Ozzy's Wearable Cyborg May Be The Future of Physical Therapy

When I read thru this  I realized this has no possibility of helping me since I have dead brain no longer sending any signals anywhere close to my muscles. Higher functioning stroke survivors only need apply.

Ozzy's Wearable Cyborg May Be The Future of Physical Therapy

Effects of periodic robot rehabilitation using the Hybrid Assistive Limb for a year on gait function in chronic stroke patients

And you really think chronic survivors can get insurance to pay for this?

Effects of periodic robot rehabilitation using the Hybrid Assistive Limb for a year on gait function in chronic stroke patients

Author links open overlay panelHirokiTanaka^ab

ManabuNankaku^aTakayukiKikuchi^cHidehisaNishi^cdToruNishikawa^aHonamiYonezawa^aGakutoKitamura^aYasushiTakagi^eSusumuMiyamoto^cRyosukeIkeguchi^afShuichiMatsuda^af

https://doi.org/10.1016/j.jocn.2021.07.040Get rights and content

Highlights

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About 30% of stroke survivors have some obstacles to walking even in chronic phase.

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Robot rehabilitation has attracted attention for the last several decades.

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The long-term HAL training improves gait function in stroke patients over a year.

Abstract

Using a robot for gait training in stroke patients has attracted attention for the last several decades. Previous studies reported positive effects of robot rehabilitation on gait function in the short term. However, the long-term effects of robot rehabilitation for stroke patients are still unclear. The purpose of the present study was to investigate the long-term effects of periodic gait training using the Hybrid Assistive Limb (HAL) on gait function in chronic stroke patients. Seven chronic stroke patients performed 8 gait training sessions using the HAL 3 times every few months. The maximal 10-m walk test and the 2-minute walking distance (2MWD) were measured before the first intervention and after the first, second, and third interventions. Gait speed, stride length, and cadence were calculated from the 10-m walk test. Repeated one-way analysis of variance showed a significant main effect on evaluation time of gait speed (F = 7.69, p < 0.01), 2MWD (F = 7.52, p < 0.01), stride length (F = 5.24, p < 0.01), and cadence (F = 8.43, p < 0.01). The effect sizes after the first, second, and third interventions compared to pre-intervention in gait speed (d = 0.39, 0.52, and 0.59) and 2MWD (d = 0.35, 0.46, and 0.57) showed a gradual improvement(NOT RECOVERY!) of gait function at every intervention. The results of the present study showed that gait function of chronic stroke patients improved over a year with periodic gait training using the HAL every few months.

 

Clinical application of the Hybrid Assistive Limb (HAL) for gait training-a systematic review

In the 5 years since this came out have we had decent enough research that allows conclusions to be drawn? Your doctor and stroke hospital should know that if they have any competence at all.

Clinical application of the Hybrid Assistive Limb (HAL) for gait training-a systematic review

2015, Frontiers in systems neuroscience

Anneli Wall^1,2*, Jörgen Borg^1,2 and Susanne Palmcrantz^1,2

• ¹Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
• ²Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden

Objective: The aim of this study was to review the literature on clinical applications of the Hybrid Assistive Limb system for gait training.

Methods: A systematic literature search was conducted using Web of Science, PubMed, CINAHL and clinicaltrials.gov and additional search was made using reference lists in identified reports. Abstracts were screened, relevant articles were reviewed and subject to quality assessment.

Results: Out of 37 studies, 7 studies fulfilled inclusion criteria. Six studies were single group studies and 1 was an explorative randomized controlled trial. In total, these studies involved 140 participants of whom 118 completed the interventions and 107 used HAL for gait training. Five studies concerned gait training after stroke, 1 after spinal cord injury (SCI) and 1 study after stroke, SCI or other diseases affecting walking ability. Minor and transient side effects occurred but no serious adverse events were reported in the studies. Beneficial effects on gait function variables and independence in walking were observed.

Conclusions: The accumulated findings demonstrate that the HAL system is feasible when used for gait training of patients with lower extremity paresis in a professional setting. Beneficial effects on gait function and independence in walking were observed but data do not allow conclusions. Further controlled studies are recommended.

