AU773133B2

AU773133B2 - Orthotic bracing walking trainer

Info

Publication number: AU773133B2
Application number: AU65281/99A
Authority: AU
Inventors: David Hart
Original assignee: Individual
Current assignee: Individual
Priority date: 1998-12-17
Filing date: 1999-12-16
Publication date: 2004-05-20
Anticipated expiration: 2019-12-16
Also published as: GB9827627D0; GB2344769A; GB2344769B; NZ501853A; CA2292188A1; AU6528199A

Description

r/UUIU II 2 /1Y Regulation 3.2(2)

AUSTRALIA

Patents Act 1990

ORIGINAL

COMPLETE SPECIFICATION STANDARD PATENT Application Number: Lodged: 0@ Invention Title: ORTHOTIC BRACING WALKING TRAINER The following statement is a full description of this invention, including the best method of performing it known to me I

I

1 ORTHOTIC BRACING WALKING TRAINER Technical Field This invention relates to a walking trainer aid.

Background Art Of the many children and young people who, through no fault of their own, have failed, or are failing, to learn to walk due to the effects of cerebral palsy, or similar resultant medical condition, it is believed that most have the potential to do so with properly applied physical help.

There are existing walking aids comprising orthotic trunk and hinged lower limb bracing, releasably attached, via the rear portion of the body bracing, to a wheeled frame unit, which keeps the user in an upright posture while standing and executing steps. However, these aids are cumbersome, can only be used upon a continuous smooth ground surface and demand additional effort and skills from the user to move and control the mass of the 15 wheeled frame unit.

There also exits walking aids intended to help the more severely disabled persons, which incorporate orthotic trunk and lower limb bracing, hinged at the hips and knees, and which employ knee locks to fix the user's legs in full extension for "straight-legged" walking and, when the knee locks 20 are released, will allow the user to sit with flexed knees. However, walking with immobilised knee flection, to prevent the user's lower limbs from folding, is very inefficient and restrictive, and does not provide a capable user with the opportunity to develop independent mobility skills. Furthermore, this kind of aid can usually only be used in conjunction with a separate hand-held supporting frame, tripods, or the like, to assist balance and mobility.

There also exits bracing with hinged knee joints, which employ the means to urge the user's lower limbs into extension by way of springs, or the like, attached to the bracing and acting about the knee hinges. However, these are not intended to be training aids and, used in conjunction with a hand held supporting frame or the like, these devices employ such means to help the user control descent when sitting from standing and to assist lift when standing from sitting, and keep the user's knees secured in extension to provide support for standing and "straight-legged" walking.

112355486 2 Although such equipment examples have helped many people onto their feet, the various available means employed to help the user achieve upright mobility is restrictive and over-supportive for those who are capable of making progress with less support and in need of greater freedom to develop the overall skills necessary for independent mobility.

A common problem that prevents many of those who suffer the effects of cerebella palsy, or a similar resultant condition, from achieving an upright standing posture and walking, is that of excessive and forceful toe-down movement with any attempt to control lower limb movement, and although there exists orthotic bracing with hinged ankles that employ the use of cam stops to adjust the amount of permissible toe-down movement, these are difficult to adjust and invariably work loose under load due to rotational forces acting upon their one screw fixing arrangement.

Summary of the Invention In one aspect of the present invention there is provided an orthotic bracing walking trainer including pelvic and hinged lower limb orthotic bracing, means for adjustably assisting each of the user's knees toward extension while allowing knee flexion for walking, means for attaching and adjusting one or more provided brace limb-to-floor stabilising members to one or both brace limbs.

In another aspect of the present invention there is provided an orthotic bracing walking trainer having pelvic and lower limb braces, the or each lower limb brace having a hinge in the vicinity of the knee which has means for adjustably urging the knee to the extended position while allowing for flexion, and one or more stabilising members which are removable and adjustably attached to the limb brace and extend to, or within proximity of, a ground surface on which 0 :.the walking trainer is placed in use.

