{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:25:17Z","timestamp":1783009517166,"version":"3.54.5"},"reference-count":29,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Drop finger may occur in patients with C7 and\/or C8 cervical radiculopathy caused by cervical spondylosis. Although surgical decompression of the affected nerve roots is performed in patients with drop finger refractory to conservative treatment, postoperative recovery of drop finger is often unsatisfactory. Furthermore, no effective rehabilitation strategy for improving drop finger has yet been established. Methods: Here, we report a patient with drop finger who underwent a novel postoperative rehabilitation program. A 64-year-old man presented with drop finger of the left hand caused by left C7 and C8 radiculopathy and underwent cervical foraminotomy. For postoperative rehabilitation, we applied the single-joint Hybrid Assistive Limb (HAL), a wearable robotic suit. The patient underwent a total of 21 sessions of metacarpophalangeal HAL training, which assisted voluntary flexion and extension movements of the metacarpophalangeal joints, and 6 sessions of wrist abduction HAL training, which assisted ulnar-direction wrist abduction movements. Results: As a result, improvement in the left-sided drop finger was achieved. In this case, the use of HAL enabled voluntary motor training within the normal range of motion of the fingers and wrist even during the early postoperative phase, when sufficient neurological recovery had not yet been achieved. Conclusions: This successful motor experience may have facilitated the reacquisition of normal movement patterns, thereby contributing to improvement in drop finger.<\/jats:p>","DOI":"10.3390\/jcm15135182","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T14:51:25Z","timestamp":1783003885000},"page":"5182","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic Rehabilitation Using the Hybrid Assistive Limb for Drop Fingers in a Patient with Cervical Spondylotic Radiculopathy: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"given":"Yuichiro","family":"Soma","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"},{"name":"Division of Regenerative Medicine for Musculoskeletal System, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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 305-8575, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2953-6434","authenticated-orcid":false,"given":"Hideki","family":"Kadone","sequence":"additional","affiliation":[{"name":"Center for Innovating Medicine and Engineering (CIME), University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4455-4585","authenticated-orcid":false,"given":"Shigeki","family":"Kubota","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"},{"name":"Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki 300-0394, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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 305-8575, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Homma","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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 305-8575, Japan"},{"name":"Department of Orthopaedic Surgery, Ichihara Hospital, Tsukuba 300-3253, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1007\/s00776-003-0672-4","article-title":"Unilateral drop finger due to cervical spondylosis at the C6\/7 intervertebral level","volume":"8","author":"Kaneko","year":"2003","journal-title":"J. Orthop. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"411","DOI":"10.3171\/2014.4.SPINE13681","article-title":"Characteristics and surgical results of the distal type of cervical spondylotic amyotrophy","volume":"21","author":"Tauchi","year":"2014","journal-title":"J. Neurosurg. Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1007\/s00586-016-4836-2","article-title":"Drop finger caused by 8th cervical nerve root impairment: A clinical case series","volume":"26","author":"Koda","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.1007\/s00264-021-05197-w","article-title":"Detailed features and prognostic factors of twenty-three patients with drop finger caused by cervical radiculopathy: A retrospective multicentre study","volume":"45","author":"Makino","year":"2021","journal-title":"Int. Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1007\/s00586-019-06060-8","article-title":"Surgical outcomes for distal-type cervical spondylotic amyotrophy: A multicenter retrospective analysis of 43 cases","volume":"28","author":"Yamada","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"23","DOI":"10.22603\/ssrr.2019-0040","article-title":"Surgical Results of Microscopic Cervical Foraminotomy for Cervical Radiculopathy Presenting Drop Finger and Proposal of Classification Based on Drop Finger Patterns","volume":"4","author":"Furukawa","year":"2019","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s00586-010-1544-1","article-title":"Cervical spondylotic amyotrophy","volume":"20","author":"Jiang","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"39512","DOI":"10.1038\/srep39512","article-title":"Predisposing factors for poor outcome of surgery for cervical spondylotic amyotrophy: A multivariate analysis","volume":"6","author":"Zhang","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1177\/15589447221150516","article-title":"Tendon Transfers, Nerve Grafts, and Nerve Transfers for Isolated Radial Nerve Palsy: A Systematic Review and Analysis","volume":"19","author":"Jain","year":"2024","journal-title":"Hand"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/00003086-198301000-00033","article-title":"Radial nerve paralysis associated with fractures of the humerus. A review of 62 cases","volume":"172","author":"Shah","year":"1983","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1016\/j.clinph.2008.03.018","article-title":"Evaluation and management of peripheral nerve injury","volume":"119","author":"Campbell","year":"2008","journal-title":"Clin. Neurophysiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2610522","DOI":"10.1080\/23320885.2025.2610522","article-title":"Brachioradialis tendon transfer for a thumb and finger extension disorder owing to distal-type cervical spondylotic amyotrophy: A case report","volume":"13","author":"Takenaka","year":"2025","journal-title":"Case Rep. Plast. Surg. Hand Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"eaat3912","DOI":"10.1126\/scirobotics.aat3912","article-title":"Exoskeletal cyborg-type robot","volume":"3","author":"Sankai","year":"2018","journal-title":"Sci. Robot."