Analysis of Gait Motion Changes by Intervention Using Robot Suit Hybrid Assistive Limb (HAL) in Myelopathy Patients After Decompression Surgery for Ossification of Posterior Longitudinal Ligament

Study on intervention effect of Wearable Cyborg HAL through narrative analysis

Background

The medical effectiveness of Cybernics Treatment with the Wearable Cyborg HAL (Hybrid Assistive Limb) has been verified, and its treatment method has started to be used in many countries around the world. However, the focus of medical evaluations has predominantly been on simple measurement evaluation of physical function, while Patient Reported Outcome (PRO), which encompass various evaluation axes of patients, remain largely unexplored. The mental/psychological field has the potential to develop cutting-edge fields targeting individuals. As the social implementation of HAL progresses, it is important to capture how the physical intervention by HAL affects not only the physical function but also the mental state and social activities of individual users. This approach will help us understand the various aspects of the effects of Cybernics Treatment using HAL.

Objective

In order to elicit deeper narratives of HAL users, this study aims to capture how HAL users with limited physical functionality have changed physically, mentally and socially due to using HAL, through a narrative analysis utilizing counseling methods. Based on the results, the significance of using HAL will also be discussed.

Methods

We analyzed the narratives of nine HAL users who received the services of "Neuro HALFIT." During the interview survey, we also visualized the narratives using mathematical engineering methods (cluster analysis, dendrogram) based on the similarity distance matrix between the association items and elicited them by deepening the narratives through counseling methods and captured the state of change in the physical, mental, and social aspects of the subjects.

Results

The results suggested that "Neuro HALFIT" improved physical function and provided mental and social improvements. These three aspects influenced and circulated each other, advancing toward improvement and enhancement, and the "Mutual feedback structure model in physical, mental, and social aspects of patients" was proposed and presented. Based on the above analysis, it was considered that the greatest significance of using HAL was to help many people with fixed disabilities or those who were considered to have no treatment to turn the process of this model without losing hope and to participate in society with a sense of fulfillment in their lives.

Adapting Young Adults' In-Shoe Motion Sensor Gait Models for Knee Evaluation in Older Adults: A Study on Osteoarthritis and Healthy Knees

The human knee joint is crucial for mobility, especially in older adults who are susceptible to conditions like osteoarthritis (OA). Traditionally, assessing knee health requires complex gait analysis in clinical settings, which limits opportunities for convenient and continuous monitoring. This study leverages advancements in wearable technology to explore the adaptation of models based on in-shoe motion sensors (IMS), initially trained on young adults, for evaluating knee function in older populations, both healthy and with OA. Data were collected from 44 older OA patients, presenting various levels of severity, and 20 healthy older adults, with a focus on key knee indicators: knee angle measures (S1 to S3), temporal gait parameters (S4 and S5), and knee angular jerk cost metrics (S6 to S8). The models effectively identified trends and differences across these indicators between the healthy group and the OA group. Notably, in indicators S1, S2, S3, S7, and S8, the models exhibited a large effect size in correlation with true values. These findings suggest that gait models derived from younger, healthy individuals are possible to be robustly adapted for non-invasive, everyday monitoring of knee health in older adults, offering valuable insights for the early detection and management of knee impairments. However, limitations such as fixed biases due to differences in measurement systems and sensor placement inaccuracies were identified. Future research will aim to enhance model precision by addressing these limitations through domain adaptation techniques and improved sensor calibration.

