Early rehabilitation with lumbar-type hybrid assistive limb for acute stroke patients: a pilot study and clinical review

Abstract

[Purpose] To examine the impacts of using lumbar-type hybrid assistive limbs during the acute stage of stroke, specifically on motor function involving the trunk and activities of daily living, as compared to conventional physical therapy. [Participants and Methods] This was a single-center randomized controlled trial. Participants were randomly assigned to either the hybrid assistive limb or conventional physical therapy groups and underwent early rehabilitation with and without hybrid assistive limb training for ten 40-minute sessions over 10 days. Motor functions, including trunk function and activities of daily living, were evaluated before and immediately after the rehabilitation. [Results] Fifteen patients (median age, 67 years; hybrid assistive limb, n=7; conventional physical therapy, n=8) completed the study. No adverse events were observed. After training, both groups exhibited significant improvements on Berg Balance Scale, Functional Independence Measure-total, Functional Independence Measure-motor, and Stroke Impairment Assessment Set-motor scores. The conventional physical therapy group further exhibited significant enhancement in the Functional Independence Measure-cognitive and Functional Ambulation Category. The degree of improvement on the Berg Balance Scale was significantly larger in the hybrid assistive limb group than in the conventional physical therapy group. [Conclusion] Early rehabilitation using lumbar-type hybrid assistive limbs can improve trunk function in the early stages of stroke more than conventional physical therapy and may enhance walking ability and activities of daily living.

Keywords: Hybrid assistive limb (HAL); Postural balance; Rehabilitation.

Fig. 1.

Study flowchart. This single-center randomized controlled trial consisted of three phases: pre-intervention assessment, intervention, and post-intervention assessment. Before the pre-intervention assessment, participants are randomly assigned to either the group receiving conventional physical therapy (CPT group) or the group using the lumbar-type Hybrid Assistive Limb (HAL) (HAL group). BBS: Berg Balance Scale; BRS: Brunnstrom recovery stage; CPT: conventional physical therapy; FAC: functional ambulation categories; FIM: functional independence measure; HAL: Hybrid Assistive Limb; SIAS-m: stroke impairment assessment set-motor.

Fig. 2.

Example of applying the bioelectrical signals (BES) sensor. Electrodes detecting bioelectrical signals (BES) are attached to the skin over the lumbar erector spinae muscles in the non-affected right or left side of the patient, with the reference electrode placed on the side.

Fig. 3.

Hybrid assistive limb (HAL)-assisted exercise. The standing training focused on “leaning forward with the trunk”. For those with an unstable standing posture, training was conducted by having them hold onto a walker with their unaffected side.