title: Decrease of spasticity after hybrid assistive limb®training for a patient with C4 quadriplegia due to chronic SCI.
abstract: 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.
authors.affiliation: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan.
authors.forename: Akira
authors.identifier: 0000-0001-6034-1593
authors.initials: A
authors.lastname: Ikumi
authors.affiliation: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan.|b Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine , University of Tsukuba, Ibaraki , Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kubota
authors.affiliation: c Department of Rehabilitation Medicine , University of Tsukuba Hospital , Ibaraki , Japan.
authors.forename: Yukiyo
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: d Center for Innovating Medicine and Engineering (CIME) , University of Tsukuba Hospital , Ibaraki , Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kadone
authors.affiliation: e Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan.
authors.forename: Aiki
authors.initials: A
authors.lastname: Marushima
authors.affiliation: c Department of Rehabilitation Medicine , University of Tsukuba Hospital , Ibaraki , Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ueno
authors.affiliation: f Faculty of Systems and Information Engineering , University of Tsukuba , Ibaraki , Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawamoto
authors.affiliation: c Department of Rehabilitation Medicine , University of Tsukuba Hospital , Ibaraki , Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hada
authors.affiliation: e Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
authors.affiliation: f Faculty of Systems and Information Engineering , University of Tsukuba , Ibaraki , Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sankai
authors.affiliation: a Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan.|d Center for Innovating Medicine and Engineering (CIME) , University of Tsukuba Hospital , Ibaraki , Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
mesh_terms: D006801:Humans; D008297:Male; D015915:Motion Therapy, Continuous Passive / Q000379:methods*; D000066530:Neurological Rehabilitation / Q000379:methods*; D011782:Quadriplegia / Q000534:rehabilitation / Q000628:therapy*; D012371:Robotics / Q000379:methods; D013119:Spinal Cord Injuries / Q000473:pathology / Q000534:rehabilitation / Q000628:therapy*; D016138:Walking; D055815:Young Adult
keywords: Hybrid assistive limb (HAL); Locomotor training; Robotics; Spasticity; Spinal cord injury