PMC5822893_01
A summary of the progression of symptoms of the patient.
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fig2
The progression of his gait dysfunction is summarized in Figure 2. Figure 3, obtained 2 years prior to the HAL intervention and 15 years after the T9-T12 laminectomy, shows a high-intensity change persisting in the spinal cord. From this finding, the patient was diagnosed with late-onset neurological deterioration due to spinal atrophy at the site of prior decompression of the thoracic spinal cord.
(a) Midsagittal T2-weighted magnetic resonance image of the thoracic spine, 2 years before the HAL intervention and 15 years after the T9-T12 laminectomy. (b) A high-power magnification view of (a), showing a high-intensity change persisting in the decompressed spinal cord at the T11-T12 level (arrow).
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fig3
Figure 3, obtained 2 years prior to the HAL intervention and 15 years after the T9-T12 laminectomy, shows a high-intensity change persisting in the spinal cord. From this finding, the patient was diagnosed with late-onset neurological deterioration due to spinal atrophy at the site of prior decompression of the thoracic spinal cord.
A photograph of the HAL exoskeleton, including the All-in-One Walking Trainer with the harness which was used during gait session to prevent a fall. The trainer provided consent for use of his image in this report.
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fig4
For safety reasons, the All-in-One Walking Trainer (Ropox, Denmark), which includes a harness, was used for all sessions to prevent falls (Figure 4).
Graphs of the measured variables of the 10 MWT: (a) walking speed, (b) cadence, and (c) step length, measured without HAL, before each HAL session, and (d) walking speed, (e) cadence, (f) step length, and (g) walking distance, measured with the HAL, during each HAL session.
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fig5
HAL intervention improved all measured features of gait performance during the 10 MWT, with the pre- to postintervention increases (Figures 5-5) in gait speed (0.83 m/s to 0.97 m/s; beta = 0.61, p=0.036), cadence (1.83 steps/s to 2.00 steps/s), and step length (0.45 m to 0.48 m; beta = 0.52, p=0.082). Figures 5-5 show those outcomes during HAL session.
(a) Temporal profile of the angular position of the hip joint over the gait cycle, measured without the HAL, before and after the HAL intervention. (b) Range of motion of the hip over the gait cycle, measured without the HAL, before and after the HAL intervention. Error bars indicate the standard errors of the mean. Flex, flexion; Ext, extension; ROM, range of motion.
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Changes in lower limb kinematics are shown in Figures 6-9. SD maximum hip angle flexion during the swing phase increased from 23.4 +- 1.3  to 31.3 +- 1.0  on the left side and from 28.1 +- 1.6  to 35.3 +- 2.0  on the right side (Figure 6).
(a) Temporal profile of the angular position of the knee joint over the gait cycle, measured without the HAL, before and after the HAL intervention. (b) Range of motion of the knee over the gait cycle, measured without the HAL, before and after the HAL intervention. ROM, range of motion.
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fig7
Changes in lower limb kinematics are shown in Figures 6-9. Similarly, maximum flexion decreased at the knee from 57.2 +- 1.5  to 53.3 +- 0.6  on the left side and from 63.6 +- 1.9  to 57.3 +- 2.4  on the right side (Figure 7), with a further decrease in ankle plantar flexion, from 5.3 +- 1.8  to 3.6 +- 1.2  on the right side (Figure 8). Surface EMG profiles of the gastrocnemius are shown in Figure 8.
(a) Temporal profile of the angular position of the ankle joint over the gait cycle, measured without the HAL, before and after the HAL intervention. (b) Surface electromyography of the gastrocnemius muscles. (c) The muscle activation ratio of the gastrocnemius (swing phase to the total step cycle), before and after the HAL intervention. (d) Toe clearance, before and after the HAL intervention.
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fig8
Changes in lower limb kinematics are shown in Figures 6-9. Similarly, maximum flexion decreased at the knee from 57.2 +- 1.5  to 53.3 +- 0.6  on the left side and from 63.6 +- 1.9  to 57.3 +- 2.4  on the right side (Figure 7), with a further decrease in ankle plantar flexion, from 5.3 +- 1.8  to 3.6 +- 1.2  on the right side (Figure 8). Surface EMG profiles of the gastrocnemius are shown in Figure 8. The muscle activation ratio of the gastrocnemius decreased from 30 +- 10% to 14 +- 5% (Figure 8), while toe clearance increased from 59 +- 6 to 62 +- 7 mm (Figure 8).
Step length before and after the HAL intervention.
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fig9
Changes in lower limb kinematics are shown in Figures 6-9. Step length increased from 477 +- 31 mm to 510 +- 23 mm on the left side and from 417 +- 43 to 464 +- 26 mm on the right side (Figure 9).