Nishimura Masahiko, Kobayashi Shigetaka, Kinjo Yuki, Hokama Yohei, Sugawara Kenichi, Tsuchida Yukio, Tominaga Daisuke, Ishiuchi Shogo
Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus.
Okinawa Study Center, the Open University of Japan.
Neurol Med Chir (Tokyo). 2018 Jan 15;58(1):39-48. doi: 10.2176/nmc.oa.2017-0082. Epub 2017 Dec 1.
The factors that lead to the improvement of gait function in patients with diseases of the central nervous system (CNS) who use a hybrid assistive limb (HAL) are not yet fully understood. The purpose of the present study was to analyze these factors to determine the prognosis of the patients' gait function. Patients whose CNS disease was within 180 days since onset were designated as the subacute-phase patients, and patients whose disease onset had occurred more than 180 days previously were designated as chronic-phase patients. Fifteen subacute-phase patients and 15 chronic-phase patients were given HAL training. The study analyzed how post-training walking independence in these patients was affected by the following factors: age, disease, lesion area, lower limb function, balance, period until the start of training, number of training sessions, additional rehabilitation, higher-order cognitive dysfunction, HAL model, and the use of a non-weight-bearing walking-aid. In subacute-phase patients, walking independence was related to lower limb function (r = 0.35). In chronic-phase patients, there was a statistically significant correlation between post-training walking independence and balance (r = 0.78). In addition, in patients with a severe motor dysfunction that was accompanied by inattention and global cognitive dysfunction, little improvement occurred, even with double-leg model training, because they had difficulty wearing the device. The results demonstrated that the factors that improved walking independence post HAL training differed between patients with subacute- and chronic-stage CNS diseases. The findings may serve as valuable information for future HAL training of patients with CNS diseases.
使用混合辅助肢体（HAL）的中枢神经系统（CNS）疾病患者步态功能改善的相关因素尚未完全明确。本研究旨在分析这些因素，以确定患者步态功能的预后情况。将发病180天以内的CNS疾病患者指定为亚急性期患者，发病超过180天的患者指定为慢性期患者。对15例亚急性期患者和15例慢性期患者进行了HAL训练。该研究分析了以下因素如何影响这些患者训练后的步行独立性：年龄、疾病、病变区域、下肢功能、平衡能力、开始训练前的时间、训练次数、额外康复治疗、高阶认知功能障碍、HAL型号以及非负重助行器的使用。在亚急性期患者中，步行独立性与下肢功能相关（r = 0.35）。在慢性期患者中，训练后步行独立性与平衡能力之间存在统计学上的显著相关性（r = 0.78）。此外，对于伴有注意力不集中和整体认知功能障碍的严重运动功能障碍患者，即使进行双腿模型训练，改善也很少，因为他们佩戴设备有困难。结果表明，HAL训练后改善步行独立性的因素在亚急性期和慢性期CNS疾病患者之间存在差异。这些发现可能为未来CNS疾病患者的HAL训练提供有价值的信息。
