Efficacy of combined treatment with a wearable cyborg hybrid assistive limb and intrathecal baclofen therapy in a pediatric patient with spastic paraplegia

Tomoyuki Masuda , Ryota Nishikawa , Takenori Natsume , Masahisa Komatsu , Motomu Maruyama , Sayaka Sato , Saki Otao , Masaru Nasuno , Shihoko Takeuchi , Maki Shirai , Mitsuo Motobayashi , Yuka Misawa , Yosuke Miyairi , Yuji Inaba
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Abstract

Background

Hybrid Assistive Limb (HAL) is a movement support robot that assists the walking function of patients with diseases causing muscle weakness in the lower limbs.
Intrathecal baclofen (ITB) therapy exerts positive effects on muscle tone in children with severe spasticity who have difficulty walking.
The present case report describes a child with spastic paraplegia who underwent intensive robotic rehabilitation with HAL and combined ITB therapy.

Case

A 14-year-old boy with spastic paraplegia from Pelizaeus-Merzbacher disease was undergoing treatment with oral muscle relaxants and botulinum toxin A. However, the medications were ineffective and his spasticity was progressing. A baclofen infusion pump was implanted with the catheter tip at the T10 level and ITB therapy was started. A regimen of 12.5 μg/day dose of baclofen was administered and his spasticity of limbs and trunk were attenuated. Walking practice using HAL was performed under spasticity relief by ITB therapy and gait function and patterns, excluding endurance, were improved. The attenuation of spasticity by ITB therapy made “Lying, Rolling and Sitting” easier for the patient, but may have affected “Standing”, which was supported using spasticity, and also affected the Caregiver Assistance Scale of the Mobility domain of the Pediatric Evaluation of Disability Inventory (PEDI). While, the amount of assistance required for the Activities of Daily Living (ADLs) related to self-care and the overall caregiver burden both decreased.

Conclusion

This is the first case report to demonstrate the efficacy and safety of combined ITB therapy and HAL rehabilitation in an ambulatory pediatric patient.
可穿戴半机械人混合型辅助肢体和鞘内巴氯芬联合治疗小儿痉挛性截瘫的疗效
混合辅助肢体(HAL)是一种运动支持机器人,可以帮助患有下肢肌肉无力疾病的患者实现行走功能。鞘内巴氯芬(ITB)治疗对行走困难的严重痉挛患儿的肌肉张力有积极作用。本病例报告描述了一个患有痉挛性截瘫的儿童,他接受了HAL和ITB联合治疗的强化机器人康复。病例:一名14岁的男孩,因伯利兹-默兹巴赫病而痉挛性截瘫,正在接受口服肌肉松弛剂和肉毒杆菌毒素a的治疗。然而,药物无效,他的痉挛进展。导管尖端植入巴氯芬输注泵至T10水平,开始ITB治疗。给予12.5 μg/d巴氯芬治疗后,四肢和躯干痉挛症状明显减轻。在ITB治疗缓解痉挛的情况下,使用HAL进行步行练习,步态功能和模式(不包括耐力)得到改善。ITB治疗对痉挛的减弱使“躺、滚、坐”对患者来说更容易,但可能影响了痉挛支持的“站立”,也影响了儿科残疾评估量表(PEDI)中活动域的照顾者协助量表。与此同时,与自我照顾相关的日常生活活动(ADLs)所需的援助量和总体照顾者负担均有所减少。结论:这是首个在门诊儿科患者中证实ITB联合HAL康复的有效性和安全性的病例报告。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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