Hybrid assistive limb device may accelerate elbow flexion after nerve transfer
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Virtual rehabilitation with a hybrid assistive limb device after nerve transfer in patients with brachial plexus injuries may accelerate elbow flexion and decrease rehabilitation time.
Researchers compared postoperative functional outcomes and rehabilitation performance between patients with brachial plexus injuries who underwent intercostal nerve to musculocutaneous nerve transfer followed by either rehabilitation using an upper limb single-joint hybrid assistive limb device (HAL-FS01, Cyberdyne Inc.; n=8) or conventional postoperative rehabilitation with electromyographic biofeedback techniques (n=50).
Researchers noted hybrid assistive limb training consisted of virtual and power training courses, with virtual training beginning before the hybrid assistive limb device picked up motor unit potentials from the target muscle through electrodes attached to the skin overlying the original donor muscles and power training beginning after the maturation of motor unit potentials. Researchers added hybrid assistive limb assist was carried out in the power training phase by decreasing the settings in an inversely proportionate manner to the increase in target muscle strength.
Results showed similar follow-up times, elbow flexion range of motion or power of elbow flexion assessed using the British Medical Council grade, and quantitative measurement using Kin-Com dynamometer among the hybrid assistive limb device and electromyographic biofeedback groups. However, researchers noted patients in the hybrid assistive limb device group had significantly fewer rehabilitation sessions vs. patients in the electromyographic biofeedback group.
Although patients in the electromyographic biofeedback group could not elicit elbow flexion when the power of elbow flexion was British Medical Council grade 1, researchers found the hybrid assistive limb device assisted elbow flexion when electrodes were attached to British Medical Council grade 1 power strength biceps.
“Through the electrical amplifier circuit, the patient experienced the full recovery of elbow flexion even in the early stages of rehabilitation,” the authors wrote. “Furthermore, patients could easily train and strengthen their muscle power when the assist mode was employed in a gradually decreasing manner.”
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This is an interesting study on the serial use of the upper limb single-joint hybrid assistive limb for rehabilitation of the arm after nerve transfer for elbow flexion in patients with brachial plexus injury. The hybrid assistive limb training was made of both virtual and power training courses.
It was interesting that the virtual training was started before the detection of motor unit potentials from the target muscle, and power training started after the maturation of the motor unit potentials. The authors were able to achieve similar outcome measures including range of motion, power of elbow flexion assessed using British Medical Council grade and Kin-Com dynamometer in patients treated with the hybrid assistive limb and those with conventional postoperative rehabilitation protocol with electromyographic biofeedback technique. However, they found that the number of rehabilitation sessions was significantly less in hybrid assistive limb.
We have tried a similar pattern of virtual training on patients after muscle transfers and we were able to achieve even better outcome in addition to the shorter duration of rehabilitation.
We believe that the application of such tools that include both virtual and power training is going to improve the postoperative patients’ outcome specifically in complex upper extremity reconstruction.
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