Improved Physiological Gait in Acute and Chronic SCI Patients After Training With Wearable Cyborg Hybrid Assistive Limb.

Alexis Brinkemper,Birger Jettkant,Dennis Grasmücke,Thomas Armin Schildhauer,Thomas Rosteius,Emre Yilmaz,Mirko Aach,Marcel Dudda

doi:10.3389/fnbot.2021.723206

Abstract

In recent years robotic devices became part of rehabilitation offers for patients suffering from Spinal Cord Injury (SCI) and other diseases. Most scientific publications about such devices focus on functional outcome. The aim of this study was to verify whether an improvement in physiological gait can be demonstrated in addition to the functional parameters after treatment with neurological controlled HAL® Robot Suit. Fifteen subjects with acute (<12 months since injury, n = 5) or chronic (>12 months since injury, n = 10) incomplete paraplegia (AIS B, n = 0/AIS C, n = 2/AIS D, n = 8) or complete paraplegia (AIS A, n = 5) with zones of partial preservation participated. Subjects underwent a body weight supported treadmill training for five times a week over 12 weeks using HAL®. At baseline and at the end of the study a gait analysis was performed and additional functional parameters such as 10-Meter-Walk-Test, Timed-Up-and-Go-Test, 6-Minutes-Walk-Test, and WISCI II score were collected. Results were evaluated for whole group and individually for acute and chronic subgroups. All functional parameters improved. Differences were also found in physiological parameters such as phases of gait cycle and accompanied by significant improvement in all spatiotemporal and gait phase parameters. The presented study shows signs that an improvement in physiological gait can be achieved in addition to improved functional parameters in patients with SCI after completing 12-week training with HAL®.Trial Registration: DRKS, DRKS00020805. Registered 12 February 2020—Retrospectively registered, https://www.drks.de/DRKS00020805.

Highlights

In times of increasingly extensive rehabilitation offers and spreading medical technology, robotic therapy approaches, and the use of exoskeletal systems play a progressively important role
Comparisons were made for whole group (n = 15) and the group was divided into subgroups of acute (n = 5) and chronic patients (n = 10). 53.33% of the participants represent association impairment scale (AIS) D, 13.33% AIS C and 33.33% AIS A
Data from gait analysis was time-normalized to 100% gait cycle for 27.6 steps and 21.2 steps on average

Summary

Introduction

In times of increasingly extensive rehabilitation offers and spreading medical technology, robotic therapy approaches, and the use of exoskeletal systems play a progressively important role. Improved Gait After HAL Training to regain or improve their walking skills In terms of their objective, the available models differ in aid, intended for domestic use, and remedies, for example in form of therapy. In this context, effects of training with HAL R (Hybrid Assistive Limb) Robot Suit (Cyberdyne Inc., Ibaraki, Japan) have been investigated in patients with gait disorders of different etiology for several years. In Germany, the HAL R Robot Suit was first used in a study by Aach et al (2015), in which 8 chronic paraplegic patients showed a safe usage and improved in functional testing such like 10-Meter-WalkTest (10MWT), Timed-Up-and-Go-Test (TUG) and 6-MinutesWalk-Test (6MWT). A positive effect of HAL R training on bladder and bowel function for SCI patients was recently described (Brinkemper et al, 2021)

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