The effects of hybrid assistive limb (HAL) application on locomotor function and balance parameters in individuals with multiple sclerosis

Background: Multiple Sclerosis (MS) often causes walking and balance impairments, limiting daily independence. Hybrid Assistive Limb (HAL), a wearable robotic exoskeleton, may assist in improving these functions. Objective: To investigate the effect of HAL-assisted rehabilitation on locomotor function, balance performance, and functional mobility in individuals with MS. Methods: Thirteen individuals with MS were included in this single-group pre-post quasi-experimental study. This study did not include a control group. Participants underwent gait rehabilitation using a lower-limb HAL device for 1 h per day, 5 days a week, for 2 months. Locomotor function and balance were assessed using the 10-Meter Walk Test (10MWT), the Timed Up and Go (TUG) test, and the 6-Minute Walk Test (6MWT). Spatiotemporal parameters of the gait were analyzed using the Tecnobody Walker View system. Static balance was evaluated using the Tecnobody D-Wall system. Results: Thirteen adults with MS (mean age 46.2 f 7.5 years) completed the 2-month HAL-assisted rehabilitation program. Significant improvements were observed in locomotor function and functional mobility: TUG time decreased from 18.85 f 12.20 s to 14.04 f 11.04 s (p < 0.001), 10MWT time decreased from 25.64 f 21.54 s to 21.05 f 21.08 s (p = 0.001), and 6MWT distance increased from 174.62 f 58.68 m to 261.54 f 95.03 m (p = 0.001). EDSS scores showed a decrease from 4.62 f 1.33 to 2.62 f 1.85 (p = 0.002). Static balance improved under both eyes-open and eyes-closed conditions, and step length increased significantly bilaterally. Cadence and hip/lumbar ROM showed no significant changes, while left knee ROM improved significantly (p = 0.008). These findings should be interpreted as preliminary, given the absence of a control group. Conclusions: HAL-assisted rehabilitation may be a feasible and promising approach for improving walking performance, balance, and functional mobility in individuals with MS. However, these preliminary findings from a single-group pre-post design without a control group should be interpreted with caution, and further randomized controlled trials are needed to confirm these results.