AT504269B1 - DEVICE FOR THE PASSIVE HEALING GYM - Google Patents

Abstract

A device is described for passive therapeutic gymnastics of a patient. According to the invention, the device comprises the following components: - a plurality of linked actively controllable pivotable levers (1, 2, 3) of constant length, wherein the pivotable levers (1, 2, 3) each comprise a base (1.1, 2.1, 3.1), a Support (1.2, 2.2, 3.2), a pivotable part (1.4, 2.4, 3.4) and air muscles (1.3, 2.3, 3.3) consist, - a at least one of these pivotable lever (1, 2, 3) mounted bearing surface (4) for a body part of the patient to be moved, and - a programmable control unit connected to the pivotable levers (1, 2, 3) in which repetitive movements of the support surface (4) can be preprogrammed, the support surface (4) for a body part of the patient to be moved, which has flexible partial areas (4.1), extends over at least two of the pivotable levers (1, 2, 3). Furthermore, a method for driving the device will be described.

Description

Austrian Patent Office AT 504 269 B1 2011-07-15

The invention relates to a device for passive therapeutic gymnastics of a patient, which is formed of a plurality of concatenated actively controllable pivoting levers of constant length, wherein at least one of these pivotable lever is mounted a support surface for a moving body part of the patient, and wherein movements of the support surface are preprogrammed in a communicating with the pivotable levers control unit.

The US 5,417,643 and DE 299 22 651 U1 show a chair which is provided with a designed as such device, multi-armrest. The individual members are guided movably attached to each other. Between the individual links act controllable drives. The patient taking a seat on the chair puts one arm on the armrest. According to a control program then the armrest and with this the patient's arm is moved. According to the DE-font will not be discussed what happens if the controlled movements of the armrest deviate from the possibilities of movement of the patient and thus could cause pain or even injury to the patient. According to the US-Script a fast shutdown is provided for this case. The disadvantage of this is that when this shutdown takes effect, already dangerous large forces on the patient may have acted and that so that the treatment is stopped.

WO 2006/061834 A2 describes a similar device. The publication WO 2006/092872 describes a training device in which a defined load is exerted on the muscle while the device is performing a predefined movement. US 2004/0267331 describes a system and method that supports the restoration of physical functions of the neuromuscular system. The US 4,846,466 describes an exercise device with an electro-hydraulic system, which on rotation of a working arm of this rotation opposes a predefined and substantially constant resistance.

According to EP 1 609 451 A1, a device for passive therapeutic exercise is proposed, which consists of rigid, shell-like parts, which are similar to parts of a knight's armor worn by the patient and which are connected to each other via joints. Between each of the mutually movable shell parts act air muscles as controllable actuators. Nothing is said about the type of actuation of the actuators. The construction of shell-like parts makes the device quite heavy and the process of putting it on and off is somewhat cumbersome.

The US 2003/0223844 A1 also shows a device which consists of a plurality of rigid, shell-like members, which are similar to parts of a knight's armor worn by a person and are connected to each other via joints. The device is used to control a remote, for example in space, arranged robot. Elastic prestressed Bowden cables help to lift individual limbs against the action of gravity and they serve to measure the position of individual limbs relative to one another. Depending on the measurement result, a remote robot is moved. In an advantageous further development, controlled forces are also exerted between the individual shells of the device as a function of the forces acting on the robot.

The document DE 36 30 822 A1 describes a driving device with tactile properties, which has at least one set of two elastic stretchable and contractible air muscles for pivoting a lever. The publication WO 2004/096083 also relates to a pneumatic muscle which is capable of providing bidirectional forces. The US 4,615,260 relates to an arrangement of mutually-working pneumatic muscles for pivoting levers.

The inventor has set itself the task of providing a flexible controllable device for the passive mobilization of limbs of a standing, sitting or lying person, preferably for moving an arm of a seated person to provide. The new device is said to have two major improvements compared with previously known devices for this purpose: [0008] In response to deviations from the desired trajectory, that is to say from the desired path-time curve, according to reactions the patient should respond softly so that the patient is never injured.

