DE102019130404A1 - Orthosis for the controlled movement and / or fixation of a forearm and / or a hand - Google Patents

Abstract

The present invention relates to an orthosis (1) for the controlled movement and / or fixation of a hand (91) and / or a forearm (92) of a patient and is characterized in that it comprises at least one hand control means (11) which is set up to allow both a controlled movement and an angle-dependent fixation of the hand (91); and / or comprises at least one forearm control means (12) which is set up to provide both a controlled supination-pronation movement of the forearm (92) and an angle-dependent fixation at a specific angular position with respect to a rotation about the longitudinal axis of the forearm (92) to allow. It supports and controls physiological movements in the elbow joint (93) and in the wrist and is particularly suitable for building up training, for example in the case of muscle atrophy and / or joint stiffness. In addition, it enables movements, which from a medical point of view must be restricted or blocked at the beginning of a therapy, to be adjusted in their permitted extent of movement by means of adjustment devices, with movement patterns that can be kept free during the therapy being allowed to the full extent at the same time.

Description

The present invention relates to an orthosis for the controlled movement and / or fixation of a hand and / or a forearm of a patient, at least comprising a first receiving means for receiving at least part of the hand, a second receiving means for receiving at least part of the forearm and a connecting means along a longitudinal axis of the orthosis for the (operative) connection of the first receiving means with the second receiving means.

As part of the rehabilitation process after a hand injury, the affected hand or forearm of the patient must in many cases be immobilized for a certain period of time. The immobilization is usually done with hand / forearm orthoses, which fix the hand and forearm in a certain position and after the fixation no longer allow any movement of the said limbs. However, joints of the hand and / or forearm that are not affected by the injury are also inevitably immobilized. Depending on the length of time such an orthosis is worn, this can disadvantageously lead to so-called secondary stiffening of the joints not affected by the injury, the additional mobilization of which after the end of the healing process causes unnecessary costs due to a longer rehabilitation period and thus longer periods of absence from work for the patient. In the case of complex injuries to the hand or forearm, it may also be desirable to move individual joints that are more advanced in their healing process in a controlled manner and, at the same time, to continue to fix even more damaged joints, which is not possible with the conventionally used orthotics of the prior art becomes.

Taking this as a starting point, the present invention is based on the object of providing an orthosis which is improved over the prior art and with which unnecessary immobilization of healthy or at least partially restored joints can be avoided and the patient's freedom of movement can be adapted to the individual clinical picture or its healing process .

This object is initially achieved by an orthosis with the features of independent claim 1.

The orthosis according to the invention is distinguished from orthoses of the prior art in that it comprises at least one hand control means which is set up to allow both a controlled movement and an angle-dependent fixation of the hand; and / or comprises at least one forearm control means which is set up to permit both a controlled supination-pronation movement of the forearm and an angle-dependent fixation at a specific angular position with respect to a rotation about the longitudinal axis of the forearm.

The orthosis according to the invention advantageously makes it possible to control the angles of all physiological movements of the hand and / or forearm depending on the patient's state of health and therapy needs, with the angles being fixed independently of one another in certain angular positions, released or released in a certain range of motion (= angular range). can be fully shared. As a result, the orthosis according to the invention can advantageously accompany the healing process in such a way that the patient's freedom of movement can be increased in a controlled manner, movement permitted from a therapeutic point of view being controlled and, at the same time, from a therapeutic point of view, critical movements can be completely or partially restricted.

In this way, unnecessary stiffening of healthy joints of the hand and / or the forearm can advantageously be counteracted.

Further advantageous configurations and developments, which can be used individually or in combination with one another, are the subject of the dependent claims.

In a first embodiment of the invention, it is preferred that the hand control means is set up to allow both a controlled movement and an angle-dependent fixation of the hand, the controlled movement being an extension and / or flexion of the hand and the angle-dependent fixing being a Fixation of the hand in a certain position in the plane of movement of the extension and / or Is inflection. A hand control means set up in this way advantageously enables the controlled movement of the wrist in the sense of a bending or stretching movement and thus a controlled extension and / or flexion of the hand to a physiological extent or a fixation in a therapeutically desired position within the radius of movement of said flexion - or stretching movement.

In a further embodiment of the invention, it has been proven that the hand control means is set up to allow both a controlled movement and an angle-dependent fixation of the hand, the controlled movement being an ulnar and / or radial deviation and the angle-dependent fixing being a fixation of the hand is at a certain position in the plane of movement of the ulnar and / or radial deviation. A hand control device set up in this way advantageously enables either the movement of the wrist in the sense of a wiping movement in a controlled amount of movement and thus a controlled ulnar and / or radial deviation of the hand to a physiological extent or a fixation in a therapeutically desired position within the radius of movement of the said wiping movement .

