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In recent years, there has been growing demand for flat electrical machines in order to minimize system size while also maintaining high efficiency. In general, axial flux machines (AFMs) are more suitable for flat form than radial flux machines (RFMs). AFMs usually employ a soft magnetic composite (SMC) for the stator core, and their efficiency can be improved by employing an SMC that has low iron loss. However, this reduces the average torque because there is generally a tradeoff relationship between iron loss and magnetic permeability in SMCs. This article, therefore, proposes an AFM with a coreless rotor structure in which the torque performance is not easily affected by the permeability of the SMC. This article aims to reveal the ideal SMC characteristics for high efficiency in AFMs. First, many virtual SMC materials with different iron loss and permeability are used for simulations of AFMs in order to investigate sensitivity to material properties. The simulations by virtual SMCs take into account the experimental increase in the iron loss. As a result, guidelines for developing SMCs are constructed based on the experimental results. Finally, prototype AFMs employing new SMCs developed by following the guidelines are shown, and it is found that they offer higher efficiency in all operating area than conventional AFMs. In particular, one prototype achieves an extremely high efficiency of over 96% at 6000 r/min, 0.8 Nm in experiments.

Fibrosis is a condition characterized by the overproduction of extracellular matrix (ECM) components (e.g., collagen) in the myofibroblasts, causing tissue hardening and eventual organ dysfunction. Currently, the molecular mechanisms that regulate ECM production in the myofibroblasts are still obscure. In this study, we investigated the function of GPRC5B in the cardiac and lung myofibroblasts using real-time RT-PCR and siRNA-mediated knockdown. We discovered a significantly high expression of Gprc5b in the tissues of the fibrosis mice models and confirmed that Gprc5b was consistently expressed in the myofibroblasts of fibrotic hearts and lungs. We also found that Gprc5b expression was associated and may be dependent on the actin-MRTF-SRF signaling pathway. Notably, we observed that Gprc5b knockdown reduced the expression of collagen genes in the cardiac and lung myofibroblasts. Therefore, our findings reveal that GPRC5B enhances collagen production in the myofibroblasts, which directly promotes fibrosis in the tissues.

Sintered materials are superior in productivity because of their simple process, but they are not applied to high-load gears because of their insufficient strength. To improve the fatigue strength of sintered materials, the authors have developed liquid-phase sintering which can achieve high-density without using secondary processing. In this study, the effect of boron addition (0-0.4 mass%) on the rolling contact fatigue strength of Fe-Ni-Mo-B-C sintered and carburized material was evaluated. In addition, in order to evaluate only the boron addition effect excluding the influence of density, the sintered density of each specimen was controlled to be the same. In the test range of this study, the rolling contact fatigue limit (pmax)lim of material with an additional quantity of boron of 0.1 mass% showed the highest value exceeding 1700 MPa. This value was not only significantly higher than the (pmax)lim of the boron-free material (1100 MPa), but also an extremely high value comparable to the (pmax)lim of wrought steel (1900 MPa). The reason why the (pmax)lim of a 0.1B roller was remarkably high was investigated from the viewpoints of both pore structure and material structure. As for the pore structure, the pore shape of the boron-free roller was irregular, whereas the pore shape of the 0.1B roller was spherical. As a result of CAE analysis of the orthogonal shear stress inside the roller during the rolling contact fatigue test, it was found that the maximum value of orthogonal shear stress around the pores of the 0.1B roller was about 35 % lower than that of the boron-free roller. This result suggests that cracks are less likely to occur in the 0.1B roller than in the boron-free roller. In other words, it is thought that the pore shape of 0.1B material affects the improvement of rolling contact fatigue strength.

