case_images: PMC9263275_01
case_images: A photograph showing a hybrid-assisted limb (HAL) for medical use (lower limb type). For safety reasons, we also used a mobile hoist (All-in-One , Ropox A/S, Denmark) to prevent falls during cybernic treatment with HAL.
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case_images: PMC9263275_01_fneur-13-905613-g0001.jpg
case_images: F1
case_images: Tsukuba, Japan) commenced after fitting the device and adjusting the torque and signal sensitivity of the motor unit potentials (Figure 1). The duration of the walking exercise with HAL was 20-30 min per day in one session. The patient completed nine HAL sessions (one course) in ~2 weeks with regular physiotherapy.
case_images: The effect of cybernic treatment with a hybrid-assisted limb (HAL) on gait function. (A) The black dots indicate the measured walk distance (a 2-min walk test, 2MWT). (B) The black dots indicate the speed (a 10-min walk test, 10MWT). Vertical gray bars indicate one course of cybernic treatment with HAL.
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case_images: PMC9263275_01_fneur-13-905613-g0002.jpg
case_images: F2
case_images: As shown in Figure 2, the patient's walking ability improved with clinical significance after the first course of cybernic treatment; the 2MWT improved from 111.5 m at the baseline to 134.2 m (+20.3%) after the first course (Figure 2A). His walking speed also improved from 1.31 to 1.58 m/s (+21.2%) (Figure 2B). However, despite self-training at home, both the 2MWT and the 10MWT worsened mildly after 1 month (Figure 2). Ten months after the initiation of HAL, the 2MWT reached a peak at 177.3 m (+59.0%) (Figure 2A; Supplementary Video 1). The rate of improvement in the 2MWT over 2 years was higher than that in the 10MWT (+59.6% vs. +38.2%) (Figures 2A,B).
case_images: The effect of cybernic treatment with a hybrid-assisted limb (HAL) on the serum levels of creatine kinase and creatinine. (A) The black dots indicate the serum levels of creatine kinase. (B) The black dots indicate the serum levels of creatinine. Vertical gray bars indicate one course of cybernic treatment with HAL.
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case_images: PMC9263275_01_fneur-13-905613-g0003.jpg
case_images: F3
case_images: The patient's serum CK levels decreased from 1,230 to 622 U/L after his first course of cybernic treatment with HAL (Figure 3A). CK levels due to HAL's therapeutic effect and efficacy in improving gait. Conversely, the patient's serum creatinine level, a biomarker of muscle mass in SBMA, was maintained (Figure 3B).