Department of Neurosurgery, Fukuoka University Hospital.
Department of Rehabilitation, Fukuoka University Hospital.
Neurol Med Chir (Tokyo). 2020 Apr 15;60(4):217-222. doi: 10.2176/nmc.oa.2019-0268. Epub 2020 Mar 13.
The single-joint Hybrid Assistive Limb (HAL-SJ) robot is an exoskeleton-type suit developed for the neurorehabilitation of upper limb function. Several studies have addressed the usefulness of the robot; however, the appropriate patient selection remains unclear. In this study, we evaluated the effectiveness of the HAL-SJ exoskeleton in improving upper limb function in the subacute phase after a stroke, as a function of the severity of arm paralysis. Our analysis was based on a retrospective review of 35 patients, treated using the HAL-SJ exoskeleton in the subacute phase after their stroke, between October 2014 and December 2018. The severity of upper limb impairment was quantified using the Brunnstrom recovery stage (BRS) as follows: severe, BRS score 1-2, n = 10; moderate, BRS 3-4, n = 12; and mild, BRS 5-6, n = 13. The primary endpoint was the improvement in upper limb function, from baseline to post-intervention, measured using the Fugl-Meyer assessment upper limb motor score (ΔFMA-UE; range 0-66). The ΔFMA-UE score was significant for all three severity groups (P <0.05). The magnitude of improvement was greater in the moderate group than in the mild group (P <0.05). The greatest improvement was attained for patients with a moderate level of upper limb impairment at baseline. Our findings support the feasibility of the HAL-SJ to improve upper limb function in the subacute phase after a stroke with appropriate patient selection. This study is the first report showing the effect of robot-assisted rehabilitation using the HAL-SJ, according to the severity of paralysis in acute stroke patients with upper extremity motor deficits.
单关节混合辅助肢体（HAL-SJ）机器人是一种为上肢功能神经康复而开发的外骨骼式套装。已经有几项研究探讨了该机器人的实用性，但合适的患者选择仍不清楚。在这项研究中，我们根据 35 名患者的回顾性分析，评估了 HAL-SJ 外骨骼在中风后亚急性期改善上肢功能的效果，其作用与手臂瘫痪的严重程度有关。我们使用 Brunnstrom 恢复阶段（BRS）量化上肢损伤的严重程度，具体如下：严重，BRS 评分 1-2，n = 10；中度，BRS 3-4，n = 12；轻度，BRS 5-6，n = 13。主要终点是从基线到干预后的上肢功能改善，使用 Fugl-Meyer 上肢运动评分（ΔFMA-UE；范围 0-66）进行评估。所有三个严重程度组的 ΔFMA-UE 评分均有显著差异（P <0.05）。中度组的改善程度大于轻度组（P <0.05）。基线时上肢损伤程度为中度的患者改善最大。我们的研究结果支持 HAL-SJ 在适当的患者选择下，在中风后亚急性期改善上肢功能的可行性。这是第一项根据上肢运动功能缺损的急性中风患者瘫痪严重程度报告 HAL-SJ 机器人辅助康复效果的研究。