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jocn.2018.01.038","article-title":"Application of a newly developed upper limb single-joint hybrid assistive limb for postoperative C5 paralysis: An initial case report indicating its safety and feasibility","volume":"50","author":"Kubota","year":"2018","journal-title":"J. Clin. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/s13256-017-1367-3","article-title":"Robotic device-assisted knee extension training during the early postoperative period after opening wedge high tibial osteotomy: A case report","volume":"11","author":"Yoshioka","year":"2017","journal-title":"J. Med. Case Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.jos.2019.12.011","article-title":"Shoulder training using shoulder assistive robot in a patient with shoulder elevation dysfunction: A case report","volume":"27","author":"Kubota","year":"2020","journal-title":"J. Orthop. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Soma, Y., Tokunaga, K., Kubota, S., Muraoka, M., Watanabe, S., Sakai, M., Ohya, W., Arakawa, D., Sasage, T., and Yamazaki, M. (2023). New Neuromuscular Training for Peripheral Nerve Disorders Using an Ankle Joint Hybrid Assistive Limb: A Case Series. Medicina, 59.","DOI":"10.3390\/medicina59071251"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Soma, Y., Kubota, S., Kadone, H., Shimizu, Y., Ezaki, S., Hada, Y., Sankai, Y., and Yamazaki, M. (2025). Hybrid Assistive Limb Treatment for the Shoulder and Elbow Joints Enabled Recovery from Chronic-Phase Severe C5 Palsy Following Cervical Spine Surgery. J. Clin. Med., 14.","DOI":"10.3390\/jcm14217520"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Popescu, M.N., C\u0103pe\u021b, C., Beiu, C., and Berteanu, M. (2025). The Elias University Hospital Approach: A Visual Guide to Ultrasound-Guided Botulinum Toxin Injection in Spasticity: Part I\u2014Distal Upper Limb Muscles. Toxins, 17.","DOI":"10.3390\/toxins17030107"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1136\/jnnp-2022-329696","article-title":"Recent advances in neuroanatomy: The myotome update","volume":"94","author":"Sonoo","year":"2023","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/j.jhsa.2017.07.026","article-title":"Management of Atraumatic Posterior Interosseous Nerve Palsy","volume":"42","author":"Sigamoney","year":"2017","journal-title":"J. Hand Surg. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.spinee.2010.10.023","article-title":"North American Spine Society An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders","volume":"11","author":"Bono","year":"2011","journal-title":"Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1056\/NEJMcp043887","article-title":"Clinical practice. Cervical radiculopathy","volume":"353","author":"Carette","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1080\/10790268.2018.1525975","article-title":"Hybrid assistive limb (HAL) treatment for patients with severe thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL) in the postoperative acute\/subacute phase: A clinical trial","volume":"42","author":"Kubota","year":"2019","journal-title":"J. Spinal Cord Med."},{"key":"ref_25","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_26","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1177\/17531934231209882","article-title":"Biofeedback training using a hybrid assistive limb after brachial plexus injury","volume":"49","author":"Kubota","year":"2024","journal-title":"J. Hand Surg. Eur. Vol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Kubota, S., Kadone, H., Shimizu, Y., Watanabe, H., Koda, M., Sankai, Y., and Yamazaki, M. (2023). Feasibility and Efficacy of the Newly Developed Robotic Hybrid Assistive Limb Shoulder Exercises in Patients with C5 Palsy during the Acute Postoperative Phase. Medicina, 59.","DOI":"10.3390\/medicina59081496"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lafitte, M.N., Kadone, H., Kubota, S., Shimizu, Y., Tan, C.K., Koda, M., Hada, Y., Sankai, Y., Suzuki, K., and Yamazaki, M. (2022). Alteration of muscle activity during voluntary rehabilitation training with single-joint Hybrid Assistive Limb (HAL) in patients with shoulder elevation dysfunction from cervical origin. Front. Neurosci., 16.","DOI":"10.3389\/fnins.2022.817659"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"836.e1","DOI":"10.1016\/j.jhsa.2023.01.007","article-title":"Tendon Transfer for Correction of the Radial Deviation Deformity of the Wrist and Centralization in Posterior Interosseous Nerve Palsy","volume":"48","author":"Jones","year":"2023","journal-title":"J. Hand Surg. Am."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5182\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:13:02Z","timestamp":1783008782000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":29,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135182"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135182","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}