EP2156815A1 - System for training movement processes - Google Patents

Abstract

The assembly (1) for training the movements of limbs has a number of units (2-5), for different applications, linked to a central data processing unit (6). Each unit has a sensor to monitor movements and an evaluation unit.

Description

The present invention relates to an arrangement for exercising movements of the upper and / or lower extremities as well as of the trunk.

Such arrangements can be used for a variety of different health-promoting measures, wherein the use of such an arrangement for the treatment of neurological, geriatric and / or orthopedic diseases of patients is described below in particular. All possible uses of the arrangement have in common that they should lead to an improvement in the function of the upper extremities, torso and / or lower extremities, ie the arms, the trunk and / or the legs. A special field of application is the treatment of stroke patients whose upper and / or lower extremities often have acute, subacute and / or chronic functional disorders after a stroke. However, similar functional disorders also occur in geriatric and / or orthopedic diseases.

The disadvantage is that so far in neurological, geriatric and orthopedic rehabilitation hardly systematized apparatus approaches for the treatment of these disorders are.

Therefore, it is the object of the present invention, an arrangement for training movements of the upper and / or lower extremities To provide a very efficient treatment of dysfunction of the upper and / or lower extremities, as studies have already demonstrated.

This object is achieved by an arrangement of the type mentioned, which is characterized by at least two differently configured means for moving the extremities, which allow different complex movements with different degrees of freedom, and a central data processing system, which is connected to the facilities.

The embodiment of the arrangement according to the invention for training movement sequences of the upper and / or lower extremities offers the advantage that treatment successes can be achieved in a relatively short time, since the differently configured devices, of which preferably a number suitable for the respective type of application of the arrangement, are present the central data processing system work together to enable a very targeted and individual treatment of patients. For example, an individual training program may be stored in the central data processing system, which contains specific prescriptions of a physician, occupational therapist or physiotherapist as training parameters. The arrangement can thereby monitor the training progress or success automatically and guide a patient to be treated accordingly. By the targeted use of cooperating devices according to the invention, a very efficient treatment of dysfunctions of the upper and / or lower extremities is possible, whereby the time required for rehabilitation can be significantly reduced. The arrangement according to the invention can also be used equally in inpatient, day-patient and outpatient areas as well as in connection with nursing institutions.

The invention is based on the recognition that the time required for rehabilitation can be significantly shortened if complex movement sequences to be learned are first divided into less complex partial movements and these partial movements subsequently isolated from one another and at high levels Be practiced repetition rate, after which a gradual joining together of each sufficiently well-trained sub-movements can be done to the complex and everyday movement sequences. Treatment success is much faster in this approach than if the patient is directly confronted with the practice of complex movement sequences. The arrangement preferably has as many devices as there are partial movements. The individual less complex partial movements can thus be carried out at the respective devices for moving the extremities. Examples of such partial movements are the active and passive training of extension and flexion in the wrist, pro- and supination in the forearm, flexion and extension around the elbow joint, ante and retroversion in the shoulder joint, parallel and alternating movement, the bimanual training using so-called mirror neurons, the distal therapeutic approach and the like.

The arrangement according to the invention preferably has a number of differently configured devices which are suitable for their particular application and which interact optimally to achieve a desired treatment result. As a result, a sequential and graded treatment is possible, with the individual treatment stages can be optimally adapted to each other. The progress of this treatment can be monitored in a very simple manner by means of the central data processing system connected to the devices, which is preferably able to compare predefined training parameters currently acquired to automate the treatment to a great extent, while at the same time providing a better comparison State of the art is provided much more efficient treatment option.

The respective extremity movement devices are preferably matched so that a patient at the device can begin training commensurate with the degree of his illness, meaning that a more severe illness should suitably begin with a simpler exercise session than a lighter one. A patient often performs one particular movement at a given facility one at a time, until after a suitable number of similar ones Training units a desired treatment success is preferably determined by the central data processing system. Then the patient can switch to another device, which allows a somewhat more complicated movement sequence, in order likewise to achieve a further step of mobilization of a limb by a frequently repeated execution of a certain course of movement. In particular, this step-like treatment with synergistic treatment stages allows a very targeted and optimal treatment of a patient, with desired treatment successes set relatively quickly.

