Immediate effects of a single session of robot-assisted gait training using Hybrid Assistive Limb (HAL) for cerebral palsy

[Purpose] Robot-assisted gait training (RAGT) using Hybrid Assistive Limb (HAL, CYBERDYNE) was previously reported beneficial for stroke and spinal cord injury patients. Here, we investigate the immediate effect of a single session of RAGT using HAL on gait function for cerebral palsy (CP) patients. [Subjects and Methods] Twelve patients (average age: 16.2 ± 7.3 years) with CP received a single session of RAGT using HAL. Gait speed, step length, cadence, single-leg support per gait cycle, hip and knee joint angle in stance, and swing phase per gait cycle were assessed before, during, and immediately after HAL intervention. [Results] Compared to baseline values, single-leg support per gait cycle (64.5 ± 15.8% to 69.3 ± 12.1%), hip extension angle in mid-stance (149.2 ± 19.0° to 155.5 ± 20.1°), and knee extension angle in mid-stance (137.6 ± 20.2° to 143.1 ± 19.5°) were significantly increased immediately after intervention. Further, the knee flexion angle in mid-swing was significantly decreased immediately after treatment (112.0 ± 15.5° to 105.2 ± 17.1°). Hip flexion angle in mid-swing also decreased following intervention (137.2 ± 14.6° to 129.7 ± 16.6°), but not significantly. Conversely, gait speed, step length, and cadence were unchanged after intervention. [Conclusion] A single-time RAGT with HAL improved single-leg support per gait cycle and hip and knee joint angle during gait, therapeutically improving gait function in CP patients.

[1]  A. Meyer-Heim,et al.  Sustainability of motor performance after robotic-assisted treadmill therapy in children: an open, non-randomized baseline-treatment study. , 2010, European journal of physical and rehabilitation medicine.

[2]  Walaa Abd El-hakiem,et al.  Effect of treadmill training with partial body weight support on spine geometry and gross motor function in children with diplegic cerebral palsy , 2017 .

[3]  Kazumichi Yoshida,et al.  Factors Predicting the Effects of Hybrid Assistive Limb Robot Suit during the Acute Phase of Central Nervous System Injury , 2015, Neurologia medico-chirurgica.

[4]  A. Esquenazi,et al.  The ReWalk Powered Exoskeleton to Restore Ambulatory Function to Individuals with Thoracic-Level Motor-Complete Spinal Cord Injury , 2012, American journal of physical medicine & rehabilitation.

[5]  L. Noreau,et al.  Association between characteristics of locomotion and accomplishment of life habits in children with cerebral palsy. , 1998, Physical therapy.

[6]  G. Colombo,et al.  Feasibility of robotic‐assisted locomotor training in children with central gait impairment , 2007, Developmental medicine and child neurology.

[7]  K. Jahn,et al.  Prospective controlled cohort study to evaluate changes of function, activity and participation in patients with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy. , 2014, European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society.

[8]  J. Borg,et al.  Gait training early after stroke with a new exoskeleton – the hybrid assistive limb: a study of safety and feasibility , 2014, Journal of NeuroEngineering and Rehabilitation.

[9]  Andrew Kerr,et al.  The evaluation of an inexpensive, 2D, video based gait assessment system for clinical use. , 2013, Gait & posture.

[10]  L. Mutch,et al.  Epidemiology of cerebral palsy in England and Scotland, 1984–9 , 1998, Archives of disease in childhood. Fetal and neonatal edition.

[11]  M. Merzenich,et al.  Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys , 1996, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[12]  R. Nudo,et al.  Role of adaptive plasticity in recovery of function after damage to motor cortex , 2001, Muscle & nerve.

[13]  J L Hutton,et al.  Effects of cognitive, motor, and sensory disabilities on survival in cerebral palsy , 2002, Archives of disease in childhood.

[14]  Monica A. Perez,et al.  Motor skill training induces changes in the excitability of the leg cortical area in healthy humans , 2004, Experimental Brain Research.

[15]  P. Schwenkreis,et al.  Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. , 2014, The spine journal : official journal of the North American Spine Society.

[16]  Joanna Dudek,et al.  Functional effects of robotic-assisted locomotor treadmill thearapy in children with cerebral palsy. , 2013, Journal of rehabilitation medicine.