Novel Gait Training with a Hybrid Assistive Limb Improved Delayed Progressive Spastic Paraplegia After a Lightning Strike

Background/Objectives: A 68-year-old man presented with progressive walking difficulty that developed into spastic paraplegia. This condition was a long-term consequence of a lightning strike injury sustained at the age of 22 years. His symptoms progressively deteriorated, eventually requiring double crutches for ambulation at approximately 40 years of age. A physical evaluation prior to hybrid assistive limb (HAL) training revealed a T10 level neurological injury and an American Spinal Cord Injury Association impairment scale grade D. Here, we aimed to evaluate the therapeutic effects of novel gait training with an HAL in this patient with chronic and progressive neural damage caused by a lightning strike. Methods: The HAL training program is composed of two sections. In the first section, one month of gait training with HAL was conducted across 10 sessions, with 2-3 sessions weekly. The second section followed 6 months later. A final evaluation was performed three months after the second section. Results: Electromyographic and kinematic evaluation showed that the HAL gait training inhibited abnormal antagonistic muscle activation in his lower extremities, especially after the first section. Our results collectively indicate that the repeated HAL gait training improved the gait pattern of this patient. Conclusions: Our results suggest that HAL gait training may improve the gait pattern in patients with delayed progressive spastic paraplegia, as observed in this case. In addition, a longer intervention period is recommended to facilitate better adaptation to HAL training. Hence, neurorehabilitation with an HAL could be an innovative treatment approach for delayed progressive spastic paraplegia.

Estimating Indicators for Assessing Knee Motion Impairment During Gait Using In-Shoe Motion Sensors: A Feasibility Study

Knee joint function deterioration significantly impacts quality of life. This study developed estimation models for ten knee indicators using data from in-shoe motion sensors to assess knee movement during everyday activities. Sixty-six healthy young participants were involved, and multivariate linear regression was employed to construct the models. The results showed that eight out of ten models achieved a "fair" to "good" agreement based on intra-class correlation coefficients (ICCs), with three knee joint angle indicators reaching the "fair" agreement. One temporal indicator model displayed a "good" agreement, while another had a "fair" agreement. For the angular jerk cost indicators, three out of four attained a "fair" or "good" agreement. The model accuracy was generally acceptable, with the mean absolute error ranging from 0.54 to 0.75 times the standard deviation of the true values and errors less than 1% from the true mean values. The significant predictors included the sole-to-ground angles, particularly the foot posture angles in the sagittal and frontal planes. These findings support the feasibility of estimating knee function solely from foot motion data, offering potential for daily life monitoring and rehabilitation applications. However, discrepancies in the two models were influenced by the variance in the baseline knee flexion and sensor placement. Future work will test these models on older and osteoarthritis-affected individuals to evaluate their broader applicability, with prospects for user-tailored rehabilitation applications. This study is a step towards simplified, accessible knee health monitoring through wearable technology.

The evolution of robotics: research and application progress of dental implant robotic systems

The use of robots to augment human capabilities and assist in work has long been an aspiration. Robotics has been developing since the 1960s when the first industrial robot was introduced. As technology has advanced, robotic-assisted surgery has shown numerous advantages, including more precision, efficiency, minimal invasiveness, and safety than is possible with conventional techniques, which are research hotspots and cutting-edge trends. This article reviewed the history of medical robot development and seminal research papers about current research progress. Taking the autonomous dental implant robotic system as an example, the advantages and prospects of medical robotic systems would be discussed which would provide a reference for future research.

Feasibility and safety study of wearable cyborg Hybrid Assistive Limb for pediatric patients with cerebral palsy and spinal cord disorders

Introduction

The wearable cyborg Hybrid Assistive Limb (HAL) is the world's first cyborg-type wearable robotic device, and it assists the user's voluntary movements and facilitates muscle activities. However, since the minimum height required for using the HAL is 150 cm, a smaller HAL (2S size) has been newly developed for pediatric use. This study aimed to (1) examine the feasibility and safety of a protocol for treatments with HAL (2S size) in pediatric patients and (2) explore the optimal method for assessing the efficacy of HAL.

Methods

This clinical study included seven pediatric patients with postural and motor function disorders, who received 8-12 sessions of smaller HAL (2S size) treatment. The primary outcome was the Gross Motor Function Measure-88 (GMFM-88). The secondary outcomes were GMFM-66, 10-m walk test, 2- and 6-min walking distances, Canadian Occupational Performance Measure (COPM), a post-treatment questionnaire, adverse events, and device failures. Statistical analyses were performed using the paired samples t-test or Wilcoxon signed-rank test.