According to the invention, an embodiment is preferred in which the hand control means is operatively connected to the first receiving means and has at least one first swivel joint, the axis of rotation of which is arranged perpendicular to the longitudinal axis of the orthosis, the swivel joint being set up at an angle between a longitudinal axis of the first receiving means and to change the lanyard. The axis of rotation of the first swivel joint can advantageously be designed dorsally, i.e. towards the back of the hand, or palmar, i.e. towards the palm of the hand, with respect to a distance to the connecting means so that the orthosis can advantageously be adapted to the anatomy of the respective user, here the position of the wrist, to be able to customize.

It has proven useful if the radius of movement of the first swivel joint around its axis of rotation can be restricted to any angle ranges less than or equal to 180 ° and / or can be fixed at a certain angle between the longitudinal axis of the first receiving means and the connecting means.

Such a first swivel joint advantageously allows the angular range of flexion and extension to be set individually, to be restricted in a controlled manner or to be fixed to a desired angle on the circular arc traversed during flexion and extension of the hand. The setting can preferably be carried out continuously and / or in particular step by step in increments of degrees.

In a further preferred embodiment, the hand control means is operatively connected to the first receiving means and has at least one second rotary joint, the axis of rotation of which is arranged perpendicular to the longitudinal axis of the orthosis and perpendicular to an axis of rotation of a first rotary joint, the second rotary joint being set up at an angle to change between the longitudinal axis of the first receiving means and the axis of rotation of the first pivot joint.

It has proven useful if the radius of movement of the second rotary joint around its axis of rotation can be restricted to any angle ranges less than or equal to 180 °, preferably less than or equal to 100 °, and / or at a certain angle between the longitudinal axis of the first receiving means and the axis of rotation of the first Swivel joint is fixable

Such a second swivel joint advantageously allows the angular range of the ulnar and radial deviation, that is to say a lateral wiping movement of the hand, to be individually adjusted, restricted in a controlled manner or fixed to a desired angle. The setting can preferably be carried out continuously and / or in particular step by step in increments of degrees. In addition, the radial deviation can be set in such a way that, contrary to the physiological width, a larger gap is created at the TFCC (triangular fibro-cartilaginous) complex in order to artificially open the gap so wide that the compression in the TFCC complex is reduced and the TFCC is relieved. For example, a step-by-step enlargement of the gap at the TFCC up to 10 ° beyond the physiological range of motion can be carried out.

In addition, an embodiment has proven itself in which the hand control means, in particular its first swivel joint, comprises a first displacement mechanism via which the hand control means is operatively connected to the connecting means, the first displacement mechanism being set up so that the hand control means compared to the Move lanyards dorsally and / or palmarly; and that the hand control means, in particular its second swivel joint, comprises a second displacement mechanism, via which the hand control means is operatively connected to the first receiving means, the second displacement mechanism being set up to move the first receiving means towards the hand control means in all three spatial directions move. Such a first displacement mechanism advantageously enables the axis of rotation of the first swivel joint for the extension and flexion movement of the hand to be advantageously adapted to the individual anatomical conditions of the user. Such a second displacement mechanism advantageously makes it possible to adapt the positions of the first receiving means to the respective user in such a way that a contact surface of the first receiving means rests optimally on the surface of the hand. The displacement mechanism can preferably be fixed in its end position with the aid of a screw and / or clamping device.

In a further preferred embodiment, the forearm control means has at least one swivel joint, the axis of rotation of which is arranged parallel to the longitudinal axis of the orthosis, the radius of movement of the swivel joint around its axis of rotation being restricted to any angle ranges less than or equal to 180 ° and / or at a certain angle between an axis of rotation of a second swivel joint of the hand control means and a transverse axis of the orthosis can be fixed.

A forearm control means with such a swivel joint advantageously allows the angular range of the supination and pronation movement, i.e. a rotation of the hand around the axis of the forearm, to be individually adjusted, restricted in a controlled manner or fixed to a desired angle.

In addition, an embodiment has proven itself in which the forearm control means comprises at least one means for generating a mechanical resistance, the means for generating a mechanical resistance in particular from a combination of a full metal element in the form of an inclined cone and a screw adjusting device or from a preloaded spring is formed. A forearm control means with a means for generating a mechanical resistance advantageously allows the supination-pronation movement of the forearm or hand to be opposed to the supination-pronation movement of the forearm or hand, which is permitted by the orthosis according to the invention, and thus enables the user to train to build up strength in the corresponding arm muscles and to prevent sticking of the joints or soft tissues through targeted mobilization within the scope of the permitted range of motion.

