Abstract
Study design:
This is a retrospective study.
Objectives:
The objectives of this study were to categorize unexpected postural changes (UPCs) during gait training in paraplegic patients with wearable gait-assist robots, to reveal the incidence of the UPC and its time-dependent changes during initial gait training period and to investigate neurological level-specific differences.
Setting:
This study was conducted in Fujita Health University, Aichi, Japan.
Methods:
We investigated five patients (46.2±14.6 years; lesion level: T6:3, T12:2). All patients had previously achieved gait with wearable robot and walker at supervision level. The UPCs were counted for 2 years and classified according to their type. The time-course data were calculated from the incidence of UPCs for 10 days from initial gait training with the walker. The neurological level-specific differences were investigated between T6 and T12 injuries.
Results:
Eighty-five UPCs were observed and classified into three categories: anterior breakdown, posterior breakdown (PBD) and mal-timing. The average rate over the entire period was 0.96±0.62 (incidents/h/subject). PBD, which was defined as hyperflexion of both hip joints, occurred with the highest frequency (0.64±0.64 incidents/h/subject). During initial gait training, there was a gradual decrease in the occurrence of UPC. For neurological level-specific differences, UPCs were observed more frequently in T6 injuries (1.36±0.35 incidents/h/subject) compared with T12 injuries (0.36±0.31 incidents/h/subject).
Conclusion:
PBDs might be the result of near collisions between the trunk of the user and the walker, which make it difficult for the users to move their trunk over an anterior stance limb. Training that is focused upon well-timed forward movements of the walker might be required to avoid the occurrence of this common UPC.
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Acknowledgements
Our heartfelt appreciation goes to the late Professor Toru Suzuki who provided helpful advice on experimental design and suggestions on the interpretation of present results. We thank also Hagemu Higuchi and Kiyokazu Nakamura for their helpful data collection and technical assistance. We also thank all subjects for participating in the study. This work is financially supported by the NEDO grant for Basic Technology Development for Practical Application of Human Support Robots (8068149) and Practical Development of Industrial Technology (8080694), and fund from Aichi Science and Technology Foundation (22–2).
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TT is a salaried employee of the ASKA Corporation, which produces WPAL. AU is a salaried employee of the Tomei Brace Company, which distributes WPAL. The remaining authors declare no conflict of interest.
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Koyama, S., Tanabe, S., Saitoh, E. et al. Characterization of unexpected postural changes during robot-assisted gait training in paraplegic patients. Spinal Cord 54, 120–125 (2016). https://doi.org/10.1038/sc.2015.138
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DOI: https://doi.org/10.1038/sc.2015.138
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