A journey to HSP/FSP: Exoskeleton for HSP approved in Japan

Friday 27 January 2023

Exoskeleton for HSP approved in Japan

I saw this in the news the other day.

A lower body exoskeleton has been approved in Japan for the treatment of HSP. The exoskeleton is meant to improve gait and reduce progression. The various documentation points to a clinical trial, but the results do not appear to be published.

The trial appears to have begun in 2016 and was completed in 2018. They seem to have looked at both people with HSP and with HTLV-1-associated myelopathy (HAM). In total 42 people took part, but it doesn't say how many had HSP.

The trial had people using the exoskeleton and a hoist in 40 minute blocks, nine times within one month. The 40 minute period comprised a 5 minute warm-up, 30 minutes of gait training and 5 minutes of cool down. A control was run using the same 40 minute blocks with a hoist but not the exoskeleton. The primary outcome was a two minute walking test, and various secondary measures were also measured.

The exoskeleton reads bioelectric signals and adjusts the power of the exoskeleton in response. They call this process interactive biofeedback, and identify that this process can regenerate some neural function.

No results are given to identify what the benefits were for people with HSP or how long those benefits lasted, but it is interesting to think that this may be an option to help people with HSP. One of the doctors who ran the test is quote in a press release saying that the exoskeleton significantly improved gait (in the primary and clinically important secondary endpoints) in HAM and hereditary spastic paraplegia. The trials demonstrated that Cybernics Treatment can regenerate neural function through interactive biofeedback (iBF).

This exoskeleton is also used to similarly treat other neurological conditions: Spinal muscular atrophy (SMA), Spherospinal muscular atrophy (SBMA), Amyotrophic lateral sclerosis (ALS), Charcot-Marie-Tooth disease, Distal myopathy, Inclusion body myositis, Congenital myopathy, Muscular dystrophy.