Sintered materials are superior in productivity because of their simple process, but their mechanical properties are low. To improve the mechanical properties of sintered materials, we focus on liquid-phase sintering. In this study, we selected boron as sintering aids and evaluated on the effect of the addition quantity of boron (0-0.6 mass%) to the mechanical properties of liquid-phase sintered and heat-treated materials. In the test range of this study, the tensile strength of material with an additional quantity of boron of 0.1 mass% showed the highest value, 1386 MPa, which is about 35% higher compared to the tensile strength of material without adding boron. On the other hand, materials with an additional quantity of boron of 0.2 mass% or higher showed higher-density than material with an additional quantity of boron of 0.1 mass%, but both their elongation and tensile strength were significantly decreased. The precipitates changed between the boundary of the quantity of boron added of 0.1 and that of 0.2 mass%. Only Fe23B6 was formed in the material with the boron addition amount of 0.1 mass% or less, and Fe23B6 and Fe2B were formed in the material with the boron addition amount of 0.2 mass% or more. By cross-sectional observation of the test specimen after the tensile test, it was confirmed that in the material with the boron addition amount of 0.2 mass% or more cracks occurred and propagated at the Fe23B6/Fe2B interface and finally resulted in fracture. In the material with the boron addition amount of 0.1 mass%, however, such a fracture was not confirmed. The phenomena could be explained the fact that the mechanical properties were sharply changed between the quantity of boron added of 0.1 mass% and 0.2 mass%. The existence of Fe23B6/Fe2B interface would significantly affect the strength of the liquid-phase sintered materials.

International audience; Accentuated by the ongoing coronavirus disease (COVID-19) pandemic, the change in Japan to community-based health and care services for older adults indicates an urgent need to enhance and spread citizens’ understanding of care. This is a broader notion of care that incorporates conditions within the community to support the inclusion of older adults, involving not only those older adults receiving care and their direct providers of care, but also others in the community who are involved in the daily lives of these older adults. To underpin such a broader notion of care across citizens, this paper proposes ‘care literacy’ as a novel analytical concept, defined as the knowledge and capabilities that enable people in need of care to live their daily lives in the community and facilitate potential health and care solutions. Reflecting the interconnection of health and care and rooted in the local context, care literacy underpins aging by enabling this involvement of the broader community, and is disseminated through media and grassroot activities.

Fibrosis is attributed to excess deposition of extracellular matrix (ECM) proteins including collagen and is associated with various organ dysfunction. This excessive ECM is produced by myofibroblasts, which are differentiated from various cells by a variety of stimuli, represented by TGF-β. However, molecular mechanisms for the regulation of ECM production in myofibroblasts remain obscure. In this study, we demonstrate that the expression of drebrin, which binds to and increases the stability of actin filament in neurons, is increased in mouse hearts and lungs upon fibrosis. Drebrin is mainly expressed in myofibroblasts in the fibrotic hearts and lungs and promotes the expression of fibrosis-related genes, such as Acta2 and Col1a1. Taken together, our study identifies drebrin as a molecule that promotes the production of fibrosis-related genes in myofibroblasts.

Here, we present a study on exoskeleton robot control based on inter-limb locomotor synergies using a robot control method developed to target hemiparesis. The robot control is based on inter-limb locomotor synergies and kinesiological information from the non-paretic leg and a walking aid cane to generate motion patterns for the assisted leg. The developed synergy-based system was tested against an autonomous robot control system in five patients with hemiparesis and varying locomotor abilities. Three of the participants were able to walk using the robot. Results from these participants showed an improved spatial symmetry ratio and more consistent step length with the synergy-based method compared with that for the autonomous method, while the increase in the range of motion for the assisted joints was larger with the autonomous system. The kinematic synergy distribution of the participants walking without the robot suggests a relationship between each participant's synergy distribution and his/her ability to control the robot: participants with two independent synergies accounting for approximately 80% of the data variability were able to walk with the robot. This observation was not consistently apparent with conventional clinical measures such as the Brunnstrom stages. This paper contributes to the field of robot-assisted locomotion therapy by introducing the concept of inter-limb synergies, demonstrating performance differences between synergy-based and autonomous robot control, and investigating the range of disability in which the system is usable.