 

Clinical application of the Hybrid Assistive Limb (HAL) for gait training-a systematic review

This completely and totally exemplifies the stupidity in the stroke medical world for not having a database of all stroke research and protocols where these reviews would never be needed because the database would be up-to-date all the time.  And survivors could then use it to train their doctors and therapists in the appropriate 100% recovery rehab.  I know pie in the sky but with survivors in charge it would get accomplished. 

These later ones shouldn't have been needed? Or didn't you and your mentors know about this 2015 one?

Clinical application of the Hybrid Assistive Limb (HAL) for gait training-a systematic review February 2020

 

Gait training early after stroke with a new exoskeleton--the hybrid assistive limb: a study of safety and feasibility January 2020

A Randomized and Controlled Crossover Study Investigating the Improvement of Walking and Posture Functions in Chronic Stroke Patients Using HAL Exoskeleton – The HALESTRO Study (HAL-Exoskeleton STROke Study) April 2019

The earliest  here(2015):

Clinical application of the Hybrid Assistive Limb (HAL) for gait training-a systematic review

Anneli Wall1,2*, Jörgen Borg1,2 and Susanne Palmcrantz1,2
1Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
2Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden

Objective: 
The aim of this study was to review the literature on clinical applications of the Hybrid Assistive Limb system for gait training.
Methods: 
A systematic literature search was conducted using Web of Science, PubMed, CINAHL and clinicaltrials.gov and additional search was made using reference lists in identified reports. Abstracts were screened, relevant articles were reviewed and subject to quality assessment.
Results:
Out of 37 studies, 7 studies fulfilled inclusion criteria. Six studies were single group studies and 1 was an explorative randomized controlled trial. In total, these studies involved 140 participants of whom 118 completed the interventions and 107 used HAL for gait training. Five studies concerned gait training after stroke, 1 after spinal cord injury (SCI) and 1 study after stroke, SCI or other diseases affecting walking ability. Minor and transient side effects occurred but no serious adverse events were reported in the studies. Beneficial effects on gait function variables and independence in walking were observed.
Conclusions: 
The accumulated findings demonstrate that the HAL system is feasible when used for gait training of patients with lower extremity paresis in a professional setting. Beneficial effects on gait function and independence in walking were observed but data do not allow conclusions. Further controlled studies are recommended.

Background

Normal gait depends on the functional integrity and interactions in sensory-motor neural networks at spinal and supraspinal levels (Bowden et al., 2013). This complex system may be disturbed in many neurological conditions such as stroke or spinal cord injury (SCI) resulting in limited mobility and impaired gait function, which are major challenges in neuro rehabilitation. Intensive, repetitive task specific training may drive beneficial neuroplasticity, enhance functional restitution and improve final outcome (Kwakkel et al., 2004; Langhorne et al., 2009, 2011; Peurala et al., 2014). However, there is a need for further development of training methods in response to an increasing understanding of the individual capacity for regaining functioning (Krakauer et al., 2012; Bowden et al., 2013).
Approaches to improve gait function after stroke and SCI include treadmill training with or without use of partial body weight support (BWS), yet the evidence to support this is inconclusive (Schwartz and Meiner, 2013; Dobkin et al., 2014). Gait machines (GM) may allow more reproducible gait movements compared to conventional training and reduce the burden on the therapist. GM work according to the end-effector principle (foot plates move the feet in a controlled gait pattern) or as exoskeletons, which have joints matching the limb joints and motors that drive movements over these joints to assist, e.g., leg movements (Hesse et al., 2010). A recent Cochrane review concluded that electromechanically assisted gait training in combination with physiotherapy after stroke increases the odds of achieving independent walking and most so when applied for severely impaired patients in the first 3 months after stroke (Mehrholz et al., 2013) but less clear after SCI (Mehrholz et al., 2012).
The importance of incorporating more active participation than allowed by gait machines to enhance training effects and the need for new concepts and devices are recognized (Dobkin, 2009; Pennycott et al., 2012). One new approach is represented by the Hybrid Assistive Limb system (HAL). HAL is an exoskeleton with a hybrid system allowing both a voluntary and an autonomous mode of action to support training of gait. HAL comprises a control algorithm and supporting devices, where each knee and hip joint can be controlled separately. Key features of the HAL system have been reported in detail (Kawamoto, 2002; Suzuki et al., 2007; Kawamoto et al., 2010). Movements are triggered by use of either the “Cybernic Voluntary Control” (CVC), which is based on the users voluntary activation of gait muscles as recorded by surface electromyography (EMG), or by the “Cybernic Autonomous Control” (CAC), which is based on the users weight shifting and input from force pressure sensors in the shoes. The CVC mode allows the operator to adjust the degree of support for each joint and reduce the support as training progress and to adjust settings to achieve a gait pattern that is as close as possible to normal gait. In case of complete loss of voluntary activation of gait muscles the CAC mode may be used. Gait is then initiated and sustained by input from force-pressure sensors in the shoes. HAL is manufactured in single-leg and double-leg versions and training with HAL may be performed with or without BWS.
A number of clinical studies with HAL have been conducted and there is a need for an evaluation of available data to guide further trials. The aim of this report was to provide a systematic review in order to evaluate current evidence with regard to feasibility (i.e., usability and safety) and effects and to make recommendations for further studies.

