Objective: We performed rehabilitation using a Hybrid Assisted Limb (HAL) for PD and found that gait and balance functions improved before and after HAL rehabilitation.

Background: In patients with Parkinson’s disease (PD), 65% of Yahr4 patients have a history of falls in the previous month, with or without the On-Off phenomenon. Freezing of gait (FOG) is another symptom that becomes more apparent in severe patients. Although both falls and FOG are factors that reduce ADL and quality of life in PD, there are few effective ways to improve them.

Method: The subjects were 13 PD patients (mean age 72.7 years, mean disease duration 10.1 years) who requested HAL rehabilitation. 11 patients were evaluated for gait function before and after HAL rehabilitation, and 11 patients were evaluated for the center of gravity sway test. Both tests were performed in 8 patients. Walking function was evaluated in terms of time (sec), speed (m/s), number of steps (steps), and stride length (m). Postural improvement was determined by measurement. The center-of-gravity sway test evaluated the unit area trajectory length, total trajectory length, outer circumference area, average center displacement of the X-axis and Y-axis sway, and Romberg’s ratio.

Results: Improvement in posture was observed before and after HAL rehabilitation, and no difference was observed in time, number of steps, or stride length, which are gait assessments, but significant improvement in walking speed was observed (P<0.05). As previously reported, the center of gravity of PD patients was shifted backward. No significant change was observed in the center of gravity, but there was a significant improvement in the spinal cord intrinsic reflex. Significant improvement was seen in unit area trajectory length, which indicates spinal cord intrinsic reflex postural control, and in circumferential area, which indicates balance function impairment (P < 0.05).

Conclusion: Factors such as stiffness, dystonia, medicines, disuse syndrome, spinal degeneration, and abnormal endogenous sensory receptors are involved in postural abnormalities in PD. As we have reported in the past, there is a disturbance of the sensory integration system in PD. The improvement in posture after HAL rehabilitation, and the improvement in the center-of-gravity test, suggest that HAL rehabilitation may be involved in the sensory integrative system.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/why-is-hal-effective-in-improving-gait-and-balance-function-in-parkinsons-disease/