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

J Spinal Cord Med. 2019 Jul;42(4):460-468. doi: 10.1080/10790268.2017.1423267. Epub 2018 Jan 19.

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Disease
  • Electromyography / methods
  • Exoskeleton Device*
  • Humans
  • Male
  • Motion Therapy, Continuous Passive / instrumentation
  • Motion Therapy, Continuous Passive / methods*
  • Muscle, Skeletal / physiology*
  • Paraplegia / diagnostic imaging
  • Paraplegia / etiology
  • Paraplegia / rehabilitation*
  • Spinal Cord Injuries / complications
  • Spinal Cord Injuries / diagnostic imaging
  • Spinal Cord Injuries / rehabilitation*
  • Thoracic Vertebrae / diagnostic imaging
  • Thoracic Vertebrae / injuries
  • Upper Extremity / physiology
  • Walking / physiology*

Grants and funding

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