It is a device manufactured by the Japanese Cyberdyne company, made of very light and extremely durable plastic. It is known as the Hybrid Assistive Limb, in short HAL®.
The Lower Limb HAL® Version was approved in December 2015 by the international health organization as a device for medical therapy (i.e. medical device certificate CE 0197).
HAL® is the only device that is activated and controlled directly by the nervous system of the patient – the so-called active exoskeleton. The movement command, which is created in the brain, specifically in the motor cortex, is transmitted to the muscles of the patient in the form of a nerve impulse, transmitted through the spinal cord and peripheral nerves, causing muscle contraction and movement.
In patients with neurogenic gait dysfunctions (after an accident or as a result of a disease), induction or transmission of such a signal is significantly weakened. For this reason, the patient is not able to initiate movement. With the HAL® device, residual nerve signals are received by sensors (located on the surface of the skin, the muscles of the lower limbs of the patient), then amplified and transmitted to the robot. The system recognizes them and provides the patient the necessary force support which allows him/her to perform a desired, target movement. This stimulates to the maximum the phenomenon called neuroplasticity. The formation of new connections between neurons (nerve cells) improves the transmission of nerve-muscle signals, which stimulates the central nervous system even more effectively (the so-called biofeedback).
This phenomenon is responsible for the effectiveness of therapy. Systematic exercises performed during training create new neural connections, rebuild the gait pattern, enhance the muscle strength and restore the ability to walk.
Not every patient is able to start therapy HAL from the first moment after arriving to our clinic.
If the signals we read from the patient’s muscles are too weak, there is a chance that they will be strengthened during the preparatory therapy and the patient will be able to start therapy with HAL.
We want HAL therapy to be effective from the very beginning so the patient must be well prepared for it from the physical side.
A. Therapy preparing to use HAL® System or as an independent therapy – without using HAL System (An example of the scope of therapy)
Time frames of rehabilitation are adjusted to current patient’s health condition (2-6 weeks). Therapy is conducted 6 days per week.
Therapy program (example):
Total time spent on therapy is approximately 240-300 minutes daily.
The cost of rehabilitation is individual and depends on the amount and type of treatments.
B. Main Therapy using HAL® System
Recommended length of therapy for people with spinal cord injury: 12 weeks (60 sessions on HAL)
Recommended length of therapy for people after stroke: 12 weeks (60 session on HAL)
Recommended length of therapy for people with multiple sclerosis: Four-week stays (20 sessions on HAL) repeated at intervals of one or two months
Total time spent on therapy is approximately 240-300 minutes daily.
There is possibility of accommodation outside the resort. In this case, the patient will have two three-hour therapeutic sessions in our clinic. The cost of accommodation and meals are on the patient side.
The clinic can arrange transportation from the place of accommodation by taxi (3 times a day). Planned break between morning and afternoon training – up to 4 hours.
The final cost of rehabilitation is individual and depends on the amount and type of treatments.
Detailed program of treatment and therapy is being discussed and consulted individually, depending on indications and health condition of the Patient
Concerning all packages: A, B
All of Therapy packages include consultation with prof. Małgorzata Łukowicz – specialist from medical rehabilitation, physical medicine and balneology (one consultation before starting therapy program and), if patient decides to stay longer than 4 weeks, second consultation after finishing therapy program).
Therapy is being conducted only individually- each therapist is working only with one Patient.
Our therapists are using the most recent, widely known and globally approved methods such as: PNF, IBITA Bobath, Advance European Neuromuscular Techniques, Kaltenborn-Evjent, Cyriax, McKenzie, Orthopedic Manual Therapy and Osteopathy.
Because HAL® effectively improves the muscle strength of the lower limbs the treatment is dedicated to a wide group of patients with impaired gait, who have the minimal function of the lower limbs (paraparesis) so as to be able to control the robot through own nerve impulses.
The bionic HAL® skeleton can be used in the following diseases:
• Incomplete spinal cord injury
• Craniocerebral injury
• Multiple sclerosis
• Neurodegenerative diseases
• Muscular dystrophy
• Neuromuscular diseases
Qalifying session - HAL®
Rehabilitation increases independence of the patient, in particular improves the walking ability and the strength of muscle groups of the lower limbs as well as improves balance and gait pattern.
It is important that after completion of the therapy with neuromuscular biofeedback its effects remain stable, of course, provided that the patient.
WHAT IS THE COURSE OF HAL® THERAPY?
Neuromuscular feedback therapy in paraplegic patients requires weak neurological residual impulses in the muscles that can be picked up by sensors. Other patient groups, patients suffering from stroke and patients with neuromuscular conditions for which studies are currently underway, must meet certain suitability prerequisites.
As a paralyzed patient, ask your attending physician or physical therapist if you still have a residual activity in the muscles relevant for the hip and knee joints. According to experience, this is the case with 20 to 30 percent of all paraplegic patients. Your medical records then need to be forwarded to Constance Care Rehabilitation Center (www.constancecare.pl , firstname.lastname@example.org ) where an initial medical evaluation will take place. If you are suitable, you will be invited for test training.
The basis for the start of therapy is a positive result of the first (test) training. If the test training was successful and the patient is eligible for the HAL®treatment, we offer the therapeutic cycle which lasts for about 3 months. In outpatient mode (visits) the patient is subjected to the therapy every day for 5 days a week. Daily treatment duration is about two hours, including the time required for preparation of the patient before and after substantial training. In stationary mode (residence) the patient is accommodated in our rehabilitation centre and in addition to the HAL® therapy, which is run for 5 or 6 days a week, has individually developed comprehensive therapy program – additional therapeutic activities. The duration of rehabilitation is up to 300 minutes a day. The scope and intensity is each time adjusted to the needs and possibilities of the patient.
Progress of the therapy is daily recorded and made available to both the patient and the medical services of the insurer (if the insurance company finances the treatment).
On request, the patient or the payer receives a video showing the progress of therapy.
Published on 18.05.2017
Against the odds: what to expect in rehabilitation of chronic spinal cord injury with a neurologically controlled Hybrid Assistive Limb exoskeleton. A subgroup analysis of 55 patients according to age and lesion level.
Published on 18.01.2017
“Experiences in Four Years of HAL Exoskeleton SCI Rehabilitation” in Converging Clinical and Engineering Research on Neurorehabilitation II. Editor: Ibáñez, J., González-Vargas, J., Azorín, J.M., Akay, M., Pons, J.L. (Eds.)
In this book chapter the authors draw a résumé from the experience of the past years with the HAL® therapy. The positive results of 40 chronic and 20 acute patients with spinal cord injuries are described.