In a further preferred embodiment, it has been proven that the orthosis, in particular the second receiving means, comprises an elbow control means which is set up to allow both a controlled movement and an angle-dependent fixation of the forearm, the controlled movement being flexion and / or Extension of the forearm around an elbow joint and where the angle-dependent fixation is a fixation of the forearm at a certain position in the plane of movement of extension and / or flexion around the elbow joint. With such an elbow control means, which can preferably be connected to the orthosis, in particular to the distal end of the second receiving means, by means of a click mechanism and which preferably covers the end of the upper arm proximal to the elbow joint, the flexion movement of the forearm opposite can also be advantageous the upper arm can be checked or fixed for therapy purposes.

In addition, it has proven useful if the orthosis comprises at least one means for length adjustment with respect to its longitudinal axis, which is in operative connection with the second receiving means, the means for length adjustment being formed in particular from a round rod or an n-corner rod with a correspondingly designed sleeve. A means for length adjustment advantageously makes it possible to adapt the length of the orthosis individually to the length of the forearm of the respective user. In the case of a means for length adjustment designed as an n-corner bar with a correspondingly designed sleeve, the number n can in particular be a natural number greater than or equal to 3.

In a further preferred embodiment of the invention, the orthosis comprises an adjustment means for adjusting the axis geometry of the connecting means, in particular a ball joint and / or a ball tilting device with a link. Such an adjustment means advantageously enables the orthosis, in particular the connection means, to be adapted with respect to its longitudinal axis to the axis geometry of the respective forearm when the elbow is extended and to control the range of motion of the supination and pronation movement. In addition, with the help of the adjustment means, in particular with the help of a ball joint and / or a ball tilting device with a coulisse, advantageously anatomically different axis positions, which can be compensated for by positioning the forearm between full extension (stretched forearm) and full flexion (forearm fully bent around the elbow joint) .

Furthermore, it is preferred in one embodiment that the connecting means is formed as a two-part axis, the first part of which effectively connects the hand control means, the forearm control means and optionally a means for length adjustment and the second part of which the forearm control means or optionally the means for length adjustment operatively connected to the adjustment means. It has proven useful if the first part of the connecting means is rotatably mounted relative to the second part of the connecting means.

A connecting means configured in this way advantageously enables muscle building training to be carried out on the one hand by interacting with the means for generating a mechanical resistance, i.e. in particular by pushing the angled cone or the screw-adjusting device apart and thereby achieving a higher contact pressure on the inner side of the connecting means. On the other hand, a total fixation at a certain angle of pronation or supination and thus a complete immobilization of the hand or the forearm with respect to a rotation about the forearm axis can also take place.

Finally, in one embodiment of the invention, it has been proven that the at least one hand control means, the at least one forearm control means, the connection means, optionally an adjustment means and a means for Length adjustment are surrounded by a protective cover, the protective cover in one piece or in two parts, consisting of an outer, at least the means for length adjustment and a second part of the connecting means surrounding, shell and an inner, at least the hand control means, the forearm control means and a first Part of the connecting means surrounding, shell, is formed. Such a protective cover protects both the user of the orthosis and the individual assemblies of the orthosis from touching one another. On the one hand, this reduces the risk of injury and, on the other hand, increases the longevity of the orthosis. A two-part design of the protective cover can also advantageously adapt the mechanism of a means for length adjustment and can thus also be adapted to the respective length of the forearm.

An orthosis according to the invention is preferably suitable for use on the forearm and / or on the hand. It supports and controls physiological, 3-dimensional movements in the elbow joint and in the wrist joint in an advantageous manner and within the permitted range of movement and is particularly suitable for building up training, for example in the case of muscle atrophy and / or joint stiffness. In addition, the orthosis advantageously enables, if necessary, based on the clinical picture and the associated therapy or healing process, movements which, from a medical point of view, have to be restricted or completely blocked at the beginning of a therapy, to be adjusted accordingly by means of adjustment devices in their permitted range of motion, with movement patterns at the same time , which can be kept free during therapy, are allowed to the full extent.

These and additional details and further advantages of the invention are described below with reference to preferred exemplary embodiments to which the present invention is not limited, and in conjunction with the accompanying drawings.

