Iijima Kensuke, Watanabe Hiroki, Nakashiro Yuichi, Iida Yuki, Nonaka Michio, Moriwaka Fumio, Hamada Shinsuke
Department of Rehabilitation, Hokuyukai Neurological Hospital, Sapporo, Japan.
Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Front Neurol. 2023 Jun 8;14:1143820. doi: 10.3389/fneur.2023.1143820. eCollection 2023.
Spinal and bulbar muscular atrophy (SBMA) is a progressive neuromuscular degenerative disease characterized by the degeneration of lower motor neurons in the spinal cord and brainstem and neurogenic atrophy of the skeletal muscle. Although the short-term effectiveness of gait treatment using a wearable cyborg hybrid assistive limb (HAL) has been demonstrated for the rehabilitation of patients with SBMA, the long-term effects of this treatment are unclear. Thus, this study aimed to investigate the long-term effects of the continued gait treatment with HAL in a patient with SBMA.
A 68-year-old man with SBMA had lower limb muscle weakness and atrophy, gait asymmetry, and decreased walking endurance. The patient performed nine courses of HAL gait treatment (as one course three times per week for 3 weeks, totaling nine times) for ~5 years. The patient performed HAL gait treatment to improve gait symmetry and endurance. A physical therapist adjusted HAL based on the gait analysis and physical function of the patient. Outcome measurements, such as 2-min walking distance (2MWD), 10-meter walking test (maximal walking speed, step length, cadence, and gait symmetry), muscle strength, Revised Amyotrophic Lateral Sclerosis Functional Assessment Scale (ALSFRS-R), and patient-reported outcomes, were evaluated immediately before and after gait treatment with HAL for each course. 2MWD improved from 94 m to 101.8 m, and the ALSFRS-R gait items remained unchanged (score 3) for approximately 5 years. The patient could maintain walking ability in terms of gait symmetry, walking endurance, and independence walking despite disease progression during HAL treatment.
The long-term gait treatment with HAL in a patient with SBMA may contribute to the maintenance and improvement of the gait endurance and ability to perform activities of daily living. The cybernics treatment using HAL may enable patients to relearn correct gait movements. The gait analysis and physical function assessment by a physical therapist might be important to maximize the benefits of HAL treatment.
脊髓延髓性肌萎缩症（SBMA）是一种进行性神经肌肉退行性疾病，其特征为脊髓和脑干的下运动神经元变性以及骨骼肌的神经源性萎缩。尽管已证明使用可穿戴半机械人混合辅助肢体（HAL）进行步态治疗对SBMA患者的康复具有短期疗效，但这种治疗的长期效果尚不清楚。因此，本研究旨在调查SBMA患者持续使用HAL进行步态治疗的长期效果。
一名68岁的SBMA男性患者存在下肢肌肉无力和萎缩、步态不对称以及步行耐力下降的问题。该患者进行了约5年的9个疗程HAL步态治疗（一个疗程为每周3次，每次3周，共9次）。患者通过HAL步态治疗来改善步态对称性和耐力。物理治疗师根据患者的步态分析和身体功能调整HAL。在每个疗程的HAL步态治疗前后，立即评估诸如2分钟步行距离（2MWD）、10米步行测试（最大步行速度、步长、步频和步态对称性）、肌肉力量、修订版肌萎缩侧索硬化功能评估量表（ALSFRS-R）以及患者报告的结果等指标。2MWD从94米提高到101.8米，并且ALSFRS-R步态项目在大约5年内保持不变（评分为3分）。尽管在HAL治疗期间疾病进展，但患者在步态对称性、步行耐力和独立行走方面仍能维持步行能力。
SBMA患者长期使用HAL进行步态治疗可能有助于维持和改善步态耐力以及进行日常生活活动的能力。使用HAL的控制论治疗可能使患者重新学习正确的步态动作。物理治疗师的步态分析和身体功能评估对于最大化HAL治疗的益处可能很重要。