In general, radial gap motors employing neodymium sintered permanent magnet (Nd sintered PM) are used to achieve high torque density in many applications. However, the motors are not suited to a flat, disk-like shape because the dead space, such as the coil ends, occupies most of the motor volume. Therefore, axial gap motors are frequently used for flat shape instead of radial gap motors. Nd sintered PM is a well-known high-performance magnet that has high residual magnetic flux density, but eddy current loss easily occurs in the magnet because of its high conductivity. In axial gap motors for industrial applications, it is difficult to take measures against eddy current loss of Nd sintered PM in terms of cost. Therefore, general axial gap motors employing Nd sintered PM often have unsatisfactory characteristics, such as low efficiency, even though the motor produces high torque. On the other hand, radial gap motors can take measures to suppress eddy current in PMs easily if radial gap motors employ interior permanent magnet structure. Accordingly, this paper discusses an axial gap motor employing neodymium bonded permanent magnet (Nd bonded PM) for flat shape. Compared with Nd sintered PM, Nd bonded PM has lower residual magnetic flux density, but also lower cost. In addition, Nd bonded PM has extremely low eddy current loss due to its low conductivity. It is found from three-dimensional finite element analysis and experimental results that the axial gap motor employing Nd bonded PM can achieve higher torque and higher efficiency compared with the radial gap motor employing Nd sintered PM with the same PM weight and a flat shape.

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.

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.

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.

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.

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.

This questionnaire serves to interview subjects undergoing rehabilitation of joint movement by means of exoskeleton robot HAL (hybrind assistive limbs). The goal is to learn about subjective control strategies during voluntary initiation of joint movement. Questions and multiple-choice answers build on phenomenological introspection. The results of the questionnaire are correlated to a gait score analysis.

This questionnaire serves to interview subjects undergoing rehabilitation of joint movement by means of exoskeleton robot HAL (hybrind assistive limbs). The goal is to learn about subjective control strategies during voluntary initiation of joint movement. Questions and multiple-choice answers build on phenomenological introspection. The results of the questionnaire are correlated to a gait score analysis.

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.

Purpose: The somatosensory event-related potential N140 is thought to be related to selective attention. This study aimed to compare the somatosensory event-related potential N140 in healthy subjects to that in patients with stroke to determine whether N140 and attentiveness are associated in patients with stroke with or without hemispatial agnosia. Materials and Methods: Normal somatosensory event-related potential N140 values were determined using data from ten healthy subjects. Fifteen patients with stroke were divided into two groups based on the presence of hemispatial neglect. Somatosensory event-related potential N140 components were compared between the two groups. Results: Stimulation of the affected limb in the hemispatial agnosia group resulted in significantly longer N140 latency at the contralateral vs. the ipsilateral electrode. This was the inverse of the relationship observed in normal subjects, with stimulation of the intact side in patients with hemispatial agnosia, and with stimulation of both the intact and affected sides in patients without agnosia. In the hemispatial agnosia group, the peak latency of N140 following stimulation of the affected side was significantly longer than it was following stimulation of the intact side and when compared to that in patients without agnosia. In addition, abnormal N140 peak latencies were observed at the Cz and ipsilateral electrodes in patients with hemispatial agnosia following stimulation of the intact side. Conclusions: These findings suggest that somatosensory event-related potential N140 is independently generated in each hemisphere and may reflect cognitive attention.

