Over the past few years researchers have introduced various wearable and mobile exoskeletons that are used not only for therapeutic purposes but also as medical and assistive walking aids for daily use. However, most available devices are controlled by the posture. They use autonomously generated predefined gait patterns for passive mobilization of patients with spinal cord injuries by direct motion support.

“Hybrid Assistive Limb” also known as HAL® is the only device that is activated and controlled directly by the nervous system of the wearer. This so-called active exoskeleton is manufactured by Cyberdyne Inc. – a Japanese robotics and technology company. The specific commands to move are created in the form of nerve impulses in the motor cortex of the brain. These commands are later transmitted through the spinal cord and peripheral nerves to the various muscles and make them contract. In patients with neurogenic gait dysfunctions (after an accident or as a result of a disease), induction or transmission of such a signal is significantly weakened. For this reason, the patient is not able to initiate a movement.

In the HAL® device, sensors are placed on the surfaces of the skin and muscles of the lower limbs. These sensors are able to receive residual nerve signals and then amplify and transmit them to the robot. The system recognizes the impulses and provides the patient the necessary force support, which allows him or her to perform a desired, target movement. This means that the patient is not moved passively during the neuromuscular feedback therapy, but he demands the required support by his own residual neuronal functions.

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The formation of new connections between neurons (nerve cells) improves the transmission of nerve-muscle signals, which stimulates the central nervous system even more effectively. This physiological phenomenon is called neuroplasticity and is also responsible for the therapy´s effectiveness. Systematic exercises performed during training create new neural connections, rebuild the gait pattern, enhance the muscle strength and restore the ability to walk.

Today HAL® is used in a 3-month therapy program to help patients amplify signals from the brain, thereby training the muscular and neural structures to a point where independent movement of the legs may become possible. This partially depends on the severity of the injury or disease that led to an inability to walk. The Lower LimbHAL® Version was approved in December 2015 by the World Health Organization as a device for medical therapy and has proven its effectiveness in several studies. HAL® is not only feasible and safe in patients with acute and chronic spinal conditions, but it also increases their functional mobility, over-ground walking, muscle strength, and motor functions without the HAL® exoskeleton.

A recent study by German and American clinicians showed very promising results. In this study, 55 patients with different chronic spinal cord injuries underwent treatment with HAL® devices. After the completion of the 3-month therapy, the HAL-assisted treadmill training leads to continuous functional improvements in all 55 patients. The similar positive outcomes were demonstrated in all treadmill HAL-supported tests. Interestingly, this study also demonstrated that on the contrary to the older opinion, the age of the patient and the level of an injury are much less important negative predictors of the motor improvement and recovery. These findings show that intensive training with HAL® exoskeleton can - under the right circumstances - restore the ability to move lower body limbs and walk again.

Constance Care Rehabilitation Center is the leading HAL® medical center in Europe. Constance Care specializes in the treatment of both adults and children that require comprehensive treatment, including neurological, neuropsychological, orthopedic, and speech therapy. Their activities are aimed at improving the health and life quality of patients with motor dysfunctions, resulting from various accidents, diseases, and aging. This center provides the highest quality of care with the team of experienced professionals – doctors and therapists with advanced degrees in rehabilitation or physiotherapy, masseurs, speech therapists specializing in neurological disorders as well as psychologists.

Founded by Jacek Walukiewicz in 1995, the company´s rehabilitation center was launched in June 2015 and today is one of the most technologically advanced rehabilitation centers in Europe. “We work with the best medical centers in the world. We are in a partnership with one of the most technologically advanced manufacturers of devices for robotic rehabilitation the Japanese company Cyberdyne, the creator of cybernetic HAL-therapy. We work with one of the best networks of clinics in the USA, Europe, and Asia,” says Walukiewicz.

Speaking of the medical services they provide, Walukiewicz states, “Our activity is aimed at improvement of health and life quality of patients with motor dysfunctions resulting from various accidents, diseases, and aging. We also offer rehabilitation of cognitive functions for children and adults. Therapeutic methods are tailored to each patient individually. The comprehensive offer involves many different specialized procedures and types of treatment, Neurological rehabilitation with the cutting-age medical devices, manual therapy, physical therapy, massage, etc.”

If you are interested in this treatment for yourself or a loved one, Constance Care has collaborated with Medscout as a service partner who will assist international patients in getting the therapy they need.