BG2708U1 - Complex device for passive and active rehabilitation of the lower limb - Google Patents

Abstract

The utility model will find application in active and passive rehabilitation of lower limb movement disorders in post-stroke patients and such suffering from CCP (Children Cerebral Palsy) or spinal traumas. The device comprises a metal base frame (101) in the center of the bottom of which is mounted a hydraulic cylinder (109) on the stem of which are mounted a seat (108) and a belt (107) fixed to a removable backrest (106). At the bottom of the frame (101), longitudinally on the cylinder (109) are mounted parallel and longitudinal two linear guides (204), on each of them is mounted a carriage (202) driven by a gear-belt-drive mechanism with electric motor (201). On each carriage (202) is mounted a second electric motor (205) leading a crank mechanism (206) on which is mounted a triangular bracket (203) on which four rollers (212) are mounted. Inside the bracket (203) is mounted a third electric motor (208), and on the rollers (212) is mounted an arched frame (211) which is driven by the third electric motor (208) by means of a gear transmission composed of a toothead gear mounted on the shaft of the third electric motor (208) and teeth made on one edge of an arched slit formed in the frame (211). The arched frame (211) is composed of two parallel arched plates connected with each other in a U-shaped form by a flat plate (210) on which is mounted a fourth electric motor (209) and a base for foot with shoe shape (207) beared to the footbase (207) in the heel area. On the shaft of the fourth electric motor (209) there is mounted a toothed gear geared with teeth made at the rear edge of the footbase (207). 2 claims, 4 figures

Description

This useful model relates to medical technology in human medicine, in particular the rehabilitation of the lower limbs. The device is an electromechanical construction with electronic control, which provides a comprehensive rehabilitation of the motor capabilities of the lower extremities of people in the post-stroke condition suffering from cerebral palsy or spinal injuries. The device provides passive and active rehabilitation of the lower limbs by performing two types of activities - differentiated movements and complex movements. In particular, differentiation and combinations of differentiated movements are performed, and walking, sitting and straightening are performed.

One type of activity involves programmable differentiated and combined movements - flexion and extension of the pelvic and knee joints, dorsiflexion, plantar flexion, supination, pronation, and rotation of the ankle joints.

Other types of activities include assisted seating and straightening, and feature-adjustable walking, which is combined with an actively height-adjustable body support that carries the patient's center of gravity to its natural location in the pelvis.

BACKGROUND OF THE INVENTION

The purpose of the rehabilitation of the lower limbs is to stimulate the movement of the limbs repeatedly, forcing multiple, repetitive and identical signals in the patient's nervous system through the limb vector - brain. As a result of these signals, appropriate new connections are formed in the brain to process the incoming signals so that they become instinctual, on the basis of which they can subsequently serve the patient to perform these movements on their own, ensuring sending signals the same way, but in the opposite direction, along the vector brain - limbs. Because the limb movement signals are compulsory, it is important and necessary for the patient to be in an upright position, especially when it comes to lower limb rehabilitation. This ensures that the compulsory information is correctly interpreted and linked in the brain to the incoming information through other channels, for example, parallel information from the vestibular apparatus, torso muscles, vision, sensation, etc.

A traditional technique aimed at treating lower extremity motor difficulties in post-stroke conditions, cerebral palsy and spinal injuries is based on the generally accepted principles of rehabilitation and the empirical experience gained prior to the availability of specialized equipment. Historically, the oldest way to perform rehabilitation of the lower extremities of patients in post-stroke conditions, cerebral palsy and spinal injuries is to manually perform rehabilitation of the lower extremity of the patient.

This manual method has a number of limitations to achieve the desired goals, for example - the exhaustive physical strength of the rehabilitator leads to:

- short duration of therapy;

- impossibility of multiplicity, identity and repetition of the movements performed;

- the usual practice of therapy in a lying or sitting posture, which does not contribute to the proper construction of new connections in the brain.

Overcoming some of these limitations and the development of the technique has led to the emergence of various rehabilitation devices, which facilitates the work of the rehabilitator to varying degrees. Such are the proposals of Lokomat (Hocoma AG, Volketswill Switzerland), Lokohelp (LokoHelp Group, Germany), Reoambulator (Motorika Ltd., Mount Laurel, NJ, USA). A training simulator for natural walking in rehabilitation of patients with cerebral palsy was observed (Elena Filatova, Moscow, patent RU 2351304 C2), as well as a Robotic system for simultaneous rehabilitation of the upper and lower limbs (Daniel Bratanov, Ruse ).