• 1a bis 1d Bewegungsabläufe einer a) Extensions- bzw. Flexionsbewegung einer Hand in einer Seitenansicht, b) einer ulnaren bzw. radialen Deviationsbewegung einer Hand, c) einer Supinations- bzw. Pronations-Bewegung eines Unterarms nebst Hand und d) einer Extensions- bzw. Flexionsbewegung eines Unterarms um ein Ellenbogengelenk jeweils in einer Draufsicht;
• 2 eine Ausgestaltung einer erfindungsgemäßen Orthese bei Benutzung in einer Draufsicht;
• 3 die Orthese aus 2 in unbenutztem Zustand in einer perspektivischen Seitenansicht;
• 4 die Orthese aus 2 in unbenutztem Zustand mit einem im Rahmen einer radialen Deviation ausgelenkten ersten Aufnahmemittel in einer Draufsicht;
• 5 eine Projektion einiger, durch die Orthese bestimmter Achsen auf einen Unterarm und eine Hand; und
• 6 eine Ausgestaltung eines Hand-Kontrollmittels in einer perspektivischen Ansicht.

They show schematically:

• 1a to 1d Movement sequences of a) extension or flexion movement of a hand in a side view, b) an ulnar or radial deviation movement of a hand, c) a supination or pronation movement of a forearm and hand and d) an extension or flexion movement of a Forearm around an elbow joint in each case in a plan view;
• 2 an embodiment of an orthosis according to the invention when used in a plan view;
• 3rd the orthosis off 2 in the unused state in a perspective side view;
• 4th the orthosis off 2 in the unused state with a first receiving means deflected within the scope of a radial deviation, in a top view;
• 5 a projection of some axes determined by the orthosis onto a forearm and a hand; and
• 6th an embodiment of a hand control means in a perspective view.

In the following description of preferred embodiments of the present invention, the same reference symbols designate the same or comparable components.

In the 1a to Id are initially to explain the medical terms used in the following, the movement sequences of an extension or flexion movement E / F one hand 91 in a side view (Fig. la), an ulnar or radial deviation movement urD one hand 91 ( 1b) , a supination or pronation movement S / P of a forearm 92 plus hand 91 ( 1c ) and an extension or flexion movement of a forearm 92 around an elbow joint 93 ( 1d ) each shown schematically in a plan view.

2 shows an embodiment of an orthosis according to the invention 1 when used in a plan view.

An orthosis 1 for controlled movement and / or fixation of a hand 91 and / or a forearm 92 of a patient, comprises at least one first receiving means 2 for holding at least part of the hand 91 ; a second receiving means 3rd for receiving at least part of the forearm 92 ; and a connecting means 14th along a longitudinal axis LA the orthosis 1 for the (operative) connection of the first receiving means 2 with the second receiving means 3rd . The second receiving means 3rd and / or the connecting means 14th can be designed in particular as individual components, preferably made of plastic and / or metal, or as a textile covering, which in particular covers the forearm 92 encloses and at least the forearm control means 12th and, if necessary, a means for length adjustment 13th and / or an adjustment means 15th includes. The orthosis according to the invention 1 is characterized by the fact that it has at least one hand control means 11 comprises, which is set up, both a controlled movement and an angle-dependent fixation of the hand 91 to allow; and / or that they have at least one forearm control means 12th comprises, which is set up, both a controlled supination-pronation movement of the forearm 92 as well as an angle-dependent fixation at a certain angular position with respect to a rotation about the Long axis of the forearm 92 to allow. The at least one hand control device 11 , the at least one forearm control device 12th , the lanyard 14th and, as shown here, an adjustment means if necessary 15th and a means for length adjustment 13th can preferably from a protective cover 16 be surrounded, with the protective cover 16 one-piece or two-piece, consisting of an outer, at least one means for length adjustment 13th and a second part 142 of the lanyard 14th surrounding, shell 162 and an internal one, at least the hand control means 11 , the forearm control device 12th and a first part 141 of the lanyard 14th surrounding, shell 161 , can be formed. And in the protective cover that surrounds all of the technology 16 a length adjustment to the length of the forearm 92 to enable the protective cover 16 especially in the amount of the means for length adjustment 13th be constructed in such a way that "tube in tube" can slide. This can be implemented by removing the external pipe (outer shell 162 ) has exactly the same diameter as the inner tube including its wall thickness (inner shell 161 ).

The ones from the hand control agent 11 controlled movement can preferably include extension and / or flexion E / F of the hand 91 and the angle-dependent fixation fixes the hand 91 at a certain position in the plane of movement of extension and / or flexion E / F be. The hand control device 11 can for this purpose in particular with the first receiving means 2 be operatively connected and at least one first swivel joint 111 have, its axis of rotation 1111 perpendicular to the longitudinal axis LA the orthosis 1 is arranged, the swivel joint 111 is set up an angle α between a longitudinal axis 21st of the first receiving device 2 and the connecting means 14th to change. The axis of rotation 1111 of the first swivel joint 111 can in particular include an extension and / or flexion E / F of the hand 91 enable to a patient-individual physiological extent.

