Abstract
The Ossification of the Posterior Longitudinal Ligament (OPLL) is an idiopathic degenerative spinal disease which may cause motor deficit. For patients presenting myelopathy or severe stenosis, surgical decompression is the treatment of choice; however, despite adequate decompression residual motor impairment is found in some cases. After surgery, there is no therapeutic approach available for this population. The Hybrid Assistive Limb® (HAL) robot suit is a unique powered exoskeleton designed to predict, support, and enhance the lower extremities performance of patients using their own bioelectric signals. This approach has been used for spinal cord injury and stroke patients where the walking performance improved. However, there is no available data about gait kinematics evaluation after HAL therapy. Here we analyze the effect of HAL therapy in OPLL patients in acute and chronic stages after decompression surgery. We found that HAL therapy improved the walking performance for both groups. Interestingly, kinematics evaluation by the analysis of the elevation angles of the thigh, shank, and foot by using a principal component analysis showed that planar covariation, plane orientation, and movement range evaluation improved for acute patients suggesting an improvement in gait coordination. Being the first study performing kinematics analysis after HAL therapy, our results suggest that HAL improved the gait coordination of acute patients by supporting the relearning process and therefore reshaping their gait pattern.
Highlights
The Ossification of the Posterior Longitudinal Ligament (OPLL) is an uncommon disease characterized by a pathological ectopic ligament ossification affecting usually the cervical or thoracic spine segments (Epstein, 2002; Kalb et al, 2011)
Surgical decompression of the spinal cord is usually necessary when the medullar compression leads to symptomatic neurological deterioration (Mehdi et al, 2016); despite appropriate decompression residual motor impairment is found in some patients
We found that Hybrid Assistive Limb® (HAL) therapy improved the walking performance; the walking speed and stride length were increased, and the time and number of steps to cover 10 m were decreased, in all acute and chronic patients (Figure 1A)
Summary
The Ossification of the Posterior Longitudinal Ligament (OPLL) is an uncommon disease characterized by a pathological ectopic ligament ossification affecting usually the cervical or thoracic spine segments (Epstein, 2002; Kalb et al, 2011). This degenerative disease has high prevalence in Asian populations, with a high incidence in the Japanese community (Epstein, 2002; Kalb et al, 2011; Smith et al, 2011; Kommu et al, 2014); in the past years features of OPLL has been recognized in patients from Europe and North America. If gait disturbances are sustained there is no available intervention to support the motor rehabilitation of such patients
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