Akira Ikumi1, Shigeki Kubota1,2, Yukiyo Shimizu3, Hideki Kadone4, Aiki Marushima5, Tomoyuki Ueno3, Hiroaki Kawamoto6, Yasushi Hada3, Akira Matsumura5, Yoshiyuki Sankai6, Masashi Yamazaki1,4. 1. a Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan. 2. b Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine , University of Tsukuba, Ibaraki , Japan. 3. c Department of Rehabilitation Medicine , University of Tsukuba Hospital , Ibaraki , Japan. 4. d Center for Innovating Medicine and Engineering (CIME) , University of Tsukuba Hospital , Ibaraki , Japan. 5. e Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan. 6. f Faculty of Systems and Information Engineering , University of Tsukuba , Ibaraki , Japan.
Abstract
CONTEXT: Recently, locomotor training with robotic assistance has been found effective in treating spinal cord injury (SCI). Our case report examined locomotor training using the robotic suit hybrid assistive limb (HAL) in a patient with complete C4 quadriplegia due to chronic SCI. This is the first report examining HAL in complete C4 quadriplegia. FINDINGS: The patient was a 19-year-old man who dislocated C3/4 during judo 4 years previously. Following the injury, he underwent C3/4 posterior spinal fusion but remained paralyzed despite rehabilitation. There was muscle atrophy under C5 level and no sensation around the anus, but partial sensation of pressure remained in the limbs. The American Spinal Injury Association impairment scale was Grade A (complete motor C4 lesion). HAL training was administered in 10 sessions (twice per week). The training sessions consisted of treadmill walking with HAL. For safety, 2 physicians and 1 therapist supported the subject for balance and weight-bearing. The device's cybernic autonomous control mode provides autonomic physical support based on predefined walking patterns. We evaluated the adverse events, walking time and distance, and the difference in muscle spasticity before and after HAL-training using a modified Ashworth scale (mAs). No adverse events were observed that required discontinuation of rehabilitation. Walking distance and time increased from 25.2 meters/7.6 minutes to 148.3 meter/15 minutes. The mAs score decreased after HAL training. CONCLUSION: Our case report indicates that HAL training is feasible and effective for complete C4 quadriplegia in chronic SCI.
CONTEXT: Recently, locomotor training with robotic assistance has been found effective in treating spinal cord injury (SCI). Our case report examined locomotor training using the robotic suit hybrid assistive limb (HAL) in a patient with complete C4 quadriplegia due to chronic SCI. This is the first report examining HAL in complete C4 quadriplegia. FINDINGS: The patient was a 19-year-old man who dislocated C3/4 during judo 4 years previously. Following the injury, he underwent C3/4 posterior spinal fusion but remained paralyzed despite rehabilitation. There was muscle atrophy under C5 level and no sensation around the anus, but partial sensation of pressure remained in the limbs. The American Spinal Injury Association impairment scale was Grade A (complete motor C4 lesion). HAL training was administered in 10 sessions (twice per week). The training sessions consisted of treadmill walking with HAL. For safety, 2 physicians and 1 therapist supported the subject for balance and weight-bearing. The device's cybernic autonomous control mode provides autonomic physical support based on predefined walking patterns. We evaluated the adverse events, walking time and distance, and the difference in muscle spasticity before and after HAL-training using a modified Ashworth scale (mAs). No adverse events were observed that required discontinuation of rehabilitation. Walking distance and time increased from 25.2 meters/7.6 minutes to 148.3 meter/15 minutes. The mAs score decreased after HAL training. CONCLUSION: Our case report indicates that HAL training is feasible and effective for complete C4 quadriplegia in chronic SCI.
Authors: T George Hornby; Donielle D Campbell; Jennifer H Kahn; Tobey Demott; Jennifer L Moore; Heidi R Roth Journal: Stroke Date: 2008-05-08 Impact factor: 7.914
Authors: Mirko Aach; Oliver Cruciger; Matthias Sczesny-Kaiser; Oliver Höffken; Renate Ch Meindl; Martin Tegenthoff; Peter Schwenkreis; Yoshiyuki Sankai; Thomas A Schildhauer Journal: Spine J Date: 2014-04-04 Impact factor: 4.166