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Published in: BMC Neurology 1/2013

Open Access 01-12-2013 | Research article

Pilot study of locomotion improvement using hybrid assistive limb in chronic stroke patients

Authors: Hiroaki Kawamoto, Kiyotaka Kamibayashi, Yoshio Nakata, Kanako Yamawaki, Ryohei Ariyasu, Yoshiyuki Sankai, Masataka Sakane, Kiyoshi Eguchi, Naoyuki Ochiai

Published in: BMC Neurology | Issue 1/2013

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Abstract

Background

Locomotor training using robots is increasingly being used for rehabilitation to reduce manpower and the heavy burden on therapists, and the effectiveness of such techniques has been investigated. The robot suit Hybrid Assistive Limb (HAL) has been developed to rehabilitate or support motor function in people with disabilities. The HAL provides motion support that is tailored to the wearer’s voluntary drive. We performed a pilot clinical trial to investigate the feasibility of locomotor training using the HAL in chronic stroke patients, and to examine differences between two functional ambulation subgroups.

Methods

Sixteen stroke patients in the chronic stage participated in this study. All patients were trained with the HAL over 16 sessions (20–30 min/day within 2 days/week). Primary outcomes were walking speed, cadence, and number of steps recorded during a 10-meter walk test (10MWT). Berg balance scale (BBS) and timed up and go (TUG) were also measured. All outcome measures were evaluated without wearing HAL assistance before and after the intervention in all patients as well as in the dependent ambulatory and independent ambulatory subgroups.

Results

All participants completed the intervention with no adverse events. Gait speed, cadence, number of steps during the 10MWT, and BBS increased significantly from 0.41 m/s to 0.45 m/s (P = 0.031), from 68.6 steps/min to 72.0 steps/min (P = 0.020), from 37.5 steps to 33.1 steps (P = 0.017), and from 40.6 to 45.4 (P = 0.004) respectively. The TUG test score improved, although this difference was not statistically significant. The findings in the dependent ambulatory subgroup primarily contributed to the significant differences observed in the group as a whole.

Conclusions

This pilot study showed that locomotor training using the HAL is feasible for chronic stroke patients. Randomized controlled trials are now required to demonstrate the effectiveness of HAL-based rehabilitation over conventional therapies.

