Pilot study of locomotion improvement using hybrid assistive limb in chronic stroke patients

BackgroundLocomotor training using robots is increasingly being used for rehabilitation to reduce manpower and the heavy burden on therapists, and the effectiveness of such techniques has been investigated. The robot suit Hybrid Assistive Limb (HAL) has been developed to rehabilitate or support motor function in people with disabilities. The HAL provides motion support that is tailored to the wearer’s voluntary drive. We performed a pilot clinical trial to investigate the feasibility of locomotor training using the HAL in chronic stroke patients, and to examine differences between two functional ambulation subgroups.MethodsSixteen stroke patients in the chronic stage participated in this study. All patients were trained with the HAL over 16 sessions (20–30 min/day within 2 days/week). Primary outcomes were walking speed, cadence, and number of steps recorded during a 10-meter walk test (10MWT). Berg balance scale (BBS) and timed up and go (TUG) were also measured. All outcome measures were evaluated without wearing HAL assistance before and after the intervention in all patients as well as in the dependent ambulatory and independent ambulatory subgroups.ResultsAll participants completed the intervention with no adverse events. Gait speed, cadence, number of steps during the 10MWT, and BBS increased significantly from 0.41 m/s to 0.45 m/s (P = 0.031), from 68.6 steps/min to 72.0 steps/min (P = 0.020), from 37.5 steps to 33.1 steps (P = 0.017), and from 40.6 to 45.4 (P = 0.004) respectively. The TUG test score improved, although this difference was not statistically significant. The findings in the dependent ambulatory subgroup primarily contributed to the significant differences observed in the group as a whole.ConclusionsThis pilot study showed that locomotor training using the HAL is feasible for chronic stroke patients. Randomized controlled trials are now required to demonstrate the effectiveness of HAL-based rehabilitation over conventional therapies.Trial registrationUMIN000002969

[1]  A. Eagger.  Rehabilitation , 1960 .

[2]  K. Mauritz,et al.  Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison , 2002, European journal of neurology.

[3]  R. Teasell,et al.  The Role of Task-Specific Training in Rehabilitation Therapies , 2005, Topics in stroke rehabilitation.

[4]  Michael Pieper.  Recommending Context-Sensitive and Process-Oriented Tourist Information to the Disabled - The PALIO Case , 2002, ICCHP.

[5]  L. Ada,et al.  A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. , 2003, Archives of physical medicine and rehabilitation.

[6]  V. Dietz,et al.  Treadmill training of paraplegic patients using a robotic orthosis. , 2000, Journal of rehabilitation research and development.

[7]  S. Hesse,et al.  Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support , 1999, Clinical rehabilitation.

[8]  Yoshiyuki Sankai,et al.  Feasibility of rehabilitation training with a newly developed wearable robot for patients with limited mobility. , 2013, Archives of physical medicine and rehabilitation.

[9]  Yoshiyuki Sankai,et al.  Power Assist System HAL-3 for Gait Disorder Person , 2002, ICCHP.

[10]  M. Molinari,et al.  Rehabilitation of gait after stroke: a review towards a top-down approach , 2011, Journal of NeuroEngineering and Rehabilitation.

[11]  Yea-Ru Yang,et al.  Cortical reorganization induced by body weight-supported treadmill training in patients with hemiparesis of different stroke durations. , 2010, Archives of physical medicine and rehabilitation.

[12]  Kelly P Westlake,et al.  Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke , 2009, Journal of NeuroEngineering and Rehabilitation.

[13]  JoAnne K. Gronley,et al.  Classification of walking handicap in the stroke population. , 1995, Stroke.

[14]  Chao Qian,et al.  Population , 1940, State Rankings 2020: A Statistical View of America.

[15]  Pamela W Duncan,et al.  Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. , 2005, Stroke.

[16]  E. Roth,et al.  Locomotor Training Improves Daily Stepping Activity and Gait Efficiency in Individuals Poststroke Who Have Reached a “Plateau” in Recovery , 2010, Stroke.

