Postoperative Acute-Phase Gait Training Using Hybrid Assistive Limb Improves Gait Ataxia in a Patient with Intradural Spinal Cord Compression Due to Spinal Tumors

Yuichiro Soma; Shigeki Kubota; Hideki Kadone; Yukiyo Shimizu; Yasushi Hada; Masao Koda; Yoshiyuki Sankai; Masashi Yamazaki

doi:10.3390/medicina58121825

Postoperative Acute-Phase Gait Training Using Hybrid Assistive Limb Improves Gait Ataxia in a Patient with Intradural Spinal Cord Compression Due to Spinal Tumors

Medicina (Kaunas). 2022 Dec 12;58(12):1825. doi: 10.3390/medicina58121825.

Authors

Yuichiro Soma¹, Shigeki Kubota², Hideki Kadone³, Yukiyo Shimizu¹, Yasushi Hada¹, Masao Koda², Yoshiyuki Sankai⁴, Masashi Yamazaki²

Affiliations

¹ Department of Rehabilitation Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan.
² Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan.
³ Center for Innovating Medicine and Engineering (CIME), University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan.
⁴ Faculty of Systems and Information Engineering, University of Tsukuba, Tsukuba 305-0006, Ibaraki, Japan.

Abstract

Sensory ataxia due to posterior cord syndrome is a relevant, disabling condition in nontraumatic spinal cord dysfunction. Ataxic gait is a common symptom of sensory ataxia that restricts activities of daily living. A 70-year-old woman with severe sensory disturbance was diagnosed with intradural extramedullary spinal cord tumors found in the thoracic spine region (T8). Surgical management of the tumors was performed. The patient received gait training 20 days after surgery (postoperative acute phase) using a hybrid assistive limb (HAL). HAL is a wearable exoskeleton cyborg that provides real-time assistance to an individual for walking and limb movements through actuators mounted on the bilateral hip and knee joints. Walking ability was assessed using the 10 m walking test, which included evaluating walking speed, step length, and cadence in every session. To evaluate the immediate effects of HAL training, walking speed and step length were measured before and after the training in each session. During the 10 m walking test, gait kinematics and lower muscle activity were recorded using a motion capture system and wireless surface electromyography before the first session and after completion of all HAL sessions. After the HAL training sessions, improvement in the patient’s gait performance was observed in the gait joint angles and muscle activity of the lower limb. After 10 training sessions, we observed the following changes from baseline: walking speed (from 0.16 m/s to 0.3 m/s), step length (from 0.19 m to 0.37 m), and cadence (from 50.9 steps/min to 49.1 steps/min). The average standard deviations of the knee (from right, 7.31; left, 6.75; to right, 2.93; p < 0.01, left, 2.63; p < 0.01) and ankle joints (from right, 6.98; left, 5.40; to right, 2.39; p < 0.01, left, 2.18; p < 0.01) were significantly decreased. Additionally, walking speed and step length improved immediately after completing all the HAL training sessions. This suggests that HAL gait training might be a suitable physical rehabilitation program for patients with sensory ataxia causing dysfunctional movement of the lower limb.

Keywords: electromyography; gait ataxia; hybrid assistive limb; motion analysis; non-traumatic spinal cord dysfunction; robotic rehabilitation.

Publication types

Case Reports

MeSH terms

Activities of Daily Living
Aged
Female
Gait / physiology
Gait Ataxia
Humans
Spinal Cord Compression*
Spinal Cord Neoplasms*
Spinal Neoplasms*

Grants and funding

This work was funded by the Industrial Disease Clinical Research Grants of the Ministry of Health, Labour, and Welfare, grant number 14060101-01. This work was also supported by Grants-in-Aid for Encouragement of Scientists, grant numbers 20H01124 and 20K19303.