# Novel Gait Training with a Hybrid Assistive Limb Improved Delayed Progressive Spastic Paraplegia After a Lightning Strike

## TL;DR

A 68-year-old man with long-term walking issues from a lightning strike showed improved gait after using a hybrid assistive limb for training.

## Contribution

Demonstrates the potential of HAL gait training to improve mobility in chronic spastic paraplegia caused by lightning injuries.

## Key findings

- HAL gait training reduced abnormal muscle activation in the patient's lower limbs.
- Repeated HAL training improved the patient's gait pattern over time.
- Longer training periods may enhance adaptation to HAL-assisted rehabilitation.

## Abstract

Background/Objectives: A 68-year-old man presented with progressive walking difficulty that developed into spastic paraplegia. This condition was a long-term consequence of a lightning strike injury sustained at the age of 22 years. His symptoms progressively deteriorated, eventually requiring double crutches for ambulation at approximately 40 years of age. A physical evaluation prior to hybrid assistive limb (HAL) training revealed a T10 level neurological injury and an American Spinal Cord Injury Association impairment scale grade D. Here, we aimed to evaluate the therapeutic effects of novel gait training with an HAL in this patient with chronic and progressive neural damage caused by a lightning strike. Methods: The HAL training program is composed of two sections. In the first section, one month of gait training with HAL was conducted across 10 sessions, with 2–3 sessions weekly. The second section followed 6 months later. A final evaluation was performed three months after the second section. Results: Electromyographic and kinematic evaluation showed that the HAL gait training inhibited abnormal antagonistic muscle activation in his lower extremities, especially after the first section. Our results collectively indicate that the repeated HAL gait training improved the gait pattern of this patient. Conclusions: Our results suggest that HAL gait training may improve the gait pattern in patients with delayed progressive spastic paraplegia, as observed in this case. In addition, a longer intervention period is recommended to facilitate better adaptation to HAL training. Hence, neurorehabilitation with an HAL could be an innovative treatment approach for delayed progressive spastic paraplegia.