Context: The purpose of this report was to describe the improvement in walking ability using the Hybrid Assistive Limb® (HAL®) intervention in the case of a patient with paraplegia after spinal cord injury whose condition deteriorated because of a spinal dural arteriovenous fistula (SDAVF). Findings: A 48-year-old man started the HAL® intervention twice per week (total 10 sessions), after his neurologic improvement had plateaued from 3 to 6 months postoperatively for an SDAVF. During the HAL® intervention, the 10-m walk test (10MWT) without HAL® was performed before and after each session. An electromyography system was used to evaluate muscle activity of both the gluteus maximus (Gmax) and quadriceps femoris (Quad) muscles in synchronization with the Vicon motion capture system. The International Standards for Neurological and Functional Classification of Spinal Cord Injury (ISNCSCI) motor scores of the lower extremities and the Walking Index for Spinal Cord Injury II (WISCI II) score were also assessed to evaluate motor function. The HAL® intervention improved gait speed and cadence during the 10MWT. Before the intervention, both the Gmax and left Quad muscles were not activated. After the intervention, the right Gmax and both Quad muscles were activated in stance phase rhythmically according to the gait cycle. The ISNCSCI motor score also improved from 14 to 16, and the WISCI II scored improved from 7 to 12. Conclusion/clinical relevance: Our experience with this patient suggests that the HAL® can be an effective tool for improving functional ambulation in patients with chronic spinal cord injury.

Introduction/Background We developed Qolo, a new personal mobility device for those with motor disability in their lower limbs It assists sit-to-stand and stand-to-sit postural transitions, as well as navigation in standing posture with hands-free operation Its mechanism to assist postural transition is implemented with passive gas springs without using electric actuators, making it compact, light-weight and low cost The purpose of this study is to report a clinical assessment of the device with people with spinal cord injury (SCI), and investigate plausibility of the device and discuss further technical improvements. Material and method Four participants with SCI (age: 31–52y, 3 males and one female, neurological level: T10-L3, AIS: A-C, MMT Hip Ext: 0-1, Knee Ext: 1–5) were asked to conduct stand-up and sit-down postural transitions using the device ( Fig. 1 ) Feasibility and duration of the assisted motions were evaluated. Results Two of the participants conducted stand-up motion by themselves using the device (duration: 14 and 16 s) The other two needed external posture support The main factor that differed in relation to the ability of performing stand-up motion using the device was MMT Knee Ext; greater than 2 for the group that was able to perform, and 1 for the other All participants conducted sit-down motion by themselves using the device without external support (10–15 s). Conclusion Capability of the device to assist posture transition was shown for some SCI people through the experiment At the same time, greater assistance on the knee joint was found to be necessary Because the device utilizes voluntary control of the trunk to induce assisted motion of knee and ankle joints for posture transition, we considered that assistance for trunk motion would be helpful for them For the next step, we plan to introduce a mechanism for lumbar posture stabilization that can support motion of hip in coordination with knee.

Background Gait disturbance often occurs in stroke survivors. Recovery of walking function is challenging, as some gait disturbance due to hemiparesis often remains even after rehabilitation therapy, presenting a major obstacle towards regaining activities-of-daily-living performance and achieving social reintegration. Objective This study aims to clarify the effectiveness of a walking program involving the wearable Hybrid Assistive Limb (HAL-TS01) robotic exoskeleton for improving walking ability in stroke patients with hemiparesis and stagnant recovery despite ongoing rehabilitation. Methods This is a multicenter, randomized, parallel-group, controlled study (HAL group, n=27; control group, n=27). The study period includes preintervention observation (until stagnant recovery), intervention (HAL-based walking therapy or conventional rehabilitation; 5 weeks), and postintervention observation (2 weeks). Following provision of informed consent and primary registration, the patients undergo conventional rehabilitation for preintervention observation, during which the recovery of walking ability is monitored to identify patients with stagnant recovery (based on weekly assessments using the 10-meter maximum walking speed [MWS] test). Patients with an MWS of 30-60 m/minute and insufficient weekly improvement in MWS undergo secondary registration and are randomly assigned to undergo HAL-based walking therapy (HAL group) or conventional rehabilitation (control group). The primary outcome is the change in MWS from baseline to the end of the 5-week intervention. Results This study began in November 2016 and is being conducted at 15 participating facilities in Japan. Conclusions Assessments of walking ability vary greatly and it is difficult to define the threshold for significant differences. To reduce such variability, our study involves conducting conventional rehabilitation to the point of saturation before starting the intervention. Stagnation in the recovery of walking ability despite conventional rehabilitation highlights the limits of current medical care. The present study may bring evidence that HAL-based therapy can overcome such limitations and induce added recovery of walking ability, which would promote the use of HAL technology in the clinical setting. Trial Registration UMIN Clinical Trials Registry UMIN000024805; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000028545