Deviations from the desired trajectory reactions of the patient should be registered and recorded by the device - to better assess the success of therapy and to be able to adapt the therapy accordingly better targeted.

To solve the problem, a device is proposed as in US 5,417,643 and DE 299 22 651 U1, which consists of several concatenated, mutually controllable pivoting levers, and can be arranged on the side of a chair on which the attending person is sitting. Two levers of the device provide a support surface for the forearm and upper arm of the person to be treated, by being arranged below these members approximately parallel thereto. In contrast to the prior art devices, the controllable actuators between the individual levers of the device use pneumatic muscles, and the detection of the lengths of the pneumatic muscles and the pressure in the pneumatic muscles, which are required to control the pneumatic muscles, is also used to detect the actually traversed trajectories , The setting of a device in the elastic range very soft reaction to deviations from the desired trajectory, can be done by a corresponding adjustment of the anyway required for the controlled operation of the muscles of the air control.

Advantageous details of the mechanical structure and advantageous properties of the control to be provided are described with the aid of the drawing: FIG. 1: is a schematic diagram of an exemplary embodiment according to the invention

Device in side view. Individual details are shown in sectional view.

Fig. 2: shows in the form of a flow chart a possible information processing and control sequence of a device according to the invention.

Air muscles consist essentially of a tube-like middle part and two plate-like end pieces, of which at least one is provided with an air passage. When inflated, the tubing mid-section expands in circumference and shortens in length, to a maximum of about 75% of the original length. This shortening of the length can also be done by overcoming an external tensile force. One of the first publications is GB 1331756 (Trish Energetics, published in 1973). These air muscles have no static friction.

Characterized in that the change in length of the air muscles is caused by pressure of the volume-elastic medium air, the force-displacement characteristic is already soft elastic in itself. It is therefore much easier to achieve with the help of pneumatic muscles a soft-elastic behavior against deviations from the desired trajectory, as is the case with other conventional actuators such as hydraulic cylinders or electric motors. Unlike pneumatic cylinders, there is no breakaway force on air muscles after standstill; So even with the smallest of attacking forces, there is an elastic yield without jerking. An additional safety gain results from the fact that the force with which an air muscle acts on an external object can not increase abruptly for physical reasons.

In addition to the base 0 and provided with flexible sections 4.1 support surface 4 for the arm of the person to be treated, the exemplary device outlined in Fig. 1 consists of three concatenated pivoting levers 1, 2, 3. One side of the first pivotable Lever 1 is held immovable over the base 1 opposite the chair or bed on which the person to be treated is located. Each pivotable lever has a constant length, and consists of a support 1.2, 2.2, 3.2, with the first end of a base 1.1, 2.1, 3.1 is rigidly connected, and at the second end of a pivotable Austrian patent office AT 504 269 B1 2011-07-15

Part 1.4, 2.4, 3.4 is arranged. The base of the third pivotable lever is rigidly connected to the pivotable part of the second pivotable lever. The base of the second pivotable lever is rigidly connected to the pivotable part of the first pivotable lever. Between the base and pivotable part of a pivotable lever air muscles 1.3, 2.3, 3.3 are arranged, by means of which the respective pivot position can be actively adjusted. The pivotable part of the individual pivotable levers is fastened, for example via a ball and socket joint, a cardan joint, or even a bolt-cylinder joint to the associated support over the longitudinal direction of the pivotable lever. Thus, a movement can be generated as needed around one or more non-parallel axes. The air muscles of a pivot lever are aligned parallel to the support, and arranged on different sides of the respective hinge axes. By contracting an air muscle and stretching the other air muscle of a pivotable lever, the pivotable part of this pivotable lever is actively rotated about the respective axis or axes.