A trainer embodied by the invention may also include one or more of hyperextension knee stops which are adjustable with the user in situ, means to safely adjust the distance between the orthotic hip and knee hinges with the user in situ, means to safely adjust the distance between the orthotic knee and ankle hinges with the user in situ, means to easily detach and replace the common structural members linking the orthotic ankle and knee hinges, means to easily detach and replace the common structural members linking the orthotic knee and S112355486 3 hip hinges, and means to easily adjust the amount of permitted toe-down movement about the orthotic ankle joint with the user in situ and reliable means to secure such adjustment.

Advantageously, the present invention in one or more embodiments, may provide means for providing a person who cannot normally stand and walk due to limited supportive lower limb strength and/or limited muscle control with an initial minimum amount of support and control, which can be regulated to be kept appropriate to their ongoing needs while helping them to stand and take steps, and so make progress with the development of their ability to be independently mobile.

Throughout this specification the word "comprise", or variations such as "comprises" or "comprising", will be understood to imply the inclusion of a stated element, integer or step, or group of elements, integers or steps, but not the exclusion of any other element, integer or step, or group of elements, integers or steps.

All publications mentioned in this specification are herein incorporated by reference. Any discussion of documents, acts, or materials, devices, articles or the like which has been included in the present specification is solely for the purpose of providing a context for the present invention. It is not to be taken as 20 an admission that any or all of these matters form part of the prior art base or were common knowledge in the field relevant to the present invention as it existed anywhere before the priority date of each claim of this specification.

:Brief Description of the Drawings For better understanding of the present invention, reference will be made by way of examples to the accompanying drawings in which:- Figure 1 shows lower limbs of a person using an example of the aid; :ie. :Figure 2 shows top view of example orthotic pelvic bracing arrangement; Figure 3 shows right side view of example hip hinge and orthotic pelvic bracing arrangement; Figure 4 shows part sectioned front view of example hip hinge; Figure 5 shows end view of example orthotic pelvic width adjusting arrangement; 112355486 3a Figure 6 shows side view of example right orthotic knee hinge arrangement; Figure 7 shows front view of example right orthotic knee hinge arrangement; Figure 8 shows side view of example right orthotic ankle hinge arrangement; Figure 9 shows front view of example right orthotic ankle hinge arrangement; Figure 10 shows outer side view of example stabiliser attaching block; Figure 11 shows top view of example stabiliser attaching block; Figure 12 shows front view of example stabiliser wheel arrangement; Figure 13 shows side view of example stabiliser wheel arrangement with near wheel removed for easier understanding; Figure 14 shows enlarged sectioned view of example orthotic knee hinge arrangement; Figure 15 shows inside view of example orthotic knee hinge; Figure 16 shows top view of example calf trough arrangement.

I) f 4 Figure 17 shows front view example of right leg front and side stabiliser arms and Figure 18 shows front view of example side stabiliser wheel.

Detailed Description of the Preferred Embodiment Referring to Figures 1, 2, 3, 4 and 5, the orthotic pelvic bracing is adjusted to fit closely, but not securely, across the width of the user's pelvis by means of releasing the screws 1 and sliding the pelvic arm 3 within the locating slot of the pelvic plate 4. Any adjustment is shared equally to both sides of the pelvic bracing and the arrangement secured by tightening screws 1 which clamp the pelvic arm 3 between pelvic plate 4 and clamp plate 2.

Orthotic foam pads 5 and 6, adhered to the inner faces of the pelvic bracing, provide protection and comfort for the user's pelvis within the bracing.

Although most of the detail within the following description refers to the :right leg of the orthosis, the same detail also applies to the left leg.

•ell Referring to figures 2, 3 and 4. Hip plate 7, located between needle thrust bearings 8 and 9 with minimum side-play, is free to swing upon bush 11, which is held captive between the head of headed spindle 10 and pelvic arm 3. Hip disc 12 is brazed or welded centrally to pelvic arm 3. Headed spindle passes through bush 11 and, by means of its hexagonal key socket, its S 20 threaded end secured into the threaded cross hole, which is produced centrally through hip disc 12 and pelvic arm 3, and, referring to figure 4, is permanently retained by way of riveting its threaded end.

