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Additional file 5: Data of the kinematic motion analysis of the knee joint for HAL session 4. (A) Temporal profile of the angular position of the knee joint over the gait cycle (A) and range of motion of the knee over the gait cycle (B), measured without, immediately before, and after the HAL training. Error bars indicate standard error of the mean. Flex, flexion; Ext, extension; Pre, Pre-HAL training; Post, Post-HAL training; ROM, range of motion.

Additional file 6: The 10-m walk test data immediately before and after HAL gait training, sessions 1���10. Gait speed (A), step length (B), and cadence (C).

Additional file 9: Kinematic motion analysis using the VICON motion capture system and surface electromyography (HAL session 4). (A) Surface electromyography of the gastrocnemius muscles of the right and left legs during the stance and swing phases. (B) Gastrocnemius stance ratio of the right and left legs before, during, and after the HAL gait training. The gastrocnemius stance ratio indicates the muscle activation ratio of the gastrocnemius (swing phase to the total step cycle). Pre, Pre-HAL training; Post, Post-HAL training.

Additional file 2: Magnetic resonance (MR) images of the cervical and thoracic spine 14 months after surgery. T1-weighted (A) and T2-weighted (B) midsagittal MR images show sufficient decompression of the spinal cord at the thoracic spine. Magnification of the T2-weighted image at the cervical spine area (C) shows slight posterior compression of the spinal cord at the C3���C4 level (red arrow).

Additional file 1: Reconstruction images from computed tomography (CT) myelography of the cervical and thoracic spine before surgery. Midsagittal reconstruction CT myelogram of the cervical spine (A) and axial CT image at the C5 level (B) reveal segmental ossification of the longitudinal ligament (OPLL) at the C4���C6 vertebrae. The asterisks in (A) and (B) indicate the C5 OPLL. The spinal cord was compressed from the anterior and posterior directions at the C3���C4 and C4���C5 levels (red arrows). Midsagittal reconstruction CT myelogram of the thoracic spine (C) and axial CT image at the T4���T5 level (D) reveal multilevel ossification of the ligamentum flavum (OLF) at the T3���T8 vertebrae. The asterisks in (C) and (D) indicate the T4���T5 OLF. The spinal cord was compressed posteriorly at the T4���T5 level (blue arrow).

Additional file 7: Data of the kinematic motion analysis of step length for HAL session 4. Step length of the right and left legs immediately before and after HAL training. Pre, Pre-HAL training; Post, Post-HAL training.

Additional file 8: Data of the kinematic motion analysis of toe clearance for HAL session 4. Toe lift of the right and left legs before, during, and after HAL gait training. The toe lift indicates toe clearance. Pre, Pre-HAL training; Post, Post-HAL training.

Additional file 4: Data of the kinematic motion analysis of the hip joint for HAL session 4. (A) Temporal profile of the angular position of the hip joint over the gait cycle (A) and range of motion of the hip over the gait cycle (B), measured without, immediately before, and after the HAL training. Error bars indicate standard error of the mean. Flex, flexion; Ext, extension; Pre, Pre-HAL training; Post, Post-HAL training; ROM, range of motion.

Yuichiro Soma,1 Shigeki Kubota,2 Hideki Kadone,3 Yukiyo Shimizu,1 Hiroshi Takahashi,2 Yasushi Hada,1 Masao Koda,2 Yoshiyuki Sankai,4 Masashi Yamazaki2 1Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan; 2Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; 3Center for Innovating Medicine and Engineering (CIME), University of Tsukuba Hospital, Ibaraki, Japan; 4Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki, JapanCorrespondence: Shigeki KubotaDepartment of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, JapanTel +81-29-853-3219Fax +81-29-853-3162Email skubota@tsukuba-seikei.comIntroduction: The hybrid assistive limb (HAL) is a wearable exoskeleton cyborg that assists walking and lower limb movements via real-time actuator control by detecting the wearer’s bioelectric signals on the surface of their skin.Purpose: The purpose of this study was to report the improvement in walking ability following HAL gait training in a patient with tetraplegia after incomplete cervical spinal cord injury (SCI).Patient and Methods: A 47-year-old man with traumatic cervical SCI for six months after fall had incomplete tetraplegic SCI grade C as classified according to the American Spinal Cord Injury Association impairment scale and was unable to walk in conventional rehabilitation.Results: The HAL gait training was received 2 or 3 times per week for 13 sessions. Improvement was observed in gait speed (baseline: 0.12; after training: 0.45 m/sec), step length (baseline: 0.30; after training: 0.45 m), and cadence (baseline: 23.1; after training: 59.6 steps/min) based on a 10-meter walking test; International Standards for Neurological and functional Classification of Spinal Cord Injury (ISNCSCI) motor score (baseline: 59; after training: 76); and walking index for spinal cord injury (WISCI) II score (baseline: 1; after training: 6).Conclusion: We report the recovery of walking ability in a patient with chronic severe incomplete tetraplegic SCI following the HAL training.Keywords: hybrid assistive limb, robotic rehabilitation, incomplete spinal cord injury, robotic gait training

We report a case in which elbow flexion exercises using the upper limb single-joint Hybrid Assistive Limb (upper limb HAL-SJ) were implemented in a patient 13 months postoperatively following elbow flexion reconstruction with intercostal nerve transfer after a traumatic brachial plexus injury. Treatment using the upper limb HAL-SJ was administered once a week for 10 sessions from 13 to 16 months after surgery. Exercises using the upper limb HAL-SJ supported elbow motion by detecting bioelectric signals through surface electrodes on the biceps and triceps brachii. No adverse events were observed during treatment with the upper limb HAL-SJ. Improvements in elbow flexion strength were observed during treatment. Treatment with the upper limb HAL-SJ can be performed safely and effectively following elbow flexion reconstruction by intercostal nerve transfer after a traumatic brachial plexus injury.

Questionnaire about voluntary initiation of foward gait during HAL exoskeleton robot therapy

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.