In the design of the individual pivotable levers and the connecting pieces between them, approximately the individual members of a human arm with respect to length and degrees of freedom of the movement can be simulated. But you can also provide a longer chaining of several, even longer pivoting lever, and thus allow a much greater freedom of movement with respect to the mechanical design. The device is thus better for different sized people and for a wider range of possible movements applicable. Especially when using longer links of swiveling levers can be found with such levers good Auslangen in which the pivotable part with respect to the base is pivotable about a single axis. As a result, costs can be avoided and robustness can be gained.

In order to keep inertia forces as small as possible during operation, should - in adaptation to the expected moment loads - the pivot lever in the order of the base 0 away slimmer and weaker, and thus run easier per length.

In the flow chart of Fig. 2, the framed texts mean operations. The arrowheaded lines in between either indicate only the order of operations, or they also mean information that is the result of a process, and feed into a next process.

The operations in the region of the curved bracket b relate to the usual operation of controlled air muscles. Taking into account the actually measured lengths and the pressures actually measured with the aid of tables or curves stored in the data base, a nominal value of the length of the individual pneumatic muscles is tracked by changing the pressure in the individual pneumatic muscles in a controlled manner.

The operations in the region of the curved bracket a concern data processing steps, which can be performed in a simple data processing system. On the one hand, they relate to the superordinate program, on the other hand, the bidirectional conversion between the lengths of the individual air muscles 1.3, 2.3, 3.3, and the position data of the support surface 4, and between the forces on the individual air muscles and the forces on the support surface.

From the parent program is specified, which path-time curves are to be traversed by the support surface and it is also given in what way to respond to external forces on the support surface. This reaction may be, for example, a more or less soft set elastic behavior, ie a behavior in which the restoring reaction force is proportional to the deflection of the desired position. However, it can also be adjusted, for example, that the reaction force has a constant - small - size, regardless of the deflection. Of course, also 3/11 Austrian Patent Office AT 504 269 B1 2011-07-15

Combinations thereof, such as "elastic behavior only up to a certain (low) maximum force", and any other settings by appropriate program settings feasible, and often useful.

For example, can be dispensed with a reaction force in deviation from the predetermined path-time course of the shelf for training the coordination ability. Instead, the desired course of the path over time, as well as deviations can be communicated by optical and / or acoustic signals. Through the measurement and, for example, the integration of the deviations over time statements about the coordination ability are obtained.

It is essential that the actual path-time curves are not only measured, but above all their deviations from the desired course can be recorded and evaluated. From this essential information on the course of therapy and for the further design of the therapy can be derived.

Of course, many safety-related limitations can be provided in the parent program. For example, can be automatically excluded by the program routine that physiologically impossible positions are approached at all. Acceleration, speed and force limitations can be incorporated. It can be judged on the basis of the evaluations of the deviations of the actual path-time courses, whether a patient is increasingly cramping, whether he is relaxing, or whether he is too tired; Accordingly, the further course can be coordinated, or even the treatment be interrupted or canceled.

Of course, instead of path-time courses and force-time courses can be preprogrammed in compliance with certain speed and position restrictions.

In the inventive embodiment of the device for passive therapeutic gymnastics, the essential information and control means are already provided by using controlled air muscles as actuators anyway. Moreover, for the advantageous application as a therapy device, essentially only a relatively simple programmable data processing unit is required. This data processing unit can be realized, for example, in the form of a simple, conventional portable computer with a computing power that is low compared with conventional workstation computers.

Of course, the data processing system is to be programmed such that the desired path-time profiles can be entered via the keyboard by means of an input mask. Since it is in any case designed to record the actual path-time progressions during operation, it is only a small step to use such recorded progressions as new target progressions. That The system can be easily programmed by means of a teach-in procedure by touching the support surface in the appropriate mode and manually moving it in the desired sequence, which will later be automatically run through.

In practical application, this means that the way for the device to go through automatically subsequently can be programmed by the patient puts his arm on the support surface and the therapist carefully moves the support surface together with the arm as he thinks it's right.

With appropriate skill, of course, the patient can program a way even in this way, by then when the device is switched to the recording mode, the support surface moves once accordingly.