Gait training early after stroke with a new exoskeleton--the hybrid assistive limb: a study of safety and feasibility

This was 6 years ago, did your hospital conclude that this wasn't needed because their stroke rehab program was functioning at such a high level nothing further was needed? If so, your hospital must be the best in the world.  Have they solved all these problems in stroke? If yes, then they need to nominate themselves for the Nobel prize in medicine.

I see nothing that suggests that any objective damage diagnosis was done so you know the candidates that this would be helpful for.  Without that, useless.

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

 Anneli Nilsson, 1*, 

Katarina Skough Vreede,1,2, 

Vera Häglund,1, 

Yoshiyuki Sankai,3

Hiroaki Kawamoto,3,

Abstract

Background:

 Intensive task specific training early after stroke may enhance(NOT GOOD ENOUGH, , what will it take to be definite?) beneficial neuroplasticity and functionalrecovery. Impaired gait after hemiparetic stroke remains a challenge that may be approached early after stroke byuse of novel technology. The aim of the study was to investigate the safety and feasibility of the exoskeletonHybrid Assistive Limb (HAL) for intensive gait training as part of a regular inpatient rehabilitation program forhemiparetic patients with severely impaired gait early after stroke.
Methods:
 Eligible were patients until 7 weeks after hemiparetic stroke. Training with HAL was performed 5 daysper week by the autonomous and/or the voluntary control mode offered by the system. The study protocolcovered safety and feasibility issues and aspects on motor function, gait performance according to the 10 MeterWalking Test (10MWT) and Functional Ambulation Categories (FAC), and activity performance.
Results:
 Eight patients completed the study. Median time from stroke to inclusion was 35 days (range 6 to 46). Training started by use of the autonomous HAL mode in all and later switched to the voluntary mode in all butone and required one or two physiotherapists. Number of training sessions ranged from 6 to 31 (median 17) andwalking time per session was around 25 minutes. The training was well tolerated and no serious adverse eventsoccurred. All patients improved their walking ability during the training period, as reflected by the 10MWT (from 111.5 to 40 seconds in median) and the FAC (from 0 to 1.5 score in median). Is this walking with or without HAL? It should be without HAL since the goal is recovery NOT compensation.
Conclusions:
 The HAL system enables intensive training of gait in hemiparetic patients with severely impaired gaitfunction early after stroke. The system is safe when used as part of an inpatient rehabilitation program for thesepatients by experienced physiotherapists.

Gait training early after stroke with a new exoskeleton--the hybrid assistive limb: a study of safety and feasibility

What other walking exoskeletons is your stroke hospital already using? Is this better? No control leg, so this research is practically useless.

