Hybrid Assistive Limb Exoskeleton HAL in the Rehabilitation of Chronic Spinal Cord Injury: Proof of Concept; the Results in 21 Patients.

Document Type


Publication Date


Publication Title

World Neurosurg


Adolescent; Adult; Aged; Analysis of Variance; Chronic Disease; Exoskeleton Device; Female; Humans; Male; Middle Aged; Neurological Rehabilitation; Proof of Concept Study; Spinal Cord Injuries; Treatment Outcome; Walk Test; Walking; Young Adult; Body weight–supported treadmill training; Exoskeleton; Functional mobility; Hybrid assistive limb; Spinal cord injury


INTRODUCTION: The use of mobile exoskeletons is becoming more and more common in the field of spinal cord injury (SCI) rehabilitation. The hybrid assistive limb (HAL) exoskeleton provides a tailored support depending on the patient's voluntary drive.

MATERIALS AND METHODS: After a pilot study in 2014 that included 8 patients with chronic SCI, this study of 21 patients with chronic SCI serves as a proof of concept. It was conducted to provide further evidence regarding the efficacy of exoskeletal-based rehabilitation. Functional assessment included walking speed, distance, and time on a treadmill, with additional analysis of functional mobility using the following tests: 10-meter walk test (10MWT), timed up and go (TUG) test, 6-minute walk test (6MWT), and the walking index for SCI II (WISCI-II) score.

RESULTS: After a training period of 90 days, all 21 patients significantly improved their functional and ambulatory mobility without the exoskeleton. Patients were assessed by the 6MWT, the TUG test, and the 10MWT, which also indicated an increase in the WISCI-II score along with significant improvements in HAL-associated walking speed, distance, and time.

CONCLUSION: Although, exoskeletons are not yet an established treatment in the rehabilitation of spinal cord injuries, the devices will play a more important role in the future. The HAL exoskeleton training enables effective, body weight-supported treadmill training and is capable of improving ambulatory mobility. Future controlled studies are required to enable a comparison of the new advances in the field of SCI rehabilitation with traditional over-ground training.

Clinical Institute

Neurosciences (Brain & Spine)