Referring to Figure 3. In this example the structural connecting member 13 is square section steel and locates into the locating slot of hip plate 7 which, being slightly shallower than the thickness of connecting member 13, allows the assembly to be secured by way of tightening the four screws 14, which clamp connecting member 13 between hip plate 7 and clamp plates and 16.

Adjustment to the distance between the orthotic hip and knee hinges can safely be carried out with the user standing within the bracing, and is achieved by way of slackening the four screws 14 sufficiently to allow connecting member 13 to slide to the desired position within the slot of hip plate 7, and the four screws 14 re-tightened to secure the assembly.

Although, in this example, the means for adjusting the distance between orthotic hip hinge and knee hinge is achieved by way of the elongated and slotted hip plate 7 into which connecting member 13 is positioned and releasably secured, a similar arrangement, incorporating an elongated and vertically slotted knee member extending upwards and into which connecting member 13 could similarly be positioned and releaseably secured, could be employed to provide the adjustment, or, if one desired a greater amount of adjustment, then both arrangements could be incorporated into the orthotic limbs.

Referring to figures 1, 6, 7 and 14. Knee plate 17, located between needle thrust bearings 18 and 19 with the minimum of side-play, is free to swing upon the spindle of knee spigot 20, and is retained upon such with screw 21, which is fitted with washer 22 and secured, with a commercially available thread securing adhesive, into threaded through hole of knee spigot Referring to figures 7 and 15. Connecting member 13 is secured into locating slot of knee spigot 20 which, being slightly shallower than the ol i S 20 thickness of connecting member 13, allows the assembly to be secured by way of tightening the two screws 23, which clamp connecting member 13 .oo.

between knee spigot 20 and clamp plate 24.

This arrangement, together with the fact that connecting member 13 comprises readily-available bar stock which requires no fashioning other than that of being cut to the required length and any sharp edges and corners removed, provides the means to quickly, easily and economically replace connecting member 13, such as with a longer member 13 in the event of the user outgrowing the available adjustment for example, allowing the knee and hip hinges to continue in service, and thus eliminating the costly and inefficient traditional practises of either having to replace hinges permanently secured to structural connecting members, or having to fashion the end of a replacement

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6 structural connecting member to make it fit into or onto a more complex securing arrangement with that of a hinge, under such circumstances.

Although, in this example, connecting member 13 comprises square section steel bar stock, a multi-sided rod made of an alternative material, such as an alloy or composite material for example, could be employed.

Referring to Figures 1, 6 and 7. Connecting member 13 is located in the slot of clamp boss 26 which, being slightly shallower than the thickness of connecting member 13, allows extender arm 25 to be secured at the desired height upon connecting member 13 by way of tightening two screws 27.

Referring to Figures 6, 7 and 16. Knee plate 17 is located in the slot of calf trough block 28 which can be positioned and secured at any site along the parallel portion of knee plate 17 by means of tightening the two screws 29 which clamp knee plate 17 between calf trough block 28 and extender arm the locating slot of calf trough block 28 being slightly shallower than the 15 thickness of knee plate 17. A second deeper but narrower slot formed in calf through block 28 provides clearance for connecting member 33.

Calf trough 31, which is of an existing construction, is secured to the calf trough block 28 with two counter sunk screws 32, and orthotic foam 34 S adhered to cover its inner surface. The user's calf is secured into calf trough 20 31 by means of strap 35 and fastening buckle 64.

Referring to Figure 7. Knee plate 17, being set at an angle, provides an automatic setting of the distance between the inner face of the orthotic knee hinge and the user's knee when the height of the calf trough is adjusted relative to the orthotic knee hinge, according to the size of the user. For example, the calf trough would be positioned vertically closer to the orthotic knee hinge to accommodate a smaller user and therefore the lateral distance between the orthotic knee hinge and the user's knee would also be smaller.

