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case_images: Progression of the patient's symptoms following the lightning strike injury and the timing of the initiation of hybrid assistive limb gait training.
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case_images: A 68-year-old man presented with progressive walking difficulties, which progressed to spastic paraplegia that began to worsen around the age of 40 years (Figure 1).
case_images: Mid-sagittal section (a) and axial sections at the T5/6 level (b) and L1 level (c) of the T2-weighted magnetic resonance image showed that his thoracic spinal cord was slightly atrophic (arrow in (b)).
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case_images: Magnetic resonance imaging (MRI) showed that his thoracic spinal cord was slightly atrophic (Figure 2).
case_images: Schematic representation of the hybrid assistive limb (HAL) gait training program used in this study. The program comprised 1 month of gait training using HAL conducted across 10 sessions, ranging between 2 and 3 sessions weekly, a 6-month retention period during which the patient did not undergo any rehabilitation training, another month of HAL training, and an evaluation 3 months after the 2nd HAL training section.
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case_images: The 2nd HAL training section commenced 6 months after the 1st HAL training section, with an evaluation conducted three months after the 2nd HAL training section (Figure 3).
case_images: (a) Photograph of the hybrid assistive limb exoskeleton featuring the All-in-One Walking Trainer with its harness system. This setup was used during gait training sessions to prevent falls and provide support for the safe movement of the patient. (b) For the 10 m walking test, the patient was instructed to walk on a flat surface at a comfortable pace while using double crutches.
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case_images: For added safety and support, a harness was used to deliver body weight support (Figure 4a). During the 10 m walking test, the patient was instructed to walk at a comfortable pace on a flat surface while using double crutches (Figure 4b).