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The effects of hybrid assistive limb (HAL) application on locomotor function and balance parameters in individuals
Görkem Açar1, Miray Baser2, Mehmet Özkeskin3
1Department of Sport Science, Faculty of Sports Sciences, Istanbul Gelisim University, Istanbul, Turkey.
Background:
Multiple Sclerosis (MS) often causes walking and balance impairments, limiting daily independence. Hybrid Assistive Limb (HAL), a wearable robotic exoskeleton, may assist in improving these functions.
Objective:
To investigate the effect of HAL-assisted rehabilitation on locomotor function, balance performance, and functional mobility in individuals with MS.
Methods:
Thirteen individuals with MS were included in this single-group pre-post quasi-experimental study. This study did not include a control group. Participants underwent gait rehabilitation using a lower-limb HAL device for 1 h per day, 5 days a week, for 2 months. Locomotor function and balance were assessed using the 10-Meter Walk Test (10MWT), the Timed Up and Go (TUG) test, and the 6-Minute Walk Test (6MWT). Spatiotemporal parameters of the gait were analyzed using the Tecnobody Walker View system. Static balance was evaluated using the Tecnobody d-Wall system.
Results:
Thirteen adults with MS (mean age 46.2 ± 7.5 years) completed the 2-month HAL-assisted rehabilitation program. Significant improvements were observed in locomotor function and functional mobility: TUG time decreased from 18.85 ± 12.20 s to 14.04 ± 11.04 s (p < 0.001), 10MWT time decreased from 25.64 ± 21.54 s to 21.05 ± 21.08 s (p = 0.001), and 6MWT distance increased from 174.62 ± 58.68 m to 261.54 ± 95.03 m (p = 0.001). EDSS scores showed a decrease from 4.62 ± 1.33 to 2.62 ± 1.85 (p = 0.002). Static balance improved under both eyes-open and eyes-closed conditions, and step length increased significantly bilaterally. Cadence and hip/lumbar ROM showed no significant changes, while left knee ROM improved significantly (p = 0.008). These findings should be interpreted as preliminary, given the absence of a control group.
Conclusions:
HAL-assisted rehabilitation may be a feasible and promising approach for improving walking performance, balance, and functional mobility in individuals with MS. However, these preliminary findings from a single-group pre-post design without a control group should be interpreted with caution, and further randomized controlled trials are needed to confirm these results.