Referring to Figures 1, 6 and 7. The structural connecting member 33 locates into a shallow slot formed on the vertical inside face of the knee plate 17 and is secured into such by means of tightening the four screws 35 which clamp connecting member 33 between knee plate 17 and the vertical locating slot of clamp plate 34, the combined depth of the locating slot of knee plate 17 and locating slot of clamp plate 34 being less than the thickness of connecting member 33.

The above arrangement provides the means to safely adjust the distance between the orthotic knee and ankle hinge while the user is standing within the device, which is achieved by releasing screws 35 and vertically sliding connection member 33 to the desired location relative to knee plate 17 and re-tightening the screws Although, in this example, the means for adjusting the distance between orthotic knee hinge' and ankle hinge is achieved by way of the elongated and slotted knee plate 17 into which connecting member 33 is positioned and releasably secured, a similar arrangement incorporating an S. elongated and slotted ankle member extending upwards and into which connecting member 33 could similarly be positioned and releasably secured, could be employed to provide the adjustment, or, if one desired a greater amount of adjustment, then both arrangements could be incorporate into the orthotic limbs.

Referring to Figures 1 and 6. Although arrangements incorporating steel springs or gas filled activators, generally referred to as gas struts, or the like could be employed to assist the user to achieve knee extension and 20 support body-weight, in this example elasticated shock cord 36 is threaded through the desired number of holes of extender arms 25 and 30, from one to the other, and tensioned just sufficiently to urge the orthotic knee hinge towards extension so that, when combined with the user's knee extension ability, the user is not only able to support body-weight using both lower limbs for standing, but is able to support body-weight with alternate lower limbs in order to execute an efficient gait with a flexing knee and swing through of the unloaded limb. Once the required tension is achieved, the shock cord 36 is terminated at its ends with a simple knot to prevent it from sliding back through the holes.

The above arrangement also provides the means to modify the characteristics of the assistance provided for the user to achieve knee extension and support body-weight. For example, a single strand of shock cord 36, tensioned between the outer-most hole of extender arms 25 and would have to stretch more per degree of knee flection than a single strand tensioned between the inner-most holes of extender arms 25 and 30, the latter therefore allowing more knee flection per unit of force urging the knee towards extension.

The number of times the tensioned shock cord 36 passes between extender arms 25 and 30 also affects the characteristics of the assistance being provided. Under a consistent tension, the greater the number of passes of shock cord 36 between extender arms 25 and 30, the greater the force urging the knee towards extension, which, together with the means to adjust the overall tension of shock cord 36 and its positioning upon the extender arms 25 and 30, offers the means to provide and maintain assistance that is in harmony with the user's initial and ongoing needs as they hopefully progress towards independent mobility.

By employing the above simple and economical arrangement, the minimum amount of assistance, having the required characteristics, can be easily provided to accommodate the usual differing needs of each of the user's lower limbs and in so doing help the individual user to achieve symmetry in standing balance and gait. The assistance applied to the knees S 20 also keeps the pelvic bracing in situ, thus eliminating the need for a securing front waist strap which would restrict pelvic movement.

Referring to Figure 6. In this example, to prevent hyperextension of the user's knees and that of the orthotic knees when the user is out of the device, a high tensile strength, non-stretch cord 37 is positioned between the rearmost holes of extender arms 25 and 30, each end of cord 37 being terminated with a simple knot to prevent it from sliding out of the hole. Any adjustment to make cord 37 check extension of the knee at the desired angle, can be achieved by releasing screws 27, sliding extender arm 25 to the desired position and re-securing. In practise any such adjustment would usually be conducted prior to tensioning the shock cord 36.

Although, in this example, a high strength, non-stretch cord is employed into the arrangement for preventing hyperextension of the knees, alternative 1. .1 9 high tensile strength, non-stretch flexible components could be employed, such as multi-stranded steel cable, webbing or link chain for example.

