Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury.
Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury.
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DOI：
10.3389/fnins.2017.00649
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发表时间：
2017
影响因子：
4.3
通讯作者：
Yamazaki M
中科院分区：
文献类型：
--
作者：
Shimizu Y;Kadone H;Kubota S;Suzuki K;Abe T;Ueno T;Soma Y;Sankai Y;Hada Y;Yamazaki M
脊髓损伤（SCI）后完全截瘫的患者无法独立站立或行走。站立锻炼可降低SCI患者褥疮、骨质疏松和关节畸形的风险。完全截瘫的常规步态训练需要过度使用上肢来承重，并且在完全四肢瘫痪的情况下是困难的。本研究的目的是描述在慢性SCI后完全四肢/截瘫患者中使用混合辅助肢体®（HAL）通过上肢活动触发的自愿截肢。本研究入组了4例患者（3例男性，1例女性）。患者平均年龄±标准差为37.2 ± 17.8（范围：20-67）岁。干预前的临床评估显示了以下结果：病例1，神经学水平C6，美国脊髓损伤协会损伤量表（AIS）B级;病例2，T6，AIS A;病例3，T10 AIS A;和病例4，T11，AIS A。HAL干预包括10次会议。每个HAL疗程持续60-90 min。用于髋关节和膝关节屈伸的HAL电极放置在上肢的前后两侧，与每个下肢对应。表面肌电图（EMG）用于评估阔筋膜张肌和股四头肌（Quad）的肌肉活动，并与Vicon运动捕捉系统同步。在每次治疗前后还评估了改良Ashworth量表（mAs）评分。所有参与者都完成了所有10次会议。病例1、2和3显示，与治疗前测量值相比，治疗后mAs评分显著降低。在所有情况下，干预前的EMG显示任一Quad均无明显激活。然而，下肢肌肉的步态时相依赖的活动，被认为是在自愿触发Ambassador驱动的上肢肌肉活动。在病例3和4中，干预后观察到两个四头肌的主动收缩。这些结果表明，上肢触发HAL截肢术是一种安全可行的选择，用于慢性SCI引起的完全性四肢/截瘫患者的康复。
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.
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影响因子：
2.9
作者：
La Scaleia V;Sylos-Labini F;Hoellinger T;Wang L;Cheron G;Lacquaniti F;Ivanenko YP
通讯作者：
Ivanenko YP
影响因子：
2.6
作者：
Kawamoto H;Kamibayashi K;Nakata Y;Yamawaki K;Ariyasu R;Sankai Y;Sakane M;Eguchi K;Ochiai N
通讯作者：
Ochiai N
中风后与新外骨骼 - 混合辅助肢体：安全性和可行性的研究。
影响因子：
5.1
作者：
Nilsson A;Vreede KS;Häglund V;Kawamoto H;Sankai Y;Borg J
通讯作者：
Borg J
影响因子：
1.7
作者：
Fujii, Kengo;Abe, Tetsuya;Yamazaki, Masashi
通讯作者：
Yamazaki, Masashi
影响因子：
2.5
作者：
Kawashima, N;Nozaki, D;Nakazawa, K
通讯作者：
Nakazawa, K