title: The voluntary driven exoskeleton Hybrid Assistive Limb (HAL) for postoperative training of thoracic ossification of the posterior longitudinal ligament: a case report.
abstract: 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.
authors: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba City , Japan.
authors: Kengo
authors: 0000-0003-4450-0819
authors: K
authors: Fujii
authors: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba City , Japan.
authors: Tetsuya
authors: T
authors: Abe
authors: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba City , Japan.
authors: Shigeki
authors: S
authors: Kubota
authors: b Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Tsukuba City , Japan.|c Center for Innovating Medicine and Engineering , University of Tsukuba , Tsukuba City , Japan.
authors: Aiki
authors: A
authors: Marushima
authors: d Information and Systems, Faculty of Engineering , University of Tsukuba , Tsukuba City , Japan.|e Cybernic Research Center , University of Tsukuba , Tsukuba City , Japan.
authors: Hiroaki
authors: H
authors: Kawamoto
authors: f Department of Rehabilitation , University of Tsukuba , Tsukuba City , Japan.
authors: Tomoyuki
authors: T
authors: Ueno
authors: b Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Tsukuba City , Japan.|e Cybernic Research Center , University of Tsukuba , Tsukuba City , Japan.
authors: Akira
authors: A
authors: Matsushita
authors: b Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Tsukuba City , Japan.
authors: Kei
authors: K
authors: Nakai
authors: e Cybernic Research Center , University of Tsukuba , Tsukuba City , Japan.
authors: Kosaku
authors: K
authors: Saotome
authors: c Center for Innovating Medicine and Engineering , University of Tsukuba , Tsukuba City , Japan.
authors: Hideki
authors: H
authors: Kadone
authors: f Department of Rehabilitation , University of Tsukuba , Tsukuba City , Japan.
authors: Ayumu
authors: A
authors: Endo
authors: f Department of Rehabilitation , University of Tsukuba , Tsukuba City , Japan.
authors: Ayumu
authors: A
authors: Haginoya
authors: f Department of Rehabilitation , University of Tsukuba , Tsukuba City , Japan.
authors: Yasushi
authors: Y
authors: Hada
authors: b Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Tsukuba City , Japan.
authors: Akira
authors: A
authors: Matsumura
authors: d Information and Systems, Faculty of Engineering , University of Tsukuba , Tsukuba City , Japan.|e Cybernic Research Center , University of Tsukuba , Tsukuba City , Japan.
authors: Yoshiyuki
authors: Y
authors: Sankai
authors: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba City , Japan.|c Center for Innovating Medicine and Engineering , University of Tsukuba , Tsukuba City , Japan.
authors: Masashi
authors: M
authors: Yamazaki
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive / Q000295:instrumentation / Q000379:methods*; D017887:Ossification of Posterior Longitudinal Ligament / Q000534:rehabilitation* / Q000601:surgery; D020127:Recovery of Function; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000473:pathology; D016138:Walking
keywords: Ambulation difficulty; Ossification of the posterior longitudinal ligament of the spine; Postoperative procedures; Recovery of function; Robotics