Wearable Robotic Gait Training Linked to Improved Walking Distance in ALS

Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease that damages nerve cells controlling voluntary muscles. As the disease advances, patients can lose the ability to walk, speak, swallow, and breathe independently. Rehabilitation is important because medications may slow progression but cannot reliably restore lost muscle strength. Researchers have now evaluated whether training with a wearable robotic system can improve walking performance while preserving short-term quality of life.

The study was conducted by researchers at Toho University in Japan and involved the Hybrid Assistive Limb (HAL; Cyberdyne, Inc.).  The wearable robotic device is designed to support gait training by responding to the user’s own intention to move. Skin sensors detect faint electrical signals generated by muscle activity, and the system uses those signals to assist walking exercises. HAL has been covered by Japan’s public health insurance for certain neuromuscular diseases, including ALS, since 2016.

The study included 30 patients with ALS who completed one course of HAL-assisted gait training. The intervention consisted of nine sessions over approximately four to five weeks. Each session lasted 20 to 40 minutes, including preparation and rest periods. Researchers assessed walking distance during a two-minute walking test and also measured walking speed, cadence, and step length over 10 meters.

After treatment, patients increased their average two-minute walking distance from about 92 meters to about 104 meters. This improvement of nearly 12 meters was statistically significant. However, walking speed, cadence, and step length during the 10-meter assessment did not change significantly. The findings suggest that patients covered more distance over two minutes, even though short-distance gait measures remained largely unchanged.

Quality of life was measured with the SF-36 questionnaire, which evaluates physical, mental, and social health domains. Before treatment, physical health and social role scores were lower than Japanese population averages, while mental well-being was relatively preserved. After one course of HAL training, none of the three main SF-36 component scores changed significantly. The study was published in Frontiers in Neurology under the title “Impact of Hybrid Assistive Limb on Gait Ability and Quality of Life in Patients with Amyotrophic Lateral Sclerosis.”

The researchers cautioned that the study did not include a control group, so the findings do not prove that HAL alone caused the walking improvement. They also noted that the clinical importance of an approximately 12-meter increase remains uncertain. Larger controlled studies with longer follow-up will be needed to determine whether HAL-assisted rehabilitation can sustain walking gains and affect daily activity or quality of life.

Related Links
Toho University
Cyberdyne, Inc.