Robot-assisted gait training using a robotic exoskeleton during inpatient rehabilitation in acute Guillain-Barré Syndrome.

A woman in her early 60s with acute Guillain-Barré syndrome (GBS) developed rapidly progressive tetraparesis and respiratory failure requiring non-invasive ventilation. Following intravenous immunoglobulin and medical stabilisation, she entered inpatient rehabilitation with severe weakness, poor truncal control and inability to ambulate. Despite intensive conventional therapy, early gait training was limited. Exoskeleton-based robot-assisted gait training (RAGT) using the Hybrid Assistive Limb (HAL; Cyberdyne Inc, Tsukuba, Japan) was introduced during inpatient rehabilitation as an adjunct to standard therapy. The patient completed 10 HAL sessions over a 15-day period without adverse events. During this time, progressive improvements in ambulatory distance and functional independence were observed. By completion of HAL training, she was able to ambulate 50 m with a walking stick and minimal assistance. She subsequently continued conventional rehabilitation and achieved independent ambulation by discharge. This case suggests that HAL-based RAGT may be a feasible adjunct to inpatient rehabilitation in medically stable patients with acute GBS. The intervention was well tolerated in this patient. Further studies are required to establish patient-selection criteria, optimal timing and the effectiveness of exoskeleton-assisted gait training in GBS.