Hybrid Assistive Limb program may improve walking and functional independence but not muscle strength after incomplete spinal cord injury.

Sébastien Mateo, Enguerran Houdry, Lucas Pignon, Louise Segault, Clemence Garrone, Virginie Duplay, Rosalie Mervoyer, Delphine Delubac, Edith Comemale, Alba Toimil-Igesias, Maxime Cheminon, Marion Charvin, Thealie Pierot, Baptiste Eklu, Mathilde Duboisset, Jacques Luauté
Purpose:

To assess the effect of HAL-based program, combined with standard rehabilitation, after incomplete SCI on muscle strength, activity and functional independence.

Methods:

The program involved 30 HAL-assisted walking sessions over six weeks at Henry Gabrielle University Hospital (Hospices Civils de Lyon), alongside rehabilitation. Patients with incomplete SCI seeking improved walking were eligible. Pre- and post-program measures included American Spinal Injury Association (ASIA) motor score, and Impairment Scale (AIS), Walking Index for SCI (WISCI), Spinal Cord Independence Measure (SCIM-II)I, and 10-meter walking test (10WT). Satisfaction was measured after the program by the Clinical Global Impression Improvement (CGI). Ethical approval was obtained (Local Hospital Ethics Committee 23-5108). Linear mixed models (R 4.1.1) were used to compare pre- and post-program effects, with significance set at 5%. Data are reported as mean ±SD and mean difference before and after the program.

Results:

Six patients (mean age 48 ± 14 years) with incomplete SCI (ASIA Impairment Scale C or D) participated. Their motor levels ranged from C2 to L1, with 67% having cervical lesions. The average time since injury was 4 ± 2 months (acute SCI, n=3) or 70 ± 91 months (chronic SCI, n=3). All patients completed at least 25 sessions. Participants reported increased satisfaction, with a mean CGI improvement of 3.8 (±1.5). Post-program, WISCII improved to 11/20 ± 4, with a 2-point (SE=3) increase for acute SCI and 3 points (SE=3) for chronic SCI. The 10WT time decreased by 6s (SE=58) for acute SCI and 45s (SE=58) for chronic SCI. SCIM-III improved by 23 points (SE=15) for acute SCI (z=2.8, p0.01) and by 3 points (SE=12) for chronic SCI. No change was observed in ASIA motor scores.

Conclusion(s):

To our knowledge, this is the first study to investigate the effects of a six-week exoskeleton-based program on muscle strength, mobility, and functional independence. The preliminary results showed high patient compliance and satisfaction with the program. Acute SCI patients significantly improved their walking speed following training. Larger, controlled studies are needed to confirm these promising improvements in mobility and functional independence, as well as the lack of change in muscle strength in response to HAL training.

Implications:

The HAL program demonstrates high patient satisfaction and compliance among those with incomplete SCI, but further research is needed before it can be recommended for routine rehabilitation.

Funding acknowledgements:
The study did not receive any funding.
Keywords:
Proof-of-concept study
exoskeleton
rehabilitation
Primary topic:
Neurology: spinal cord injury
Second topic:
Innovative technology: robotics
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Local Hospital Ethics Committee Hospices Civils de Lyon
Provide the ethics approval number:
23-5108
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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