Benefits of a Wearable Cyborg HAL (Hybrid Assistive Limb) in Patients with Childhood-Onset Motor Disabilities: A 1-Year Follow-Up Study

Round 1

Reviewer 1 Report

Comments to the authors.

The authors reported the long term benefits of a wearable cyborg HAL in patients with childhood-onset motor disabilities. This manuscript has some value to be published in Pediatric report, but there are some specific comments.

Major comments;

CIP is not a central nervous disorder. It is not appropriate include in this study. The subjects for this study should be focused on CP only.

What is “the appropriate ethics committee” in L139, P4 ?  Is the committee in author’s university?

There is no discussion about the mechanisms why HAL training effect is maintained for one year.

The most important point is that there are no control subjects in this study.

Minor comments;

There are too many key words; “neurological rehabilitation; rehabilitation”.

Refer the following paer;

Nakajima T, Sankai Y, Takata S, et al. Cybernic treatment with wearable cyborg Hybrid Assistive Limb (HAL) improves ambulatory function in patients with slowly progressive rare neuromuscular diseases: a multicentre, randomised, controlled crossover trial for efficacy and safety (NCY-3001). Orphanet J Rare Dis. 2021 Jul 7;16(1):304. doi: 10.1186/s13023-021-01928-9. PMID: 34233722 

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for giving me the opportunity to review this interesting paper featuring wearable hybrid assisted limb (HAL) device to long term rehabilitation in cerebral palsy patients. Even though there were previous reports evaluating benefit of HAL for the same group of patients, this study looked at the long-term (up to one year) outcome.  The research question is well formulated, and the study design and the statistical analysis have been performed accordingly. What is very impressive is that only 12 total sessions consisting of 20 minutes use of HAL could lead to statistically significant differences in walking ability and gross motor function measure (GMFM). It would be even more interesting to see how much more benefit could be gained from daily 20 min sessions for an entire year considering brain plasticity. Maybe authors can comment on this in the discussion?

Author Response

We thank the Reviewer for their thoughtful comments, which have helped us significantly improve our manuscript.

We agree with the reviewer’s advice and add paragraphs in “4. Discussion” (Lines 340-347) about intervention dose and more benefit could be gained.

Reviewer 3 Report

The article "Benefits of a wearable cyborg HAL (Hybrid Assistive Limb) in 2 patients with childhood-onset motor disabilities: a 1-year follow-up study" is very well-written and interesting. The topic is important and could have important practical applications. Good job. 

I have only a few points to highlights. Figure 1 and figure 2 are interesting, but I think it could be better to move them after the introduction part. They distracted me in reading and made me lose for a moment the thread of the speech. 

Please, improve a little bit the tables, in order to not have to get to the bottom of the numbers (table 2) or the word (table 1, heigh t).

Author Response

We thank the Reviewer for their thoughtful comments, which have helped us significantly improve our manuscript.

We agree with the reviewer’s advice and have therefore revised the manuscript as follows: We have moved Figure 1 and Figure 2 after the introduction part (Line 115-124).

And We have revised Table1 and Table 2 regarding line height and line break position (Line 215 and 251).

Round 2

Reviewer 1 Report

The manuscript is revised correctly according to the reviewer's comments.

There are some limitations in this study, but it is important to suggest the possibility of HAL for childhood-onset motor disabilities improvement.