The Hybrid Assistive Limb® intervention for a postoperative patient with spinal dural arteriovenous fistula and chronic spinal cord injury: A case study

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.

Keywords:

• Hybrid Assistive Limb (HAL®)
• Spinal dural arteriovenous fistula
• Chronic spinal cord injury
• Gait analysis
• Rehabilitation

Acknowledgements

We thank Mayuko Sakamaki and Yumiko Ito, Center for Innovative Medicine and Engineering (CIME), University of Tsukuba Hospital, for their excellent technical assistance. This study was supported by the Industrial Disease Clinical Research Grants of the Ministry of Health Labour and Welfare, Japan (14060101-01).

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. Hiroaki Kawamoto is a stockholder of the company. Cyberdyne is the manufacturer of the robot suit HAL. 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, Kei Nakai, Hideki Kadone, Shunsuke Yamauchi, Shigeki Kubota, Tomoyuki Ueno, Aiki Marushima, Kayo Hiruta, Ayumu Endo, Akira Matsumura, Yasushi Hada, and Masashi Yamazaki.

Declarations of interest

None.

Ethics approval

This study was conducted with approval from the Ethics Committee of the Tsukuba. University Faculty of Medicine (approval no.: H26-22).

Informed consent

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

ORCID

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

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).

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