In 3rd the orthosis is off 2 shown in an unused state in a perspective side view. This shows the angle α, which is an extension and / or flexion movement E / F of the hand 91 describes how they are also used in 1a is shown schematically. The first swivel joint 111 can move around its axis of rotation in its radius of motion 1111 restricted to any angle ranges less than or equal to 180 ° and / or at a certain angle α between the longitudinal axis 21st of the first receiving device 2 and the connecting means 14th be fixable. 6th shows an embodiment of a manual control means 11 in a perspective view. It can be seen that the number of degrees of flexion and / of extension movement E / F can be individually set or limited, so for example the extension can be limited to a movement to 10 ° dorsal and the flexion to 30 ° palmar, or vice versa regarding the numerical values. The limitation or setting to any angle ranges less than or equal to 180 ° can preferably take place continuously or in increments of degrees. On the outer edge of the first swivel joint 111 In addition, a scale can be arranged which shows the treating person the number of degrees set in each case (not shown here). The hand control device 11 , especially its first swivel joint 111 , can also preferably have a first displacement mechanism 1112 include, with the help of which the first swivel joint 111 shifted dorsally and / or palmar and thus advantageously adapted to the individual anatomical conditions of the patient.

4th shows the orthosis off 2 in the unused state with a first receiving means deflected in the context of a radial deviation 2 in a top view. As shown here, the hand control means 11 be set up alternatively or cumulatively, both a controlled movement and an angle-dependent fixation of the hand 91 to allow, the controlled movement in particular an ulnar and / or radial deviation urD and where the angle-dependent fixation is, in particular, a fixation of the hand 91 at a certain position in the plane of movement of the ulnar and / or radial deviation urD is. The hand control device 11 can preferably with the first receiving means 2 be operatively connected and at least one second swivel joint 112 have, its axis of rotation 1121 perpendicular to the longitudinal axis LA the orthosis 1 and perpendicular to an axis of rotation 1111 a first swivel joint 111 is arranged, the second pivot joint 112 is set up an angle β between the longitudinal axis 21st of the first receiving device 2 and the axis of rotation 1111 of the first swivel joint 111 to change. The active connection of the hand control agent 11 with the first receiving means 2 , in particular via the second swivel joint 112 , can advantageously be designed so that the hand 91 if there is a radial and / or ulnar deviation urD is accompanied without the first receiving means being twisted due to the design 2 or limitations with regard to the physiological range of motion. The second swivel joint 112 can thereby in its radius of motion around its axis of rotation 1121 can be restricted to any angle ranges less than or equal to 180 ° and / or at a certain angle β between the longitudinal axis 21st of the first receiving device 2 and the axis of rotation 1111 of the first swivel joint 111 be fixable. 6th shows an embodiment of a manual control means 11 in a perspective view. It can be seen that the degree of ulnar and / or radial deviation urD can be individually set or limited, so for example the ulnar deviation can be reduced to a movement of 15 ° ulnar and radial deviation can be limited radially to 20 °, or vice versa with regard to the numerical values. The limitation or setting to any angle ranges less than or equal to 180 ° can preferably take place continuously or in increments of degrees. On the outer edge of the second swivel joint 112 In addition, a scale can be arranged which shows the treating person the number of degrees set (not shown here).

The hand control device 11 , especially its second swivel joint 112 , can also preferably have a second displacement mechanism 1122 include over the hand control means 11 with the first receiving means 2 is operatively connected, the second displacement mechanism 1122 is set up, the first receiving means 2 compared to the hand control means 11 to move in all three spatial directions.

In the 2 to 4th is also shown that the forearm control means 12th at least one swivel joint 121 may have its axis of rotation 1211 parallel to the longitudinal axis LA the orthosis 1 is arranged, the swivel joint 121 in its range of motion around its axis of rotation 1211 preferably restricted to any angle ranges less than or equal to 180 ° and / or at a certain angle γ between an axis of rotation 1121 a second swivel joint 112 of the hand control device 11 and a transverse axis QA the orthosis 1 is fixable. In 5 is a projection of some through the orthosis 1 certain axes on a forearm 92 and a hand 93 in which the angle γ between an axis of rotation 1121 a second swivel joint 112 of the hand control device 11 and a transverse axis QA the orthosis 1 is identified.