Although they manage to overcome some of the limitations of the conventional method, such as placing the patient in a straight posture, providing repeated repetition of steps, prolonging a training session, etc., the available devices fail to overcome a number of other disadvantages. Yeah, they're like that:

- when performing the walking action, these devices keep the patient in an upright position using a tap type mechanism. The system of belts and ropes on which the patient hangs is used. This hanging system holds the patient in the chest area - the point of attachment of the patient is above the real center of gravity that is around the pelvis. This impedes the ability of the patient to learn to balance independently, ie. the usefulness of therapy is diminished. In addition, the ropes on which the patient hangs are stretched upwards and, in some patients, rub against the shoulders and chest and create discomfort;

- Although overcoming the recumbent or seated posture characteristic of human-made rehabilitation, the devices that keep the patient straight do not allow for independent, differentiated ankle movements. Their movements are realized only as part of the walking complex, and such as supination, pronation and rotation of the ankle are not performed at all. The patient needs to work out and correct a specific movement, or to release a smasmatic or contracted limb, as preparation before or after the move, when a marked asymmetry of movement when walking or jogging is evident. The lack of possibility for differentiated movements - dorsiflexion, plantar flexion, supination, pronation and rotation of the ankle joints, necessitates the purchase of other devices for their realization and prolongs the time for therapy and achieving a therapeutic effect;

- the devices observed so far do not allow for a gradual adjustment to the correct position when sweeping the foot. The foot is either fixed in a rigid ski boot or left loose. Gradual adjustments in the directions of supination, pronation, dorsiflexion and plantar flexion cannot be made;

- the available devices do not allow the training of the patient's ability to sit upright and to sit upright;

- The available devices are voluminous because of the treadmills and the "taps" that make up them. Some of them move with the patient, and he steps on the floor. In both cases, they occupy entire rooms for themselves, which makes the provision of rehabilitation difficult and cost-effective, given that they only practice walking without exercise in differentiated movements;

- the devices available are relatively difficult to operate - the patient often needs to be lifted manually to be harnessed before getting into the device. In adult patients, this means additional support staff.

The technical nature of the utility model

A complex device for passive and active rehabilitation of the lower limb provides the implementation of a complex, passive and active rehabilitation of the motor capabilities of the lower extremities of people in post-stroke condition suffering from cerebral palsy or spinal injuries, by performing two types of activities - rehabilitation of the lower limbs through differentiated movements and rehabilitation of the lower limbs by performing straightening, sitting and walking.

One type of activity involves programmable differentiated movements - flexion and extension of the pelvic and knee joints, dorsiflexion, plantar flexion, supination, pronation, and rotation of the ankle joints.

The other type of activity involves combined (complex) movements such as programmable walking, sitting and straightening. These movements are complex because they involve the simultaneous movement of all major joints of the legs, as well as periodic changes in the position of the torso vertically. The torso support - under the seat and with actively varying height - further enhances the therapeutic effect by bringing the patient's center of gravity to its natural place in the pelvis.

All activities are performed when the patient is positioned in the device in the intended position for rehabilitation.

Explanation of the annexed figures

Figure 1 shows the general appearance and operation of the device.

Figure 2 illustrates the mechanism to which the patient's foot engages and by means of which the flexion and extension of the pelvic and knee joints, dorsiflexion, plantar flexion, supination, pronation, and rotation of the ankle joints are performed.

Figure 3 shows the lifting device arrangement (300), in particular the position of the patient in a wheelchair before being lifted by the lifting mechanism.

Figure 4 shows the device of the lifting mechanism (300), in particular the position of the patient after being lifted by the lifting mechanism.

An example of a utility model

The utility model consists of:

Main frame 101, consisting of a rectangular parallelepiped of metal construction and a slip-proof cover, in and on which all the elements of the device are located:

1. A combined kinematic system, driven by hydraulics and electric motors and controlled by a control device, which aims to support the wearer's torso in an upright position and to move his legs along trajectories imitating gait (including motion of the ankle when walking), sitting, straightening, as well as individual movements of each leg - flexion and extension of the hip and knee joints, dorsiflexion, plantar flexion, supination, pronation and rotation of the ankle joints. All movements performed have programmable characteristics (range, trajectory, force). The elements of the combined kinematic system are:

- a hydraulic cylinder 109, with a seat 108 mounted on its trunk, which maintains the patient in a position of rehabilitation with a low center of gravity and the ability to self-balance the torso;

- two actuators for the soles of the soles 200 (see figure 2) in which the soles are placed. Each device is driven by four electric motors 201,205, 208 and 209. To perform its tasks, the hydraulic cylinder 109 has a sensor for the position of the barrel, in the seat 108 - a sensor for the weight of the user, the electric motors driving the devices 200 have feedback on current and have position sensors built in. The data from the sensors serve to realize the functions of the utility model, to safety programs, programs to stimulate the use of self-power, and to monitor the condition of the user over time. In connection with the safety of the user is also the selection of actuators without gears and screws. Thus, in the event of a power failure, not only will the power applied to the user by the electric motors be stopped, but his limbs can also be released freely.

