Use of Robot-Assisted Ankle Training in a Patient with an Incomplete Spinal Cord Injury: A Case Report

J. Funct. Morphol. Kinesiol., 2023 · DOI: https://doi.org/10.3390/jfmk8010031 · Published: February 27, 2023

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This case report explores the use of robot-assisted ankle training in a patient with an incomplete spinal cord injury. The patient experienced paraplegia after a lumbar vertebra fracture. The intervention involved using a single-joint hybrid assistive limb (HAL-SJ) ankle joint unit (HAL-T) to assist with ankle plantar dorsiflexion exercises, knee flexion and extension, and stepping exercises. The study found that the HAL-SJ intervention induced muscle potentials in the patient's left tibialis anterior muscle, suggesting a potential for muscle contraction that was previously masked by severe motor-sensory deficit.

Study Duration

Not specified

Participants

A 34-year-old male with incomplete paraplegia following a spinal cord injury

Evidence Level

Level IV: Case Report

Key Findings

1
Phasic electromyographic activity was developed in the left tibialis anterior muscle during plantar dorsiflexion of the ankle joint after the intervention.
2
No changes were observed in the left and right ankle joint angles following the HAL-T intervention.
3
Intervention using HAL-SJ induced muscle potentials in a patient with a spinal cord injury who was unable to perform voluntary ankle movements due to severe motor–sensory dysfunction.

Research Summary

This case report describes the use of robot-assisted ankle training (HAL-T) in a patient with incomplete spinal cord injury to improve ankle joint function. The HAL-T intervention consisted of a combination of ankle joint plantar dorsiflexion exercises, squat exercise, and stepping exercises under HAL assistance. The study found that the HAL-T intervention induced muscle potentials in the left tibialis anterior muscle, suggesting potential for muscle contraction masked by severe motor-sensory deficit, though no significant joint angle changes were observed.

Practical Implications

Potential for Muscle Activation

HAL-SJ intervention may help activate muscles in patients with spinal cord injury who have limited voluntary movement.

Adjunct to Traditional Therapy

HAL-SJ can be used as a complementary intervention to traditional physical and occupational therapy programs.

Improved Feedback

The device provides rich visual and sensory feedback that can aid in motor learning and rehabilitation.

Study Limitations

1
The HAL-SJ intervention was performed at approximately 100 days after injury, which is a period of spontaneous recovery due to neuroplasticity after SCI.
2
It is not clear whether the effect of EMG appearance in the left TA obtained in this study was attributed to neuroplasticity or the activation and manifestation of voluntary movements that were difﬁcult to perform due to severe motor sensory impairment.
3
The device is subject to rental fees, which could be a potential cost and may make it difﬁcult to use in all hospitals and institutions.

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