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Cybernic treatment involves the generation of an interactive bio-feedback loop between an individual’s nervous system and the worn cyborg Hybrid Assistive Limb (HAL); this treatment has been applied for several intractable neuromuscular disorders. Thus, it is of interest to determine its potential for parkinsonian patients. This study confirmed the feasibility of using a HAL trunk unit to improve parkinsonian gait disturbance. HAL establishes functional and physical synchronization with the wearer by providing lateral cyclic forces to the chest in the form of somatosensory and motor cues. To confirm the feasibility of its use for improving parkinsonian gait disturbances, we conducted experiments with three Parkinson’s disease patients and two patients with progressive supranuclear palsy. During the experiments, the immediate effect of the intervention was assessed; all participants exhibited improvements in gait disturbance while wearing the HAL unit, and this improvement effect persisted without the HAL unit in two participants. Afterward, based on the assessment, we conducted a continuous intervention for one participant. In this intervention, the number of steps in the final experiment was significantly decreased compared with the initial state. These findings suggest that the proposed method is an option for treating parkinsonian patients to generate somatosensory and motor cues.

Compact and lightweight sensors with a high-frequency resolution are required for the passive observation of atmospheric water and oxygen emission lines at a reduced cost and power consumption. A molecular assessment high-resolution observation spectrometer (MAHOS) is developed as a compact, low power, digital fast Fourier transform spectrometer to be installed on a microsatellite. MAHOS has a compact design with dimensions of 0.154 × 0.125 × 0.040 m3 and mass of 0.7 kg. It uses only a few materials including a field programmable gate array (FPGA) module with a lightweight aluminum alloy box. The highly stable spectrometer exhibits a sampling speed of 2.6624 GS/s and 16,384 frequency channels. The stability of the spectrometer is longer than 1200 s within the 1 GHz bandwidth. Thermal dissipation is achieved through a heat conductive gel filled in the gap between the most heat generating component, the FPGA and the aluminum alloy case. Results of a finite element analysis indicate that the design stiff and stable enough to survive in the launch environment. Thermal analysis indicates the durability of the system during operation. Even in space where heat dissipation is not possible, self-heating temperatures are not a problem for the FPGA. In the future, the performance of the spectrometer will be verified by conducting environmental tests.

Background Rare neuromuscular diseases such as spinal muscular atrophy, spinal bulbar muscular atrophy, muscular dystrophy, Charcot-Marie-Tooth disease, distal myopathy, sporadic inclusion body myositis, congenital myopathy, and amyotrophic lateral sclerosis lead to incurable amyotrophy and consequent loss of ambulation. Thus far, no therapeutic approaches have been successful in recovering the ambulatory ability. Thus, the aim of this trial was to evaluate the efficacy and safety of cybernic treatment with a wearable cyborg Hybrid Assistive Limb (HAL, Lower Limb Type) in improving the ambulatory function in those patients. Results We conducted an open-label, randomised, controlled crossover trial to test HAL at nine hospitals between March 6, 2013 and August 8, 2014. Eligible patients were older than 18 years and had a diagnosis of neuromuscular disease as specified above. They were unable to walk for 10 m independently and had neither respiratory failure nor rapid deterioration in gait. The primary endpoint was the distance passed during a two-minute walk test (2MWT). The secondary endpoints were walking speed, cadence, and step length during the 10-m walk test (10MWT), muscle strength by manual muscle testing (MMT), and a series of functional measures. Adverse events and failures/problems/errors with HAL were also evaluated. Thirty patients were randomly assigned to groups A or B, with each group of 15 receiving both treatments in a crossover design. The efficacy of a 40-min walking program performed nine times was compared between HAL plus a hoist and a hoist only. The final analysis included 13 and 11 patients in groups A and B, respectively. Cybernic treatment with HAL resulted in a 10.066% significantly improved distance in 2MWT (95% confidence interval, 0.667–19.464; p = 0.0369) compared with the hoist only treatment. Among the secondary endpoints, the total scores of MMT and cadence at 10MWT were the only ones that showed significant improvement. The only adverse effects were slight to mild myalgia, back pain, and contact skin troubles, which were easily remedied. Conclusions HAL is a new treatment device for walking exercise, proven to be more effective than the conventional method in patients with incurable neuromuscular diseases. Trial registration: JMACTR, JMA-IIA00156

Study Design: Prospective experimental study in humans.Purpose: To determine whether the hybrid assistive limb (HAL) for Care Support can reduce lumbar load during a patient transfer.Overview of Literature: The prevalence of work-related low back pain (LBP) among nurses is high. In particular, transferring patients poses a high risk for LBP due to the large lumbar load. Attempts to reduce the lumbar load are crucial to avoid the risk of LBP. Therefore, we investigated the effects of the HAL for Care Support.Methods: Nineteen volunteers (16 men, three women) lifted a 60-kg doll from a seated position to a standing position. The first transfer was performed without the HAL for Care Support, and the second was performed with the HAL for Care Support assistive robot. We evaluated transfer performance, the visual analog scale (VAS) score for lumbar fatigue, and electromyogram analyses of the trunk and hip.Results: Four participants (two men, two women) succeeded with the HAL for Care Support even though they were unable to perform the task without it. The mean lumbar fatigue VAS score for all participants without the HAL for Care Support was 62 mm, while that with it was 43 mm. With lumbar assistance from the HAL for Care Support, subjective lumbar fatigue during the transfer decreased significantly. A power analysis indicated adequate statistical power to detect a difference in the VAS score for lumbar fatigue (0.99). The activity of the left gluteus maximus alone increased significantly during transfers with the HAL for Care Support. No adverse events occurred during use of the HAL for Care Support for transfers.Conclusions: The HAL for Care Support was able to reduce lumbar load in a simulated patient transfer.