[17]  S. Olney,et al.  Hemiparetic gait following stroke. Part II: Recovery and physical therapy , 1996 .

[18]  Jacob Cohen,et al.  A power primer. , 1992, Psychological bulletin.

[19]  I. Tarkka,et al.  The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke. , 2005, Archives of physical medicine and rehabilitation.

[20]  L. Lucas,et al.  Robot-Assisted Gait Training for Patients with Hemiparesis Due to Stroke , 2011, Topics in stroke rehabilitation.

[21]  A. Mayr,et al.  Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis , 2007, Neurorehabilitation and neural repair.

[22]  E. Roth,et al.  Impairment and disability: their relation during stroke rehabilitation. , 1998, Archives of physical medicine and rehabilitation.

[23]  Shawnna L. Patterson,et al.  Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report. , 2008, Journal of rehabilitation research and development.

[24]  I. Schwartz,et al.  Robot-assisted gait training in multiple sclerosis patients: a randomized trial , 2012, Multiple sclerosis.

[25]  賢二 鈴木.  慢性副鼻腔炎に対するrandomized controlled study , 2002 .

[26]  T. Demott,et al.  Enhanced Gait-Related Improvements After Therapist- Versus Robotic-Assisted Locomotor Training in Subjects With Chronic Stroke: A Randomized Controlled Study , 2008, Stroke.

[27]  S. Hesse,et al.  Treadmill Training With Partial Body Weight Support and an Electromechanical Gait Trainer for Restoration of Gait in Subacute Stroke Patients: A Randomized Crossover Study , 2002, Stroke.

[28]  Raymond K Y Tong,et al.  Gait Training of Patients After Stroke Using an Electromechanical Gait Trainer Combined With Simultaneous Functional Electrical Stimulation , 2006, Physical Therapy.

[29]  Yasuhisa Hasegawa,et al.  Intention-based walking support for paraplegia patients with Robot Suit HAL , 2007, Adv. Robotics.

[30]  J. Hidler,et al.  Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke , 2009, Neurorehabilitation and neural repair.

[31]  Ross Querry,et al.  Robotic orthoses for body weight-supported treadmill training. , 2006, Physical medicine and rehabilitation clinics of North America.

[32]  Yoshiyuki Sankai,et al.  Power assist method based on Phase Sequence and muscle force condition for HAL , 2005, Adv. Robotics.

[33]  K. Fong,et al.  Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. , 2001, Brain injury.

[34]  S. Hesse,et al.  Gait rehabilitation machines based on programmable footplates , 2007, Journal of NeuroEngineering and Rehabilitation.

[35]  C. Hui-Chan,et al.  The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. , 2005, Archives of physical medicine and rehabilitation.

[36]  I. Schwartz,et al.  The Effectiveness of Locomotor Therapy Using Robotic‐Assisted Gait Training in Subacute Stroke Patients: A Randomized Controlled Trial , 2009, PM & R : the journal of injury, function, and rehabilitation.

[37]  S Hesse,et al.  Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS) , 2007, Clinical rehabilitation.

[38]  Steven Y Cen,et al.  Effects of Task-Specific and Impairment-Based Training Compared With Usual Care on Functional Walking Ability After Inpatient Stroke Rehabilitation , 2013, Neurorehabilitation and neural repair.

[39]  P. Trueblood.  Partial body weight treadmill training in persons with chronic stroke. , 2001, NeuroRehabilitation.

[40]  F. Müller,et al.  Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke: A Randomized Controlled Pilot Study , 2007, Stroke.

[41]  S. Paolucci.  Epidemiology and treatment of post-stroke depression , 2008, Neuropsychiatric disease and treatment.

[42]  J. Krakauer.  Motor learning: its relevance to stroke recovery and neurorehabilitation. , 2006, Current opinion in neurology.

[43]  J. Mehrholz,et al.  Gait training with the newly developed ‘LokoHelp’-system is feasible for non-ambulatory patients after stroke, spinal cord and brain injury. A feasibility study , 2008, Brain injury.