Hybrid Assistive Limb Research Articles

Should External Powered Orthoses be Used by Paraplegic Subjects or Not?

Spinal cord injury (SCI) is a damage to spinal cord that results in loss of function, mobility and sensation below the level at which the spinal cord has been injured. The incidence of this disorder varies between 12.7 and 59 new cases per million each year (1). These subjects used various orthoses to improve their abilities to stand and walk, such as mechanical orthoses, functional electrical stimulation (FES), external powered orthoses (EPO) and hybrid system, which is a combination of FES and mechanical orthosis (2). However patients experience some problems such as high energy consumption during walking, high loads applied on upper limb and reduced walking speed (3). The external powered orthoses employ various kinds of power sources which include pneumatic, hydraulic and electrical power. Some orthoses such as pneumatic active gait orthosis (PAGO), powered gait orthosis (PGO), weight bearing control orthosis (WBCO), two degree of freedom orthosis (TDFO), driven gait orthosis (DGO), hybrid assistive limb (HAL) and lowered extremity powered exoskeleton (LEPE) have been designed to improve the performance of the subjects (4-10). However, the main questions posted here is how much the performance of paraplegic subjects is improved while walking with EPO in contrast to mechanical systems. Furthermore, it is not clear that how much is the willingness of subjects to use these orthoses (3). An electronic search was done via Pubmed, Embase and ISI web of knowledge data from 1960 to 2010. Some key words such as external power orthosis, spinal cord injury and rehabilitation were used. The abstracts and titles of each individual study were assessed by two reviewers based on whether the abstracts addressed the research question of interest, Figure 1. The quality of the studies was assessed by use of Black and Down tool. PubMed ISI Web of Knowledge Embase

A Newly Developed Robot Suit Hybrid Assistive Limb Facilitated Walking Rehabilitation after Spinal Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament: A Case Report

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.

Feasibility and Safety of Acute Phase Rehabilitation After Stroke Using the Hybrid Assistive Limb Robot Suit

Acute phase rehabilitation is an important treatment for improving the functional outcome of patients after stroke. The present cohort study analyzed the feasibility and safety of acute phase rehabilitation using the hybrid assistive limb robot suit in 22 patients, 7 males and 15 females (mean age 66.6 ± 17.7 years). Neurological deterioration, mortality, or other accidents were recorded as adverse events. Baseline characteristics of each patient were recorded at the first hybrid assistive limb rehabilitation. Hybrid assistive limb rehabilitation was conducted for 12.1 ± 7.0 days with the patients in stable condition. Acute phase hybrid assistive limb rehabilitation was performed a total of 84 times with no adverse events recorded except for orthostatic hypotension. Good functional outcomes were obtained in 14 patients. Orthostatic hypotension was observed during the first hybrid assistive limb rehabilitation in four patients, and was significantly associated with intracerebral hemorrhage (p = 0.007) and lower Brunnstrom stage (p = 0.033). Acute phase rehabilitation using the hybrid assistive limb suit is feasible and safe. Patients with intracerebral hemorrhage and lower Brunnstrom stage should be carefully monitored for orthostatic hypotension.

Design of Human Exo-skeleton Suit for Rehabilitation of Hemiplegic People

Abstract The end of the 20th century witnessed the development of Exo-Skeleton Suits. These suits were fabricated for various reasons and their main focus was to reduce human effort.They were made so that the daily activities of human beings are simplified and therefore to be less stressful. So the advancement of Exo-Skeleton Suits started and were made for areas ranging from defence to medicine. But much focus was given to increase human strength.Even the recent Human Exo-Skeleton Suit HAL(Hybrid Assistive Limb) which is a multi-purpose suit but its primary aim is to reduce human force for work.In this paper the focus is shifted to the paralyzed people especially Hemiplegic people.Hemiplegia is a disorder in which one half of the Human body Fails to perform its functions, including one Arm and one Leg i.e. half of the body is Paralysed. As a result of this, they are not able to walk and do other physical activities.The main reason of Hemiplegia found is due to stroke and in many cases it is hereditary .Recovery from stroke is difficult and the treatment is prolonged hence the Exo-Skeleton Suit H1 is designed and proposed in this paper. Enabling these people to walk using a wearable Exo-Skeleton Suit-H1, which is cost-effective and will enable walking is the real motive behind the ideology.H1 Suit is designed to focus purely for hemiplegic people unlike HAL which has multi-applications and is extremely costly for a common man. Instead of conventional motors, which are used in earlier Exo-Skeleton Suit for the movement of limbs, Pneumatic actuation is used for better locomotion. The Control of this actuation is done by means of a fixed Potentiometer. The device is tested using Softwares like Festo Fluid Sim and Pro-Engineer which is exhibited in this paper. A Test Case is performed and satisfying Results were obtained. In its Later stages of implementation the similar device will be made for Paraplegia- the medical condition in which both the Legs are Paralysed.