Your doctor can analyze the intersection of these three sets of data.

exoskeleton (118)

walking (517)

gait training (29)

Gait training early after stroke with a new exoskeleton--the hybrid assistive limb: a study of safety and feasibility

 Anneli Nilsson
1*
, Katarina Skough Vreede
1,2
, Vera Häglund
1
, Hiroaki Kawamoto
3
, Yoshiyuki Sankai
3
and Jörgen Borg
1,2

Abstract

Background:
 Intensive task specific training early after stroke may enhance beneficial neuroplasticity and functional recovery. Impaired gait after hemiparetic stroke remains a challenge that may be approached early after stroke by use of novel technology. The aim of the study was to investigate the safety and feasibility of the exoskeleton Hybrid Assistive Limb (HAL) for intensive gait training as part of a regular inpatient rehabilitation program for hemiparetic patients with severely impaired gait early after stroke.
Methods:
 Eligible were patients until 7 weeks after hemiparetic stroke. Training with HAL was performed 5 days per week by the autonomous and/or the voluntary control mode offered by the system. The study protocol covered safety and feasibility issues and aspects on motor function, gait performance according to the 10 Meter Walking Test (10MWT) and Functional Ambulation Categories (FAC), and activity performance.
Results:
 Eight patients completed the study. Median time from stroke to inclusion was 35 days (range 6 to 46). Training started by use of the autonomous HAL mode in all and later switched to the voluntary mode in all but one and required one or two physiotherapists. Number of training sessions ranged from 6 to 31 (median 17) and walking time per session was around 25 minutes. The training was well tolerated and no serious adverse events occurred. All patients improved their walking ability during the training period, as reflected by the 10MWT (from 111.5 to 40 seconds in median) and the FAC (from 0 to 1.5 score in median).
Conclusions:
 The HAL system enables intensive training of gait in hemiparetic patients with severely impaired gait function early after stroke. The system is safe when used as part of an inpatient rehabilitation program for these patients by experienced physiotherapists.

Acute stroke rehabilitation for gait training with cyborg type robot Hybrid Assistive Limb: A pilot study

You mean these earlier two were not enough to determine efficacy?

FIM is pretty much useless since it is subjective.Cherry picking participants again because those who can walk at one week had much smaller strokes. 

 

A Randomized and Controlled Crossover Study Investigating the Improvement of Walking and Posture Functions in Chronic Stroke Patients Using HAL Exoskeleton – The HALESTRO Study (HAL-Exoskeleton STROke Study)

April 2019 

Biofeedback effect of hybrid assistive limb in stroke rehabilitation: A proof of concept study using functional near infrared spectroscopy

January 2018

The latest here. 

 

Acute stroke rehabilitation for gait training with cyborg type robot Hybrid Assistive Limb: A pilot study

Author links open overlay panelChiakiYokota^ac

YukioYamamoto^aMasatoshiKamada^aMichikazuNakai^bKunihiroNishimura^bDaisukeAndo^cTakeoSato^cMasatoshiKoga^cMasafumiIhara^dKazunoriToyoda^cYasuyukiFujimoto^aHirotakaOdani^aKazuoMinematsu^cTakashiNakajima^e

https://doi.org/10.1016/j.jns.2019.07.012Get rights and content

Under a Creative Commons license

open access

Highlights

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Hybrid Assistive Limb (HAL) promotes functional recovery post-stroke.

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There is limited published data on the efficacy of HAL on gait training post-stroke.

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The FIM scale is useful to gauge efficacy of HAL for acute stroke rehabilitation.

Abstract

Robot-assisted gait training following acute stroke could allow patients with severe disability to receive a high dosage and intensity of gait training compared with conventional physical therapy (CP). However, given the limited data on gauging the efficacy of Hybrid Assistive Limb (HAL) on gait training in patients with acute stroke, we aimed to evaluate several outcome measures following gait training with HAL. Patients with first-ever stroke, who required a walking aid and were able to start gait training within 1 week of stroke onset were included in the current study. Patients were assigned to either the CP or HAL group. Outcome measures were collected at baseline, and at the 2nd (at 2–6 weeks), and 3rd (at 3–5 months) assessments. All patients underwent physical therapy until the 3rd assessment; patients in the HAL group underwent gait training using HAL until the 2nd assessment. Thirty-seven patients (19 from CP and 18 from HAL, median age = 69 years) completed the study. At the 2nd assessment, the total Functional Independence Measure (FIM) score was higher in the HAL group than in the CP group (90.1 vs. 79.0, p = 0.042). In conclusion, the FIM scale could be used to identify responsiveness to acute stroke rehabilitation using HAL.

