Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan.
Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata 950-0165, Japan.
Medicina (Kaunas). 2023 Jul 5;59(7):1251. doi: 10.3390/medicina59071251.
Peripheral nerve disorder of the lower extremities causes drop foot and disturbs the daily living activities of patients. The ankle joint hybrid assistive limb (HAL) provides voluntary ankle joint training using surface bioelectrical signals from the muscles of the lower extremities. We investigated the neurological effects of ankle joint HAL training in three patients. Sensory nerve action potentials (SNAPs) and compound muscle action potentials (CMAPs) were analyzed for the peroneal and tibial nerves prior to the first ankle joint HAL training session. Integrated surface electromyography EMG signals were recorded before and after the HAL training sessions to evaluate the effects of training for neuromuscular disorders. The patients were hospitalized to receive rehabilitation with HAL training for 2 weeks. The HAL training was performed daily with two 60 min sessions. All cases demonstrated severe neuromuscular impairment according to the result of the CMAP. All integrated EMG measurements of antagonistic muscle activities decreased after the ankle joint HAL training. The manual muscle testing (MMT) scores of each muscle were slightly increased after the HAL intervention for Case 2(tibialis anterior, from 2 to 2+; gastrocnemius muscles, from 2- to 2; extensor digitorum longus, and extensor hallucis longus, from 1 to 3). The MMT scores were also slightly increased except for gastrocnemius muscle for Case 3 (tibialis anterior, extensor digitorum longus, and extensor hallucis longus, from 2- to 2). These two patients demonstrated voluntary muscle contractions and nerve signals in the CMAP before the HAL training. Even though the amplitude of CMAPs was low, the HAL training may provide voluntary ankle joint movements by reducing the antagonistic muscle contraction via computer processing. The HAL training may enhance muscle movement and coordination through motor learning feedback.
下肢周围神经障碍会导致足下垂，扰乱患者的日常生活活动。踝关节混合辅助肢体 (HAL) 使用来自下肢肌肉的表面生物电信号提供自愿踝关节训练。我们在三名患者中研究了踝关节 HAL 训练的神经学效果。在第一次踝关节 HAL 训练前，分析了腓肠神经和胫神经的感觉神经动作电位 (SNAP) 和复合肌肉动作电位 (CMAP)。在 HAL 训练前后记录综合表面肌电图 (EMG) 信号，以评估对神经肌肉障碍的训练效果。患者住院接受 HAL 训练 2 周的康复治疗。HAL 训练每天进行两次，每次 60 分钟。根据 CMAP 的结果，所有病例均表现出严重的神经肌肉功能障碍。所有拮抗肌活动的综合 EMG 测量值在踝关节 HAL 训练后均降低。HAL 干预后，Case 2 的各肌肉手动肌肉测试 (MMT) 评分略有增加（胫骨前肌从 2 级增加到 2+级；腓肠肌从 2-级增加到 2 级；趾长伸肌和踇长伸肌从 1 级增加到 3 级）。除腓肠肌外，Case 3 的 MMT 评分也略有增加（胫骨前肌、趾长伸肌和踇长伸肌从 2-级增加到 2 级）。这两名患者在 HAL 训练前的 CMAP 中表现出自愿的肌肉收缩和神经信号。即使 CMAP 的幅度较低，HAL 训练也可以通过计算机处理减少拮抗肌收缩来提供自愿的踝关节运动。HAL 训练可以通过运动学习反馈增强肌肉运动和协调性。