For example, a patient trained in post-stroke rehabilitation for the treatment of stroke-induced dysfunction on a device according to the invention connects the affected limb to a suitable device for moving it, with the limb substantially forcibly guided by the devices can perform. This forced guidance makes it possible to provide devices which allow different complex movements with different degrees of freedom. The number of degrees of freedom can preferably be slightly varied in order to be able to carry out an optimal adaptation of the arrangement according to the invention to its respective intended use.

In severe neurological disorders of the upper extremities, it is advantageous if the first device of the device is a device for exercising and moving the patient's fingers. However, in patients whose arm function is largely established or undisturbed, the device may also be located at the end of the assembly for better training of fine motor skills. The device for exercising the fingers is preferably a mechanical, motor-driven device, which is set up for the passive movement of the fingers of the neurologically disturbed upper extremity. Preferably, the hand with special attention to the thumb can be stored on a support rail. After subsequent creaming of the fingers they can be placed on rolls of a lower roller apparatus and gently fixed from above with a skate-like upper apparatus. The lower roller apparatus is preferably a crankshaft similarly formed. Its rollers advantageously have structuring on their side facing the fingers. After placement and correct fixation of the hand or the fingers on the device, the lower roller apparatus is set in motion, whereby its rollers rotate about an eccentric axis and unevenly raise and lower the fingers respectively arranged on them. By arranging roles on the upper apparatus and the structuring of the roles of the lower role apparatus the sensory input is increased by this exercise and a special learning stimulus for the damaged brain is achieved. As a further step could be activated for additional information acquisition attached to the bottom of the device vibration motor, which irritates additional other receptors.

The patients who train on the arrangement according to the invention, preferably sit in the execution of the motion sequences at the respective institutions. In order to prevent unwanted compensatory movements, for example, of the shoulder during the execution of the movements and at the same time to guarantee a correct movement guidance, the exercising patient is preferably fixed to the chair by means of a fixing belt or the like.

However, patients who are able to walk may also train standing and tilting devices. By additional difficulties under the feet, for example generated by a balance mat, fabrics or the like, they can simultaneously train their balance and their core stability.

According to an advantageous embodiment of the invention, each device comprises a base unit and an actuating unit, wherein the actuating unit is movable relative to the base unit. Such a device is, for example, a stationary device on which a patient connects the limb to be mobilized with the operating unit and thus can perform movements together with the operating unit relative to the base unit. The relative movement of the actuator to the base unit provides a component of the device enabled complex movement sequence, wherein the actuating unit may further comprise actuating elements which are also movable and preferably independent of the relative movement of the remaining actuating unit to the base unit to provide additional degrees of freedom or adaptation to specific needs. The relative movement of the actuating unit to the base unit essentially determines a degree of freedom of the movement, which means a forced guidance of the extremity during the movement of the same in a certain direction.

A further advantageous embodiment of the invention provides that at least one device has a drive unit which is connected to the actuating unit. This makes it possible for a limb, which is almost completely paralyzed, to be set in motion in a passive manner in order to start the mobilization of this limb. If progress is made in such a treatment of a limb, provision can be made, for example, for the drive unit, which is designed approximately as a servomotor, to be switched off and for the patient to actively carry out the same movements on the corresponding device. Such a training success is generated in particular by the frequent repetition of a same sequence of movements.

It is understood that, according to the invention, the means for moving the extremities are passive as well as active. Passive means that the device dictates the movement to the patient in order to provide a learning incentive.

According to a further advantageous embodiment of the invention, at least one device has an evaluation unit, which is connected to the actuating unit. By means of this configuration of a device, it is possible, for example, to record motion parameters, such as the number of movements performed or the like. For example, a training program can be predetermined by the evaluation unit, which a patient should perform to create the desired success, which can be monitored by the evaluation unit. The device is preferably via the evaluation unit with the central Data processing system connected, so that a central monitoring of the training can be done in total. Based on the signals received from the evaluation unit, the central data processing system can, for example, control the corresponding device in order to implement a specific training program. It is conceivable that the central data processing system controls the drive unit of the device as a function of the determined, so far achieved training success.

Expediently, at least one device has a sensor with which the actuation of the actuation unit can be monitored. By this configuration, for example, it can be detected whether in a passive operation of an operating unit using a drive unit, a resistance is generated by the limb to be trained, after which an emergency shutdown of the device can take place, for example by means of the evaluation and / or the central data processing system to injury to avoid the extremity. Furthermore, the number of movements and dynamics of the movements can be recorded in detail by means of a sensor and forwarded to the evaluation unit and / or the central data processing system for further processing of these training data for further evaluation.