Referring to Figures 1, 8 and 9. Connecting member 33 is secured into the locating slot of ankle spigot 34 which, being slightly shallower than the thickness of connecting member 33, allows the assembly to be secured by way of tightening the two screws 35, which clamp connecting member 33 between ankle spigot 34 and clamp plate 62.

This arrangement, together with the fact that connecting member 33 comprises readily-available bar stock which requires no fashioning other than that of being cut to the required length and any sharp edges and corners removed, provides the means to quickly, easily and economically replace .connecting member 33, such as with a longer member 33 in the event of the user outgrowing the available adjustment for example, allowing the ankle and :knee hinges to continue in service, and thus eliminating the costly and inefficient traditional practises of either having to replace the hinges permanently secured to structural connecting members, or having to fashion the end of a replacement structural connecting member to make it fit into or onto a more complex securing arrangement with that of a hinge, under such circumstances.

S 20 Although, in this example, connecting member 33 comprises square section steel bar tock, a multi-sided rod made of an alternative material, such as an alloy or composite material for example, could be employed.

Footplate 63 is located between hardened bearing washer 38 and 39 with the minimum amount of side play, and is free swinging upon the spindle of ankle spigot 34, the end of which being riveted to secure the assembly.

Although there are various existing methods that could be employed for attaching the orthotic bracing to the footwear, such as stirrup bar with releasable welt clamps arrangements, in this example, the lower end of foot plate 63 is cranked so as to locate into the heel socket of the user's footwear, using existing orthotic practises.

Referring to Figures 8 and 9. To prevent any excessive toe-down movement in this example, the upper end of foot plate 63 is fashioned to I .I I I' provide a profile to carry ankle stop 40. The smaller diameter of ankle stop is secured into the cross hole of foot plate 63 by way of riveting its end. The vertical slot of ankle stop clamp 41, which is shallower than the thickness of connecting member 33, locates onto connecting member 33 and is secured in the desired position by way of tightening two screws 42, which clamp connecting member 33 between ankle stop clamp 41 and clamp plate 43.

Toe-up and toe-down movement of the user's foot about the ankle is achieved by way of foot plate 63 being able to rotate upon the spindle of ankle spigot 34. The amount of toe-down movement is limited by the ankle stop making contact with ankle stop clamp 41. The ability to adjust the position of the ankle stop clamp 41 upon connecting member 33, by way of releasing '•screws 42, provides the accurate means to adjust the toe-down stop position to best suit the needs of the user, after which screws 42 are re-tightened to reliably secure the setting.

Referring to Figures 1, 10, 11 and 17. To help prevent the user from falling over while developing standing balance and walking skills, there is provided attachable ground-to-lower limb stabilising arms 44, 45 and 49, from which one or more, depending upon the ability and needs of the user, are selected and attached to each lower limb connecting member 33, to provide support to the front, and/or to the rear and/or to the side of the user.

Means are provided to individually adjust each stabilising arm so as to offer the user the desired amount of stability in the direction it extends from the brace limb. Continuous stability is provided by way of having a stabiliser's wheels in contact with the ground, or any stabiliser can be adjusted to be clear of the ground so as to only be effective in halting a fall in the direction that it extends.

Although the stabilising arms could be made from an alternative multisided material, in this example, the stabilising arms 44, 45 and 49 are made from a square section steel having the property to bend slightly under the working loads of the orthosis and return to the manufactured profile when the load is removed. This allows stabilising arms 44, 45 and 49 to have their wheeled ends sat firmly on the ground for a new user for example, and yet still 11 allow the user sufficient movement to start developing balance and stepping skills, the 'recoil' effect of the stabilisers tending to help push the user back to upright in the event of them leaning excessively in any direction.

The upper ends of stabilising arms 44, 45 and 49 are attached to the orthotic bracing by way of securing into their relative locating slots of clamping block 46. The stabilising arms 44, 45 and 49 being slightly thicker than the depth of the locating slots of clamping block 46, are clamped between clamping block 46 and their relative clamp plates 48 by way of tightening screws 47. Clamping block 46 is secured onto connecting member 33 by way of the same method.

