Wearable cyborg training linked to longer walking distances in people with ALS
Study finds increased walking distance while quality of life remains stable over the short term
Could a wearable robot help people with amyotrophic lateral sclerosis (ALS) walk farther? A new study from Toho University in Japan examined walking performance and quality of life in 30 patients with ALS who underwent training with the Hybrid Assistive Limb (HAL). After completing one course of treatment, participants walked nearly 12 meters farther in a two-minute walking test, while their quality-of-life scores remained largely stable. The findings suggest that walking performance may improve over the short term without a measurable decline in quality of life, although larger controlled studies are needed to confirm the benefits of HAL-assisted rehabilitation.
For people living with amyotrophic lateral sclerosis (ALS), everyday movements can become increasingly difficult. The progressive disease damages the nerve cells that control muscles, gradually making activities such as walking, speaking, swallowing, and breathing more challenging. Although some medications can slow the progression of ALS, restoring lost muscle strength remains difficult. Rehabilitation therefore plays an important role in helping patients maintain their physical abilities and independence.
One promising approach involves a wearable robotic device called the Hybrid Assistive Limb, or HAL. Unlike robots that simply move a person's legs, HAL is designed to respond to the wearer's own intention to move. Sensors attached to the skin detect faint electrical signals produced by muscle activity, allowing the device to provide assistance during walking exercises.
In Japan, HAL treatment has been covered by public health insurance for certain neuromuscular diseases, including ALS, since 2016. Researchers at Toho University have been providing HAL-assisted gait training to patients with ALS since 2018. Previous studies suggested that patients could walk farther after treatment. But an important question remained: would changes in walking performance be accompanied by changes in quality of life?
To investigate, the researchers studied 30 patients with ALS who completed one course of HAL-assisted training. The program included nine sessions over approximately four to five weeks, with each session lasting 20 to 40 minutes, including preparation and rest breaks.
Before and after treatment, the researchers measured how far patients could walk in two minutes. They also evaluated walking speed, cadence, and step length over a shorter, 10-meter distance. Quality of life was assessed using the SF-36 questionnaire, which measures physical, mental, and social aspects of health.
The most noticeable change was in the two-minute walking test.
Before training, patients walked an average of about 92 meters in two minutes. Afterward, that distance increased to about 104 meters—nearly 12 meters farther. The increase was statistically significant.
However, walking speed, cadence, and step length measured over 10 meters did not change significantly. This suggests that patients were able to cover more ground during a two-minute walk, even though their short-distance walking measurements remained largely unchanged.
Quality of life remained stable
The researchers also looked at how patients rated their physical and mental well-being. Before treatment, scores for physical health and social roles were lower than Japanese population averages. Mental well-being, however, was relatively well preserved.
After one course of HAL training, quality-of-life scores remained largely stable. None of the three main SF-36 component scores showed a statistically significant change. For patients living with a progressive disease such as ALS, maintaining quality of life is an important goal of care. Although this study cannot establish that HAL treatment prevented a decline in quality of life, the findings show that patients' reported quality of life did not change significantly during the short observation period.
The results also highlight an important point: improvements in walking performance do not necessarily lead to immediate changes in how patients experience their daily lives. Quality of life is shaped by many factors beyond physical function, including emotional well-being and social participation.
What comes next?
The researchers caution that the findings should not be interpreted as proof that HAL treatment alone caused the increase in walking distance. The study did not include a control group, and the clinical importance of an approximately 12-meter increase in the two-minute walking test remains uncertain. Nevertheless, the findings provide useful information about short-term walking performance and quality of life following HAL-assisted rehabilitation in patients with ALS.
Larger studies comparing HAL-assisted training with other rehabilitation approaches, along with longer follow-up periods, will be needed to determine whether improvements in walking performance can be maintained and whether repeated treatment affects patients' daily activities and quality of life.
For now, the study offers a hopeful but measured message: after HAL-assisted training, patients with ALS walked farther in a two-minute test, while their quality of life remained largely stable over the short term.
Publication information
Journal: Frontiers in Neurology
Article title: Impact of Hybrid Assistive Limb on Gait Ability and Quality of Life in Patients with Amyotrophic Lateral Sclerosis
Authors: Harumi Morioka, Takehisa Hirayama, Mari Shibukawa, Tatsuki Sugisawa, Junpei Nagasawa, Sayori Hanashiro, Junya Ebina, Ryuichi Okamoto, Makiko Ogawa, Ikuko Okuni, Yoshitaka Murakami, and Osamu Kano
Publication date: October 14, 2026
doi: 10.3389/fneur.2026.1823485
Article URL: https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2026.1823485/
Journal
Frontiers in Neurology
Method of Research
Experimental study
Subject of Research
People
Article Title
Impact of hybrid assistive limb on gait ability and quality of life in patients with amyotrophic lateral sclerosis
Article Publication Date
14-Oct-2026
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