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

[18]  S. Hesse,et al.  A mechanized gait trainer for restoring gait in nonambulatory subjects. , 2000, Archives of physical medicine and rehabilitation.

[19]  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.

[20]  Mirko Aach,et al.  Against the odds: what to expect in rehabilitation of chronic spinal cord injury with a neurologically controlled Hybrid Assistive Limb exoskeleton. A subgroup analysis of 55 patients according to age and lesion level. , 2017, Neurosurgical focus.

[21]  J. Henson,et al.  Plasticity , 2010, Neurology.

[22]  A. Meyer-Heim,et al.  Improvement of walking abilities after robotic-assisted locomotion training in children with cerebral palsy , 2009, Archives of Disease in Childhood.

[23]  Ju Lu,et al.  REPETITIVE MOTOR LEARNING INDUCES COORDINATED FORMATION OF CLUSTERED DENDRITIC SPINES IN VIVO , 2012, Nature.

[24]  Sarah Foley,et al.  Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial. , 2010, Archives of physical medicine and rehabilitation.

[25]  H. Kawamoto,et al.  Gait training with Hybrid Assistive Limb enhances the gait functions in subacute stroke patients: A pilot study. , 2017, NeuroRehabilitation.

[26]  Yoshiyuki Sankai,et al.  Efficacy of a hybrid assistive limb in post-stroke hemiplegic patients: a preliminary report , 2011, BMC neurology.

[27]  Joseph Hidler,et al.  Kinematic trajectories while walking within the Lokomat robotic gait-orthosis. , 2008, Clinical biomechanics.

[28]  Ingo Borggraefe,et al.  Patient‐specific determinants of responsiveness to robot‐enhanced treadmill therapy in children and adolescents with cerebral palsy , 2014, Developmental medicine and child neurology.

[29]  A. E. Hill,et al.  ENERGY CONSUMPTION IN CHILDREN WITH SPINA BIFIDA AND CEREBRAL PALSY: A COMPARATIVE STUDY , 1996, Developmental medicine and child neurology.

[30]  J. Laíns,et al.  Can we improve gait skills in chronic hemiplegics? A randomised control trial with gait trainer. , 2007, Europa medicophysica.

[31]  S. Hesse,et al.  A mechanized gait trainer for restoration of gait. , 2000, Journal of rehabilitation research and development.

[32]  Y. Sankai,et al.  Effectiveness of Acute Phase Hybrid Assistive Limb Rehabilitation in Stroke Patients Classified by Paralysis Severity , 2015, Neurologia medico-chirurgica.

[33]  H Kern,et al.  Treadmill training with partial body weight support in nonambulatory patients with cerebral palsy. , 2000, Archives of physical medicine and rehabilitation.

[34]  J. Rodda,et al.  Management of the knee in spastic diplegia: what is the dose? , 2010, The Orthopedic clinics of North America.

[35]  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.

[36]  R. Cherng,et al.  Effect of Treadmill Training with Body Weight Support on Gait and Gross Motor Function in Children with Spastic Cerebral Palsy , 2007, American journal of physical medicine & rehabilitation.

[37]  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.

[38]  Y. Kerlirzin,et al.  Robotic-assisted gait training improves walking abilities in diplegic children with cerebral palsy. , 2017, European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society.

[39]  Yoshiyuki Sankai,et al.  Gait training of subacute stroke patients using a hybrid assistive limb: a pilot study , 2017, Disability and rehabilitation. Assistive technology.

[40]  A. Matsumura,et al.  Effects of gait training using the Hybrid Assistive Limb® in recovery-phase stroke patients: A 2-month follow-up, randomized, controlled study. , 2017, NeuroRehabilitation.

[41]  Yoshiyuki Sankai,et al.  Predictive control estimating operator's intention for stepping-up motion by exo-skeleton type power assist system HAL , 2001, Proceedings 2001 IEEE/RSJ International Conference on Intelligent Robots and Systems. Expanding the Societal Role of Robotics in the the Next Millennium (Cat. No.01CH37180).

[42]  A. Esquenazi,et al.  Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: A pilot study , 2012, The journal of spinal cord medicine.

[43]  Rita M. Kiss,et al.  The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis , 2006, Knee Surgery, Sports Traumatology, Arthroscopy.