In a thus easily realizable expectant therapy form, a range of motion is given, which should be able to go through the support surface together with the arm of the patient ultimately, but initially can not go through. The device seeks to go through the given path. For example, because of the fear of pain, immobility in the joints, lack of coordination, or lack of muscle power, the patient forces another, less demanding, path. This forcing is painless for the patient, since the device responds very yielding to the deflections caused by the patient. The device remembers this second path and goes through this path several times, so that the patient relaxes in this possible movement. Gradually, the device tries to approach the path to be traveled back to the original target path. For this purpose, the position deviations in the individual desired paths to the original desired path at the respective time chamfers in the individual runs are set lower and lower.

Further key terms for the programming of the superordinate controlling data processing system are: - Prepared path-time force profiles.

Editability of programmed movements with respect to geometrical changes, changes in speed, changes in the forces to be applied.

- Einsteilbarkeit of safety-related limitations such as maximum speed VELOCITY, maximum acceleration, maximum forces.

Adjustability of large-scale positional tolerance with constant contact force, as long as the support surface is in contact with the target object. The contact surface "follows" that is, the force-controlled object, even if the object moves within certain limits.

- Regulation in such a way that a set position of the device is automatically restarted when it is moved due to an external effect, such as a shock on one of its moving parts from this position.

All of these functions can be easily obtained using the construction described by programming work within the scope of normal professional practice; therefore, it will not be discussed further here. It is the merit of the inventor to have realized that such functions can be very valuable for the therapy, and that they are simple, inexpensive and safe to implement using the construction according to the invention.

Further advantages which result from the use of controlled pneumatic muscles as actuators for the device for passive medical gymnastics are: Extreme robustness

Compared to differently driven devices, the soft-elastic muscles of the air can absorb and dampen impacts on the device itself. This makes the device, despite its lightweight construction, extremely robust against peak loads and vibrations. The air muscles themselves are also very robust compared to piston-cylinder actuators because they have no surfaces on which parts slide and seal against each other, and because they are practically unbreakable due to their flexibility as a hose by abutting objects.

Security

Dangers for people can be avoided in an advantageous manner even in the event that the control of the device works incorrectly. One only needs to limit the pressure in the pneumatic muscles, for example by means of pressure relief valves or by an additional control unit operating independently of the central control unit. In other constructions, breaking points would be required.

Cost-effective

Due to the simple structure of pneumatic muscles are cheaper than hydraulic or pneumatic cylinders, or comparable usable electric drives. In addition to the control elements required by default for control, no additional special control elements are required for the device according to the invention in addition to the central data processing system. 5/11

Claims (11)

