Article

Chronic neuropathic pain (CNP) is a common condition associated with spinal cord
injury (SCI) and has been reported to be severe, disabling and often
treatment-resistant and therefore remains a clinical challenge for the attending
physicians. The treatment usually includes pharmacological and / or
nonpharmacological approaches. Body weight supported treadmill training (BWSTT)
and locomotion training with driven gait orthosis (DGO) have evolved over the
last decades and are now considered to be an established part in the
rehabilitation of SCI patients. Conventional locomotion training goes along with
improvements of the patients' walking abilities in particular speed and gait
pattern. The neurologic controlled hybrid assistive limb (HAL(R), Cyberdyne Inc.,
Ibraki, Japan) exoskeleton, however, is a new tailored approach to support motor
functions synchronously to the patient's voluntary drive. This report presents
two cases of severe chronic and therapy resistant neuropathic pain due to chronic
SCI and demonstrates the beneficial effects of neurologic controlled exoskeletal
intervention on pain severity and health-related quality of life (HRQoL). Both of
these patients were engaged in a 12 weeks period of daily HAL(R)-supported
locomotion training. In addition to improvements in motor functions and walking
abilities, both show significant reduction in pain severity and improvements in
all HRQoL domains. Although various causal factors likely contribute to abatement
of CNP, the reported results occurred due to a new approach in the rehabilitation
of chronic spinal cord injury patients. These findings suggest not only the
feasibility of this new approach but in conclusion, demonstrate the effectiveness
of neurologic controlled locomotion training in the long-term management of
refractory neuropathic pain. Implications for Rehabilitation CNP remains a
challenge in the rehabilitation of chronic SCI patients. Locomotion training with
the HAL exoskeleton seems to improve CNP in chronic SCI.
HAL locomotion training
is feasible and safe in the rehabilitation of chronic SCI patients.

Langue : ANGLAIS