title: Active elbow flexion is possible in C4 quadriplegia using hybrid assistive limb (HAL®) technology: A case study.
abstract: 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.
authors.affiliation: a Department of Rehabilitation Medicine , University of Tsukuba Hospital , Tsukuba, Ibaraki 305-8576 , Japan.
authors.forename: Yukiyo
authors.identifier: 0000-0001-7491-4516
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: b Center for Innovative Medicine and Engineering , University of Tsukuba Hospital , Tsukuba, Ibaraki 305-8576 , Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kadone
authors.affiliation: c Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kubota
authors.affiliation: d Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan.
authors.forename: Akira
authors.identifier: 0000-0001-6034-1593
authors.initials: A
authors.lastname: Ikumi
authors.affiliation: d Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Abe
authors.affiliation: e Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan.
authors.forename: Aiki
authors.initials: A
authors.lastname: Marushima
authors.affiliation: a Department of Rehabilitation Medicine , University of Tsukuba Hospital , Tsukuba, Ibaraki 305-8576 , Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ueno
authors.affiliation: a Department of Rehabilitation Medicine , University of Tsukuba Hospital , Tsukuba, Ibaraki 305-8576 , Japan.
authors.forename: Ayumu
authors.initials: A
authors.lastname: Endo
authors.affiliation: f Faculty of Systems and Information Engineering , University of Tsukuba , Tsukuba, Ibaraki 305-8573 , Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawamoto
authors.affiliation: b Center for Innovative Medicine and Engineering , University of Tsukuba Hospital , Tsukuba, Ibaraki 305-8576 , Japan.
authors.forename: Kousaku
authors.initials: K
authors.lastname: Saotome
authors.affiliation: g Department of Neurosurgery , Ibaraki Prefectural University Hospital of Health Sciences , Inashiki-gun, Ibaraki 300-0331 , Japan.
authors.forename: Akira
authors.identifier: 0000-0003-2335-674X
authors.initials: A
authors.lastname: Matsushita
authors.affiliation: e Department of Neurosurgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
authors.affiliation: f Faculty of Systems and Information Engineering , University of Tsukuba , Tsukuba, Ibaraki 305-8573 , Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sankai
authors.affiliation: a Department of Rehabilitation Medicine , University of Tsukuba Hospital , Tsukuba, Ibaraki 305-8576 , Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hada
authors.affiliation: d Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
mesh_terms: D004550:Elbow / Q000503:physiopathology*; D006801:Humans; D008297:Male; D015915:Motion Therapy, Continuous Passive / Q000295:instrumentation* / Q000379:methods; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000503:physiopathology; D000066530:Neurological Rehabilitation / Q000295:instrumentation* / Q000379:methods; D011782:Quadriplegia / Q000473:pathology / Q000534:rehabilitation* / Q000628:therapy; D055815:Young Adult
keywords: Active elbow flexion; Complete quadriplegia; Hybrid assistive limb for single joint; Spinal cord injury; Surface electromyography