Trial registration

Appendix
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Literature
2.
go back to reference Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D: Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke. 2005, 36 (9): e100-e143. 10.1161/01.STR.0000180861.54180.FF.CrossRefPubMed Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D: Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke. 2005, 36 (9): e100-e143. 10.1161/01.STR.0000180861.54180.FF.CrossRefPubMed
3.
go back to reference Fong KN, Chan CC, Au DK: Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. Brain Inj. 2001, 15 (5): 443-453.CrossRefPubMed Fong KN, Chan CC, Au DK: Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. Brain Inj. 2001, 15 (5): 443-453.CrossRefPubMed
4.
go back to reference Roth EJ, Heinemann AW, Lovell LL, Harvey RL, McGuire JR, Diaz S: Impairment and disability: their relation during stroke rehabilitation. Arch Phys Med Rehabil. 1998, 79 (3): 329-335. 10.1016/S0003-9993(98)90015-6.CrossRefPubMed Roth EJ, Heinemann AW, Lovell LL, Harvey RL, McGuire JR, Diaz S: Impairment and disability: their relation during stroke rehabilitation. Arch Phys Med Rehabil. 1998, 79 (3): 329-335. 10.1016/S0003-9993(98)90015-6.CrossRefPubMed
6.
go back to reference Bayona NA, Bitensky J, Salter K, Teasell R: The role of task-specific training in rehabilitation therapies. Top Stroke Rehabil. 2005, 12 (3): 58-65. 10.1310/BQM5-6YGB-MVJ5-WVCR.CrossRefPubMed Bayona NA, Bitensky J, Salter K, Teasell R: The role of task-specific training in rehabilitation therapies. Top Stroke Rehabil. 2005, 12 (3): 58-65. 10.1310/BQM5-6YGB-MVJ5-WVCR.CrossRefPubMed
7.
go back to reference Patterson SL, Rodgers MM, Macko RF, Forrester LW: Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report. J Rehabil Res Dev. 2008, 45 (2): 221-228. 10.1682/JRRD.2007.02.0024.CrossRefPubMedPubMedCentral Patterson SL, Rodgers MM, Macko RF, Forrester LW: Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report. J Rehabil Res Dev. 2008, 45 (2): 221-228. 10.1682/JRRD.2007.02.0024.CrossRefPubMedPubMedCentral
8.
go back to reference Moore JL, Roth EJ, Killian C, Hornby TG: Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a “plateau” in recovery. Stroke. 2010, 41 (1): 129-135. 10.1161/STROKEAHA.109.563247.CrossRefPubMed Moore JL, Roth EJ, Killian C, Hornby TG: Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a “plateau” in recovery. Stroke. 2010, 41 (1): 129-135. 10.1161/STROKEAHA.109.563247.CrossRefPubMed
9.
go back to reference Nadeau SE, Wu SS, Dobkin BH, Azen SP, Rose DK, Tilson JK, Cen SY, Duncan PW: Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial. Neurorehabil Neural Repair. 2013, 27 (4): 370-380. 10.1177/1545968313481284.CrossRefPubMed Nadeau SE, Wu SS, Dobkin BH, Azen SP, Rose DK, Tilson JK, Cen SY, Duncan PW: Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial. Neurorehabil Neural Repair. 2013, 27 (4): 370-380. 10.1177/1545968313481284.CrossRefPubMed
10.
go back to reference Trueblood PR: Partial body weight treadmill training in persons with chronic stroke. NeuroRehabilitation. 2001, 16 (3): 141-153.PubMed Trueblood PR: Partial body weight treadmill training in persons with chronic stroke. NeuroRehabilitation. 2001, 16 (3): 141-153.PubMed
11.
go back to reference Werner C, Bardeleben A, Mauritz KH, Kirker S, Hesse S: Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison. Eur J Neurol. 2002, 9 (6): 639-644. 10.1046/j.1468-1331.2002.00492.x.CrossRefPubMed Werner C, Bardeleben A, Mauritz KH, Kirker S, Hesse S: Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison. Eur J Neurol. 2002, 9 (6): 639-644. 10.1046/j.1468-1331.2002.00492.x.CrossRefPubMed
12.
go back to reference Yang YR, Chen IH, Liao KK, Huang CC, Wang RY: Cortical reorganization induced by body weight-supported treadmill training in patients with hemiparesis of different stroke durations. Arch Phys Med Rehabil. 2010, 91 (4): 513-518. 10.1016/j.apmr.2009.11.021.CrossRefPubMed Yang YR, Chen IH, Liao KK, Huang CC, Wang RY: Cortical reorganization induced by body weight-supported treadmill training in patients with hemiparesis of different stroke durations. Arch Phys Med Rehabil. 2010, 91 (4): 513-518. 10.1016/j.apmr.2009.11.021.CrossRefPubMed
