Home-based hybrid assistive limb lumbar type telerehabilitation in spinocerebellar ataxias: a nonrandomized open-label trial

Background A hybrid assistive limb (HAL) can improve the motor performance of patients with various neurodegenerative diseases, but the efficacy of home-based rehabilitation using HAL for spinocerebellar ataxias (SCA) has yet to be elucidated. Objectives To evaluate the efficacy and safety of home-based telerehabilitation with lumbar type HAL in patients with SCA. Methods In this non-randomized open-label single center trial, all participants underwent a 20-min home-based telerehabilitation program using the HAL lumbar type three times a week for 4 weeks. The primary outcome was the Timed Up and Go test (TUG), and secondary outcomes were the scale for the assessment and rating of ataxia (SARA), 10-m walk test, Berg Balance Scale (BBS), cerebellar cognitive affective/Schmahmann Syndrome Scale (CCAS-S), visual analogue scale, and clinical global impressions (CGI) scale. The assessments were conducted pre- and post-intervention and at 4 and 12 weeks after completion of the 4-week HAL rehabilitation. Results There was a non-significant mean change in TUG of − 1.3 s after the intervention ( p  = 0.051) but significant improvements in BBS (2.6 points; p  = 0.011), CCAS-S (3.7 points; p  = 0.027), and CGI-Improvement (− 0.9 points; p  = 0.028). All participants completed the 4-week rehabilitation without any serious adverse events or dropout. Conclusions Home-based telerehabilitation with HAL lumbar type is feasible and safe for patients with SCA. Despite its efficacy on TUG not being demonstrated, telerehabilitation improved balance, cognitive function, and subjective symptoms in patients with SCA.