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Keywords

Robot-assisted rehabilitation

Acute stroke

Gait training

HAL

FIM

Measures

1. Introduction

Minimizing physical impairment and facilitating functional recovery following stroke is the most important target of managing patients with acute stroke. There is accumulating evidence of enhanced plasticity, such as alterations of gene expression, inhibitory/excitatory synaptic input balance, and structural changes including synaptogenesis, which occur immediately after stroke [[1], [2], [3], [4], [5]]. Task-specific motor training that is initiated soon after stroke facilitates the reorganization of connections in a sensitive manner, which reportedly induces dramatic recovery if residual motor cortical areas are spared [[6], [7], [8]]. Thus, motion-focused training during the early phase of post-stroke may prove to be a promising intervention to increase the resolution of impairment in a proportional manner in patients with stroke.

There are still several challenges associated with making an acute stroke rehabilitation protocol. A very early rehabilitation trial (AVERT) demonstrated that a higher dose and very early mobilization within 24 h of stroke onset in acute strokes did not improve functional outcome at 3 months in patients with very early mobilization, compared to those who received usual care [9]. According to a meta-analysis, newly developed electromechanical-assisted training using various devices for walking, in combination with physical therapy, within 3 months after stroke improved independent walking compared with gait training without a device [10]. However, a device selection and rehabilitation protocol to enhance recovery of function in patients with acute stroke has not yet been established.

A cyborg-type robot, Hybrid Assistive Limb (HAL), which is manufactured by Cyberdyne Inc., Tsukuba, Japan, is a promising robotic device using innovative technology cybernics, where man and machine are connected mechanically and electronically, is used in the system. A biped non-medical model of HAL, HAL-FL05, was chosen in the present clinical setting according to Japanese device regulation. Briefly, HAL can estimate and decode the wearer's motion intension of bilateral hips and knee joints in real time from bioelectrical signals, such as the wearer's motor unit potentials on the skin with joint angles and shoe force plate signals analyses. It can enhance the wearer's gait movement by means of appropriate actuator torque using four actuators on the bilateral hip and knee joints, as described in detail elsewhere [11]. In Japan, HAL was approved as a medical device for patients with eight rare neuromuscular diseases in 2015; however, it has not yet been approved for patients with acute stroke. Although there are reports on the safety or feasibility of the HAL system [12,13], and its beneficial effects on gait [14,15], its effectiveness on gait training following acute stroke has not yet been confirmed. Before a randomized controlled clinical trial to test the efficacy of HAL in patients with acute stroke can be conducted, appropriate outcome measures must first be established.

The aim of the present study was to evaluate several outcome measures following gait training, which was initiated within 1 week of acute stroke onset, to design a confirmatory clinical trial for gait training using HAL in the future.

More at link.

A Randomized and Controlled Crossover Study Investigating the Improvement of Walking and Posture Functions in Chronic Stroke Patients Using HAL Exoskeleton – The HALESTRO Study (HAL-Exoskeleton STROke Study)

I see NO PROTOCOL coming out of this so useless.  Do researchers think stroke survivors are stupid and will accept this crapola? 

A Randomized and Controlled Crossover Study Investigating the Improvement of Walking and Posture Functions in Chronic Stroke Patients Using HAL Exoskeleton – The HALESTRO Study (HAL-Exoskeleton STROke Study)

Matthias Sczesny-Kaiser^1*, Rebecca Trost¹, Mirko Aach², Thomas A. Schildhauer³, Peter Schwenkreis¹ and Martin Tegenthoff¹

• ¹Department of Neurology, BG University Hospital Bergmannsheil Bochum, Bochum, Germany
• ²Department of Spinal Cord Injury, BG University Hospital Bergmannsheil Bochum, Bochum, Germany
• ³Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Bochum, Germany

Background: The exoskeleton HAL (hybrid assistive limb) has proven to improve walking functions in spinal cord injury and chronic stroke patients when using it for body-weight supported treadmill training (BWSTT). Compared with other robotic devices, it offers the possibility to initiate movements actively. Previous studies on stroke patients did not compare HAL-BWSTT with conventional physiotherapy (CPT). Therefore, we performed a crossover clinical trial comparing CPT and HAL-BWSTT in chronic stroke patients with hemiparesis, the HALESTRO study. Our hypothesis was that HAL-training would have greater effects on walking and posture functions compared to a mixed-approach CPT.