In addition, the forearm control device can be used 12th at least one means 122 for generating a mechanical resistance, wherein the means 122 can be formed in particular from a combination of a full metal element in the form of an inclined cone and a screw adjusting device or from a pretensioned spring (not shown here) to generate a mechanical resistance. The forearm control device 12th can be at an angle to the longitudinal axis LA include cut full metal element (inclined cone), with one part running freely with respect to an internal threaded rod, the other part can be provided with a thread for the threaded rod. A screw adjusting device can be arranged on the threaded rod, which either at the end of a full metal element or in the middle, with corresponding cutouts, is of the same size as the movement amplitudes of the forearm control means 12th , especially its swivel joint 121 , provided, lies in the inclined cone. The full metal element is pushed apart by turning the screw adjusting device and, thanks to the completely continuous angle cut and the combination of freewheel / thread, it slides apart on both sides in such a way that there is pressure all around in a protective cover 16 the orthosis 1 , especially in an inner shell 161 , arises. The force of the inclined cone can either be applied directly to the lanyard 14th the orthosis 1 or on in the lanyard 14th integrated friction resistances e.g. B. in the form of a PTFE (polytetrafluoroethylene) envelope.

The swivel joint 121 can in particular be identical to the swivel joints 111 and 112 of the hand control device 11 be designed, the axis of rotation 1211 of the swivel joint 121 preferably parallel to the longitudinal axis LA the orthosis 1 is arranged. The middle 122 to generate a mechanical resistance advantageously enables training to build up strength in pronation and supination S / P of the forearm 92 .

Furthermore, the orthosis 1 , in particular the second receiving means 3rd , as in 2 to see an elbow control agent 31 include, which is set up, both a controlled movement and an angle-dependent fixation of the forearm 92 allow the controlled movement to flexion and / or extension of the forearm 92 around an elbow joint 93 and where the angle-dependent fixation is a fixation of the forearm 92 at a certain position in the plane of movement of extension and / or flexion around the elbow joint 93 is.

In the 2 to 4th is also shown that the orthotic 1 preferably at least one means for length adjustment 13th with respect to its longitudinal axis LA may include, which with the second receiving means 3rd is in operative connection, the means for length adjustment 13th can be formed in particular from a round bar or an n-corner bar with a correspondingly designed sleeve, which advantageously enables both components to slide in smoothly. At least part of the sleeve (negative shape) can advantageously have a larger diameter than the respective positive shape (n-corner rod or round rod) in order to accommodate the positive shape and thereby enable length adjustment. The fixation of the positive form, that is to say the round bar or the n-corner bar in the negative form, that is to say the correspondingly designed sleeve, can for example take place by means of a clamping cone (clamping cone). The negative mold, that is to say the sleeve, is also preferably fixed with an adjustment means 15th , which in particular on the second receiving means 3rd can be arranged connected. With the help of the means of length adjustment 13th can the orthosis 1 advantageous in their length to the respective length of the forearm 92 customized by the user.

The second receiving means 3rd for receiving at least part of the forearm 92 can preferably be used as a form-fitting, flexible enclosure of the proximal forearm 92 be formed, whereby the orthosis 1 advantageously proximal on the forearm 92 can be fixed. Rotary screw mechanisms or Velcro strips (as in 2 shown). The material of the means for fixing is selected in particular in such a way that it adapts to the respective anatomy of the user during the movements of the forearm 92 and when the forearm is at rest 92 adapts. Especially in the ulnar area of the second receptacle 3rd can also be an adjustment means 15th for adjusting the axis geometry of the lanyard 14th , especially a ball joint 151 and / or a ball head with a backdrop. An adjustment means, in particular arranged close to the proximal point of origin of the ulna 15th can be used to advantage, the different axis geometries with elbow extension and the then executed supination and pronation S / P to compensate. The backdrop can be enlarged or reduced to reduce the supination and pronation movement S / P serve if this has to be limited.

In the 2 to 4th can finally also be seen that the lanyard 14th can preferably be formed as a two-part axle, the first part of which 141 the hand control device 11 , the forearm control device 12th and, if necessary, a means for length adjustment 13th operatively connected to each other and their second part 142 the forearm control device 12th or, if necessary, the means for length adjustment 13th with the adjustment means 15th operatively connects, the first part 141 of the lanyard 14th compared to the second part 142 of the lanyard 14th is preferably rotatably mounted. The first part 141 of the lanyard 14th runs in particular from the hand control means 11 , preferably its first swivel joint 111 , to the distal end of a length adjustment device13. The distal part of the length adjustment device 13th is preferably used as a free lathe with regard to the fastening of the connecting means 14th educated. This can in particular with the second swivel joint 112 of the hand control device 11 advantageous muscle building training by pushing the components apart and thus achieving higher contact pressure on the inner side of the protective cover 16 or a total fixation at a certain angle within the pronation and / or supination S / P of the forearm 92 can be achieved. At the proximal end of the length adjustment device 13th then preferably the second part begins 142 of the lanyard 14th which in turn, as already mentioned above, with the adjustment means 15th for adjusting the axis geometry of the lanyard 14th , especially with the ball joint 151 and / or can be firmly connected to the ball head with the backdrop.