13.
go back to reference Winchester P, Querry R: Robotic orthoses for body weight-supported treadmill training. Phys Med Rehabil Clin N Am. 2006, 17 (1): 159-172. 10.1016/j.pmr.2005.10.008.CrossRefPubMed Winchester P, Querry R: Robotic orthoses for body weight-supported treadmill training. Phys Med Rehabil Clin N Am. 2006, 17 (1): 159-172. 10.1016/j.pmr.2005.10.008.CrossRefPubMed
14.
go back to reference Colombo G, Joerg M, Schreier R, Dietz V: Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev. 2000, 37 (6): 693-700.PubMed Colombo G, Joerg M, Schreier R, Dietz V: Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev. 2000, 37 (6): 693-700.PubMed
15.
go back to reference Banala SK, Kim SH, Agrawal SK, Scholz JP: Robot assisted gait training with active leg exoskeleton (ALEX). IEEE Trans Neural Syst Rehabil Eng. 2009, 17 (1): 2-8.CrossRefPubMed Banala SK, Kim SH, Agrawal SK, Scholz JP: Robot assisted gait training with active leg exoskeleton (ALEX). IEEE Trans Neural Syst Rehabil Eng. 2009, 17 (1): 2-8.CrossRefPubMed
16.
go back to reference Fisher S, Lucas L, Thrasher TA: Robot-assisted gait training for patients with hemiparesis due to stroke. Top Stroke Rehabil. 2011, 18 (3): 269-276. 10.1310/tsr1803-269.CrossRefPubMed Fisher S, Lucas L, Thrasher TA: Robot-assisted gait training for patients with hemiparesis due to stroke. Top Stroke Rehabil. 2011, 18 (3): 269-276. 10.1310/tsr1803-269.CrossRefPubMed
17.
go back to reference Hesse S, Uhlenbrock D, Sarkodie-Gyan T: Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support. Clin Rehabil. 1999, 13 (5): 401-410. 10.1191/026921599673896297.CrossRefPubMed Hesse S, Uhlenbrock D, Sarkodie-Gyan T: Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support. Clin Rehabil. 1999, 13 (5): 401-410. 10.1191/026921599673896297.CrossRefPubMed
18.
go back to reference Schmidt H, Werner C, Bernhardt R, Hesse S, Kruger J: Gait rehabilitation machines based on programmable footplates. J Neuroeng Rehabil. 2007, 4: 2-10.1186/1743-0003-4-2.CrossRefPubMedPubMedCentral Schmidt H, Werner C, Bernhardt R, Hesse S, Kruger J: Gait rehabilitation machines based on programmable footplates. J Neuroeng Rehabil. 2007, 4: 2-10.1186/1743-0003-4-2.CrossRefPubMedPubMedCentral
19.
go back to reference Freivogel S, Mehrholz J, Husak-Sotomayor T, Schmalohr D: Gait training with the newly developed ‘LokoHelp’-system is feasible for non-ambulatory patients after stroke, spinal cord and brain injury: a feasibility study. Brain Inj. 2008, 22 (7–8): 625-632.CrossRefPubMed Freivogel S, Mehrholz J, Husak-Sotomayor T, Schmalohr D: Gait training with the newly developed ‘LokoHelp’-system is feasible for non-ambulatory patients after stroke, spinal cord and brain injury: a feasibility study. Brain Inj. 2008, 22 (7–8): 625-632.CrossRefPubMed
20.
go back to reference Husemann B, Muller F, Krewer C, Heller S, Koenig E: Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: a randomized controlled pilot study. Stroke. 2007, 38 (2): 349-354. 10.1161/01.STR.0000254607.48765.cb.CrossRefPubMed Husemann B, Muller F, Krewer C, Heller S, Koenig E: Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: a randomized controlled pilot study. Stroke. 2007, 38 (2): 349-354. 10.1161/01.STR.0000254607.48765.cb.CrossRefPubMed
21.
go back to reference Mayr A, Kofler M, Quirbach E, Matzak H, Frohlich K, Saltuari L: Prospective, blinded, randomized crossover study of gait rehabilitation in stroke patients using the Lokomat gait orthosis. Neurorehabil Neural Repair. 2007, 21 (4): 307-314. 10.1177/1545968307300697.CrossRefPubMed Mayr A, Kofler M, Quirbach E, Matzak H, Frohlich K, Saltuari L: Prospective, blinded, randomized crossover study of gait rehabilitation in stroke patients using the Lokomat gait orthosis. Neurorehabil Neural Repair. 2007, 21 (4): 307-314. 10.1177/1545968307300697.CrossRefPubMed
22.