Methods: A total of 18 chronic stroke patients participated in this study. Treatment consisted of 30 CPT sessions and of 30 sessions of BWSTT with a double leg type HAL exoskeleton successively in a randomized, crossover study design. Primary outcome parameters were walking time and speed in 10-meter walk test (10MWT), time in timed-up-and-go test (TUG) and distance in 6-min walk test (6MWT). Secondary outcome parameters were the functional ambulatory categories (FAC) and the Berg-Balance Scale (BBS). Data were assessed at baseline, at crossover and at the end of the study, all without using and wearing HAL.

Results: Our study demonstrate neither a significant difference in walking parameters nor in functional and balance parameters. When HAL-BWSTT was applied to naïve patients, it led to an improvement in walking parameters and in balance abilities. Pooling all data, we could show a significant effect in 10MWT, 6MWT, FAC and BBS, both therapies sequentially applied over 12 weeks. Thereby, FAC improve from dependent to independent category (3 to 4). One patient dropped out of the study due to intensive fatigue after each training session.

Conclusion: HAL-BWSTT and mixed-approach CPT were effective therapies in chronic stroke patients. However, compared with CPT, HAL training with 30 sessions over 6 weeks was not more effective. The combination of both therapies led to an improvement of walking and balance functions. Robotic rehabilitation of walking disorders alone still lacks the proof of superiority in chronic stroke. Robotic treatment therapies and classical CPT rehabilitation concepts should be applied in an individualized therapy program.

Introduction

Stroke is a growing medical and socioeconomical problem these days (Feigin et al., 2015). Epidemiologic studies estimated an yearly incidence of 800,000 in the United States to 1.0 million in the European Union (EU) (Truelsen et al., 2006; Mozaffarian et al., 2016). Incidence and prevalence increased over the last 20 years, while mortality decreased remarkably due to improving emergency medicine (Reeves et al., 2008; Koton et al., 2014). Stroke incidence is supposed to raise to 1.5 million per year in 2025 in the EU (Truelsen et al., 2006). Total costs of stroke care were expected to increase up to $184.1 billion in the United States for the year 2030 (Ovbiagele et al., 2013). In the next years, stroke therapy will become an even greater burden for national socioeconomic systems. While acute stroke therapies mainly focus on reducing infarcted brain tissue, reducing expected acute functional deficits and stroke survival, rehabilitation therapies in chronic stroke patients usually focus on restoration and reducing existing and persisting functional deficits. Both treatment approaches are necessary to lower resulting costs for the public healthcare system. Therefore, studies in both stroke settings (acute/chronic) are needed to limit persisting disabilities and analyze the best possible rehabilitation options.

Today, it is generally accepted that outpatient physiotherapy and other therapies would not lead to a significant functional recovery in chronic stroke.

The functional recovery curve reaches saturation after 6 months with only few fluctuations (Duncan et al., 1994; Jørgensen et al., 1995; Kwakkel et al., 2004; Langhorne et al., 2011). However, only few studies have addressed whether modern rehabilitation tools could induce significant functional recovery even in chronic stages. First positive evidence was given by innovative robotic devices for arm and walking training (Kwakkel et al., 2004; Huang and Krakauer, 2009; Reinkensmeyer et al., 2009; Lo et al., 2010). The results indicated that functional recovery might be possible even in chronic stages of stroke. The implementation of recent scientific knowledge on neurorehabilitation and neuronal plasticity like task-specificity, context-specificity and/or high-intensity and repetitive practice is a great advantage of new rehabilitation approaches. Several different robotic devices for locomotor support have been developed over the last 10 years. Most of them serve primarily as a medical and nursing device for walking support, but can be used as a training tool as well. For example, the ReWalk exoskeleton (ReWalk Robotics Ltd., Yokneam, Isreal) and the Indego bionic exoskeleton (Parker Hannifin Corporation, Cleveland, OH, United States) allow people with paraparesis due to spinal cord injury (SCI) to stand up, walk with a defined pattern and climb stairs. Induced locomotion is passive, not neurological self-induced and not based on any biological signal. Both robots use pre-programmed walking patterns that were executed irrespective of patient’s remaining walking abilities. ReWalk and Indego have the intention to be applied predominantly as a walking aid for outdoor use. For walking rehabilitation, different robotic devices and gait trainers have been developed (e.g., Locomat, Gait Trainer GT a. s. o.). Even though, scientists showed therapeutic effects on walking parameters and disability, so far, in larger studies, they failed to show superiority when compared with conventional physiotherapies (Mehrholz and Pohl, 2012; Chang and Kim, 2013; Swinnen et al., 2014). Neither Locomat nor Gait Trainer GT uses neurobiological signal for locomotion control.

