Deep Core Activation Method Utilizing Wearable Cyborg HAL in Supine Position for Improving Anorectal Motility: A Case Study for a Patient with Chronic Spinal Cord Injury

Hayato Tamai; Hiroaki Kawamoto; Akira Uehara; Masao Koda; Yoshiyuki Sankai

doi:10.51094/jxiv.864

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Hayato Tamai Ph.D. Program in Humanics, School of Integrative and Global Majors (SIGMA), University of Tsukuba
Hiroaki Kawamoto Institute of Systems and Information Technology and Center for Cybernics Research, University of Tsukuba
Akira Uehara Institute of Systems and Information Technology, R&D Center for Frontiers of MIRAI in Policy and Technology, and Center for Cybernics Research, University of Tsukuba
Masao Koda Department of Orthopedic Surgery, Institute of Medicine, and Center for Cybernics Research, University of Tsukuba
Yoshiyuki Sankai Institute of Systems and Information Technology, R&D Center for Frontiers of MIRAI in Policy and Technology, and Center for Cybernics Research, University of Tsukuba. CYBERDYNE Inc., Tsukuba, Japan

DOI:

https://doi.org/10.51094/jxiv.864

キーワード:

Neurogenic bowel dysfunction、 Anorectal motility、 Spinal cord injury、 Hybrid Assistive Limb、 Case study

抄録

Neurogenic bowel dysfunction (NBD) is the most prevalent problem among patients with spinal cord injury (SCI) and greatly affects their quality of life. A major cause of NBD is a well associated with lack of anorectal motility, which helps to evacuate stool or maintain continence by increasing/decreasing intra-abdominal pressure (IAP) and relaxing/contracting sphincters. Current programs for anorectal dysmotility have only temporary effects or are highly invasive. In order to overcome the difficulties caused by NBD, a novel treatment method is urgently needed for anorectal dysmotility, with a sustained effect and without invasive procedures. We have previously proposed a minimally invasive method using the wearable cyborg Hybrid Assistive Limb (HAL) to sustainably improve anorectal motility. In our proposed method, long-term repetition of supine HAL-assisted hip flexions are thought to activate deep core and induce its neural plasticity, potentially regenerating anorectal function. It has been previously confirmed that the supine HAL-assisted hip flexion was realized in healthy individuals; however, it has not yet been confirmed that feasibility of our proposed methodology and its sustained functional improvement on anorectum in patients with SCI have yet to be confirmed. Here, we aimed to validate this methodology in terms of feasibility and sustained functional improvement in the anorectum of a patient with chronic SCI. A 24-year-old man with chronic SCI accompanied by anorectal dysmotility underwent four weeks of supine HAL-assisted hip flexion for thirty minutes, four times per week. To evaluate the effect of the intervention on anorectal motility, IAP measurement and sphincter electromyography were conducted for seven days pre-/post-intervention. The assessment was repeated at a two-month follow-up after the intervention to verify the persistence of the effects. The increasing trends were observed in all periods of both IAP and in sphincter electromyogram. There was a significant increase in IAP and sphincter electromyogram between the pre-intervention and two-month follow-up periods (p < 0.001). These results demonstrate not only the feasibility of the proposed methodology but also the potential for a sustained effect in improving anorectal motility in patients with chronic SCI.

利益相反に関する開示

The authors declare no conflicts of interest with any companies or commercial or organizations per the definition of Japanese Society for Medical and Biological Engineering.

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