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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.

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.

Iron-based sintered materials are fabricated via the process of compacting iron powder by using die, sintering in 1100 to 1300°C, and quenching or sizing. These materials are used as variable valve system and oil pump system in automobiles. Recently, the severe requirement for complication and high precision shape of them has increased the products machined by turning and drilling. In general, it is more difficult to machine the sintered materials than the steel. However, the quantitative evaluations and the mechanisms of those are ambiguous, then there is a few suggestion for improvement of the machining. In this study, we will report the machinability of sintered materials by compare with that of steel materials, and the improvement of machinability of sintered materials.

Cerebral palsy (CP) patients with spastic diplegia struggle to perform activities of daily life (ADL) using their upper arms. The single-joint-type Hybrid Assistive limb (HAL) for upper limbs is a new portable robot that can provide elbow motion support in accordance with bioelectric activation of patient's biceps and triceps brachii muscles. The purpose of this study is to assess the feasibility and efficacy of the use of HAL for CP patients. Two patients were enrolled in this study. (Case 1: a 19-years-old male, at the Gross Motor Function Classification System (GMFCS) level IV, Case 2: a 17-years-old male at GMFCS level III). Both these patients experienced difficulty in voluntary elbow extension in ADLs. The HAL intervention (eight sessions; voluntary extension-flexion training of the elbow with HAL and clinical evaluation) was conducted for both sides in Case 1 and for the right side in Case 2. Clinical assessments were conducted as follows: Surface electromyography was used to evaluate the muscle activities of the biceps, triceps brachii, trapezius, and pectoralis major during elbow extension-flexion. The voluntary extension-flexion angles of the elbow, the coactivation index of the biceps and triceps brachii muscles, synergy analysis, and the Action Research Arm Test (ARAT) scores were assessed before and after the HAL sessions; the FIM score was evaluated before and after the entire intervention. In Case 1, the voluntary extension angle tended to increase after the HAL sessions. In both cases, the ARAT scores improved after the sessions. The FIM scores improved after HAL intervention. The voluntary extension-flexion of the elbow using the HAL may be a feasible option for rehabilitation of CP patients.

Hemiparetic gait is a common condition after stroke which alters importantly the quality of life of stroke survivors. In recent years, several robotic interventions have been developed to support and enhance rehabilitation strategies for such population. The Hybrid Assistive Limb® (HAL) robot suit is a unique device able to collect in real time bioelectric signals from the patient to support and enhance voluntary gait. HAL has been used before in early stages of stroke showing gait improvement after the intervention. However, evaluation of the coordination of gait has not been done yet. Coordination is a key factor for an adequate gait performance; consequently, its changes may be closely related to gait recovery. In this study, we used planar covariation to evaluate coordination changes in hemiparetic stroke patients after early HAL intervention. Before starting, impaired intersegmental coordination for the paretic and non-paretic side was evident. HAL intervention was able to induce recovery of the covariation loop shape and deviation from the covariation plane improving intersegmental coordination. Also, there was a tendency of recovery for movement range evidenced by comparison of peak elevation angles of each limb segment of the patients before and after HAL intervention, and also when compared to healthy volunteers. Our results suggest that early HAL intervention contributed to the improvement of gait coordination in hemiparetic stroke patients by reinforcing central pattern generators and therefore reshaping their gait pattern. Trial registration: UMIN000022410 2016/05/23.

Most pediatric cancer patients decline physical performance therapy, resulting in limitations in the activities of daily living. The objective of this study was to investigate the effects of rehabilitation in pediatric patients with cancer using the functional independence measure (FIM) score. This retrospective study included 25 inpatient children diagnosed with cancer at a single university hospital from January 2016 to December 2016. All patients underwent rehabilitative intervention during their hospital stay. We investigated the contents of the rehabilitation program and the FIM scores before and after the rehabilitative intervention. The average FIM scores improved in all patients; however, only the total-FIM scores (+4.96 points, P=0.009) and motor-FIM scores (+4.04 points, P=0.005) improved significantly. Conversely, cognitive-FIM score did not significantly improve (+0.92 points, P=0.159). In addition, motor-FIM subgroup scores for locomotion (walk/wheelchair and stairs) were significantly higher (+0.36 points, P=0.039 and +0.64 points, P=0.046, respectively) after rehabilitative intervention, regardless of the length of hospital stay. This study showed that FIM score, particularly motor-FIM score and locomotion subgroup scores, significantly improved owing to participation in inpatient rehabilitation. In conclusion, we found that rehabilitative intervention improved physical activity, especially locomotion.

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.

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.

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.

Our objective is to provide a novel habilitation experience using play to children with special needs, in particular to those with congenital defects of the upper limbs. Our concept is a device-assisted motivational training session using tangible building block devices. In order to verify the feasibility of our concept with used bioToys in a clinical training session with occupational therapists. Our participant was a one-year-old girl with congenital amputation of the right upper limb. We verified that bioToys could be used in clinical training for a prosthesis, and could assist with both playful training and quantitative therapeutic evaluation.

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.

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.

Vascular dementia (VaD) is a heterogeneous clinical entity based on various vascular pathophysiological processes underlying the subtypes of cerebrovascular disease (CVD). Several diagnostic criteria are currently being used for the clinical diagnosis of VaD, but they are mostly more than 10 years old and need to be renovated including the use of functional brain imaging methods such as single photon emission computerized tomography (SPECT). There is a limitation in the diagnosis based on the strict dichotomy between AD and VaD, and the concept of "AD with CVD" or "mixed dementia" should be included in the clinical diagnosis of VaD.