2. Auxiliary hydraulic system 300 for the patient to be lifted from the wheelchair and positioned in the correct position for rehabilitation. The system is autonomously controlled and commanded by an operator. There are no built-in feedback sensors and the status and position of the user is monitored personally by the operator. The use of system 300 is optional. For example, if the user is a child, he or she may simply be raised and placed in a rehabilitation position.

The utility model is relatively compact, easy to use, without the need for manual lifting of adult patients and with universal application for lower limb rehabilitation. The technical solutions adopted eliminate the disadvantages described in the prior art. These advantages are absent in the devices of this kind offered so far.

The implementation of the utility model is implemented as follows:

1. The main frame 101 (see Figure 1) bears all the elements of a complex lower limb rehabilitation system and consists of a rectangular parallelepiped-shaped metal structure with an upper surface coated with a non-slip coating. A hydraulic cylinder 109 is mounted in the center of the frame 101 with a seat 108 mounted on the movable barrel. The hydraulic cylinder is controlled by a controller, driven by an electric hydraulic pump, and has a barrel position sensor that provides feedback to the steering device for the purpose of controlling the execution of the tasks. The seat 108 has a removable backrest 106 with a belt 107 and is used to position you in an upright position to perform rehabilitation and to take on the weight of the wearer (who usually cannot stand alone because he has no control over his muscles). The seat 108 has a built-in weight sensor that provides feedback to the control unit for the purpose of tracking the user's need for support. The hydraulic cylinder 109 on which the seat is mounted

108, serves both to adjust the initial seat height so that it is suitable for the forthcoming programmed task and to actively adjust the user's torso position vertically - up and down, in the course of performing tasks that require such active regulation, which are:

- walking - when walking the torso of the walking man (from the hip joint to the head) is periodically moved up and down vertically - upwards, when collecting both legs and downwards, when legs are extended. This gentle upward and downward movement of the torso is accomplished by the hydraulic cylinder 109 carrying the seat 108, which is operated by the control device in synchronization with the actuators of the soles 200 (see Figure 2) so that the body of the wearer is movable. , as it would move when stepping on a will.

- seating - when seated, the torso of the seated man moves down vertically while his legs are bent at the knee and hip joints. This downward movement of the torso is carried out by the hydraulic cylinder 109 carrying the seat 108, which is controlled by the control device, acting in synchronization with the devices 200, which drive each of the user's legs so that the user's body is moved as it would move at volitional sitting.

- Straightening - When straightened, the torso of the sedentary is moved upright while his legs are flexed in the knee and hip joints. This movement of the torso upwards is carried out by the hydraulic cylinder

109 carrying the seat 108, which is controlled by the control device, acts in synchrony with the devices 200 driving each of the user's legs so that the user's legs and torso are moved as they would be driven by a volitional stand.

To perform the tasks of walking, sitting and straightening, the soles of the wearer are placed in two devices 200 that move the wearer's legs back and forth.

This movement is performed along linear guides 204 mounted at the bottom of the frame 101. They are arranged longitudinally on the frame 101 parallel and bilaterally, each up to 20 cm away from the hydraulic cylinder 109. One carriage is mounted on each of the guides 204. 202, driven by a gear-belt mechanism with an electric motor 201. A shoe-shaped footrest 207 is mounted on each carriage 202, by which it grips and moves the legs back and forth. For the free movement of the carriages 202 along the linear guides 204, two slots of suitable width are made in the upper anti-slip surface of the main frame 101 above the linear guides 204 allowing the movement of the carriages 202. move their feet back and forth when performing the tasks of walking, sitting and straightening, and perform the following other functions:

(a) flexion and extension of the pelvic and knee joints:

- flexion of the knee and hip joint is a simultaneous folding of the two joints and is obtained by lifting the sole upwards vertically. The foot device 200 drives the wearer's feet to realize flexion of the knee and hip joints by means of a second electric motor 205 mounted on the carriage 202 and a crank system 206 which transforms the rotational motion of the second electric motor 205 in a reciprocating manner in this way, the device uprightly lifts all the mechanisms mounted on the carriage 202 together with the foot mounted in the footrest 207 up to 100 mm. relative to the carriage 202.