The above arrangement allows the height of the individual stabilising arms 44, 45 and 49 to be adjusted by way of releasing the appropriate screws 47, sliding to the desired location within clamping block 46 and re-securing screws 47. The height of clamping block 46 can also be adjusted upon connecting member 33by the same method, allowing equal height adjustment to be made to all stabilisers attached to a brace limb without losing the positional relationship to each. This ability, for example, allows all stabilisers fitted to a brace limb to be quickly adjusted to a higher site for an assessment of the user's progress and either returned to the original setting, or a new site S 20 established without disturbing the positional relationship between each.

Although the lower ends of stabilising arms 44, 45 and 49 could be fitted with alternative ground contacting members such as, for example, floor pads or feet or the like, incorporating rubber or a hard-wearing material with low frictional properties or the like, or be fitted with swivel type castors or the like, or use made of stabilisers having differing arrangement at their lower ends, such as that of having castors fitted to the rear stabilisers and rubber pads to the front stabilisers, in this example, forward rolling rubber-tyred wheels are employed to help the user move any ground-contacting stabilising members forward while walking and, although an arrangement incorporating a single wheel could be employed for each stabilising arm, in this example two wheels are employed to distribute any downward forces either side of the stabilising member positioned between such.

Referring to Figures 1, 12, 13 and 17. The lower portion of stabilising arms 44 and 45 are fashioned to be parallel to the ground and are each fitted with a wheel block 50 which can be positioned at any desired location along this portion. The locating slot of wheel block 50, being slightly shallower than the thickness of the stabilising arms 44 and 45, allows each wheel block 50 to be clamped onto the relative stabilising arms 44 and 45 by way of tightening the two screws 52 onto clamp plate 51.

Spindle 54 is a press-fit into the cross hole of wheel block 50 and protrudes by an equal amount at each side of such. Each protruding end of spindle 54 is fitted with a wheel 57, which is located and is free to rotate between washers 53 and 56, and retained by screw 55 located tightly into the central threaded hole in the end of spindle 54.

By providing the means to adjust the position of the wheel blocks upon stabilising arms 44 and 45, the distance between the user and the wheels 57 can be adjusted to the minimum requirements at any stage during the user's progress. Alternative feet or pads for example, could similarly be arranged to be positioned and secured at any point along the extending lower portion of the stabilisers.

Referring to figures 1 and 18. The lower portion of stabilising arm 49 is S 20 machined to form a round spindle and fashioned to be parallel to the ground.

Wheel 58, which is located between washers 59 and 60, is free to rotate upon the spindle of stabilising arm 49, and is retained by screw 61 located tightly into the central threaded hole in the end of such.

Referring to Figures 1, 10 and 13. The required number and site of the stabilising arms fitted to the orthotic bracing is dependent upon the individual user's initial and ongoing capabilities and needs. Having attached and adjusted the required stabilising arms to provide the necessary initial safe support for the individual user to attain and maintain a good upright standing posture from which they can execute steps, the ongoing aim is to gradually retract, inwards and/or upwards, and eventually remove those stabilisers no longer required as the user's standing balance and wallking skills develop, rather like the process of a child learning to ride a bicycle fitted with stabilisers.

13 The rate at which the support provided can be reduced is equal to the user's progress with self support. In reality the user would have their progress periodically assessed and the provided support reduced accordingly at those times. For most users it will be important to conduct such assessments frequently to enable support to be reduced in small amounts, rather than allowing a user to incorporate an increasing excess of provided support into their walking pattern to the point where they become reliant upon such.

Although a new user would most likely commence making use of the orthotic bracing walking trainer upon a smooth floor, once sufficiently competent with the equipment, the ability to lift the foot and fitted stabilisers clear of the ground for a proper swing-through gait, makes it possible for the user to walk upon more irregular and broken surfaces.

Although the invention has been described in relation to a specific embodiment, it will be understood by the person skilled in the art that the invention is not to be limited to the specific embodiment described and may include modifications and alternatives within the scope of the invention as set out in the following claims.

