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Potential of Hybrid Assistive Limb Treatment for Ataxic Gait Due to Cerebellar Disorders Including Hemorrhage, Infarction, and Tumor

  • Hiroshi Abe
  • Takashi Morishita
  • Kazuhiro Samura
  • Kenji Yagi
  • Masani Nonaka
  • Tooru Inoue
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 129)

Abstract

Cerebellar hemorrhage (CH) is a severe life-threatening disorder, and surgical treatment is often required in an emergency situation. Even in cases in which the surgical procedure is successful, functional recovery is likely to be delayed because of cerebellar symptoms such as ataxia and gait disturbance. Here, we briefly review the efficacy of hybrid assistive limb (HAL) treatment in neurosurgical practice and propose a new comprehensive treatment strategy for CH to facilitate early neurological recovery. We have experienced cases of ataxic gait due to various etiologies, treated with rehabilitation using the HAL, and our data showed that HAL treatment potentially improves ataxic gait and balance problems. HAL treatment seems to be an effective and promising treatment modality for selected cases. Future studies should evaluate gait appearance and balance, in addition to walking speed, to assess improvement in cerebellar symptoms.

Keywords

Hybrid assistive limb Cerebellar hemorrhage Neurorehabilitation Ataxic gait 

Notes

Acknowledgements

This study was in part supported by a Japan Society for the Promotion of Science Grant-in-Aid for young scientists [(B) 15 K19984], the Takeda Science Foundation, the Uehara Memorial Foundation, the Central Research Institute of Fukuoka University [No. 161042], and the Clinical Research Promotion Foundation in Japan.

Conflict of Interest

The authors have no conflicts of interest to report.

References

  1. 1.
    Yamamoto T, Nakao Y, Mori K, Maeda M. Endoscopic hematoma evacuation for hypertensive cerebellar hemorrhage. Minim Invasive Neurosurg. 2006;49:173–8.CrossRefGoogle Scholar
  2. 2.
    Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.CrossRefGoogle Scholar
  3. 3.
    Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, Greenberg SM, Huang JN, MacDonald RL, Messe SR, Mitchell PH, Selim M, Tamargo RJ, American Heart Association Stroke Council, Council on Cardiovascular Nursing. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41:2108–29.CrossRefGoogle Scholar
  4. 4.
    Basteris A, Nijenhuis SM, Stienen AH, Buurke JH, Prange GB, Amirabdollahian F. Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review. J Neuroeng Rehabil. 2014;11:111.CrossRefGoogle Scholar
  5. 5.
    Norouzi-Gheidari N, Archambault PS, Fung J. Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: systematic review and meta-analysis of the literature. J Rehabil Res Dev. 2012;49:479–96.CrossRefGoogle Scholar
  6. 6.
    Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Quality of Care and Outcomes Research. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47:e98–e169.CrossRefGoogle Scholar
  7. 7.
    Suzuki K, Mito G, Kawamoto H, Hasegawa Y, Sankai Y. Intention-based walking support for paraplegia patients with robot suit HAL. Adv Robot. 2007;21:1441–69.Google Scholar
  8. 8.
    Fukuda H, Morishita T, Ogata T, Saita K, Hyakutake K, Watanabe J, Shiota E, Inoue T. Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: a pilot study. Assist Technol. 2016;28:53–6.CrossRefGoogle Scholar
  9. 9.
    Stinear CM, Barber PA, Smale PR, Coxon JP, Fleming MK, Byblow WD. Functional potential in chronic stroke patients depends on corticospinal tract integrity. Brain. 2007;130:170–80.CrossRefGoogle Scholar
  10. 10.
    Grefkes C, Fink GR. Connectivity-based approaches in stroke and recovery of function. Lancet Neurol. 2014;13:206–16.CrossRefGoogle Scholar
  11. 11.
    Xerri C, Zennou-Azogui Y, Sadlaoud K, Sauvajon D. Interplay between intra- and interhemispheric remodeling of neural networks as a substrate of functional recovery after stroke: adaptive versus maladaptive reorganization. Neuroscience. 2014;283:178–201.CrossRefGoogle Scholar
  12. 12.
    Mohajerani MH, Aminoltejari K, Murphy TH. Targeted mini-strokes produce changes in interhemispheric sensory signal processing that are indicative of disinhibition within minutes. Proc Natl Acad Sci U S A. 2011;108:E183–91.CrossRefGoogle Scholar
  13. 13.
    Takatsuru Y, Fukumoto D, Yoshitomo M, Nemoto T, Tsukada H, Nabekura J. Neuronal circuit remodeling in the contralateral cortical hemisphere during functional recovery from cerebral infarction. J Neurosci. 2009;29:10081–6.CrossRefGoogle Scholar
  14. 14.
    Liu J, Qin W, Zhang J, Zhang X, Yu C. Enhanced interhemispheric functional connectivity compensates for anatomical connection damages in subcortical stroke. Stroke. 2015;46:1045–51.CrossRefGoogle Scholar
  15. 15.
    Ueba T, Hamada O, Ogata T, Inoue T, Shiota E, Sankai Y. Feasibility and safety of acute phase rehabilitation after stroke using the hybrid assistive limb robot suit. Neurol Med Chir (Tokyo). 2013;53:287–90.CrossRefGoogle Scholar
  16. 16.
    Fukuda H, Samura K, Hamada O, Saita K, Ogata T, Shiota E, Sankai Y, Inoue T. Effectiveness of acute phase hybrid assistive limb rehabilitation in stroke patients classified by paralysis severity. Neurol Med Chir (Tokyo). 2015;56:487–92.CrossRefGoogle Scholar
  17. 17.
    Hamada O, Samura K, Abe H, Fukuda H, Ogata T, Nonaka M, Higashi T, Shiota E, Inoue T. Three cases with ataxic gait disorder improved by using a hybrid assistive limb robot suit. Jpn J Neurosurg. 2015;24:413–9.CrossRefGoogle Scholar
  18. 18.
    Chihara H, Takagi Y, Nishino K, Yoshida K, Arakawa Y, Kikuchi T, Takenobu Y, Miyamoto S. Factors predicting the effects of hybrid assistive limb robot suit during the acute phase of central nervous system injury. Neurol Med Chir (Tokyo). 2016;56:33–7.CrossRefGoogle Scholar
  19. 19.
    Morishita T, Inoue T. Interactive bio-feedback therapy using hybrid assistive limbs for motor recovery after stroke: current practice and future perspectives. Neurol Med Chir (Tokyo). 2016;56(10):605–12.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Hiroshi Abe
    • 1
  • Takashi Morishita
    • 1
  • Kazuhiro Samura
    • 2
  • Kenji Yagi
    • 1
  • Masani Nonaka
    • 1
  • Tooru Inoue
    • 1
  1. 1.Department of NeurosurgeryFukuoka University Faculty of MedicineFukuokaJapan
  2. 2.Department of NeurosurgeryInternational University of Health and Welfare, School of MedicineNaritaJapan

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