- the extension of the knee and hip joint is a simultaneous extension of both joints and is obtained by lowering the raised foot down vertically. Extension is the opposite motion of flexion and is realized by the same mechanisms described in the previous point, but the rotation of the second electric motor 205 is done in the opposite direction, and so by the crank mechanism

206 moves all the mechanisms mounted on the carriage 202 and the foot, which is placed in the footrest 207, down to the carriage 202.

(b) dorsiflexion and plantar flexion

- dorsiflexion is the movement of the sole from a starting position inward to the lower leg, with the flexion performed in the ankle. The movement of the dorsiflexion is realized by means of a third electric motor 208, mounted inside the console 203, in the form of a triangle. The console 203 consists of two triangular bars arranged parallel and connected to one another. Two rolls 212 - four rolls in total - are mounted on the console 203 bilaterally. On the rollers is mounted an arcuate frame 211, composed of two arcuate plates, connected in a "P" shape by means of a flat plate 210. The third electric motor 208, drives the arcuate frame 211 through a gear unit consisting of a gear wheel mounted on the shaft of the third electric motor 208 and teeth made along one edge of an arcuate slot in the frame 211. To perform dorsiflexion, the arcuate frame 211 moves on the rolls 212 until it rests its rear end in the triangular bracket 203.

- Plantar flexion is the movement of the foot when the ankle is flexed and represents the reverse movement of the dorsiflexion (outward to the hip). The actuation of the wearer of the wearer to effect plantar flexion movement is by the same mechanisms described in the preceding paragraph, with the third electric motor 208 rotating in the opposite direction. The end point of this movement is reached when the leading edge of the arcuate frame 211 rests in the triangular bracket 203.

c) supination and pronation

- supination is the movement of the foot when rotating in the ankle so that the toes of the foot point to the other foot. The movement of the dorsiflexion is realized through a fourth electric motor 209 mounted on the flat plate 210, an integral part of the arcuate frame 211.

The fourth electric motor 209 rotates the sole of the sole in the form of a shoe 207, by means of a gear consisting of a gear wheel mounted on the shaft of the fourth electric motor 209 and teeth made in the back edge of the sole of the sole 207. The point of rotation of the support 207 is realized. from a bearing mounted below the center of the sole of the sole that the bearing connects to the flat plate 210 and the pedestal stand 207. Thus, the flat plate 210 can be likened to a clock face, the bearing to the axis of the clockwise arrow, and the stand 207 to an arrowon the clock. When the fourth electric motor 209 moves the gear 207 through the gear, it radially moves to its point of rotation so as to move its tip, and thus its insertion, in the direction of the other sole of the wearer.

- pronation is the movement of the foot when rotating in the ankle joint so that the toes of the foot are pointing outwards towards the other foot. Pronation is the movement back to supination. The same mechanisms described in the preceding paragraph drive the wearer's foot in order to effect plantar flexion movement, with the fourth electric motor 209 rotating in the opposite direction and driving the stand 207 together with the footer inserted therein.

e) ankle rotation - this movement of the foot, which is a combination of dorsiflexion, plantar flexion, supination and pronation. It can be illustrated by the movement that the soles would perform if a clock face was placed against the fingers and perpendicularly to the plane of the soles and the soles described rotational motion so that the fingers would consistently point to the hours on the dial. The rotational movement of the sole is realized using the mechanisms already described for performing the movements of dorsiflexion, plantar flexion, supination and pronation, which are synchronized and managed in an appropriate manner through the control device so as to obtain a rotation. In particular, the clockwise rotation movement is accomplished by simultaneous execution of the pronation-plantar flexion movements, followed by the combination of the supination-dorsiflexion movements. Counterclockwise rotation is made in the opposite order - a combination of movements supination plantar flexion, followed by a combination of movements pronation-dorsiflexion.

2. Auxiliary hydraulic system 300 (see Figure 3 and Figure 4) for the patient to recover from a wheelchair and position him on the seat for rehabilitation. The auxiliary hydraulic system 300 is autonomously operated by an operator, and its use is optional. It consists of a railing 104, in the form of two interconnected metal rails, mounted on two outer linear rails 301, mounted in a horizontal position towards the bottom of the main frame 101, bilateral, parallel and longitudinal, up to 15 cm from the sides on frame 101. The railing 104 is driven by external lines guiding 301 of the two screws of the nut mechanism.

