ArticleFrontiers in neuroscience2017
Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury.
Article in Frontiers in neuroscience, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments.Journal of neuroengineering and rehabilitation · 2021Pooled it
- Trial
- Hybrid Assistive Limb in orthopaedic rehabilitation: cybernic treatment developed in Japan for neuromotor functional restoration.International orthopaedics · 2026Review
- Development and Clinical Evaluation of Spring-Assisted Standing Training for Individuals with Spinal Cord Injury: A Safety and Feasibility Study.Journal of clinical medicine · 2025Article
- Exploring the Perceived Value of Standing in Individuals with Lower Limb Impairments.Journal of clinical medicine · 2025Article
- Advances and New Therapies in Traumatic Spinal Cord Injury.Journal of clinical medicine · 2025Review
- Exoskeleton gait training with spinal cord neuromodulation.Frontiers in human neuroscience · 2023Review
- Neurorehabilitation using a voluntary driven exoskeletal robot improves trunk function in patients with chronic spinal cord injury: a single-arm study.Neural regeneration research · 2022Article
- 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.Frontiers in neurorobotics · 2021Article
- Current Concepts of Neural Stem/Progenitor Cell Therapy for Chronic Spinal Cord Injury.Frontiers in cellular neuroscience · 2021Review
- Effects of Functional Electrical Stimulation Cycling of Different Duration on Viscoelastic and Electromyographic Properties of the Knee in Patients with Spinal Cord Injury.Brain sciences · 2020Article
- Dropped Head Syndrome Attenuation by Hybrid Assistive Limb: A Preliminary Study of Three Cases on Cervical Alignment during Walking.Medicina (Kaunas, Lithuania) · 2020Article
- Dropped Head Syndrome Treated with Physical Therapy Based on the Concept of Athletic Rehabilitation.Case reports in orthopedics · 2020Article
- Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report.Frontiers in neurology · 2020Article
- Voluntary Elbow Extension-Flexion Using Single Joint Hybrid Assistive Limb (HAL) for Patients of Spastic Cerebral Palsy: Two Cases Report.Frontiers in neurology · 2019Article
- Reshaping of Gait Coordination by Robotic Intervention in Myelopathy Patients After Surgery.Frontiers in neuroscience · 2018Article
- Lateral Symmetry of Synergies in Lower Limb Muscles of Acute Post-stroke Patients After Robotic Intervention.Frontiers in neuroscience · 2018Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20-67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60-90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings suggest that upper-limb-triggered HAL ambulation is a safe and feasible option for rehabilitation in patients with complete quadri/paraplegia caused by chronic SCI.
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