HAL Exoskeleton Treadmill Training for Chronic Spinal Cord Injury Amy Harmon BME 281 Section 1 10/7/15.

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HAL Exoskeleton Treadmill Training for Chronic Spinal Cord Injury Amy Harmon BME 281 Section 1 10/7/15

Background Motor Incomplete Complete paraplegic Extensive rehabilitation Chronic neuropathic pain (CNP) Pharmacological and non-pharmacological treatment resistent Body Weight Supported Treadmill Training: New method which rehabilitates muslce strength and over- the-ground walking ability May affect cerebellum activation Displayed reduction in CNP

BWSTT with HAL exoskeleton Cruciger et al. "Impact of Locomotion Training with a Neurologic Controlled Hybrid Assistive Limb (HAL) Exoskeleton on Neuropathic Pain and Health Related Quality of Life (HRQoL) in Chronic SCI: A Case Study*."Disability and Rehabilitation: Assistive Technology Disabil Rehabil Assist Technol (2014): 1-6. Web.

HAL exoskeleton Frame and motored robotic actuators Hip and knee muscles Electromyography (EMG) electrodes to Bio-electric signals Trigger robotic support Voluntary control Aach et al. "Voluntary Driven Exoskeleton as a New Tool for Rehabilitation in Chronic Spinal Cord Injury: A Pilot Study." The Spine Journal : Official Journal of the North American Spine Society (2014)

Methods 12 week intervention period of 6day/week treadmill training of 60 minute duration for 4 participants Harness bodyweight support set to level specific to individuals’ minimal assistance required for self- supported movement Baseline speed of treadmill 2.0 kmph with limb clearance ability determining increments of gaining speed Live biofeedback system connected to transducers at hip and knee joints for live muscle effort level results

Results Gate and Speed improvement Walking Index for Spinal Cord Injury II (WISCI II) Supraspinal activation in cerebullum fMRI scans while patients exhibited ankle plantar flexion and toe flexion at various intervals of time Winchester et al.“Changes in Supraspinal Activation Patterns Following Robotic Locomotor Therapy in Motor-Incomplete Spinal Cord Injury.”Neurorehabilitation and Neural Repair 19.4 (2005): 313;24. Pubmed. Web.

Results (Cont.) Article [2] focusing on CNP levels dropping after 12 weeks of 90-minute treadmill training with HAL 5 days per week Numerical rating scale (NRS-11) for pain severity assessment Cruciger et al. "Impact of Locomotion Training with a Neurologic Controlled Hybrid Assistive Limb (HAL) Exoskeleton on Neuropathic Pain and Health Related Quality of Life (HRQoL) in Chronic SCI: A Case Study*."Disability and Rehabilitation: Assistive Technology Disabil Rehabil Assist Technol (2014): 1-6. Web.

References [1] Winchester, P. "Changes in Supraspinal Activation Patterns following Robotic Locomotor Therapy in Motor-Incomplete Spinal Cord Injury."Neurorehabilitation and Neural Repair 19.4 (2005): PubMed. Web. [2] Cruciger, Oliver, Thomas A. Schildhauer, Renate C. Meindl, Martin Tegenthoff, Peter Schwenkreis, Mustafa Citak, and Mirko Aach. "Impact of Locomotion Training with a Neurologic Controlled Hybrid Assistive Limb (HAL) Exoskeleton on Neuropathic Pain and Health Related Quality of Life (HRQoL) in Chronic SCI: A Case Study*."Disability and Rehabilitation: Assistive Technology Disabil Rehabil Assist Technol (2014): 1-6. Web. [3] Aach, M., O. Cruciger, M. Sczesny-Kaiser, O. Ho ̈ ffken, RCh Meindl, M. Tegenthoff, P. Schwenkreis, Y. Sankai, and TA Schildhauer. "Voluntary Driven Exoskeleton as a New Tool for Rehabilitation in Chronic Spinal Cord Injury: A Pilot Study." The Spine Journal : Official Journal of the North American Spine Society (2014): n. pag. Web.