Yukiyo Shimizu1, Hideki Kadone2, Shigeki Kubota3, Akira Ikumi4, Tetsuya Abe4, Aiki Marushima5, Tomoyuki Ueno1, Ayumu Endo1, Hiroaki Kawamoto6, Kousaku Saotome2, Akira Matsushita7, Akira Matsumura5, Yoshiyuki Sankai6, Yasushi Hada1, Masashi Yamazaki4. 1. a Department of Rehabilitation Medicine , University of Tsukuba Hospital , Tsukuba, Ibaraki 305-8576 , Japan. 2. b Center for Innovative Medicine and Engineering , University of Tsukuba Hospital , Tsukuba, Ibaraki 305-8576 , Japan. 3. c Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan. 4. d Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan. 5. e Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan. 6. f Faculty of Systems and Information Engineering , University of Tsukuba , Tsukuba, Ibaraki 305-8573 , Japan. 7. g Department of Neurosurgery , Ibaraki Prefectural University Hospital of Health Sciences , Inashiki-gun, Ibaraki 300-0331 , Japan.
Abstract
CONTEXT: Patients with complete quadriplegia after high cervical spinal cord injury are fully dependent with activities of daily living. Assistive technology can improve their quality of life. We examined the use of a hybrid assistive limb for single joints (HAL-SJ) in a 19-year-old man with complete C4 quadriplegia due to chronic spinal cord injury to restore function of active elbow flexion. This is the first report on the use of the HAL-SJ in a patient with spinal cord injury. FINDINGS: The HAL-SJ intervention for each elbow was administered in 10 sessions. Clinical assessment using surface EMG was conducted to evaluate muscle activity of the trapezius, biceps brachii, infraspinatus, and triceps brachii muscle before, and during the 2nd, 3rd, 6th, and 9th interventions. Surface electromyography (EMG) before intervention showed no contraction in the upper arms, but in the bilateral trapezius. The HAL-SJ used motion intention from the right trapezius for activation. After the 6th and 7th session, respectively, biceps EMG showed that voluntary contraction and right elbow flexion could be performed by motion intention from the right biceps. After the 10th session, voluntary bicep contraction was possible. HAL-SJ treatment on the left elbow was performed using the same protocol with a similar outcome. After completing treatment on both upper extremities, both biceps contracted voluntarily, and he could operate a standard wheelchair for a short distance independently. CONCLUSION: HAL-SJ intervention is feasible and effective in restoring elbow flexor function in a patient with C4 chronic spinal cord injury and complete quadriplegia.
CONTEXT: Patients with complete quadriplegia after high cervical spinal cord injury are fully dependent with activities of daily living. Assistive technology can improve their quality of life. We examined the use of a hybrid assistive limb for single joints (HAL-SJ) in a 19-year-old man with complete C4 quadriplegia due to chronic spinal cord injury to restore function of active elbow flexion. This is the first report on the use of the HAL-SJ in a patient with spinal cord injury. FINDINGS: The HAL-SJ intervention for each elbow was administered in 10 sessions. Clinical assessment using surface EMG was conducted to evaluate muscle activity of the trapezius, biceps brachii, infraspinatus, and triceps brachii muscle before, and during the 2nd, 3rd, 6th, and 9th interventions. Surface electromyography (EMG) before intervention showed no contraction in the upper arms, but in the bilateral trapezius. The HAL-SJ used motion intention from the right trapezius for activation. After the 6th and 7th session, respectively, biceps EMG showed that voluntary contraction and right elbow flexion could be performed by motion intention from the right biceps. After the 10th session, voluntary bicep contraction was possible. HAL-SJ treatment on the left elbow was performed using the same protocol with a similar outcome. After completing treatment on both upper extremities, both biceps contracted voluntarily, and he could operate a standard wheelchair for a short distance independently. CONCLUSION:HAL-SJ intervention is feasible and effective in restoring elbow flexor function in a patient with C4 chronic spinal cord injury and complete quadriplegia.
Entities:
Keywords:
Active elbow flexion; Complete quadriplegia; Hybrid assistive limb for single joint; Spinal cord injury; Surface electromyography