Kenichi Yoshikawa1, Masafumi Mizukami2, Hiroaki Kawamoto3, Ayumu Sano1, Kazunori Koseki1, Kumiko Sano1, Yasutsugu Asakawa2, Yutaka Kohno4, Kei Nakai4,5, Masahiko Gosho6, Hideo Tsurushima5. 1. Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan. 2. Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami Ibaraki, Japan. 3. Faculty of Systems and Information Engineering, University of Tsukuba, Tsukuba Ibaraki, Japan. 4. Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan. 5. Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan. 6. Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan.
Abstract
BACKGROUND: The robotic Hybrid Assistive Limb (HAL) provides motion according to the wearer's voluntary activity. HAL training effects on walking speed and capacity have not been clarified in subacute stroke. OBJECTIVES: To determine improvement in walking ability by HAL and the most effective improvement measure for use in future large-scale trials. METHODS: Sixteen first-ever hemiplegic stroke patients completed at least 20 sessions over 5 weeks. Per session, the experimental group received no more than 20 min of gait training with HAL (HT) and 40 min of conventional physiotherapy, whereas the control group received at least 60 min of conventional physiotherapy. Primary outcome was maximum walking speed (MWS). RESULTS: The change in MWS from baseline at week 5 was 11.6±10.6 m/min (HAL group) and 2.2±4.1 m/min (control group) (adjusted mean difference = 9.24 m/min, 95% confidence interval 0.48-18.01, P = 0.040). In HAL subjects there were significant increases in Self-selected walking speed (SWS; a secondary outcome) and in step length (a secondary outcome) at MWS and SWS compared with controls. CONCLUSIONS: HT improved walking speed in hemiplegic sub-acute stroke patients. In future, randomized controlled trials are needed to confirm the utility of HT.
BACKGROUND: The robotic Hybrid Assistive Limb (HAL) provides motion according to the wearer's voluntary activity. HAL training effects on walking speed and capacity have not been clarified in subacute stroke. OBJECTIVES: To determine improvement in walking ability by HAL and the most effective improvement measure for use in future large-scale trials. METHODS: Sixteen first-ever hemiplegic strokepatients completed at least 20 sessions over 5 weeks. Per session, the experimental group received no more than 20 min of gait training with HAL (HT) and 40 min of conventional physiotherapy, whereas the control group received at least 60 min of conventional physiotherapy. Primary outcome was maximum walking speed (MWS). RESULTS: The change in MWS from baseline at week 5 was 11.6±10.6 m/min (HAL group) and 2.2±4.1 m/min (control group) (adjusted mean difference = 9.24 m/min, 95% confidence interval 0.48-18.01, P = 0.040). In HAL subjects there were significant increases in Self-selected walking speed (SWS; a secondary outcome) and in step length (a secondary outcome) at MWS and SWS compared with controls. CONCLUSIONS: HT improved walking speed in hemiplegic sub-acute strokepatients. In future, randomized controlled trials are needed to confirm the utility of HT.