Austrian Patent Office AT 504 269 B1 2011-07-15 - Ease Air muscles have a much lower weight than in the effect comparable actuators in common other construction. In addition to the gain in mobility is thus achieved a security gain, since the moving masses are lower. The proposed construction results in a previously unequaled strong bundle of advantages: safety, cost-effectiveness and value of the result. It is to be expected that by means of the device according to the invention the effective therapy by means of passive therapeutic gymnastics becomes accessible to a significantly larger proportion of those patients in whom this is potentially useful than is currently the case. So that the support surface can exert on the patient other than pure compressive forces, it should be equipped with releasable fastening means for the limbs of the patient to be moved through them. These fasteners may be, for example, straps with buckles or Velcro, or hinged brackets. The invention has been described above all for the purpose of passive therapeutic gymnastics in the arm or shoulder area of a person to be treated sitting. In principle, however, the invention is also suitable for the passive therapeutic movement of other body parts, such as the legs or the head relative to the trunk, and the person to be treated does not necessarily have to sit, but can for example also stand or lie on a bed. 1. A method for controlling a device for passive therapeutic exercise of a patient, the plurality of concatenated, pivotable lever (1, 2, 3) of constant length, arranged on at least one of these pivotable lever support surface (4) for a moving body part of the Patients and a programmable controller, which communicates with the pivotable levers (1, 2, 3), wherein the pivotable levers (1, 2, 3) each comprise a base (1.1, 2.1, 3.1), a support (1.2 , 2.2, 3.2), a pivotable part (1.4, 2.4, 3.4) and pneumatic muscles (1.3, 2.3, 3.3) and wherein the method comprises: - repeatedly traversing in the control preprogrammed movements of the support surface (4), detecting the Actual position of the support surface (4) - by the programmable controller, characterized by, - Apply the actually traversed sequence of positions of each pivotable lifting l (1, 2, 3) as a new preprogrammed desired movement sequence, and - in a similar manner, passing through individual movement sequences during a working session, wherein the respective desired course of passage from passage to passage gradually from a first predetermined form to a second, another predetermined Form is modified by the position differences of the individual target curves during the individual temporal phases of each pass to the positions of the second predetermined shape during the same time phases in the individual runs are reduced piecewise. 2. The method according to claim 1, characterized by the: - Automatic measurement of the lengths of the individual pneumatic muscles (1.3, 2.3, 3.3), and the pressures therein - Determining the voltage applied to the individual air muscles (1.3, 2.3, 3.3) forces from the measured information using data stored, characteristic tables or sets of curves for the individual pneumatic muscles (1.3, 2.3, 3.3), - Calculating the position of the individual pivotable lever (1, 2, 3) and the support surface (4) from the measured lengths of the individual pneumatic muscles (1.3, 2.3, 3.3) by geometric conversion, and calculating the forces on the individual pivoting levers (1, 2, 3) as well as on the support surface. (AT 504 269 B1 2011-07-15) 4) from the forces applied to the individual pneumatic muscles (1.3, 2.3, 3.3) by geometric conversion. 3. The method according to claim 1 or 2, characterized by setting a reaction force, which counteracts a deviation of the position of the support surface (4) from the preprogrammed position, by the programmable controller, wherein the dependence of this reaction force on the degree of deviation from the desired position editable is presettable. 4. The method according to claim 3, characterized in that the following selection options and combinations thereof are offered for the reaction force: - size of the reaction force proportional to the deviation, proportionality factor adjustable, upper limit of the reaction force adjustable; - Size of the reaction force when a minimum deviation is exceeded constant in an adjustable height, otherwise no reaction force. 5. A method for controlling a device for passive therapeutic exercise of a patient, the plurality of concatenated, pivotable lever (1, 2, 3) of constant length, a at least one of these pivotable lever (1, 2, 3) arranged support surface (4) for a body part of the patient to be moved and a programmable controller which is connected to the pivotable levers (1, 2, 3), wherein the pivotable levers (1, 2, 3) each comprise a base (1.1, 2.1, 3.1 ), a support (1.2, 2.2, 3.2), a pivotal member (1.4, 2.4, 3.4) and pneumatic muscles (1.3, 2.3, 3.3), and wherein the method comprises: - repeatedly traversing pre-programmable motion sequences of the support surface characterized by - automatically measuring the lengths of the individual pneumatic muscles (1.3, 2.3, 3.3), and the pressures therein - determining the forces applied to the individual pneumatic muscles (1.3, 2.3, 3.3), from the measured information Using data stored technically deposited, characteristic tables or sets of curves for the individual pneumatic muscles (1.3, 2.3, 3.3), - Calculating the position of the individual pivotable lever (1, 2, 3) and the support surface (4) from the measured lengths of the individual air muscles (1.3, 2.3, 3.3) by geometric conversion, and - calculating the forces on the individual pivotable lever (1, 2, 3) and on the support surface (4) from the individual air muscles (1.3, 2.3, 3.3) adjoining forces by geometric conversion, and - Setting a reaction force, which counteracts a deviation of the position of the support surface (4) from the preprogrammed position, by the programmable controller, the dependence of this reaction force on the degree of deviation from the desired position editable is preset. 