{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:48:33Z","timestamp":1760057313493,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T00:00:00Z","timestamp":1738540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Industrial Disease Clinical Research Grants of the Ministry of Health Labor and Welfare, Japan","award":["14060101-01"],"award-info":[{"award-number":["14060101-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: A 68-year-old man presented with progressive walking difficulty that developed into spastic paraplegia. This condition was a long-term consequence of a lightning strike injury sustained at the age of 22 years. His symptoms progressively deteriorated, eventually requiring double crutches for ambulation at approximately 40 years of age. A physical evaluation prior to hybrid assistive limb (HAL) training revealed a T10 level neurological injury and an American Spinal Cord Injury Association impairment scale grade D. Here, we aimed to evaluate the therapeutic effects of novel gait training with an HAL in this patient with chronic and progressive neural damage caused by a lightning strike. Methods: The HAL training program is composed of two sections. In the first section, one month of gait training with HAL was conducted across 10 sessions, with 2\u20133 sessions weekly. The second section followed 6 months later. A final evaluation was performed three months after the second section. Results: Electromyographic and kinematic evaluation showed that the HAL gait training inhibited abnormal antagonistic muscle activation in his lower extremities, especially after the first section. Our results collectively indicate that the repeated HAL gait training improved the gait pattern of this patient. Conclusions: Our results suggest that HAL gait training may improve the gait pattern in patients with delayed progressive spastic paraplegia, as observed in this case. In addition, a longer intervention period is recommended to facilitate better adaptation to HAL training. Hence, neurorehabilitation with an HAL could be an innovative treatment approach for delayed progressive spastic paraplegia.<\/jats:p>","DOI":"10.3390\/jcm14030967","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T05:55:22Z","timestamp":1738648522000},"page":"967","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Novel Gait Training with a Hybrid Assistive Limb Improved Delayed Progressive Spastic Paraplegia After a Lightning Strike"],"prefix":"10.3390","volume":"14","author":[{"given":"Yuichiro","family":"Soma","sequence":"first","affiliation":[{"name":"Division of Regenerative Medicine for Musculoskeletal System, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"},{"name":"Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4455-4585","authenticated-orcid":false,"given":"Shigeki","family":"Kubota","sequence":"additional","affiliation":[{"name":"Division of Regenerative Medicine for Musculoskeletal System, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"},{"name":"Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2953-6434","authenticated-orcid":false,"given":"Hideki","family":"Kadone","sequence":"additional","affiliation":[{"name":"Center for Innovative Medicine and Engineering (CIME), University of Tsukuba, Tsukuba 305-0821, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7491-4516","authenticated-orcid":false,"given":"Yukiyo","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kousei","family":"Miura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0292-3493","authenticated-orcid":false,"given":"Yasushi","family":"Hada","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiyuki","family":"Sankai","sequence":"additional","affiliation":[{"name":"Center for Innovative Medicine and Engineering (CIME), University of Tsukuba, Tsukuba 305-0821, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9293-3531","authenticated-orcid":false,"given":"Masashi","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2931","DOI":"10.12688\/f1000research.9537.1","article-title":"Lightning injury is a disaster in Bangladesh?\u2014Exploring its magnitude and public health needs","volume":"5","author":"Biswas","year":"2016","journal-title":"F1000 Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.burns.2007.11.006","article-title":"Lightning injury: A review","volume":"34","author":"Ritenour","year":"2008","journal-title":"Burns"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1212\/01.WNL.0000033801.15204.B5","article-title":"Neurologic manifestations of lightning strikes","volume":"60","author":"Cherington","year":"2003","journal-title":"Neurology"},{"key":"ref_4","first-page":"9","article-title":"Neurorehabilitation of spinal cord injuries following lightning and electrical trauma","volume":"20","author":"Lammertse","year":"2005","journal-title":"NeuroRehabilitation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.burns.2004.03.007","article-title":"Delayed spinal cord injury following electrical burns: A 7-year experience","volume":"30","author":"Ko","year":"2004","journal-title":"Burns"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/S0305-4179(98)00193-4","article-title":"Spinal cord injury after electrical trauma treated in a burn unit","volume":"25","author":"Lorente","year":"1999","journal-title":"Burns"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2876","DOI":"10.1007\/s00415-013-7081-1","article-title":"Analysis of high-voltage electrical spinal cord injury using diffusion tensor imaging","volume":"260","author":"Ohn","year":"2013","journal-title":"J. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1055\/s-2008-1041050","article-title":"Neurorehabilitation of lightning and electrical injuries","volume":"15","author":"Yarnell","year":"1995","journal-title":"Semin. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"470","DOI":"10.47197\/retos.v48.96756","article-title":"Evaluation of the factors that impact upper limb coordination in children with cerebral palsy: A narrative review","volume":"48","author":"Battaglino","year":"2023","journal-title":"Retos"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1163\/1568553054455095","article-title":"Virtual impedance adjustment in unconstrained motion for an exoskeletal robot assisting the lower limb","volume":"12","author":"Lee","year":"2005","journal-title":"Adv. Robot."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1163\/156855307781746061","article-title":"Intention-based walking support for paraplegia patients with robot suit HAL","volume":"21","author":"Suzuki","year":"2007","journal-title":"Adv. Robot."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"E15","DOI":"10.3171\/2017.2.FOCUS171","article-title":"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","volume":"42","author":"Zieriacks","year":"2017","journal-title":"Neurosurg. Focus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s12984-015-0058-9","article-title":"HAL\u00ae exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients","volume":"12","author":"Aach","year":"2015","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1159\/000446700","article-title":"Spinal cord infarction in clinical neurology: A review of characteristics and long-term prognosis in comparison to cerebral infarction","volume":"76","author":"Romi","year":"2016","journal-title":"Eur. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1080\/10790268.2017.1372059","article-title":"Intensive gait treatment using a robot suit hybrid assistive limb in acute spinal cord infarction: Report of two cases","volume":"42","author":"Watanabe","year":"2019","journal-title":"J. Spinal Cord Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1179\/204577211X13207446293695","article-title":"International standards for neurological classification of spinal cord injury","volume":"34","author":"Kirshblum","year":"2011","journal-title":"J. Spinal Cord Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1179\/2045772314Y.0000000196","article-title":"International standards for neurological classification of spinal cord injury: Cases with classification challenges","volume":"37","author":"Kirshblum","year":"2014","journal-title":"J. Spinal Cord Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1038\/sc.2013.9","article-title":"The walking index for spinal cord injury (WISCI\/WISCI II): Nature, metric properties, use and misuse","volume":"51","author":"Ditunno","year":"2013","journal-title":"Spinal Cord"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1038\/sc.2013.127","article-title":"Walking index for spinal cord injury version II in acute spinal cord injury: Reliability and reproducibility","volume":"52","author":"Scivoletto","year":"2014","journal-title":"Spinal Cord"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1097\/00002060-199511000-00007","article-title":"ADL structure for stroke patients in Japan based on the functional independence measure","volume":"74","author":"Tsuji","year":"1995","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/BF00688250","article-title":"Delayed myelopathy following lightning strike: A demyelinating process","volume":"77","author":"Davidson","year":"1988","journal-title":"Acta Neuropathol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kubota, S., Kadone, H., Shimizu, Y., Koda, M., Takahashi, H., Miura, K., Eto, F., Furuya, T., Sankai, Y., and Yamazaki, M. (2022). Immediate effects of hybrid assistive limb gait training on lower limb function in a chronic myelopathy patient with postoperative late neurological deterioration. BMC Res. Notes, 15.","DOI":"10.1186\/s13104-022-05979-4"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kadone, H., Kubota, S., Abe, T., Noguchi, H., Miura, K., Koda, M., Shimizu, Y., Hada, Y., Sankai, Y., and Suzuki, K. (2020). Muscular activity modulation during post-operative walking with hybrid assistive limb (HAL) in a patient with thoracic myelopathy due to ossification of posterior longitudinal ligament: A case report. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.00102"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ezaki, S., Kadone, H., Kubota, S., Abe, T., Shimizu, Y., Tan, C.K., Miura, K., Hada, Y., Sankai, Y., and Koda, M. (2021). Analysis of gait motion changes by intervention using robot suit hybrid assistive limb (HAL) in myelopathy patients after decompression surgery for ossification of posterior longitudinal ligament. Front. Neurorobot., 15.","DOI":"10.3389\/fnbot.2021.650118"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"214","DOI":"10.12688\/f1000research.50951.2","article-title":"Influence of hybrid assistive limb gait training on spatial muscle activation patterns in spinal muscular atrophy type III","volume":"10","author":"Nishikawa","year":"2021","journal-title":"F1000 Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Sczesny-Kaiser, M., Trost, R., Aach, M., Schildhauer, T.A., Schwenkreis, P., and Tegenthoff, M. (2019). Efficacy and safety study of wearable cyborg HAL (hybrid assistive limb) in hemiplegic patients with acute stroke (EARLY GAIT study): Protocols for a randomized controlled trial. Front. Neurosci., 13.","DOI":"10.3389\/fnins.2019.00259"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1080\/10790268.2023.2200362","article-title":"Feasibility, safety, and functional outcomes using the neurological controlled hybrid assistive limb exoskeleton (HAL\u00ae) following acute incomplete and complete spinal cord injury\u2014Results of 50 patients","volume":"46","author":"Aach","year":"2023","journal-title":"J. Spinal Cord Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jhsg.2021.12.005","article-title":"Virtual rehabilitation of elbow flexion following nerve transfer reconstruction for brachial plexus injuries using the single-joint hybrid assisted limb","volume":"4","author":"Doi","year":"2022","journal-title":"J. Hand Surg. Glob. Online"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Maeda, T., Sasaki, E., Kasai, T., Igarashi, S., Wakai, Y., Sasaki, T., Tsuda, E., and Ishibashi, Y. (2024). Therapeutic effect of knee extension exercise with single-joint hybrid assistive limb following total knee arthroplasty: A prospective, randomized controlled trial. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-53891-7"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/S1474-4422(17)30115-1","article-title":"Safety and efficacy of edaravone in well defined patients with amyotrophic lateral sclerosis: A randomised, double-blind, placebo-controlled trial","volume":"16","author":"Abe","year":"2017","journal-title":"Lancet Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1016\/S0140-6736(96)91680-3","article-title":"Dose-ranging study of riluzole in amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis\/Riluzole Study Group II","volume":"347","author":"Lacomblez","year":"1996","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.2169\/internalmedicine.8030-21","article-title":"Effects of long-term hybrid assistive limb use on gait in patients with amyotrophic lateral sclerosis","volume":"61","author":"Morioka","year":"2022","journal-title":"Intern. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jocn.2022.02.032","article-title":"Robot-assisted training using hybrid assistive limb ameliorates gait ability in patients with amyotrophic lateral sclerosis","volume":"99","author":"Morioka","year":"2022","journal-title":"J. Clin. Neurosci."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lee, S.-Y., Seo, C.-H., Cho, Y.-S., and Joo, S.-Y. (2023). Clinical utility of robot-assisted gait training in patients with spinal cord injury caused by electrical burns: A case report. J. Clin. Med., 12.","DOI":"10.3390\/jcm12237220"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Banks, C.L., Huang, H.J., Little, V.L., and Patten, C. (2017). Electromyography exposes heterogeneity in muscle co-contraction following stroke. Front. Neurol., 8.","DOI":"10.3389\/fneur.2017.00699"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"307","DOI":"10.2340\/16501977-2528","article-title":"Spastic co-contraction, rather that spasticity, is associated with impaired active function in adults with acquired brain injury: A pilot study","volume":"51","author":"Chalard","year":"2019","journal-title":"J. Rehabil. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"450","DOI":"10.22237\/jmasm\/1383280020","article-title":"The single-case data analysis package: Analysing single-case experiments with R software","volume":"12","author":"Onghena","year":"2013","journal-title":"J. Mod. App. Stat. Meth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/967\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:26:09Z","timestamp":1760027169000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/967"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,3]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14030967"],"URL":"https:\/\/doi.org\/10.3390\/jcm14030967","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,2,3]]}}}