Claims

1. An orthotic bracing walking trainer having pelvic and lower limb braces, the or each lower limb brace having a hinge in the vicinity of the knee which has means for adjustably urging the knee to the extended position while allowing for flexion, and one or more stabilising members which are removable and adjustably attached to the limb brace and extend to, or within proximity of, a ground surface on which the walking trainer is placed in use.

2. An orthotic bracing walking trainer as claimed in Claim 1 wherein the means for urging the knee to the extended position is by way of arrangement incorporating a resilient component acting about the brace knee hinge.

3. An orthotic bracing walking trainer as claimed in Claim 1 or Claim 2 wherein the resilient component acting about the brace knee hinge is tensioned elasticated shock cord.

4. An orthotic bracing walking trainer as claimed in Claim 1 or Claim 2 wherein the resilient component acting about the orthotic knee hinge is a steel spring.

An orthotic bracing walking trainer as claimed in Claim 1 wherein the means for urging the knee to the extended position is by way of arrangement S- incorporating a gas filled activator acting about the brace knee hinge. :o 20

6. An orthotic bracing walking trainer as claimed in any one of Claims 1 to 3 *wherein the arrangement for urging the knee to the extended position includes two spaced arms secured one above and one below, and extending forward of, the brace knee hinge pivot which, by way of one such arm being linked to the other with tensioned elasticated shock cord, are caused to be pulled towards 0000 25 each other and in so doing urge the brace limb towards extension about the knee .00. hinge pivot. 000

7. An orthotic bracing walking trainer as claimed in any one of Claims 1 to 3 or Claim 6 wherein the characteristics of the force by which the knee is urged to "extended position is adjustable by way of providing means to increase and decrease the working tension of the elasticated shock cord.

8. An orthotic bracing walking trainer as claimed in Claim 6 or 7 wherein the means to increase and decrease the working tension of the elasticated shock S112355486 chord is by way of cross holes produced in the extending portion of the arms, through which each end of the shock cord is passed and held captive with a simple knot, adjustment being achieved by lengthening or shortening the amount of working shock cord between its knotted ends.

9. An orthotic bracing walking trainer as claimed in any one of Claims 6 to 8 wherein the means to adjust the characteristics of the force by which the knee is urged to the extended position is by way of providing more than one cross hole in the extending portion of the arms, allowing the tensioned shock cord to pass from one arm to the other more than once before having each end held captive with a simple knot.

An orthotic bracing walking trainer as claimed in any one of Claims 6 to 9 wherein means to adjust the characteristics of the force by which the knee is urged to the extended position is by way of providing a range of cross holes along the extending length of each arm, allowing the distance between the orthotic knee hinge pivot and the chosen holes through which the tensioned shock cord is sited to be increased and decreased.

11. An orthotic bracing walking trainer as claimed in any one of Claims 1 to wherein the or each limb brace has adjustably attached one or more of the stabilising members positioned such that they help support and prevent the user 20 from falling in the direction of that which they extend.

12. An orthotic bracing walking trainer as claimed in Claim 11 wherein one or ,0 more of the adjustably attached stabilising members are positioned such that they help support and prevent the user from falling forward.

13. An orthotic bracing walking trainer as claimed in Claim 11 wherein one or more of the adjustably attached stabilising members are position such that they help support and prevent the user from falling rearward. 0*

14. An orthotic bracing walking trainer as claimed in Claim 11 wherein one or more of the adjustably attached stabilising members are positioned such that they help support and prevent the user from falling sideways.

15. An orthotic bracing walking trainer as claimed in any one of Claims 1 to 14 wherein means is provided to individually adjust the effective height of each stabilising member attached to the orthotic limbs. S112355486 16

16. An orthotic bracing walking trainer as claimed in any one of Claims 1 to wherein means is provided to adjust the effective height of more than one stabilising member attached to an orthotic limb while maintaining the positional relationship between such.

17. An orthotic bracing walking trainer as claimed in any one of Claims 1 to 16 wherein means is provided to adjust the distance between the user and the outermost point at which an individual stabiliser will, or is intended to, make contact with the ground.