It is further considered advantageous if the actuating unit is actuatable simultaneously with both upper or lower extremities, wherein the movements of the upper and lower extremities are coupled to each other or independent of each other. As a result, both a synchronous and an asynchronous movement of the upper or lower extremities is possible, so that a wide variety of training programs can be performed on a corresponding device. In particular, embodiments are conceivable in which a healthy limb moves along a paretic extremity (master-slave principle). It can also be provided that the paretic limb must overcome an initial resistance at the beginning of the movement. The amplitude and the speed of the movement as well as the resistance to be overcome are preferably individual via the evaluation unit and / or the central data processing system adjustable to allow movements that are ideally adapted to the individual degree of the disease.

It is also advantageous if at least one device has a stimulation unit which is arranged on the actuation unit. Such a stimulation unit can, for example, generate electrical stimuli or vibrations and allow it to act on certain parts of the limb, such as the fingertip, for example, which further improves the training effect. Such tactile-dynamic stimulation can be applied, for example, on a hand, especially the fingers, of a paretic extremity. This can be done independently or together with a movement of the other limb. This stimulation is preferably also generated as a function of predetermined training parameters by the evaluation unit and / or the central data processing system.

Furthermore, it is proposed that the base unit is designed to be height-adjustable and / or tiltable by at least one device. In this way, a patient can easily operate a corresponding device both standing up and sitting, and it can also be done to an optimal adjustment of the device to the respective body size of a patient.

Preferably, at least one device is connected to a display unit. By way of example, such a presentation unit can be a display of any configuration on a device which represents, for example, the number of movements that are carried out or still to be performed or other parameters of a training progress. In particular, it is possible for the display unit to have or cooperate with a monitor via which video recordings of specific movement sequences of the corresponding extremity to be trained, such as, for example, piano-playing fingers, are shown. This results in an additional excitation of mirror neurons, since own movements are associated with the movements shown. For example, a combination of tactile-dynamic stimulation with the presentation of video recordings is selected for optimal treatment, which is a quick setting can favor a desired treatment success. The presentation unit is also preferably controlled by means of the evaluation unit and / or the central data processing system.

It is considered advantageous, if at least one device for varying the resistance of the actuating unit has. This also makes it possible to generate a training unit individually adapted to the respective circumstances in consecutive training units by increasing the resistance to movement in order to be able to carry out a very effective training.

According to another proposal, at least one device has a signaling unit. This can signal, for example, whether a movement performed corresponds to the predetermined motion parameters, which can be monitored for example by a sensor and an associated evaluation and / or central data processing system. For example, it can be signaled whether a movement, such as an extension of an arm, takes place to a predetermined extent. As a result, the patient is given a simple way of checking that, by signaling a specific state of movement, he can check whether the movement performed by him takes place with sufficient intensity for the desired training success.

The review and evaluation of the training success or progress, for example, by means of various assessment methods, such as the Fugl Meyer Motor Score Test, Box and Block Test, Action Research Arm Test (ARAT), take place. Corresponding programs which are suitable for carrying out such a method can be stored, for example, in the central data processing system.

The present invention further proposes use of the arrangement according to one of the aforementioned embodiments for the treatment of neurological, geriatric and / or orthopedic disabilities, in particular the arms and for exercising arm and hand movements.

It can be seen that with the present invention, a very efficient rehabilitation of paretic limbs is possible by using an arrangement in which at least two devices enable a graduated training course, wherein an evaluation and monitoring of the entire patient by means of a central data processing system connected to the devices Training success or progress can be done. To achieve this goal a wide variety of combinations of the above-described embodiments of the arrangement are possible. It is clear to a person skilled in the art that the devices can have very different embodiments, which are not explicitly mentioned, which allow a graduated treatment of the type described above.

Further advantages and features of the present invention will be apparent from the in the FIG. 1 illustrated embodiment of the invention explained, wherein FIG. 1 a schematic representation of an embodiment of the inventive arrangement shows.

FIG. 1 schematically shows an embodiment of the inventive arrangement 1 for training movements of the upper extremities. In this embodiment, the arrangement 1 has four devices 2, 3, 4 and 5, which are connected to a central data processing system 6 via a data line 7. In front of the devices 2, 3, 4 and 5, respectively, a chair 8 is placed, on which a patient can take a seat while exercising.

