Yukiyo Shimizu1, Kei Nakai2,3, Hideki Kadone4, Shunsuke Yamauchi1, Shigeki Kubota5, Tomoyuki Ueno1, Aiki Marushima2, Kayo Hiruta1, Ayumu Endo1, Hiroaki Kawamoto6, Akira Matsumura2, Yoshiyuki Sankai6, Yasushi Hada1, Masashi Yamazaki7. 1. a Department of Rehabilitation Medicine , University of Tsukuba Hospital , Tsukuba, Ibaraki , Japan. 2. b Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki , Japan. 3. c Department of Neurology, Ibaraki Prefectural University Hospital of Health Sciences , Ibaraki , Japan. 4. d Center for Innovative Medicine and Engineering , University of Tsukuba Hospital , Tsukuba, Ibaraki , Japan. 5. e Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki , Japan. 6. f Faculty of Systems and Information Engineering , University of Tsukuba , Tsukuba, Ibaraki , Japan. 7. g Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki , Japan.
Abstract
CONTEXT: The purpose of this report was to describe the improvement in walking ability using the Hybrid Assistive Limb® (HAL®) intervention in the case of a patient with paraplegia after spinal cord injury whose condition deteriorated because of a spinal dural arteriovenous fistula (SDAVF). FINDINGS: A 48-year-old man started the HAL® intervention twice per week (total 10 sessions), after his neurologic improvement had plateaued from 3 to 6 months postoperatively for an SDAVF. During the HAL® intervention, the 10-m walk test (10MWT) without HAL® was performed before and after each session. An electromyography system was used to evaluate muscle activity of both the gluteus maximus (Gmax) and quadriceps femoris (Quad) muscles in synchronization with the Vicon motion capture system. The International Standards for Neurological and Functional Classification of Spinal Cord Injury (ISNCSCI) motor scores of the lower extremities and the Walking Index for Spinal Cord Injury II (WISCI II) score were also assessed to evaluate motor function. The HAL® intervention improved gait speed and cadence during the 10MWT. Before the intervention, both the Gmax and left Quad muscles were not activated. After the intervention, the right Gmax and both Quad muscles were activated in stance phase rhythmically according to the gait cycle. The ISNCSCI motor score also improved from 14 to 16, and the WISCI II scored improved from 7 to 12. CONCLUSION/CLINICAL RELEVANCE: Our experience with this patient suggests that the HAL® can be an effective tool for improving functional ambulation in patients with chronic spinal cord injury.
CONTEXT: The purpose of this report was to describe the improvement in walking ability using the Hybrid Assistive Limb® (HAL®) intervention in the case of a patient with paraplegia after spinal cord injury whose condition deteriorated because of a spinal dural arteriovenous fistula (SDAVF). FINDINGS: A 48-year-old man started the HAL® intervention twice per week (total 10 sessions), after his neurologic improvement had plateaued from 3 to 6 months postoperatively for an SDAVF. During the HAL® intervention, the 10-m walk test (10MWT) without HAL® was performed before and after each session. An electromyography system was used to evaluate muscle activity of both the gluteus maximus (Gmax) and quadriceps femoris (Quad) muscles in synchronization with the Vicon motion capture system. The International Standards for Neurological and Functional Classification of Spinal Cord Injury (ISNCSCI) motor scores of the lower extremities and the Walking Index for Spinal Cord Injury II (WISCI II) score were also assessed to evaluate motor function. The HAL® intervention improved gait speed and cadence during the 10MWT. Before the intervention, both the Gmax and left Quad muscles were not activated. After the intervention, the right Gmax and both Quad muscles were activated in stance phase rhythmically according to the gait cycle. The ISNCSCI motor score also improved from 14 to 16, and the WISCI II scored improved from 7 to 12. CONCLUSION/CLINICAL RELEVANCE: Our experience with this patient suggests that the HAL® can be an effective tool for improving functional ambulation in patients with chronic spinal cord injury.
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