go back to reference Hornby TG, Campbell DD, Kahn JH, Demott T, Moore JL, Roth HR: Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke: a randomized controlled study. Stroke. 2008, 39 (6): 1786-1792. 10.1161/STROKEAHA.107.504779.CrossRefPubMed Hornby TG, Campbell DD, Kahn JH, Demott T, Moore JL, Roth HR: Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke: a randomized controlled study. Stroke. 2008, 39 (6): 1786-1792. 10.1161/STROKEAHA.107.504779.CrossRefPubMed
23.
go back to reference Hidler J, Nichols D, Pelliccio M, Brady K, Campbell DD, Kahn JH, Hornby TG: Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair. 2009, 23 (1): 5-13.CrossRefPubMed Hidler J, Nichols D, Pelliccio M, Brady K, Campbell DD, Kahn JH, Hornby TG: Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair. 2009, 23 (1): 5-13.CrossRefPubMed
24.
go back to reference Schwartz I, Sajin A, Fisher I, Neeb M, Shochina M, Katz-Leurer M, Meiner Z: The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial. PM R. 2009, 1 (6): 516-523. 10.1016/j.pmrj.2009.03.009.CrossRefPubMed Schwartz I, Sajin A, Fisher I, Neeb M, Shochina M, Katz-Leurer M, Meiner Z: The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial. PM R. 2009, 1 (6): 516-523. 10.1016/j.pmrj.2009.03.009.CrossRefPubMed
25.
go back to reference Westlake KP, Patten C: Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke. J Neuroeng Rehabil. 2009, 6: 18-10.1186/1743-0003-6-18.CrossRefPubMedPubMedCentral Westlake KP, Patten C: Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke. J Neuroeng Rehabil. 2009, 6: 18-10.1186/1743-0003-6-18.CrossRefPubMedPubMedCentral
26.
go back to reference Pohl M, Werner C, Holzgraefe M, Kroczek G, Mehrholz J, Wingendorf I, Hoolig G, Koch R, Hesse S: Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS). Clin Rehabil. 2007, 21 (1): 17-27. 10.1177/0269215506071281.CrossRefPubMed Pohl M, Werner C, Holzgraefe M, Kroczek G, Mehrholz J, Wingendorf I, Hoolig G, Koch R, Hesse S: Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS). Clin Rehabil. 2007, 21 (1): 17-27. 10.1177/0269215506071281.CrossRefPubMed
27.
go back to reference Tong RK, Ng MF, Li LS, So EF: Gait training of patients after stroke using an electromechanical gait trainer combined with simultaneous functional electrical stimulation. Phys Ther. 2006, 86 (9): 1282-1294. 10.2522/ptj.20050183.CrossRefPubMed Tong RK, Ng MF, Li LS, So EF: Gait training of patients after stroke using an electromechanical gait trainer combined with simultaneous functional electrical stimulation. Phys Ther. 2006, 86 (9): 1282-1294. 10.2522/ptj.20050183.CrossRefPubMed
28.
go back to reference Peurala SH, Tarkka IM, Pitkanen K, Sivenius J: The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke. Arch Phys Med Rehabil. 2005, 86 (8): 1557-1564. 10.1016/j.apmr.2005.02.005.CrossRefPubMed Peurala SH, Tarkka IM, Pitkanen K, Sivenius J: The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke. Arch Phys Med Rehabil. 2005, 86 (8): 1557-1564. 10.1016/j.apmr.2005.02.005.CrossRefPubMed
29.
go back to reference Werner C, Von Frankenberg S, Treig T, Konrad M, Hesse S: Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study. Stroke. 2002, 33 (12): 2895-2901. 10.1161/01.STR.0000035734.61539.F6.CrossRefPubMed Werner C, Von Frankenberg S, Treig T, Konrad M, Hesse S: Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study. Stroke. 2002, 33 (12): 2895-2901. 10.1161/01.STR.0000035734.61539.F6.CrossRefPubMed
30.
go back to reference Suzuki K, Mito G, Kawamoto H, Hasegawa Y, Sankai Y: Intention-based walking support for paraplegia patients with Robot Suit HAL. Adv Robot. 2007, 21 (12): 1441-1469. Suzuki K, Mito G, Kawamoto H, Hasegawa Y, Sankai Y: Intention-based walking support for paraplegia patients with Robot Suit HAL. Adv Robot. 2007, 21 (12): 1441-1469.
31.
go back to reference Kubota S, Nakata Y, Eguchi K, Kawamoto H, Kamibayashi K, Sakane M, Sankai Y, Ochiai N: Feasibility of rehabilitation training with a newly developed wearable robot for patients with limited mobility. Arch Phys Med Rehabil. 2013, 94 (6): 1080-1087. 10.1016/j.apmr.2012.12.020.CrossRefPubMed Kubota S, Nakata Y, Eguchi K, Kawamoto H, Kamibayashi K, Sakane M, Sankai Y, Ochiai N: Feasibility of rehabilitation training with a newly developed wearable robot for patients with limited mobility. Arch Phys Med Rehabil. 2013, 94 (6): 1080-1087. 10.1016/j.apmr.2012.12.020.CrossRefPubMed