In this paper we present an investigation on the clinical applicability of a newly developed control method for wearable lower limbs exoskeleton robots. The method we developed is based on using body joint synergistic effect, with a walking aid cane to estimate and provide assistance on the affected limb(s). The outcome of hemiparetic persons walking with our developed system shows the subjects immediately being able to walk with the system. The outcome also shows improvement in some gait aspects such as joint range of motion on the knee of the affected side and symmetry ratio in regard to step length. This investigation exhibits the clinical applicability of the proposed method, and prospective gait function improvements of using the system. The prospect of this research contributes to the technology of assisted locomotion, which helps the locomotion of physically challenged people.

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.

Rationale: Medial medullary infarction accounts for less than 1% of brain infarctions, and medial medullary infarctions is very rarely caused by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Patient concerns: We report the case of a 76-year-old man at low risk of arteriosclerosis who presented with disorders on the left side including gaze-evoked nystagmus, paralysis of the extremities, pyramidal signs, sensory disturbance, and dysesthesia. Brain magnetic resonance imaging also showed right medial medullary infarction. Diagnoses: Medial medullary infarction caused by ANCA-related vasculitis was diagnosed based on mild renal dysfunction and high levels of blood leukocytes, C-reactive protein (CRP), and myeloperoxidase (MPO)-ANCA. Interventions and outcomes: He underwent two 3-day courses of steroid pulse therapy involving daily 1000 mg doses of methylpredonine. He then received 30 mg/day (0.5 mg/kg/day) of prednisolone (PSL) without other immunosuppressants. Levels of MPO-ANCA and the inflammatory marker CRP decreased rapidly a month after admission. Once MPO-ANCA became undetectable, the PSL dose was carefully reduced to 10 mg/day. To treat his paralysis, we provided rehabilitation with a Hybrid Assistive Limb five times starting at a month post-onset. His Barthel index score rose from 45 to 70 points. Lessons: Medullary infarction is mostly caused by arteriosclerosis and vertebral arterial dissection. When systemic inflammatory findings are obtained, ANCA-associated vasculitis should be considered a potential cause, and steroid pulse therapy should be promptly administered.

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. As a result, monitoring and managing dysphagia is of utmost importance. This study investigates the development of a smartphone-based device and a feasible real-time swallowing sound processing algorithm for the automatic screening for swallowing ability. 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 often non-quantifiable. The Swallowscope we developed is a wearable device based on mobile health, and uses the swallowing sound to quantitatively evaluate swallowing ability. As swallowing sound can be captured continuously and during activities of daily life with minimal intervention, it is an ideal approach to monitor swallowing activities, and its continuous monitoring has a better probability of capturing aspirations and risky swallow patterns. This paper describes the real-time smartphone based algorithm and the application we developed to monitor swallowing activities and evaluates the recognition accuracy by comparing them with VFSS evidence.

This project was concerned with the development of physical sculptures from the motion of an Iaido sword. Iaido is a Japanese traditional martial art concerned with moving a sword and performing a cutting motion at the same time. It is practiced to prepare the swordsman for a surprise attack. All phases of the stroke have to be absolutely flawless to keep the performer alive. From the perspective of Iaido practitioners the performance of Iaido can be regarded as the will to accomplish perfection and finality.This work is concerned with creating a physical sculpture which displays the motions of the Iaido sword during various movement cycles. In order to achieve this, the sword's movements were captured by using a motion capturing system, processed in a 3D CAD system and printed by means of a 3D printer. Video footage of the project is available at http://vimeo.com/62947874

In an ATM network, calls are transmitted through several nodes. At this time, quality control over multiple nodes is considered to be better than quality control for each node independently. In view of such considerations, this paper proposed two control methods regarding discard (loss) quality and call level delay over nodes by carrying quality information in the call. In controlling delay quality, a call delayed at a node is given a higher priority in the next node to recover the delay. Since a cell can remain in one node for a long time, the buffer length of each node is lengthened. This leads to a decrease in the discarding rate. In addition, in discard quality control, the variations in the discard quality of each call can be minimized by performing discard of cells inside a buffer on the basis of the discard quality information of previous nodes when the buffer is full. The effect of these control methods is illustrated by simulation.

In voice packet communication, a fluctuation is produced in the delay time in the network. This makes the packet, which is originally continuous, discontinuous at the receiver, and results in an interruption. The interruption deteriorates the voice quality. Then it is necessary that a delay should be provided at the side of the receiver to absorb the interruption. If the delay for absorbing the fluctuation is too small, the delay cannot sufficiently be absorbed; and if it is too large, the total delay is increased. In either case, the quality of the voice or speech is deteriorated. From such a viewpoint, this paper discusses the absorption of the delay fluctuation of the voice packet. To set the delay for absorbing the fluctuation, the quality of the voice containing interruptions must be evaluated. First, an objective evaluation measure is presented which is well aligned to the subjective evaluation of the deterioration of the voice quality with interruption. A control method to ensure the voice quality above a certain level is presented, which examines the objective evaluation measure for the varying traffic in the network. The method adjusts adaptively the delay for absorbing the delay fluctuation so that the voice quality is kept above a certain reference value.