Cybernic treatment with a wearable cyborg Hybrid Assistive Limb for medical use (Medical HAL) improves ambulatory function in patients with progressive neuromuscular diseases. The progress of cybernic treatment is evaluated based on the change in the patient's walking distance and walking speed over a certain treatment period. However, evaluation methods to capture temporal changes in gait functions during each therapy are required for more effective evaluation in clinical practice. Because the patients' muscular activities are measured with each trial of cybernic treatment, bioelectrical signals (BES) of lower limb muscles measured by Medical HAL may aid in evaluating the wearers' gait functions. Thus, this study proposed a method to quantify the BES patterns of patients during cybernic treatment and compared them with the BES patterns of healthy personnel for evaluation, which confirmed the correlation between the BES pattern and the patients' gait abilities. First, we obtained a reference BES pattern from the BES of three healthy personnel during walking using Medical HAL. Second, we calculated the similarity between the reference BES pattern of the healthy personnel and the patient's BES pattern using derivative dynamic time warping (DDTW), which quantified the patients' BES patterns based on their shape. Third, we investigated the correlation between patients' DDTW of BES patterns during cybernic treatment and 2-minute walking distances. The correlation coefficient between the patients was -0.83 (p0.01) and that within patients was -0.38 (p0.05), indicating a significant BES pattern relationship between walking with Medical HAL and gait abilities. Conclusively, the similarity between the BES patterns of healthy personnel and patients calculated using DDTW might be applied to the evaluation of patients' gait functions. The ability to assess the gait function with data measured during cybernic treatment would provide understandings of the patient's functional changes over time.

Epilepsy is a neurological disorder that causes sudden seizures due to abnormal excitation of neurons in the brain. Approximately 30 % of patients cannot control their seizures using medication. In addition, since seizures can occur anywhere and at any time, caregivers must always be with the patient. Various researchers have developed seizure detection methods using multichannel EEG to improve the quality of life of patients and caregivers. However, the large size of the measurement device impedes transportation. We believe that a portable measurement device with a small number of channels is suitable for detecting seizures in daily life. Therefore, we need a system that can detect seizures using a small number of channels. The purpose of this research is to develop a seizure detection algorithm using a single-channel frontal EEG and to confirm its basic performance. We used EEG signals from a single electrode position (Fp1-F7, Fp2-F8), which is a bipolar derivation of the frontal region. We segmented the EEG using a 2 s sliding window with 50 % overlap and converted the segments into images. After preprocessing, we fine-tuned ResNet18, pre-trained on ImageNet, and developed an ensemble classification method. In the experiments with 10 epileptic patients (3 - 19 years old) registered in the CHB-MIT scalp EEG database, the results showed that the average sensitivity was 88.73 %, the average specificity was 98.98 %, and the average detection latency time was 7.39 s. In conclusion, the developed algorithm was validated as sufficiently accurate to detect epileptic seizures.Clinical Relevance- This establishes an image recognition algorithm that can detect epileptic seizures using a single- channel frontal EEG.

BACKGROUND Aiming to establish an effective tool in new cardiac rehabilitation programs, we investigated the use of a lumbar-type hybrid assistive limb (HAL) in patients with heart failure (HF) who had difficulty in walking at the usual speed of healthy subjects (≈80 m/min).Methods and Results:We randomly assigned 28 HF patients (age, 73.1±13.8 years) to perform a sit-to-stand exercise with or without HAL. The sit-to-stand exercise was repeated as many times as possible as cardiac rehabilitation therapy over a period of 6-10 days. We measured 5 parameters before and after the completion of cardiac rehabilitation: B-type natriuretic peptide, Short Physical Performance Battery (SPPB), 6-min walking distance (6MWD), 30-s chair-stand test (CS-30), and isometric knee extensor muscle strength. The SPPB and 6MWD were significantly improved, and the CS-30 score was somewhat improved, after the exercise therapy in both the HAL and non-HAL groups. The knee extensor muscle strength improved significantly in the HAL group (0.29±0.11 to 0.35±0.11 kgf/kg, P