Recently, locomotor training with robotic assistance has been found effective in treating spinal cord injury (SCI). Our case report examined locomotor training using the robotic suit hybrid assistive limb (HAL) in a patient with complete C4 quadriplegia due to chronic SCI. This is the first report examining HAL in complete C4 quadriplegia.The patient was a 19-year-old man who dislocated C3/4 during judo 4 years previously. Following the injury, he underwent C3/4 posterior spinal fusion but remained paralyzed despite rehabilitation. There was muscle atrophy under C5 level and no sensation around the anus, but partial sensation of pressure remained in the limbs. The American Spinal Injury Association impairment scale was Grade A (complete motor C4 lesion). HAL training was administered in 10 sessions (twice per week). The training sessions consisted of treadmill walking with HAL. For safety, 2 physicians and 1 therapist supported the subject for balance and weight-bearing. The device's cybernic autonomous control mode provides autonomic physical support based on predefined walking patterns. We evaluated the adverse events, walking time and distance, and the difference in muscle spasticity before and after HAL-training using a modified Ashworth scale (mAs). No adverse events were observed that required discontinuation of rehabilitation. Walking distance and time increased from 25.2 meters/7.6 minutes to 148.3 meter/15 minutes. The mAs score decreased after HAL training.Our case report indicates that HAL training is feasible and effective for complete C4 quadriplegia in chronic SCI.

Introduction/Background Patients with complete paraplegia after spinal cord injury (SCI) are difficult to walk by themselves. Gait training with conventional orthoses requires excessive upper limb usage and is difficult to train knee extensor during ambulation. Robotic devices have recently been used in clinical settings for such patients. Hybrid Assistive Limb (HAL) is a wearable exoskeleton robot that assists the user in voluntary control of knee and hip joint motion by detecting even very weak muscle activities. However, the conventional method using HAL is not applicable in patients with complete paraplegia. The purpose of this study is to describe voluntary gait and voluntary knee extension using Heterotopic Triggered HAL (T-HAL) method in patients with complete quadri/paraplegia after chronic SCI. Material and method Seven patients, 20–67 years old, C6-T11, AIS A-B, were enrolled in this study. HAL session consisted of two parts: the first session was voluntary ambulation using upper limb muscle activation; hip flexion and extension triggered by contralateral muscle activities of anterior deltoid and posterior deltoid and knee flexion and extension triggered by contralateral biceps and triceps brachii, respectively. The second session, for cases who could contract hip flexor, was done for active knee extension using hip flexor activation. Surface electromyography (EMG) was used to evaluate muscle activity of hip flexor and quadriceps femoris (Quad) in synchronization with motion capture. The modified Ashworth scale (mAs) score was evaluated before and after each session. Results In cases 1, 2, mAs score significantly decreased after each session. In all cases, EMG before the intervention showed no activation in either Quad. However, periodic activation of the lower limb muscles was seen during HAL ambulation. In case 3, 4, active contraction in both Quads was observed after intervention. Conclusion These findings suggest that T-HAL method is feasible option for complete quadri/paraplegia with chronic SCI.

