Active elbow flexion is possible in C4 quadriplegia using hybrid assistive limb (HAL®) technology: A case study

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.

Keywords:

• Hybrid assistive limb for single joint
• Spinal cord injury
• Complete quadriplegia
• Active elbow flexion
• Surface electromyography

Acknowledgements

We thank Mayuko Sakamaki and Yumiko Ito, Center for Innovative Medicine and Engineering (CIME), University of Tsukuba Hospital, for their excellent technical assistance.

Disclaimer statements

Declaration of Interest None.

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

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

Informed consent Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Supplementary material

Supplementary Material for this article available here: 10.1080/10790268.2017.1313931

ORCID

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

Akira Ikumi http://orcid.org/0000-0001-6034-1593

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