The lumbar-type Hybrid Assistive Limb (HAL) is expected to expand the possibilities of exercise therapy for severe cardiac patients who have difficulty in moving on their own legs. We investigated whether motion assistance from HAL during squat exercise could effectively reduce the cardiopulmonary burden in healthy subjects. Twelve healthy subjects (33 ± 11 years) performed squat exercise for 3 consecutive minutes at a repetition rate of 20 squats per minute with and without assistance from a lumbar-type HAL. The oxygen uptake (VO2), carbon dioxide output (VCO2), minute ventilation (VE), and the Borg Scale were monitored during exercise. VO2 (930 ± 207 vs 992 ± 169 mL/min, p 0.05) and the Borg Scale rating (12.8 ± 1.1 vs 13.7 ± 0.8, p 0.05) at the end of exercise were significantly lower when HAL was used. When 2 subjects who regularly perform high-intensity exercise for more than 10 h per week were excluded from the analyses, VO2, VCO2, VE, and the Borg Scale were significantly lower when HAL was used. Our results demonstrate that the lumbar-type HAL significantly reduces cardiopulmonary burden during squat exercise in healthy subjects. The effects were especially striking in sedentary subjects. Further studies on cardiac patients are expected to establish a new cardiac rehabilitation program using HAL.

Background With a rapidly aging population in Japan, locomotive syndrome is becoming an increasingly serious social problem. Exercise therapy using the lumbar type HAL, which is a wearable robot suit that can assist voluntary hip joint motion, would be expected to cause some beneficial effects for people with locomotive syndrome. The purpose of this study was to assess whether the deterioration of low back pain and any other adverse events would occur following HAL exercise therapy. Moreover, the changes of motor ability variables were evaluated. Methods We enrolled 33 participants (16 men, 17 women) with locomotive syndrome in this study. They received exercise training (sit-to-stand, lumbar flexion-extension, and gait training) with HAL (in total 12 sessions). We assessed the change of low back pain (lumbar VAS). More than 50% and 25 mm increase compared to baseline was defined as adverse events. One-leg standing time (OLST), 10-m walking test (10MWT), Timed Up and Go test (TUG), 1-min sit-to-stand test (1MSTS), FIM mobility scores and EQ-5D were measured. Results Of the 33 participants, 32 (16 men, 16 women) (97.0%) completed all 12 exercise training sessions using the lumbar type HAL. One woman aged 82 years withdrew because of right upper limb pain after the second session regardless of the use of HAL. There was no participant who had deterioration of low back pain. Any other adverse events including external injuries and/or falling, skin disorders, uncontrollable cardiovascular or respiratory disorders, and other health disorders directly related to this exercise therapy did not occur. Several outcome measures of motion ability including OLST, TUG and 1MSTS, EQ VAS and lumbar pain improved significantly after this HAL training. Conclusions Almost all patients with locomotive syndrome completed this exercise training protocol without any adverse events related to HAL. Furthermore, balance function variables including OLST, TUG and 1MSTS improved after this HAL exercise therapy even though mobility function variables including 10MWT and FIM mobility scores did not show any significant change. These findings suggest that the exercise therapy using the lumbar type HAL would be one of the options for the intervention in locomotive syndrome.

Background Recent Cochrane Systematic Review suggested that the participation in cardiac rehabilitation is associated with approximately 20% lower cardiovascular mortality and morbidity. Exercise therapy is the key component of cardiac rehabilitation programs. In recent years, innovative technologies have been introduced into the field of rehabilitation, and a typical example is the wearable cyborg Hybrid Assistive Limb (HAL). The wearable cyborg HAL provides motion assistance based on detection of bioelectrical signals on the skin surface when muscle forces are generated. The lumbar-type HAL is expected to expand the therapeutic options for severe cardiac patients who have difficulty in performing usual cardiac rehabilitation programs, such as bicycle pedaling or walking. Purpose We aim to compare the efficacy of exercise therapy performed with motion assistance from a lumbar-type HAL versus conventional training (sit-to-stand exercise without HAL) in patients with chronic heart failure. Methods This clinical trial is a randomized, non-blinded, and controlled study. Twenty-eight heart failure patients (73.1±13.8 years) who have difficulty in walking at the usual walking speed of healthy subjects were randomly assigned to 2 groups (HAL group or control group) with a 1:1 allocation ratio and performed sit-to stand exercise either with HAL or without HAL for 5 to 30 minutes once a day, and 6 to 10 days during the study period. The brain natriuretic peptide (BNP), isometric knee extensor strength, standing ability (30-seconds chair-stand test: CS-30), short physical performance battery (SPPB) and 6-minute walking distance (6MWD) were measured before and after the completion of cardiac rehabilitation. Cardiac events such as death, re-hospitalization, myocardial infarction and worsening of angina pectoris and heart failure during 1 year after discharge were evaluated. Results There was no significant difference in the number of days of exercise therapy between the two groups. BNP, SPPB and 6MWD were improved in both groups. In the HAL group, the isometric knee extensor strength (0.29±0.11 vs 0.35±0.11 kgf/kg, p=0.003) significantly improved and CS-30 (5.5±5.1 vs 8.2±5.3, p=0.054) tended to improve. However, in the control group, either the isometric knee extensor strength (0.35±0.11 vs 0.36±0.14 kgf/kg, p=0.424) or CS-30 (6.0±4.3 vs 9.2±6.2, p=0.075) did not significantly change. HAL group showed significantly more improvement in the isometric knee extensor strength than control group (p=0.045). Cardiac events occurred in 20% in the HAL group and 43% in the control group. Conclusion The improvement in isometric knee extensor strength with the assistance from lumbar-type HAL suggests that exercise therapy using this device may be useful in chronic heart failure patients with flail or sarcopenia, a strong poor prognostic factor in these patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported in part by a grant-in-aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan (JSPS KAKENHI grant number JP17K09485) and funded by the ImPACT Program of the Council for Science, Technology and Innovation (Cabinet Office, Government of Japan) (grant number 2017-PM05-03-01).