Results

All participants completed the study protocol with no serious adverse events. GMFM-88 improved from 65.51 ± 21.97 to 66.72 ± 22.28 (p = 0.07). The improvements in the secondary outcomes were as follows: GMFM-66, 53.63 ± 11.94 to 54.96 ± 12.31, p = 0.04; step length, 0.32 ± 0.16 to 0.34 ± 0.16, p = 0.25; 2-MWD, 59.1 ± 57.0 to 62.8 ± 63.3, p = 0.54; COPM performance score, 3.7 ± 2.0 to 5.3 ± 1.9, p = 0.06; COPM satisfaction score, 3.3 ± 2.1 to 5.1 ± 2.1, p = 0.04.

Discussion

In this exploratory study, we applied a new size of wearable cyborg HAL (2S size), to children with central nervous system disorders. We evaluated its safety, feasibility, and identified an optimal assessment method for multiple treatments. All participants completed the protocol with no serious adverse events. This study suggested that the GMFM would be an optimal assessment tool for validation trials of HAL (2S size) treatment in pediatric patients with posture and motor function disorders.

Robotic rehabilitation therapy using Hybrid Assistive Limb (HAL) for patients with spinal cord lesions: A narrative review

Background

The Hybrid Assistive Limb (HAL) is a rehabilitation device that utilizes the "interactive biofeedback" hypothesis to facilitate the motion of the device according to the user's motion intention and appropriate sensory input evoked by HAL-supported motion. HAL has been studied extensively for its potential to promote walking function in patients with spinal cord lesions, including spinal cord injury.

Methods

We performed a narrative review of HAL rehabilitation for spinal cord lesions.

Results

Several reports have shown the effectiveness of HAL rehabilitation in the recovery of walking ability in patients with gait disturbance caused by compressive myelopathy. Clinical studies have also demonstrated potential mechanisms of action leading to clinical findings, including normalization of cortical excitability, improvement of muscle synergy, attenuation of difficulties in voluntarily initiating joint movement, and gait coordination changes.

Conclusions

However, further investigation with more sophisticated study designs is necessary to prove the true efficacy of HAL walking rehabilitation. HAL remains one of the most promising rehabilitation devices for promoting walking function in patients with spinal cord lesions.

Postoperative Acute-Phase Gait Training Using Hybrid Assistive Limb Improves Gait Ataxia in a Patient with Intradural Spinal Cord Compression Due to Spinal Tumors

Sensory ataxia due to posterior cord syndrome is a relevant, disabling condition in nontraumatic spinal cord dysfunction. Ataxic gait is a common symptom of sensory ataxia that restricts activities of daily living. A 70-year-old woman with severe sensory disturbance was diagnosed with intradural extramedullary spinal cord tumors found in the thoracic spine region (T8). Surgical management of the tumors was performed. The patient received gait training 20 days after surgery (postoperative acute phase) using a hybrid assistive limb (HAL). HAL is a wearable exoskeleton cyborg that provides real-time assistance to an individual for walking and limb movements through actuators mounted on the bilateral hip and knee joints. Walking ability was assessed using the 10 m walking test, which included evaluating walking speed, step length, and cadence in every session. To evaluate the immediate effects of HAL training, walking speed and step length were measured before and after the training in each session. During the 10 m walking test, gait kinematics and lower muscle activity were recorded using a motion capture system and wireless surface electromyography before the first session and after completion of all HAL sessions. After the HAL training sessions, improvement in the patient’s gait performance was observed in the gait joint angles and muscle activity of the lower limb. After 10 training sessions, we observed the following changes from baseline: walking speed (from 0.16 m/s to 0.3 m/s), step length (from 0.19 m to 0.37 m), and cadence (from 50.9 steps/min to 49.1 steps/min). The average standard deviations of the knee (from right, 7.31; left, 6.75; to right, 2.93; p < 0.01, left, 2.63; p < 0.01) and ankle joints (from right, 6.98; left, 5.40; to right, 2.39; p < 0.01, left, 2.18; p < 0.01) were significantly decreased. Additionally, walking speed and step length improved immediately after completing all the HAL training sessions. This suggests that HAL gait training might be a suitable physical rehabilitation program for patients with sensory ataxia causing dysfunctional movement of the lower limb.