We developed Fe/FeSiAl soft magnetic powder cores (SMCs) for realizing the miniaturization and high efficiency of an electromagnetic conversion coil in the high-frequency range (∼20 kHz). We found that Fe/FeSiAl SMCs can be formed with a higher density under higher compaction pressure than pure-iron SMCs. These SMCs delivered a saturation magnetic flux density of 1.7 T and iron loss (W1/20k) of 158 kW/m3. The proposed SMCs exhibited similar excellent characteristics even in block shapes, which are closer to the product shapes.

金沢大学国際基幹教育部, Humans employ various control strategies to initiate and maintain bodily movement. In case that the normal gait function is impaired, exoskeleton robots provide motor assistance during therapy. While the robotic control system builds on kinematic gait functions, the patient’s voluntary efforts to initiate motion also contribute to the effectiveness of the therapy process. However, it is currently not well understood how voluntary initiation as a subjective capacity affects the physiological level of motor control. In order to understand the functional nexus between voluntary initiation and motor control, we interviewed patients undergoing robotic gait rehabilitation with the HAL exoskeleton robot about their experience and command of voluntarily initiating forward gait while using the HAL system. Their reports provide phenomenal evidence for voluntary initiation as a distinct cognitive act that comes as phenomenal performance. Furthermore, phenomenal evidence about the functional relation of intention and initiation correlates with FIM-M gait scores. Based on the assumption that HAL reduces control-related difficulties of voluntarily initiating joint movement, we identified two cognitive control strategies, shaping and compensation of gait, that imply a heterarchic organization of the human system of action control. © 2018 Grüneberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The purpose of this study was to report the improvement of walking ability using Hybrid Assistive Limb (HAL) training in a case of severe thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). The patient received HAL training 2-3 times per week (10 sessions) beginning on the thirteenth postoperative day. The patient’s walking ability and lower muscles strength were significantly improved. It suggests that HAL training in the early postoperative phase has the potential to be an effective rehabilitation tool to improve functional ambulation in surgically-treated thoracic OPLL patients with inability of walk.

Dysphagia can cause serious challenges to both physical and mental health. Aspiration due to dysphagia is a major health risk that could cause pneumonia and even death. The videofluoroscopic swallow study (VFSS), which is considered the gold standard for the diagnosis of dysphagia, is not widely available, expensive and causes exposure to radiation. The screening tests used for dysphagia need to be carried out by trained staff, and the evaluations are usually non-quantifiable. This paper investigates the development of the Swallowscope, a smartphone-based device and a feasible real-time swallowing sound-processing algorithm for the automatic screening, quantitative evaluation, and the visualisation of swallowing ability. The device can be used during activities of daily life with minimal intervention, making it potentially more capable of capturing aspirations and risky swallow patterns through the continuous monitoring. It also consists of a cloud-based system for the server-side analyzing and automatic sharing of the swallowing sound. The real-time algorithm we developed for the detection of dry and water swallows is based on a template matching approach. We analyzed the wavelet transformation-based spectral characteristics and the temporal characteristics of simultaneous synchronised VFSS and swallowing sound recordings of 25% barium mixed 3-ml water swallows of 70 subjects and the dry or saliva swallowing sound of 15 healthy subjects to establish the parameters of the template. With this algorithm, we achieved an overall detection accuracy of 79.3% (standard error: 4.2%) for the 92 water swallows; and a precision of 83.7% (range: 66.6%–100%) and a recall of 93.9% (range: 72.7%–100%) for the 71 episodes of dry swallows., We developed the Swallowscope, a smartphone-based device for the automatic screening, quantitative evaluation and the visualisation of swallowing ability. The device can be used during activities of daily life by simply wearing it around the neck, and the continuous monitoring makes it potentially more capable of capturing aspirations and risky swallow patterns. This device-based swallow assessment could help to develop protocols for the quantitative evaluation of swallowing ability, which are comparable and repeatable. In this paper we discuss the development of the Swallowscope, its evaluation and how the Swallowscope could be used at hospitals or elderly care facilities for the assessment and evaluation of swallowing ability throughout the daytime and/or mealtime.