Decreasing birth rates and an aging population in society often cause labor shortages in the manufacturing industry, making the development of methods to improve productivity based on limited human resources imperative. One way to achieve this is by enhancing product quality via the reduction of product losses and the consequent need for reassembly due to human error. Human error during assembly can arise from specific actions via the arms and fingers. We assumed that these errors can be captured based on the information on human skeletal models. The purpose of this study is to propose and develop a system that acquires information about assembly procedures by using human skeletal models, including the fingers of workers, and notifies them of skipped procedures and errors in part types. Further, we confirm the basic capability of the proposed system via experiments based on simulated assembly work. The proposed system monitors workers' motion based on color and depth images captured by a single RGB-D camera. In addition, we developed a function to detect the process and to point out errors with audible and visual feedbacks when errors were made by workers in assembly processes. In the experiment using simulated assembly work, the proposed system exhibited an accuracy rate of 98.3% with respect to acquisition of assembly processes. In the case of an error in an assembly process, the system was able to point out the error correctly and provide feedback to the worker before he had finished picking up the wrong part. In conclusion, we confirmed that the developed system exhibited the basic capability to acquire work procedures and efficiently point out errors in real time.

Thumb movement is very important for object gripping. However, when a cerebrovascular disorder or spinal cord injury causes hand paralysis, which impairs the motor function of the fingers, it becomes impossible to flex and extend the fingers and to move the thumb to the opposition position; this makes it difficult to grip objects in daily life. Several assistive devices have been developed for people with hand paralysis. However, they only assist flexion/extension of the thumb, narrow the type of grip by fixing the thumb position, or have large sizes and weights due to using links and frames to assist thumb adduction and opposition. They are not effective for daily use. Thumb motion assistance that does not hinder the degree of freedom of the thumb is important for gripping objects in everyday life. In this study, we developed a wearable ring and a fingertip-cap that assist two-degree-of-freedom thumb motion by means of a tendon-drive based on the hand’s anatomy; the feasibility of the device is confirmed through basic experiments, in which the device was evaluated by a hand in a weakened state. It was confirmed that opposing movement and flexion/extension motion of the thumb were possible. In addition, we confirmed that it was possible to grip thin objects by using only thumb motion assistance. In conclusion, we developed a tendon-driven thumb motion assistive device using a ring-shaped component and confirmed the feasibility of this system to support the opposition/reposition and flexion/extension motions of the thumb.

Freezing of gait (FOG) is one of the typical locomotion disorders associated with Parkinsonism, and is described as the inability to move the feet despite an attempt to walk. The fear of falling over and other symptoms of FOG can be distressing to patients. Considering conventional external cues and physical therapy, it is necessary for Parkinsonism patients suffering from FOG to swing the body laterally and rhythmically. The purpose of this study is to develop a wearable system that can assist rhythmical and lateral swing, and to validate the performance of the system in preventing FOG by conducting a gait experiment on a Parkinsonism patient. To develop this system, we simulated lateral swing in the standing position based on features of Parkinsonism and defined a mechanism and appropriate force configurations for the system. A power unit at the back of the waist transmits a cyclic force to the chest through a link in the frontal plane. A gait experiment was performed on a Parkinsonism patient with FOG to confirm the reduction in duration time and number of steps of turning. The result showed that the cyclic assistance of the system and gait cycle were harmonized, and the developed system decreased duration time and number of steps during turning by half. In addition, Pre-FOG, i.e., transient small stepping gait, occurred when turning without using the system, while it did not occur during and immediately after the use of the system. These results suggest that the developed system is effective in preventing occurrences of FOG by providing lateral and cyclic force to the upper body.

The 40-year-old male patient was raced to our hospital complaining respiratory difficulty after hitting his left chest at a handle when falling down from a bicycle. Fracture of 5th left rib and partial lung prolapsed intercostally out of the thorax was observed by computed tomography (CT). Due to exacerbated pneumothorax and pneumoderma recognized 12 hours later by CT with the lung remained incarcerated, a surgery was conducted. Camera port was placed from 8th intercostal part at left midaxillary line. The left lung was partially incarcerated from ruptured intercostal part of fractured 5th rib. Adding a working port from 7th intercostal part at the posterior axillary line, the incarcerated lung was thoracoscopically reduced. The thoracoscopic surgery was completed by fixing the rib outside the thoracic wall with 2-0 nylon suture without partial resection of the lung. The patient was discharged on day 7 with satisfactory progress. Thoracoscopic approach is effective for traumatic intercostal lung hernia.