32.
go back to reference Kawamoto H, Sankai Y: Power assist system HAL-3 for gait disorder person. Lecture Notes in Computers helping people with special needs. 2002, 2398: 19-29. 10.1007/3-540-45491-8_6.CrossRef Kawamoto H, Sankai Y: Power assist system HAL-3 for gait disorder person. Lecture Notes in Computers helping people with special needs. 2002, 2398: 19-29. 10.1007/3-540-45491-8_6.CrossRef
33.
go back to reference Kawamoto H, Sankai Y: Power assist method based on phase sequence and muscle force condition for HAL. Adv Robot. 2005, 19 (7): 717-734. 10.1163/1568553054455103.CrossRef Kawamoto H, Sankai Y: Power assist method based on phase sequence and muscle force condition for HAL. Adv Robot. 2005, 19 (7): 717-734. 10.1163/1568553054455103.CrossRef
34.
go back to reference Perry J, Garrett M, Gronley JK, Mulroy SJ: Classification of walking handicap in the stroke population. Stroke. 1995, 26 (6): 982-989. 10.1161/01.STR.26.6.982.CrossRefPubMed Perry J, Garrett M, Gronley JK, Mulroy SJ: Classification of walking handicap in the stroke population. Stroke. 1995, 26 (6): 982-989. 10.1161/01.STR.26.6.982.CrossRefPubMed
35.
go back to reference Richards CL, Olney SJ: Hemiparetic gait following stroke. Part II: Recovery and physical therapy. Gait Posture. 1996, 4 (2): 149-162. 10.1016/0966-6362(96)01064-8.CrossRef Richards CL, Olney SJ: Hemiparetic gait following stroke. Part II: Recovery and physical therapy. Gait Posture. 1996, 4 (2): 149-162. 10.1016/0966-6362(96)01064-8.CrossRef
36.
go back to reference Ada L, Dean CM, Hall JM, Bampton J, Crompton S: A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Arch Phys Med Rehabil. 2003, 84 (10): 1486-1491. 10.1016/S0003-9993(03)00349-6.CrossRefPubMed Ada L, Dean CM, Hall JM, Bampton J, Crompton S: A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Arch Phys Med Rehabil. 2003, 84 (10): 1486-1491. 10.1016/S0003-9993(03)00349-6.CrossRefPubMed
37.
go back to reference Ng SS, Hui-Chan CW: The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. Arch Phys Med Rehabil. 2005, 86 (8): 1641-1647. 10.1016/j.apmr.2005.01.011.CrossRefPubMed Ng SS, Hui-Chan CW: The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. Arch Phys Med Rehabil. 2005, 86 (8): 1641-1647. 10.1016/j.apmr.2005.01.011.CrossRefPubMed
38.
go back to reference Schwartz I, Sajin A, Moreh E, Fisher I, Neeb M, Forest A, Vaknin-Dembinsky A, Karusis D, Meiner Z: Robot-assisted gait training in multiple sclerosis patients: a randomized trial. Mult Scler. 2012, 18 (6): 881-890. 10.1177/1352458511431075.CrossRefPubMed Schwartz I, Sajin A, Moreh E, Fisher I, Neeb M, Forest A, Vaknin-Dembinsky A, Karusis D, Meiner Z: Robot-assisted gait training in multiple sclerosis patients: a randomized trial. Mult Scler. 2012, 18 (6): 881-890. 10.1177/1352458511431075.CrossRefPubMed
40.
go back to reference Belda-Lois JM, Mena-del Horno S, Bermejo-Bosch I, Moreno JC, Pons JL, Farina D, Iosa M, Molinari M, Tamburella F, Ramos A, et al: Rehabilitation of gait after stroke: a review towards a top-down approach. J Neuroeng Rehabil. 2011, 8: 66-10.1186/1743-0003-8-66.CrossRefPubMedPubMedCentral Belda-Lois JM, Mena-del Horno S, Bermejo-Bosch I, Moreno JC, Pons JL, Farina D, Iosa M, Molinari M, Tamburella F, Ramos A, et al: Rehabilitation of gait after stroke: a review towards a top-down approach. J Neuroeng Rehabil. 2011, 8: 66-10.1186/1743-0003-8-66.CrossRefPubMedPubMedCentral
41.
go back to reference Krakauer JW: Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol. 2006, 19 (1): 84-90. 10.1097/01.wco.0000200544.29915.cc.CrossRefPubMed Krakauer JW: Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol. 2006, 19 (1): 84-90. 10.1097/01.wco.0000200544.29915.cc.CrossRefPubMed
Metadata
Title
Pilot study of locomotion improvement using hybrid assistive limb in chronic stroke patients
Authors
Hiroaki Kawamoto
Kiyotaka Kamibayashi
Yoshio Nakata
Kanako Yamawaki
Ryohei Ariyasu
Yoshiyuki Sankai
Masataka Sakane
Kiyoshi Eguchi
Naoyuki Ochiai
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2013
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-13-141

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