302 with motors mounted parallel to the outer linear guides 301. Two second hydraulic cylinders 303 are mounted in a vertical position bilaterally in the middle of the sides of the rail 104. The shafts of the second hydraulic cylinders 303 are connected by a double bridge "P" - frame 304. Stretching and shrinking of the shafts of the second hydraulic cylinders,

303 moves the support frame 304 up and down vertically, respectively. Two dismountable arms - armpits 305, are mounted transversely on the support frame

304 and serve to lift the wearer. Ramp 102 - inclined wheelchair ramp shaped with a triangular prism, which touches the frame 101 and serves to easily ascertain the trolley on the main frame 101. Two slits above the outer linear guides 301 are made in the cover with the anti-slip surface of the main frame 101. which gaps allow the rail 104 to move freely along the linear guides.

The lifting and positioning of the device user is as follows:

After boarding the wheelchair user at the beginning of the main frame 101, by means of the inclined ramp 102, the operator commands the rail 104 to move along the linear guides 301. The rail 104 is driven in the direction of the wearer in the wheelbarrow until it reaches the position at which the armpits supports 305 are located under the arms of the user in a wheelchair. Then, by actuating the second cylinders 303, at the command of the operator so that their trunks are stretched, the user is lifted up and upright. The released wheelchair is removed and the wearer is moved forward over the seat 108 by moving the railing 104 along the linear guides 301. The wearer is then lowered onto the seat 108 by retracting the cylinder trunks 303. After laying on the seat 108, mount the backrest 106 with the belt 107, the user ties with the belt 107, and the armpits 305 are dismantled. The handrail 104 may remain in the same position for the wearer to hold hands with the support frame 304, or if necessary, the handrail 104 may be moved to the end of the main frame 101. Removing the wearer from seat 108 is performs the reverse of the described procedure. Removal - mounting of the armpit supports 305, dismantling of the backrest 106 and pushing the wheelchair along the ramp 102 is done by an operator by hand.

In all cases, the dimensions may be different, tailored to the intended use only for children or children and adults.

The design of the devices is fully in line with the kinematics described above, and the production of the specific elements depends on the manufacturing technology used.

Using the utility model

As described above, the device is intended to be used for complex rehabilitation of the motor capabilities of the lower extremities of post-stroke people suffering from cerebral palsy or spinal injuries, by performing two types of activities - passive and active rehabilitation of the lower limbs through differentiated and combined movements and passive and active rehabilitation of the lower limbs by performing straightening, sitting and walking.

The present description discloses exemplary embodiments of the device and should in no way be construed as limiting the scope of the present utility model, which should receive the widest possible protection in accordance with the appended claims.

Claims (2)

A complex device for the passive and active rehabilitation of the lower limb, characterized in that a hydraulic cylinder (109) is mounted in the center of the bottom of the base metal frame (101) in the shape of a rectangular parallelepiped, on which a seat is mounted ( 108) with a removable backrest (106) and a belt (107) fastened to the backrest (106) and two linear guides mounted parallel and longitudinally up to 20 cm from the cylinder (109) at the bottom of the frame (101) (204), on each of which is mounted a carriage (202), driven by h gear belt with electric motor (201), with a second electric motor (205) mounted on each carriage (202), a drive crank mechanism (206), on which a triangle bracket (203) consisting of two parallel and connected triangular strips, on which a triangular bracket (203) is mounted two-sided in total four rollers (212) and a third electric motor (208) is mounted inside the bracket (203), with an arcuate frame (211) mounted on the rollers (212), composed of two parallel arcuate strips connected to each other by a "P" in a flat plane anca (210), the arcuate frame (211) being driven by the third electric motor (208) by means of a gear consisting of a gear wheel mounted on the shaft of the third electric motor (208) and teeth made along one edge of an arcuate gap formed in the frame (211) and a fourth electric motor (209) and a shoe-shaped footrest (207) are mounted on the flat plate (210), the footrest (207) being mounted to the plate (210) by means of a bearing below the area the fifth, and the fourth electric motor (209) is connected to a gear composed of a gear wheel, m on the shaft of the fourth electric motor (209) and the teeth made at the back edge of the pedestal stand (207). Complex device for passive and active lower limb rehabilitation according to claim 1, characterized in that two outer linear guides (101) are mounted on the bottom, two-sided, parallel and up to 15 cm away from the two longitudinal sides of the main frame (101). (301) on which a movable rail (104) is mounted, driven by two screw-type mechanisms (302), mounted parallel to the outer linear guides (301), and second hydraulic cylinders are mounted bilaterally and in the middle of the sides of the rail (104). (303), on the trunks of which the cylinders are fitted with a double "P" support frame (304) perpendicular to which two removable armpits (305) are mounted.