Work-related low back pain is a serious socioeconomic problem. This study examined whether HAL for Care Support, which is a newly developed wearable robot, would decrease lumbar fatigue and improve lifting performance during repetitive lifting movements. Eighteen healthy volunteers (11 men, 7 women) performed repetitive stoop lifting movements of a cardboard box weighing 12 kg as many times as possible. The first lifting trial was executed without HAL for Care Support, and the second was with it. We evaluated the VAS of lumbar fatigue as the lumbar load and the number of lifts and the lifting time as lifting performance. Without HAL for Care Support, the mean VAS of lumbar fatigue, the number of lifts and lifting time were 68 mm, 60 and 230 s; with HAL for Care Support, they were 51 mm, 87 and 332 s, respectively. Both lifting performance measures were significantly improved by using HAL for Care Support (Fig. 2). A power analysis showed that there was sufficient statistical power for the VAS of lumbar fatigue (0.99), the number of lifts (0.92), and lifting time (0.93). All participants performed their repetitive lifting trials safely. There were no adverse events caused by using HAL for Care Support. In conclusion, the HAL for Care Support can decrease lumbar load and improve the lifting performance during repetitive stoop lifting movements in healthy adults.

Background The Hybrid Assistive Limb (HAL®) is an exoskeleton wearable robot suit that assists in voluntary control of knee and hip joint motion. There have been several studies on HAL intervention effects in stroke, spinal cord injury, and cerebral palsy. However, no study has investigated HAL intervention for patients with cerebral palsy after surgery. Case presentation We report a case of using HAL in a postoperative patient with cerebral palsy. A 15-year-old boy was diagnosed with spastic diplegia cerebral palsy Gross Motor Function Classification System level IV, with knee flection contracture, equinus foot, and paralysis of the right upper extremity with adduction contracture. He underwent tendon lengthening of the bilateral hamstrings and Achilles tendons. Although the flexion contractures of the bilateral knees and equinus foot improved, muscle strength decreased after the soft tissue surgery. HAL intervention was performed twice during postoperative months 10 and 11. Walking speed, stride, and cadence were increased after HAL intervention. Post HAL intervention, extension angles of the knee in stance phase and hip in the pre-swing phase were improved. In the gait cycle, the proportion of terminal stance in the stance and swing phase was increased. Conclusions Hybrid Assistive Limb intervention for postoperative patients with cerebral palsy whose muscle strength decreases can enhance improvement in walking ability. Further studies are needed to examine the safety and potential application of HAL in this setting. Electronic supplementary material The online version of this article (10.1186/s13104-018-3311-z) contains supplementary material, which is available to authorized users.

An excessive lumbar load with snow-shoveling is a serious problem in snowfall areas. Various exoskeletal robots have been developed to reduce lumbar load in lifting work. However, few studies have reported the attempt of snow-shoveling work using exoskeletal robots. The purpose of the present study was to test the hypothesis that the HAL for Care Support robot would reduce lumbar load in repetitive snow-shoveling movements. Nine healthy male volunteers performed repetitive snow-shoveling movements outdoors in a snowfall area for as long as possible until they were fatigued. The snow-shoveling trial was performed under two conditions: with and without HAL for Care Support. Outcome measures were defined as the lumbar load assessed by the VAS of lumbar fatigue after the snow-shoveling trial and the snow-shoveling performance, including the number of scoops, and snow shoveling time and distance. The mean of VAS of lumbar fatigue, the number of scoops, and snow-shoveling time and distance without HAL for Care Support were 75.4 mm, 50.3, 145 s, and 9.6 m, while with HAL for Care Support were 39.8 mm, 144, 366 s, and 35.4 m. The reduction of lumbar fatigue and improvement of snow-shoveling performance using HAL for Care Support were statistically significant. There was no adverse event during snow-shoveling with HAL for Care Support. In conclusion, the HAL for Care Support can reduce lumbar load in repetitive snow-shoveling movements.

Context: The hybrid assistive limb (HAL) (the wearable robot) can assist kinesis during voluntary control of hip and knee joint motion by detecting the wearer's bioelectric signals on the surface of their skin. The purpose of this study was to report on walking ability following the wearable robot treatment in a patient with chronic myelopathy after surgery for cervical ossification of the posterior longitudinal ligament (OPLL). Findings: The patient was a 66-year-old woman with cervical OPLL who was able to ambulate independently with the aid of bilateral crutches. The wearable robot treatment was received once every 2 weeks for ten sessions beginning approximately 14 years after surgery. Improvements were observed in gait speed (BL 22.5; post 46.7 m/min), step length (BL 0.36; post 0.57 m), and cadence (BL 61.9; post 81.6 m/min) based on a 10-m walk test and a 2-minute walk test (BL 63.4; post 103.7 m) assessing total walking distance. The improvements in walking ability were maintained after the wearable robot treatment for 6 months. Conclusion: We report the functional recovery in the walking ability of a patient with chronic cervical myelopathy following the wearable robot treatment, suggesting that as a rehabilitation tool, the wearable robot has the potential to effectively improve functional ambulation in chronic cervical myelopathy patients whose walking ability has plateaued, even many years after surgery.