In contrast, the exoskeleton hybrid assistive limb (HAL) is controlled voluntarily by the patient’s own muscle signals detected by surface electrodes. This self-initiated movement is capable to induce a somatosensory feedback-loop that enhances neural plasticity and locomotor learning (Sczesny-Kaiser et al., 2015). Pilot studies on patients with SCI, and chronic stroke showed safety and beneficial effects on walking functions (Kawamoto et al., 2013; Aach et al., 2014; Cruciger et al., 2014; Nilsson et al., 2014; Yoshimoto et al., 2015; Grasmücke et al., 2017; Jansen et al., 2017). In SCI, our study group demonstrated that HAL-assisted and body-weight supported treadmill training with supervision of a specialized physiotherapist led to a significant improvement of walking parameters and ambulatory capacity as indicated by the Walking Index for SCI II. These effects were observed in acute and chronic SCI patients, even up to 19 years after ictus (Aach et al., 2014; Grasmücke et al., 2017). Treadmill- and HAL-associated parameters like walking distance, speed and time as well as independent parameters like 10-meter walk test and 6-min walk test increased significantly up to 50% (Grasmücke et al., 2017). Moreover, these improvements could be detected in chronic tetraplegic and paraplegic patients. Older age (>50 years) and spastic motor behavior were non-significant negative predictors for walking endurance improvements. In stroke patients, similar results for HAL-assisted and body-weight supported treadmill training were demonstrated by several study groups in Japan and Sweden (Wada et al., 2010; Kawamoto et al., 2013, 2014; Nilsson et al., 2014; Yoshimoto et al., 2015) The therapeutic target was hemiparesis in all studies, and predominantly, patients with hemispheric insult were enrolled. In addition to technical requirements, safety and feasibility (Kawamoto et al., 2014; Nilsson et al., 2014), effects on treadmill-bound and treadmill-independent parameters were investigated (Kawamoto et al., 2013; Yoshimoto et al., 2015, 2016; Mizukami et al., 2017). Again, study results showed significant improvements, and even promising results indicating significant improvements in the functional ambulatory category (FAC) (Kawamoto et al., 2013). In spite of these encouraging positive results of HAL-training, most of these studies were performed in an uncontrolled design, e.g., using a conventional and mixed physiotherapy setup as control group. Thus, these results encourage to perform controlled studies using HAL-assisted treadmill training in chronic stroke patients. To become an established part of neurorehabilitation programs, HAL has to be compared with conventional physiotherapy (CPT) which is the cornerstone, today. Here, Bobath’s concept and proprioceptive neuromuscular facilitation (PNF) were used regularly (Dickstein et al., 1986; Lincoln et al., 1999; Luke et al., 2004; Wang et al., 2005).

We hypothesized that, in chronic stroke patients, HAL-assisted body-weight supported treadmill training would be more effective in recovery of walking parameters than CPT (provided according to current standards of practice). We further hypothesized that exoskeletal HAL training would improve outcome parameters reflecting functional independence more than conventional therapy.

More at link. 

Biofeedback effect of hybrid assistive limb in stroke rehabilitation: A proof of concept study using functional near infrared spectroscopy

Not available, for your doctor to get.

 

Biofeedback effect of hybrid assistive limb in stroke rehabilitation: A proof of concept study using functional near infrared spectroscopy