Alteration of muscle activity during voluntary rehabilitation training with single-joint Hybrid Assistive Limb (HAL) in patients with shoulder elevation dysfunction from cervical origin

Shoulder elevation, defined here as arm raising, being essential for activities of daily living, dysfunctions represent a substantial burden in patients' lives. Owing to the complexity of the shoulder joint, the tightly coordinated muscular activity is a fundamental component, and neuromuscular impairments have devastating effects. A single-joint shoulder type version of the Hybrid Assistive Limb (HAL) allowing motion assistance based on the intention of the user via myoelectric activation has recently been developed, and its safety was demonstrated for shoulder rehabilitation. Yet, little is known about the physiological effects of the device. This study aims to monitor the changes in muscle activity and motion during shoulder HAL rehabilitation in several patients suffering from shoulder elevation dysfunction from cervical radicular origin. 8 patients (6 males, 2 females, mean age 62.4 ± 9.3 years old) with weakness of the deltoid muscle resulting from a damage to the C5 nerve root underwent HAL-assisted rehabilitation. We combined surface electromyography and three-dimensional motion capture to record muscular activity and kinematics. All participants showed functional recovery, with improvements in their Manual Muscle Testing (MMT) scores and range of motion (ROM). During training, HAL decreased the activity of deltoid and trapezius, significantly more for the latter, as well as the coactivation of both muscles. We also report a reduction of the characteristic shrugging compensatory motion which is an obstacle to functional recovery. This reduction was notably demonstrated by a stronger reliance on the deltoid rather than the trapezius, indicating a muscle coordination tending toward a pattern similar to healthy individuals. Altogether, the results of the evaluation of motion and muscular changes hint toward a functional recovery in acute, and chronic shoulder impairments from cervical radicular origin following shoulder HAL rehabilitation training and provide information on the physiological effect of the device.

Measurement Method of Human Lower Limb Joint Range of Motion Through Human-Machine Interaction Based on Machine Vision

To provide stroke patients with good rehabilitation training, the rehabilitation robot should ensure that each joint of the limb of the patient does not exceed its joint range of motion. Based on the machine vision combined with an RGB-Depth (RGB-D) camera, a convenient and quick human-machine interaction method to measure the lower limb joint range of motion of the stroke patient is proposed. By analyzing the principle of the RGB-D camera, the transformation relationship between the camera coordinate system and the pixel coordinate system in the image is established. Through the markers on the human body and chair on the rehabilitation robot, an RGB-D camera is used to obtain their image data with relative position. The threshold segmentation method is used to process the image. Through the analysis of the image data with the least square method and the vector product method, the range of motion of the hip joint, knee joint in the sagittal plane, and hip joint in the coronal plane could be obtained. Finally, to verify the effectiveness of the proposed method for measuring the lower limb joint range of motion of human, the mechanical leg joint range of motion from a lower limb rehabilitation robot, which will be measured by the angular transducers and the RGB-D camera, was used as the control group and experiment group for comparison. The angle difference in the sagittal plane measured by the proposed detection method and angle sensor is relatively conservative, and the maximum measurement error is not more than 2.2 degrees. The angle difference in the coronal plane between the angle at the peak obtained by the designed detection system and the angle sensor is not more than 2.65 degrees. This paper provides an important and valuable reference for the future rehabilitation robot to set each joint range of motion limited in the safe workspace of the patient.