Patients with complete quadriplegia after high cervical spinal cord injury are fully dependent with activities of daily living. Assistive technology can improve their quality of life. We examined the use of a hybrid assistive limb for single joints (HAL-SJ) in a 19-year-old man with complete C4 quadriplegia due to chronic spinal cord injury to restore function of active elbow flexion. This is the first report on the use of the HAL-SJ in a patient with spinal cord injury.The HAL-SJ intervention for each elbow was administered in 10 sessions. Clinical assessment using surface EMG was conducted to evaluate muscle activity of the trapezius, biceps brachii, infraspinatus, and triceps brachii muscle before, and during the 2nd, 3rd, 6th, and 9th interventions. Surface electromyography (EMG) before intervention showed no contraction in the upper arms, but in the bilateral trapezius. The HAL-SJ used motion intention from the right trapezius for activation. After the 6th and 7th session, respectively, biceps EMG showed that voluntary contraction and right elbow flexion could be performed by motion intention from the right biceps. After the 10th session, voluntary bicep contraction was possible. HAL-SJ treatment on the left elbow was performed using the same protocol with a similar outcome. After completing treatment on both upper extremities, both biceps contracted voluntarily, and he could operate a standard wheelchair for a short distance independently.HAL-SJ intervention is feasible and effective in restoring elbow flexor function in a patient with C4 chronic spinal cord injury and complete quadriplegia.

Patients with hand paralysis often suffer from motor and sensory dysfunction. In many cases, they can neither use their fingers nor feel a gripping force. Thus, they find it difficult to perform certain tasks, such as lifting small objects. It is important for patients with hand paralysis to receive assisted flexion and extension motions for their fingers and gripping-force feedback by leveraging body parts or organs where sensation remains. The purposes of this study are to develop a wearable cybernic finger to assist the gripping force needed to handle objects and to provide gripping-force feedback to patients; the feasibility of the device is confirmed through basic experiments. For the basic experiments, the device was evaluated by a model hand and able-bodied persons. The system successfully assisted the model hand’s fingers to grip, lift, hold, put down, and release cylindrical objects representative of necessary daily objects. Furthermore, six states of gripping force were identified with an average identification rate of 95.6% using vibration feedback. To summarize, a wearable hand-assist unit with sensory feedback has proven to be feasible.

This study proposes a novel integrated wheelchair-compatible support system for wheelchair users with partial or complete paralysis. This system not only provides sit-to-stand and stand-to-sit (STS) learning support for stroke and spinal cord injury patients but also enhances the independence of wheelchair users. It integrates a lower limb movement support unit with a wheelchair and supports STS movement by moving the seat up and down linearly. It also measures the ground reaction force (GRF) on both sides of the body and supports proper STS movement to allow users to improve their movements and postures. Individual experiments were conducted to evaluate the system-provided STS movement support for two patients with partial paralysis and one patient with complete paralysis. Patients with partial paralysis, both hemiplegic and quadriplegic, were able to operate the system and perform the STS movement learning with visual biofeedback. Moreover, using our system, a wheelchair user with complete paraplegia was able to perform tasks at an elevated position independently. Therefore, this system will help wheelchair users achieve the self-motor-learning of STS movement and enhance their quality of life independently.

We hypothesized that a single-leg version of the Hybrid Assistive Limb (HAL) system could improve the gait and physical function of patients with hemiparesis following a stroke. In this pilot study, we therefore compared the efficacy of HAL-based gait training with that of conventional gait training (CGT) in patients with acute stroke. Patients admitted to the participating university hospital were assigned to the HAL group, whereas those admitted to outside teaching hospitals under the same rehabilitation program who did not use the HAL were assigned to the control group. Over 3 weeks, all participants completed nine 20 min sessions of gait training, using either HAL (i.e., the single-leg version of HAL on the paretic side) or conventional methods (i.e., walking aids and gait orthoses). Outcome measures were evaluated before and after the nine training sessions. The Functional Ambulation Category (FAC) was the primary outcome measure, but the following secondary outcome measures were also assessed: National Institutes of Health Stroke Scale, Fugl–Meyer Assessment (Lower Extremity), comfortable walking speed, step length, cadence, 6-min walk distance, Barthel Index, and Functional Independence Measure. In total, 22 post-stroke participants completed the clinical trial: 12 in the HAL group and 10 in the CGT group. No serious adverse events occurred in either group. The HAL group showed significant improvement in FAC after nine sessions when compared with the CGT group (P = 0.014). However, secondary outcomes did not differ significantly between the groups. Our results demonstrate that HAL-based gait therapy may improve independent walking in patients with acute stroke hemiplegia who are dependent on ambulatory assistance. A larger-scale randomized controlled trial is needed to clarify the effectiveness of single-leg HAL therapy. Clinical Trial Registration: UMIN Clinical Trials Registry, identifier UMIN000022410.

