Wearable robotic leg device can improve walking ability in ALS

A wearable robotic device called the Hybrid Assistive Limb (HAL) can improve walking ability in people with amyotrophic lateral sclerosis (ALS), and it may also help to preserve quality of life for patients, a new study from Japan shows.

Notably, however, findings suggest that walking improvements with the HAL device do not lead to a meaningful improvement in quality of life, “highlighting the complex relationship between motor function and patient-reported outcomes in patients with ALS,” researchers wrote.

The study, “Impact of hybrid assistive limb on gait ability and quality of life in patients with amyotrophic lateral sclerosis,” was published in Frontiers in Neurology.

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ALS is a neurological disease that causes progressive muscle weakness and eventual paralysis. People with ALS usually have difficulty walking, and this can take a major toll on quality of life.

HAL is a wearable robotic device that wraps around the legs. It is designed to sense small signals from patient’s muscles when they try to move, then help assist the patient’s movements by supporting and pushing the limbs. The device is sold by Cyberdyne, which was not involved in the present study.

In Japan, HAL has been approved for more than a decade to aid in rehabilitation for people living with ALS and other disorders that affect mobility. The device is also available in the U.S. and Europe.

Previous studies have shown that the device can help improve walking ability in people with ALS, but whether its impact on mobility actually translates into better life quality for patients remained unknown.

To help find out, researchers in Japan enrolled 30 people with ALS in a study. The participants each completed a rehabilitation program using HAL for nine rehabilitation sessions over the course of about a month, with each session lasting 20 to 40 minutes. Before and after the robot-assisted rehab program, participants completed standardized assessments of walking ability and quality of life.

HAL treatment was associated with short-term improvements in gait performance in patients with ALS.

Walking ability was assessed primarily by tracking how far patients could walk in a two-minute period. Results showed that this distance improved by nearly 12 meters (39 feet) on average, from about 92 meters (302 feet) prior to the HAL program to 104 meters (341 feet) after the program.

Notably, measures of walking speed, cadence, and step length over a shorter distance did not change, indicating that the robot-assisted program helped patients walk further but didn’t alter their walking style.

“HAL treatment was associated with short-term improvements in gait performance in patients with ALS,” the researchers wrote.

Quality of life was measured with a standardized assessment called the SF-36, which measures quality of life in terms of physical health as well as mental and social well-being. Over the course of the intervention, however, SF-36 scores did not significantly change.

According to the researchers, the lack of change in SF-36 scores might mean that the HAL intervention helped preserve patients’ life quality. However, the study lasted a relatively short time, and there wasn’t a comparison group that didn’t receive HAL, making it impossible to draw definitive conclusions.

The fact that quality of life did not improve, even though walking distance did, also indicates that better walking ability doesn’t automatically mean that ALS patients will feel like their life quality is better.

The team noted a need for further research to evaluate the long-term impact of HAL-assisted rehab on ALS patients’ quality of life.