and the walking cadence decreased from 102.7 ± 17.6 to 92.7 ± 10.9 steps/min. The BI score also improved from 83.3 ± 16.0 to 95.6 ± 5.8, and the WISCI II score improved from 19.7 ± 0.5 to 20.0 ± 0.0. Furthermore, the total GARS-M score improved from 6.0 ± 5.7 to 2.3 ± 3.3. The maximum angles of the trunk swing were improved from 2.2 ± 1.9 to 1.2 ± 0.9 degrees. Neurorehabilitation therapy using HAL for spinal surgery patients was considered feasible following spine surgery.

Highlights

Robotic technologies have been increasingly gaining attention in the field of neurorehabilitation
Based on the findings indicated by these five case reports [18,19,20,21,22], in addition to the reports demonstrating the efficacy of Hybrid Assistive Limb (HAL) training for spinal cord injury (SCI) cases [8,9,10,11,12,13,14], we hypothesized that using HAL may facilitate early recovery after spine surgery
The protocol of the present study was approved by our institutional review board (IRB), and HAL treatment was performed after receiving written informed consent from each patient

Summary

Introduction

Robotic technologies have been increasingly gaining attention in the field of neurorehabilitation. The Hybrid Assistive Limb (HAL) (Cyberdyne Inc., Ibaraki, Japan) is a unique exoskeleton robot for neurorehabilitation that was developed by Sankai and colleagues based on the interactive biofeedback (iBF) theory [1, 2]. HAL has a hybrid system that allows both voluntary and autonomous modes of action to support training, and it supports voluntary muscle movement by detecting bioelectrical signals (BES). Movements of the joints are accurately adjusted by the pressure sensor in the foot bottom and joint angle sensors of the frame. Movements of the affected limbs supported by the HAL system generate sensory feedback to the brain (i.e., iBF) and accelerate motor learning in the process of functional recovery

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Conclusion