18. An orthotic bracing walking trainer as claimed in any one of Claims 1 to 17 wherein the lower end of one or more of the stabilising members are fitted with one or more floor wheels.

19. An orthotic bracing walking trainer as claimed in any one of Claims 1 to 17 wherein the lower end of one or more of the stabilising members are fitted with swivel-type castors.

20. An orthotic bracing walking trainer as claimed in any one of Claims 1 to 17 wherein the lower end of one or more of the stabilising members are fitted with floor pads or feet.

21. An orthotic bracing walking trainer as claimed in any one of Claims 1 to wherein an orthotic ankle hinge and the orthotic knee hinge are releasably secured to a common connecting member.

22. An orthotic bracing walking trainer as claimed in Claim 21 wherein the :i orthotic ankle and knee hinges each have a substantially vertically slotted member into which the common connecting member is located and releasably secured.

23. An orthotic bracing walking trainer as claimed in Claim 22 wherein means for adjusting the distance between the orthotic limb ankle and knee hinges is provided by way of the vertically slotted member of one or both hinges being :elongated to extend towards the other to provide a longer vertical slot within which the common connecting member can slide and be releasably secured in the required position. 112355486 17

24. An orthotic bracing walking trainer as claimed in Claim 22 or 23 wherein the means to releasably secure the common connecting member into the slotted member of a hinge is by way of bridge clamp and screws.

An orthotic bracing walking trainer as claimed in any one of Claims 1 to wherein an orthotic hip hinge and the orthotic knee hinge are releasably secured to a common connecting member.

26. An orthotic bracing walking trainer as claimed in Claim 25 wherein the orthotic hip and knee hinges each have a substantially vertically slotted member into which the common connecting member is located and releasably secured.

27. An orthotic bracing walking trainer as claimed in Claim 26 wherein means for adjusting the distance between the orthotic limb hip and knee hinges is provided by way of the vertically slotted member of one or both hinges being elongated to extend towards the other to provide a longer vertical slot within which the common connecting member can slide and be releasably secured in the required position.

28. An orthotic bracing walking trainer as claimed in Claim 26 or 27 wherein the means to releasably secure the common connecting member into the slotted member of a hinge is by way of bridge clamp and screws.

29. An orthotic bracing walking trainer as claimed in any one of Claims 21 20 to 28 wherein the common connecting member comprises bar stock or rod.

30. An orthotic bracing walking trainer as claimed in any one of Claims 1 to 29 wherein means to prevent each of the user's knees from hyperextending, and that of the orthotic knee hinges when the user is out of the orthosis, are providing by way of linking, to the rear of the orthotic knee hinge pivot, a member extending 25 above the knee hinge pivot and a member extending down from the knee hinge pivot, with a flexible high tensile strength component, in a manner which halts the S"extension movement of the knee hinge at the point when it is placed under tension. '112355486 18

31. An orthotic bracing walking trainer as claimed in Claim 30 wherein adjustment of the point at which extension movement of the knee hinge is halted is provided by way of at least one end of the flexible high tensile strength component being secured to a member which can be vertically adjusted and secured upon a member extending from the hinge pivot.

32. An orthotic bracing walking trainer as claimed in one of Claims 1 to 31 wherein adjustable means to limit toe-down movement about the orthotic ankle hinge is provided by way of arranging a part of the lower hinged member to halt hinge pivot movement, in a toe-down direction, upon making contact with a vertically adjustable member secured upon an upper hinge member, wherein vertical adjustment of the vertically adjustable member renders an increase or decrease in the amount by which the lower hinge member is free to pivot in a toe down direction prior to its part making contact with such.

33. An orthotic bracing walking trainer substantially as described herein with reference to one or more of figures 1 to 18 of the accompanying drawings. Dated: 12 February 2004 David Hart o Patent Attorneys for the Applicant: 20 BLAKE DAWSON WALDRON PATENT SERVICES 0 S.i