The present invention relates to an orthosis 1 for controlled movement and / or fixation of a hand 91 and / or a forearm 92 of a patient and is characterized by the fact that they have at least one hand control device 11 comprises, which is set up, both a controlled movement and an angle-dependent fixation of the hand 91 to allow; and / or at least one forearm control means 12th comprises, which is set up, both a controlled supination-pronation movement of the forearm 92 as well as an angle-dependent fixation at a certain angular position with respect to a rotation around the longitudinal axis of the forearm 92 to allow. It supports and controls physiological movements in the elbow joint 93 and in the wrist and is particularly suitable for building up training, for example in the case of muscle atrophy and / or joint stiffness. In addition, it enables movements, which from a medical point of view must be restricted or blocked at the beginning of a therapy, to be adjusted in their permitted extent of movement by means of adjustment devices, with movement patterns that can be kept free during the therapy being allowed to the full extent at the same time.

List of reference symbols

1

Orthosis

11

Hand control means

111

first swivel joint for extension / flexion ( E / F ) of the hand 91

1111

Axis of rotation

1112

first shift mechanism

112

second swivel joint for ulnar and / or radial deviation ( urD ) of the hand 91

1121

Axis of rotation

1122

second shift mechanism

12th

Forearm controls

121

Swivel joint for supination / pronation of the forearm 92

1211

Axis of rotation

122

Means for generating a mechanical resistance

13th

Means for length adjustment

14th

Lanyard

141

first part of the connecting means 14

142

second part of the connecting means 14

15th

Adjustment means

151

Ball joint

16

Protective cover

161

outer shell

162

inner shell

2

first receiving means

21st

Longitudinal axis of the first receiving means 2

3

second receiving means

31

Elbow control means

91

hand

92

forearm

93

Elbow joint

urD

ulnar / radial deviation of the hand 91

E / F

Extension / flexion of the hand 91

S / P

Forearm supination / pronation 92

LA

Longitudinal axis of the orthosis 1

QA

Orthosis transverse axis 1

Claims (15)