6. The method according to claim 5, characterized in that the following selection options and combinations thereof are offered for the reaction force: - size of the reaction force proportional to the deviation, proportionality factor adjustable, upper limit of the reaction force adjustable; - Size of the reaction force when a minimum deviation is exceeded constant in an adjustable height, otherwise no reaction force. 7. The method according to claim 5 or 6, characterized by the - detecting the actual position of the support surface (4) by the programmable controller, - take over the actually traversed sequence of positions of the individual pivotable lever (1,2, 3) as a new pre-programmed target - Movement procedure, and - in a similar way, often passing through individual movements during a working session, the respective target course from run to run after and from a first predetermined form to a second, modified other predetermined shape by the position differences of the individual target curves during the individual time phases of each pass to the positions of the second predetermined shape during the same time phases in the individual runs are reduced piecewise. 8. Apparatus for the passive therapeutic gymnastics of a patient, comprising: - a plurality of concatenated actively controllably pivotable levers (1, 2, 3) of constant length, wherein the pivotable levers (1, 2, 3) each consist of a base (1.1, 2.1, 3.1), a support (1.2, 2.2, 3.2), a pivotable part (1.4, 2.4, 3.4) and pneumatic muscles (1.3, 2.3, 3.3), - one on at least one of these pivotable lever (1, 2, 3 ) mounted support surface (4) for a moving body part of the patient, and - a with the pivotable levers (1, 2, 3) in communication, programmable control unit, in the repeatedly traversed movements of the support surface are preprogrammed, characterized in that the support surface (4) for a body part of the patient to be moved, which has flexible portions (4.1), extends over at least two of the pivotable levers (1, 2, 3). 9. Apparatus according to claim 8, characterized by more than three concatenated pivotable lever (1, 2, 3), of which at least three pivotable levers (1, 2, 3) are pivotable with respect to their base only in each case exactly one axis. 10. Apparatus for passive therapeutic gymnastics of a patient, comprising: - a plurality of concatenated actively controllably pivotable levers (1, 2, 3) of constant length, wherein the pivotable levers (1, 2, 3) each comprise a base (1.1, 2.1, 3.1), a support (1.2, 2.2, 3.2), a pivotable part (1.4, 2.4, 3.4) and pneumatic muscles (1.3, 2.3, 3.3), - one on at least one of these pivotable lever (1, 2, 3 ) mounted bearing surface (4) for a moving body part of the patient, and - a with the pivotable levers (1, 2, 3) in communication, programmable control, in the repeatedly traversed movements of the support surface (4) are preprogrammed, characterized characterized in that the control is designed to - automatically measure the lengths of the individual pneumatic muscles (1.3, 2.3, 3.3), as well as the pressures prevailing therein - the forces applied to the individual pneumatic muscles (1.3, 2.3, 3.3) from the measured Infor the position of the individual pivotable levers (1, 2, 3) and of the support surface (4) from the measured lengths, using mathematically stored, characteristic tables or sets of curves for the individual pneumatic muscles (1.3, 2.3, 3.3) to calculate the individual air muscles (1.3, 2.3, 3.3) by geometric conversion, - the forces on the individual pivotable levers (1, 2, 3) and on the bearing surface (4) from the forces applied to the individual pneumatic muscles by geometric conversion calculate, and - set a reaction force, which counteracts a deviation of the position of the support surface (4) from the preprogrammed position, by the programmable controller, wherein the dependence of this reaction force on the degree of deviation from the desired position editable is preset. 11. Apparatus according to claim 10, characterized in that the programmable controller is adapted to - the actual position of the support surface (4) to capture, - the actually traversed sequence of positions of the individual pivotable lever (1, 2, 3) as a new preprogrammed target movement sequence, and in a similar way to traverse individual movements during a working session many times, whereby the respective desired course of passage from run to run gradually from a first predetermined Form is changed to a second, different predetermined shape by the position differences of the individual target curves during the individual time phases of each pass to the positions of the second predetermined shape during the same time phases in the individual passes are reduced piecewise. For this 2 sheets drawings 9/11