A training course by means of such an arrangement 1 has the following sequence: First, a patient who has a paretic upper limb, takes place in front of the device 2 on a chair 8, at the beginning of the treatment by means of this device 2 movements with the least possible complexity and to perform a small number of degrees of freedom. These low-complexity movements are frequently repeated until a desired mobilization effect occurs, which is monitored by the central data processing system 6 by means of suitable software. For this purpose, 6 to be reached training parameters are stored in the central data processing system, which is compared with the currently detected training progress to determine whether a desired degree mobilization has been achieved and a change to a further device 3, 4 or 5 is possible, which enables a more complex movement of the upper paretic extremity than the device 2. The device 2 preferably has a drive unit, not shown, with which the paretic arm is moved passively at the beginning of training, wherein by means of a sensor, not shown, and an evaluation device, not shown, on the device 2, the resistance to movement can be monitored to paretic extremity injuries to prevent passive movement by the drive unit.

If a desired training progress by means of the central data processing system 6 to determine, the patient can finish the first training level on the device 2 and switch to the device 3, which is a mechanical arm trainer, in which both arms are moved, the healthy arm of the paretic arm carries. The possible movement of the device 3 is more complex and active than that allowed by the device 2, so that a stepped structure of the mobility of the limb can take place. If it is again determined by means of the central data processing system 6 that the mobilization progress to be achieved by the device 3 has occurred, the patient can change to the device 4, which is likewise designed as a mechanical arm trainer, in which the arms are moved independently of one another. In this case, a rectified or an alternating movement is possible. The movements that are possible through the device 4 are in turn more complex than those which are possible by the device 3, so that a gradual buildup of the mobility of the patient continues to take place. After re-determining a desired training success during the training level at device 4, the patient changes to the device 5, which is used in particular for mobilizing the hand and acts on the sensory motor system using a stimulation unit. By means of drive units, asynchronous movements of the fingers are generated, while at the same time a tactile-dynamic stimulation of the fingertip takes place and additionally a vibratory stimulus is applied. The mobilization result, which is generated by the device 5, is monitored via the central data processing system 6, so that in total by the Arrangement 1 can be a very targeted and efficient and largely automated mobilization of a paretic extremity.

Claims (12)

Arrangement (1) for exercising movements of the upper and / or lower extremities,
characterized by at least two differently configured devices (2, 3, 4, 5) for moving the extremities, which allow different complex movements with different degrees of freedom, and a central data processing system (6) connected to the devices (2, 3, 4, 5 ) connected is. Arrangement (1) according to claim 1, characterized in that each device (2, 3, 4, 5) comprises a base unit and an actuating unit, wherein the actuating unit is movable relative to the base unit. Arrangement (1) according to claim 2, characterized in that at least one device (2, 3, 4, 5) has a drive unit which is connected to the actuating unit. Arrangement (1) according to claim 2 or 3, characterized in that at least one device (2, 3, 4, 5) has an evaluation unit which is connected to the actuating unit. Arrangement (1) according to one of the preceding claims, characterized in that at least one device (2, 3, 4, 5) has a sensor with which the actuation of the actuating unit can be monitored. Arrangement (1) according to one of the preceding claims, characterized in that the actuating unit can be actuated simultaneously with both upper or lower extremities, wherein the movements of the upper and lower extremities are coupled together or independent of each other. Arrangement (1) according to one of the preceding claims, characterized in that at least one device (2, 3, 4, 5) has a stimulation unit which is arranged on the actuating unit. Arrangement (1) according to one of claims 2 to 7, characterized in that the base unit of at least one device (2, 3, 4, 5) is height-adjustable and / or tiltable. Arrangement (1) according to one of the preceding claims, characterized in that at least one device (2, 3, 4, 5) is connected to a display unit. Arrangement (1) according to one of the preceding claims, characterized in that at least one device (2, 3, 4, 5) has a unit for varying the movement resistance of the actuating unit. Arrangement (1) according to one of the preceding claims, characterized in that at least one device (2, 3, 4, 5) has a signaling unit. Use of the arrangement (1) according to one of the preceding claims for the treatment of neurological, geriatric and / or orthopedic disabilities, in particular the arms and for exercising arm and hand movements.

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