Voluntary ambulation using voluntary upper limb muscle activity and Hybrid Assistive Limb® (HAL®) in a patient with complete paraplegia due to chronic spinal cord injury: A case report

Abstract

Context: We sought to describe our experience with the Hybrid Assistive Limb® (HAL®) for active knee extension and voluntary ambulation with remaining muscle activity in a patient with complete paraplegia after spinal cord injury.

Findings: A 30-year-old man with complete paraplegia used the HAL® for 1 month (10 sessions) using his remaining muscle activity, including hip flexor and upper limb activity. Electromyography was used to evaluate muscle activity of the gluteus maximus, tensor fascia lata, quadriceps femoris, and hamstring muscles in synchronization with the Vicon motion capture system. A HAL® session included a knee extension session with the hip flexor and voluntary gait with upper limb activity. After using the HAL® for one month, the patient’s manual muscle hip flexor scores improved from 1/5 to 2/5 for the right and from 2/5 to 3/5 for the left knee, and from 0/5 to 1/5 for the extension of both knees.

Conclusion/clinical relevance: Knee extension sessions with HAL®, and hip flexor and upper-limb-triggered HAL® ambulation seem a safe and feasible option in a patient with complete paraplegia due to spinal cord injury.

Keywords:

• Chronic spinal cord injury
• Complete paraplegia
• Gait analysis
• Hybrid Assistive Limb®
• Rehabilitation
• Upper limb activity

Acknowledgements

We appreciate Daisuke Yamagami MD, physiatrist of Kanagawa Rehabilitation Hospital, and Genny Kroll-Rosen, the director, and all staff of Making Strides, for information on clinical course of the patient before inclusion to the study. We also thank Mayuko Sakamaki and Yumiko Ito, Center for Innovative Medicine and Engineering (CIME), University of Tsukuba Hospital, for their excellent technical assistance.

Disclaimer statements

Authors’ contributions All authors participated in the design, execution, and analysis of these studies and have seen and approved the final version of the manuscript. Yukiyo Shimizu and Hideki Kadone participated in the study design and drafted the manuscript. Yukiyo Shimizu, Hideki Kadone and Shigeki Kubota, executed HAL intervention, performed the data. Kosaku Saotome, Akira Matsushita performed radiological evaluation. Tomoyuki Ueno, Hiroki Watanabe, Ayumu Endo, Kazue Tsurumi, Ryu Ishimoto helped to execute HAL intervention and performed the data. Yoshiyuki Sankai conceived the device. Kenji Suzuki, Tetsuya Abe, Aiki Marushima, Masao Koda, Akira Matsumura, Yasushi Hada and Masashi Yamazaki participated in the study design and helped to draft the manuscript. Masashi Yamazaki is the principal investigator of this study and participated in the design and coordination of the study. Furthermore, this manuscript has been revised by a professional editor whose first language is English.

Contributor statement A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit to one or more of the authors. Yoshiyuki Sankai is CEO of Cyberdyne Inc., Ibaraki, Japan. This study was proposed by the authors. Cyberdyne was not directly involved in the study design, collection, analysis, interpretation of data, writing of the report, or the decision to submit the paper for publication. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the following authors or on any organization with which these authors are associated: Yukiyo Shimizu, Hideki Kadone, Shigeki Kubota, Kenji Suzuki, Kousaku Saotome, Tomoyuki Ueno, Tetsuya Abe, Aiki Marushima, Hiroki Watanabe, Ayumu Endo, Kazue Tsurumi, Ryu Ishimoto, Akira Matsushita, Masao Koda, Akira Matsumura, Yasushi Hada, and Masashi Yamazaki.

Informed consent Written informed consent was obtained from the patient for publication of this case report and accompanying images without masking.

Ethics approval This study was conducted with approval from the Ethics Committee of the Tsukuba University Faculty of Medicine.

ORCID

Yukiyo Shimizu http://orcid.org/0000-0001-7491-4516

Kenji Suzuki http://orcid.org/0000-0003-1736-5404

Hiroki Watanabe http://orcid.org/0000-0002-4436-5437

Akira Matsushita http://orcid.org/0000-0003-2335-674X

Additional information

Funding

This study was supported by the Industrial Disease Clinical Research Grants of the Ministry of Health, Labor, and Welfare in Japan (14060101-01).