Knee osteoarthritis patients have pain in their knee and it can become difficult to walk depending on the progress of symptoms. After performing chondrocyte implantation, it is necessary to reduce the load on the knee joint until the implanted cartilage is integrated. The purposes of this study were to develop a device that enables the user to walk and reduced the weight on the knee joint and to confirm basic performance of the device through experiments. The device was composed of a seat for supporting the body weight of the user, a prosthetic knee, and the floor reaction force sensor shoes. Experiments were conducted to confirm the basic performance of the device. As a result, an able-bodied participant who wore the device was able to walk while unloading two-thirds of their body weight onto their knee. As a result of gait analysis, it was found that the gait did not change significantly even when the device was worn.

Hemiplegics have difficulty conducting various daily tasks because they must perform such tasks using only their unaffected arm. If a robot arm that can replace their missing upper-limb function is made available, it will greatly contribute to an improvement in their lives. To realize such a robot arm, cooperative actions of the robot arm and the unaffected arm are important. The purpose of this research is to develop a "cybernic robot arm" that can provide work support through cooperation with the unaffected arm for realization of upper-limb tasks in the daily life of hemiplegics. The developed system can detect the external force applied to a gripped object using a tactile force sensor embedded in the robot fingers. The system estimates the motion of the unaffected arm and the user's intention regarding its operation based on the external force, and provides a support action in cooperation with the unaffected arm based on the estimated information. In addition, to confirm the applicability of the developed system, we developed a support function for opening tasks that are difficult for hemiplegics to carry out on their own, and conducted an experiment confirming the applicability of the system. The results confirm that the proposed system provides proper support by cooperating with the user's arm, allowing an opening task to be performed. The developed system will support various upper-limb tasks that are difficult for hemiplegics.

To investigate whether Robot Suit HAL treatment (HAL-T) is safe and feasible for gait disorders in adolescents and adults with cerebral palsy (CP). We tested HAL-T in adolescents and adults with bilateral spastic CP (four men, four women; mean age: 18.2 years). Three participants were classified as level III under the Gross Motor Function Classification System (GMFCS), and five were classified as level IV. The participants underwent HAL-T twice per week for 4 weeks. The outcome measures, which were assessed before and after HAL-T, included comfortable gait speed (CGS), step length (SL), cadence, and GMFCS level. Adverse events were noted. All participants completed the HAL-T sessions despite some mild adverse events occurring. The mean increases in CGS, SL, and cadence were 0.19 ± 0.14 m/s (p = 0.006), 0.09 ± 0.08 m (p = 0.020), and 18.0 ± 15.9 steps/min (p = 0.015), respectively. HAL-T is safe and feasible for gait disorders in patients with CP. HAL-T can significantly improve CGS, SL, and cadence and may be effective for improving walking ability in adolescents and adults with CP.

Patients suffering from neuromuscular intractable rare diseases gradually lose muscle strength; this muscle weakness can cause various motor dysfunctions, such as gait disturbance. In order to maintain their ability to move independently, these patients must use electric wheelchairs. Eventually, however, they will lose the muscle strength required to operate the joystick of their electric wheelchair as the disease progresses. In this study, we develop a cybernic interface that supports neuromuscular intractable rare disease patients in controlling their electric wheelchairs, and to establish the basic performance of this interface through experiments. The cybernic interface consists of a unit that can operate the joystick and an input interface that can detect small displacements. The joystick operation unit is equipped with two high-resolution linear stepping motors; it operates the electric wheelchair joystick with a high degree of sensitivity. Additionally, the small displacement of a fingertip, which is the input for the joystick operation unit, is measured by the input interface, which consists of a touch panel sensor. We conducted repetitive accuracy verification of the joystick operation unit and performed driving experiments using an electric wheelchair equipped with our system. Our results show that the system exhibited sufficient repeatability and controllability. In conclusion, we confirm that our developed system can aid neuromuscular intractable rare disease patients in controlling an electric wheelchair.

Sports experts develop skills by repeatedly practicing of ideal and appropriate motions. To improve athletic ability or reduce the risk of injury associated with incorrect motion in beginners, it is necessary to quantify the information pertaining to expert skills. While inertial motion capture is a suitable method for motion analysis, existing inertial motion capture systems cannot measure acceleration and angular velocity in case of high-speed motion. The objectives of this study are to develop an inertial measurement unit (IMU) sensor module that can measure high-speed motion and to corroborate its basic performance. The IMU sensor module consists of an IMU sensor, acceleration and gyro sensors with wide dynamic ranges of measurement, and it can change measurement ranges according to the motion. The experiment to evaluate basic performance showed that the output exhibited a linear relationship between the evaluation system whose value was calculated from the rotational speed of the motor as a true value and the sensor module even while switching between the two types of sensors with different measurement ranges. Finally, the acceleration and angular velocity in pitching motion was measured using the developed IMU sensor module, and we confirmed that it could perform measurements at high speeds. In conclusion, an IMU sensor module that can measure high-speed motion was developed, and its basic performance was confirmed in this study.