脳卒中超急性期リハビリテーションにおいて, ロボットスーツHALの使用が麻痺側生体電位検出に有効であった1例

脳卒中超急性期リハビリテーションにおいて, ロボットスーツHALの使用が麻痺側生体電位検出に有効であった1例

Efficacy of a hybrid assistive limb in post-stroke hemiplegic patients: a preliminary report

BackgroundRobotic devices are expected to be widely used in various applications including support for the independent mobility of the elderly with muscle weakness and people with impaired motor function as well as support for nursing care that involves heavy laborious work. We evaluated the effects of a hybrid assistive limb robot suit on the gait of stroke patients undergoing rehabilitation.MethodsThe study group comprised 16 stroke patients with severe hemiplegia. All patients underwent gait training. Four patients required assistance, and 12 needed supervision while walking. The stride length, walking speed and physiological cost index on wearing the hybrid assistive limb suit and a knee-ankle-foot orthosis were compared.ResultsThe hybrid assistive limb suit increased the stride length and walking speed in 4 of 16 patients. The patients whose walking speed decreased on wearing the hybrid assistive limb suit either had not received sufficient gait training or had an established gait pattern with a knee-ankle-foot orthosis using a quad cane. The physiological cost index increased after wearing the hybrid assistive limb suit in 12 patients, but removal of the suit led to a decrease in the physiological cost index values to equivalent levels prior to the use of the suit.ConclusionsAlthough the hybrid assistive limb suit is not useful for all hemiplegic patients, it may increase the walking speed and affect the walking ability. Further investigation would clarify its indication for the possibility of gait training.

Robot suit hybrid assistive limb [Industrial Activities

Since 2005, the IEEE Robotics and Automation Society and International Federation of Robotics (IFR) have cooperated to host a joint Forum of Innovation and Entrepreneurship in Robotics and Automation to foster cooperation between the scientific community and industry. As part of the forum, an award for Invention and Entrepreneurship in Robotics and Automation (IERA) is made. This year the IEEE--IFR form was held in Kobe, Japan, in conjunction with the IEEE International Conference on Robotics and Automation (ICRA) 2009.

Intention-based walking support for paraplegia patients with Robot Suit HAL

This paper proposes an algorithm to estimate human intentions related to walking in order to comfortably and safely support a paraplegia patient's walk. Robot Suit HAL (Hybrid Assistive Limb) has been developed for enhancement of a healthy person's activities and for support of a physically challenged person's daily life. The assisting method based on bioelectrical signals such as myoelectricity successfully supports a healthy person's walking. These bioelectrical signals, however, cannot be measured properly from a paraplegia patient. Therefore another interface that can estimate a patient's intentions without any manual controller is desired for robot control since a manual controller deprives a patient of his/her hand freedom. Estimation of a patient's intentions contributes to providing not only comfortable support but also safe support, because any inconformity between the robot suit motion and the patient motion results in his/her stumbling or falling. The proposed algorithm estimates a patient's intentions from a floor reaction force (FRF) reflecting a patient's weight shift during walking and standing. The effectiveness of this algorithm is investigated through experiments on a paraplegia patient who has a sensory paralysis on both legs, especially his left leg. We show that HAL supports the patient's walk properly, estimating his intentions based on the FRF, while he keeps his own balance by himself.

Power assist method based on Phase Sequence and muscle force condition for HAL

An exoskeleton robot can replace the wearer's motion function by operating the human's body. The purpose of this study is to propose a power assist method of walking, standing up and going up stairs based on autonomous motion of the exoskeleton robot suit, HAL (Hybrid assistive Limb), and verify the effectiveness of this method by experiment. In order to realize power assist of tasks (walking, standing up and going up stairs) autonomically, we used the Phase Sequence control which generates a task by transiting some simple basic motions called Phases. A task was divided into some Phases on the basis of the task performed by a normal person. The joint moving modes were categorized into active, passive and free modes according to the characteristic of the muscle force conditions. The autonomous motions which HAL generates in each Phase were designed corresponding to one of the categorized modes. The power assist experiments were performed by using the autonomous motion with a focus on the active mode. The experimental results showed that the wearer's muscle activation levels in each Phase were significantly reduced. With this, we confirmed the effectiveness of the proposed assist method.

Virtual impedance adjustment in unconstrained motion for an exoskeletal robot assisting the lower limb

The objective of this paper is to establish the criteria for adjusting the virtual impedance of an exoskeletal robot for the lower limb in order to minimize the operator's physical stress in unconstrained motion. The exoskeletal robot HAL (Hybrid Assistive Limb)-3 which we developed for assisting the motor function of the lower limb was used for experiments in this research. To accomplish the objective (i) the physical parameters around the joint of HAL-3 were identified and (ii) the relationships between the virtual impedance values and the physical stress of operators were examined through experiments for swinging motions of the lower leg. The physical stress was evaluated with myoelectricity, the musculoskeletal moment of the operator and the operator's feelings during the experimental motion. As a result, we found that the physical stress tended to decline with the decrease of virtual inertia and virtual Coulomb friction, and to increase slightly with the decrease of virtual gravitational moment. The decrease of virtual viscous friction made the physical stress increase gradually after it declined to a trough during the positive virtual viscous friction. Based on the results, we could establish the criteria for adjusting the virtual impedance for minimizing the operator's physical stress in unconstrained motion.

Apathy: a neuropsychiatric syndrome

Traditionally, apathy has been viewed as a symptom indicating loss of interest or emotions. This paper evaluates evidence that neuropsychiatric disorders also produce a syndrome of apathy. Both the symptom and the syndrome of apathy are of conceptual interest because they signify loss of motivation. An apathy syndrome is defined as a syndrome of primary motivational loss, that is, loss of motivation not attributable to emotional distress, intellectual impairment, or diminished level of consciousness. Loss of motivation due to disturbance of intellect, emotion, or level of consciousness defines the symptom of apathy. Neuropsychiatric literature dealing with apathy is reviewed within the framework of three approaches to defining the concept of a syndrome. Clinical and investigative approaches for evaluating apathy when it occurs in association with other syndromes are described.