Orthosis (1) for the controlled movement and / or fixation of a hand (91) and / or a forearm (92) of a patient, at least comprising - a first receiving means (2) for receiving at least part of the hand (91); - A second receiving means (3) for receiving at least part of the forearm (92); - A connecting means (14) along a longitudinal axis (LA) of the orthosis (1) for the (operative) connection of the first receiving means (2) to the second receiving means (3), characterized in that - the orthosis (1) - at least one Hand control means (11) which is set up to allow both a controlled movement and an angle-dependent fixation of the hand (91); and / or - comprises at least one forearm control means (12) which is set up both a controlled supination-pronation movement of the forearm (92) and an angle-dependent fixation at a specific angular position with respect to a rotation about the longitudinal axis of the forearm (92 ) to allow. Orthosis (1) Claim 1 , characterized in that the hand control means (11) is set up to allow both a controlled movement and an angle-dependent fixation of the hand (91), - the controlled movement being an extension and / or flexion (E / F) of the hand ( 91), and - where the angle-dependent fixation is a fixation of the hand (91) at a certain position in the plane of movement of extension and / or flexion (E / F). Orthosis (1) Claim 1 or 2 , characterized in that the hand control means (11) is set up to allow both a controlled movement and an angle-dependent fixation of the hand (91), - the controlled movement being an ulnar and / or radial deviation (urD), and - wherein the angle-dependent fixation is a fixation of the hand (91) at a specific position in the plane of movement of the ulnar and / or radial deviation (urD). Orthosis (1) according to one of the Claims 1 to 3rd , characterized in that the hand control means (11) is operatively connected to the first receiving means (2) and has at least one first swivel joint (111), - whose axis of rotation (1111) is arranged perpendicular to the longitudinal axis (LA) of the orthosis (1) - wherein the swivel joint (111) is set up to change an angle (α) between a longitudinal axis (21) of the first receiving means (2) and the connecting means (14). Orthosis (1) Claim 4 , characterized in that the radius of movement of the first swivel joint (111) around its axis of rotation (1111) can be restricted to any angle ranges less than or equal to 180 ° and / or at a certain angle (α) between the longitudinal axis (21) of the first receiving means (2 ) and the connecting means (14) can be fixed. Orthosis (1) according to one of the preceding claims, characterized in that the hand control means (11) is operatively connected to the first receiving means (2) and has at least one second swivel joint (112), - its axis of rotation (1121) perpendicular to the longitudinal axis ( LA) of the orthosis (1) and is arranged perpendicular to an axis of rotation (1111) of a first swivel joint (111), - the second swivel joint (112) being set up to form an angle (β) between the longitudinal axis (21) of the first receiving means ( 2) and to change the axis of rotation (1111) of the first swivel joint (111). Orthosis (1) Claim 6 , characterized in that the radius of movement of the second swivel joint (112) around its axis of rotation (1121) can be restricted to any angle ranges less than or equal to 180 °, preferably less than or equal to 100 °, and / or at a certain angle (β) between the longitudinal axis ( 21) of the first receiving means (2) and the axis of rotation (1111) of the first swivel joint (111) can be fixed. Orthosis (1) according to any one of the preceding claims, characterized in that - the hand control means (11), in particular its first swivel joint (111), - comprises a first displacement mechanism (1112) via which the hand control means (11) also the connecting means (14) is operatively connected, the first displacement mechanism (1112) being set up to displace the hand control means (11) dorsally and / or palmarly with respect to the connecting means (14); and - the hand control means (11), in particular its second swivel joint (112), - comprises a second displacement mechanism (1122) via which the hand control means (11) is operatively connected to the first receiving means (2), the second displacement mechanism (1122) is set up to move the first receiving means (2) with respect to the manual control means (11) in all three spatial directions. Orthosis (1) according to one of the preceding claims, characterized in that the forearm control means (12) has at least one swivel joint (121), - whose axis of rotation (1211) is arranged parallel to the longitudinal axis (LA) of the orthosis (1), - The swivel joint (121) can be restricted in its radius of movement around its axis of rotation (1211) to any angle ranges less than or equal to 180 ° and / or at a certain angle (γ) between an axis of rotation (1121) of a second swivel joint (112) of the hand control means (11) and a transverse axis (QA) of the orthosis (1) can be fixed. Orthosis (1) according to one of the preceding claims, characterized in that the forearm control means (12) comprises at least one means (122) for generating a mechanical resistance, - wherein the means (122) for generating a mechanical resistance in particular - from a Combination of a full metal element in the form of an inclined cone and a screw adjusting device, or - is formed from a pretensioned spring. Orthosis (1) according to one of the preceding claims, characterized in that the orthosis (1), in particular the second receiving means (3), comprises an elbow control means (31) which is set up for both controlled movement and angle-dependent fixation of the forearm (92), - wherein the controlled movement is a flexion and / or extension of the forearm (92) around an elbow joint (93) and - wherein the angle-dependent fixation is a fixation of the forearm (92) at a certain position in the plane of movement of extension and / or flexion about the elbow joint (93). Orthosis (1) according to one of the preceding claims, characterized in that the orthosis (1) comprises at least one means for length adjustment (13) with respect to its longitudinal axis (LA), which is in operative connection with the second receiving means (3), the means for length adjustment (13) is formed in particular from a round bar or an n-corner bar with a correspondingly designed sleeve. Orthosis (1) according to one of the preceding claims, characterized in that the orthosis (1) comprises an adjustment means (15) for adjusting the axis geometry of the connecting means (14), in particular a ball joint (151) and / or a ball head with a link. Orthosis (1) according to one of the preceding claims, characterized in that the connecting means (14) is formed as a two-part axle, the first part (141) of which is the hand control means (11), the forearm control means (12) and possibly a means for length adjustment (13) and their second part (142) operatively connects the forearm control means (12) or, if applicable, the means for length adjustment (13) with the adjustment means (15), the first part (141) of the connection means (14) is rotatably mounted with respect to the second part (142) of the connecting means (14). Orthosis (1) according to one of the preceding claims, characterized in that the at least one hand control means (11), the at least one forearm control means (12), the connecting means (14), optionally an adjustment means (15) and a means for Length adjustment (13) are surrounded by a protective cover (16), - the protective cover (16) - in one piece or - in two parts, consisting of an outer, at least the means for length adjustment (13) and a second part (142) of the connecting means (14 ) surrounding envelope (162) and an inner envelope (161) surrounding at least the hand control means (11), the forearm control means (12) and a first part (141) of the connecting means (14).

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