This paper proposes a new clonus management system that integrates sit-to-stand (STS) learning with informatics and physical methods. Clonus is an involuntary muscle spasm, which often interferes with motor learning or the training of chronic patients. A conventional ankle-foot orthosis makes it difficult for patients to control the onset of clonus or to improve it. A new system with an original orthosis can reduce the occurrence of clonus by the physical constraint of the ankle by firmly placing the heel of the affected side on the ground. This system also provides a ground reaction force of the heel because clonus hardly occurs when the heel is placed on the ground. The system supports STS movement by linearly moving the seat up and down when users place the heel of the affected side on the ground. Using this system, users can learn how to perform the STS movement while managing their clonus. Testing its effect on a stroke patient confirmed that the system relieves the onset of clonus and reduces the frequency with which clonus occurs during STS learning. In addition, the results of continuous learning showed that the patient could perform the STS movement without the occurrence of clonus even without using the developed orthosis. Here we discuss the results from the viewpoints of human–machine interaction and the relationship between nervous and peripheral systems. The proposed clonus management system may promote the improvement of chronic patients with clonus.

The hybrid assistive limb (HAL) is a wearable robot suit that assists in voluntary control of knee and hip joint motion by detecting bioelectric signals on the surface of the skin with high sensitivity. HAL has been reported to be effective for functional recovery in motor impairments. However, few reports have revealed the utility of HAL for patients who have undergone surgery for thoracic ossification of the posterior longitudinal ligament (thoracic OPLL). Herein, we present a postoperative thoracic OPLL patient who showed remarkable functional recovery after training with HAL.A 63-year-old woman, who could not walk due to muscle weakness before surgery, underwent posterior decompression and fusion. Paralysis was re-aggravated after the initial postoperative rising. We diagnosed that paralysis was due to residual compression from the anterior lesion and microinstability after posterior fixation, and prescribed bed rest for a further 3 weeks. The incomplete paralysis gradually recovered, and walking training with HAL was started on postoperative day 44 in addition to standard physical therapy. The patient underwent 10 sessions of HAL training until discharge on postoperative day 73. Results of a 10-m walk test were assessed after every session, and the patient's speed and cadence markedly improved. At discharge, the patient could walk with 2 crutches and no assistance. Furthermore, no adverse events associated with HAL training occurred.HAL training for postoperative thoracic OPLL patients may enhance improvement in walking ability, even if severe impairment of ambulation and muscle weakness exist preoperatively.

This study was conducted to develop a quantitative evaluation system for arc characteristics such as arc stability and welding spatter generation related to shielded metal arc welding (SMAW) without human sensory evaluation. Factors that correspond to sensory evaluations by welders were investigated based on image processing. For the quantitative evaluation of arc stability, results show that the root mean square and the standard deviation of the arc center fluctuation, respectively, correspond to welders’ sensory evaluation at AC and DC discharges. For welding spatter generation, a method of counting white pixels in a binarized image evaluates the number and size of welding spatters which closely coincide with welders’ sensory evaluations.

HAL, which assists voluntary control of joint motion, has been reported to improve walking function in patients with muscular dystrophy. Aiming to establish an effective tool in new cardiac rehabilitation programs, we investigated the effects of using a lumbar-type HAL in patients with heart failure

Stress causes various types of physical disorders. When we experience stress, vital signs change as the sympathetic nervous system works to respond to stress and cope with the stressor. To prevent the disorders associated with stress, it is important to be able to measure multiple vital signs using a non-invasive method in order to detect the occurrences that cause these disorders in our daily lives. This study aimed to develop an integrated non-invasive vital signs monitoring system to measure vital signs such as heart rate variability and alterations in skin temperature, and to assess the ability of the system to detect stress. We developed an algorithm to measure pulse rate with high accuracy, on the basis of near infrared images of the human cheek, and we measured the nasal and forehead skin temperatures based on far infrared images. In the experiments, the system was demonstrated to calculate a pulse rate with sufficient accuracy. In addition, we conducted a stress detection experiment with four human participants, and we confirmed that the proposed integrated system could effectively detect stress, on the basis of the measured pulse rate and skin temperature, as stimulated by cold water applied to the wrist. In conclusion, the developed system was validated to be a feasible means of detecting stress.

Purpose. We evaluated improvements in gait after using the Hybrid Assistive Limb (HAL®) exoskeleton robot in a patient with late-onset neurological deterioration of lower extremity function after undergoing thoracic spine surgery for a myelopathy due to ossification of the ligamentum flavum. Case Presentation. A 70-year-old man participated in ten 20 min sessions of HAL intervention, twice weekly for five weeks. The effects of each HAL session were evaluated based on changes in performance on the 10 m walk test (10 MWT), lower limb kinematics quantified from motion capture, and the activation ratio of the gastrocnemius, measured before and after the intervention. Muscle activity was recorded using surface electromyography and synchronized to measured kinematics. The HAL intervention improved gait speed and step length, with an increase in the hip flexion angle during the swing phase and a decrease in the activation ratio of the gastrocnemius. The modified Ashworth scale improved from 1+ to 1 and International Standards for Neurological and Functional Classification of Spinal Cord Injury motor scores from 34 to 49. Conclusion. Intervention using the HAL exoskeleton robot may be an effective method to improve functional ambulation in patients with chronic spinal disorders.