BR102012033595A2 - ROBOTIC DYNAMICS COUPLED TRAVEL MAT - Google Patents

Abstract

ROBOTIC ORTHESIS COUPLED TO THE TRAILING TRAY MAT This patent application comprises a robotic orthosis for gait training for individuals with motor dysfunctions consisting of a treadmill (2), two lateral heads (3) with the kinematic trajectory of the ankle and a tutor bilateral (9), responsible for the interface between patient and machine. The robotic orthosis can have a vertical support, for partial weight support, a side plate (11), to adjust the step size, and two handrails with height adjustment, so that patients can support their upper limbs.

Description

ROBOTIC DYNAMICS COUPLED TRAVEL MAT

The present patent application comprises a robotic gait training orthosis for individuals with motor dysfunctions consisting of a treadmill (2), two lateral heads (3) with a kinematic ankle trajectory 5 and a bilateral long tutor (9) responsible for patient-machine interface. The robotic orthosis may have a vertical support for partial weight bearing, a side plate (11) for adjusting the step size, and two height-adjustable handrails so that patients can support the upper limbs.

The gait of individuals with neuromotor dysfunctions presents a

different pattern from normal walking. The persistence of the abnormal pattern results in much damage, including muscle shortening, bone deformities and even loss of walking ability over the years.

Individuals with brain injuries who demonstrate impairment in walking ability and performance have limitations in the participation of activities of daily living and consequently in social interaction (BJORNSON, KF; BELZA, B .; KARTIN1 D .; LOGSDON, R .; MCLAUGHLIN, JF Ambulatory Physical Activity Performance in Youth With Cerebral Palsy and Youth Who Are Typically Developing (Journal of the 20 American Physical Therapy Association. 2007; 87: 248-257). Therefore, gait training, aiming at its improvement, is of great importance in rehabilitation.

Current concepts on motor learning assume that repetition of a specific task can significantly improve motor function (BORGGRAEFE, I.; MEYER-HEIM, A .; KUMAR, A .; SCHAEFER, JS; 25 BERWECK, S .; HEINEN, F Improved gait parameters after robotic-assisted Iocomotor treadmill therapy in a 6 year old child with cerebral palsy Movement Disorders 2008; 23 (2): 280-283). Iocomotor therapy to restore walking capacity is based on the principle of increasing neuroplasticity through task-specific training (MEYER-HEIM, A.; BORGGRAEFE, MD; AMMANN-REIFFER, C.; BERWECK, ST. ; SENNHAUSER, FH; COLOMBO, G; KNECHT, B. HEINEN, F. Feasibility of robotic-assisted locomotor training in children with central impairment. Developmental Medicine & Child Neurology. 2007; 49 (12): 900-906). There is evidence that this therapy is effective in the rehabilitation of patients with central nervous system dysfunction (BORGGRAEFE, I.; KIWULL, L.; SCHAEFER, J.S.; KOERTE, I .; BLASCHEK, A .; MEYER-HEIM, A .;

5 HEINEN, F. Sustainability of motor performance after robotic-assisted treadmill therapy in children: an open, non-randomized baseline-treatment study. European Journal of Physical Rehabilitation Medicine. 2010; 46: 125-131). Repetitive training of challenging tasks for patients results in greater cortical representation of the movement practiced. These findings and 10 other findings from many neuroscience studies indicate that continued practice of a specific task is crucial for producing permanent changes in the motor system, motor learning, and motor function networks (BIRKENMEIER, RL; PRAGER, EM; LANG, CE Tranlating animal doses of task-specific training to people with chronic stroke in 15 one hour therapy sessions: a proof-of-concept study (Neurorehabilitation Neural Repair. 2010; 24 (7): 620-635).

In recent years, the field of neurorehabilitation has adopted robotic devices to assist the treatment of individuals with diverse neurological dysfunctions (HIDLER, J .; WISMAN, W .; NECKEL, N. Kinematic trajectories while 20 waiking within the Lokomat robotic gait-orthosis. Clinical Biomechanics 2008; 23: 1251-1259; CHIN, LF; LIM, WS; KONG1 KH Singapore Medical Journal. 2010; 51 (9): 709-715). For applications aimed at gait training, robotic devices have numerous advantages over therapist-assisted training (HIDLER, J .; WISMAN, W .; NECKEL, N. 25. Kinematic trajectories while waiking within the Lokomat robotic gait-orthosis. Clinical Biomechanics, 2008; 23: 1251-1259).

The goal of robotic-assisted locomotion is to mimic the therapist's hands by guiding the patient's lower limbs through a normal gait pattern while walking on a treadmill. Robotic-assisted gait training 30 allows patients to walk with a normal pattern, with symmetrical weight shifting, and without the need to employ compensatory strategies. In addition, for therapists, robotic-assisted gait training helps to reduce the physical demands placed on them, and does not restrict patient training to therapist limitations (CHIN et al, 2010).

It is known that at the 5th end of knee extension, there is a 5th mediate rotation of the femur over the tibia. This movement generates maximum stability, so it is said that the joint is locked. To initiate knee flexion, this mediate rotation must be reversed by “unlocking” the joint. The popliteal muscle is responsible for promoting lateral rotation of the femur over the tibia, without which flexion cannot begin (DANGELO, J. G .;

FATTINI, C.A. Human Anatomy: systemic and segmental. 3rd Ed. Sao Paulo: Atheneu, 2007. Chap. 17, p.281).

There are several state-of-the-art devices used for gait training in individuals with neuromotor dysfunction. The devices described in patent applications (CN101810533; CN 101862256;

KR100841177; US2010268129; W02008032967) do not feature a treadmill, which is an extremely important element in adjusting the robotic gait to normal gait. Other devices besides not having the treadmill, the individuals are suspended by a platform, which impairs the training (KR100841177; US2010268129; Schmidt H1 Hesse S, Bernhardt R. Safety

concept for robotic gait trainers. Proceedings of the 26th Annual International Conference of the IEEE EMBS, San Francisco, CA, USA September 1-5, 2004). There are also some devices that although they may have a treadmill, they do not have a long hip, knee and ankle joint tutor (CN2558375; JP2011115323; US6880487; US2007016116;

US2010268129; US2010285929; US2011071442; US2010152629; US2011288455; WO2003018140). The long tutor is extremely important for gait training, as it helps in sustaining the patient's weight, as well as helping to delimit the movements to be performed.

The devices described in the documents (CN2558375; JP2011115323;

US6666831; US7331906; US2007016116; US2011071442; US20110288455; CN101862255; CN101862256; CN102058464; EP1716834; US6689075; US6821233; US7544155; US2004116839; US20080249438; WO2008032967; WO2009125397; Banana SK1 Kim SH1 Agrawal SK1 Scholz JP. Assisted Robot Gait Training With Active Leg Exoskeleton (ALEX). IEEE transactions on neural systems and rehabilitation engineering, vol. 17, 2009) do not present lateral heads that describe the ankle kinematic trajectory. Maintaining the ankle kinematic path during rehabilitation exercises is extremely important for restoring normal gait. Persistent abnormal pattern results in many injuries, such as muscle shortening and bone deformities.

There are also devices that have been developed for gait assessment 10 in animals (Leon RD1 Kubasak MD, Phelps PE, Timoszyk WK1 Reinkensmeyer DJ1 Roy RR, Edgerton VR. Using robotics to teach the spinal cord to walk. Brain Research Reviews, vol. 40, 267-273, 2002; Leon RD, Acosta C. Effect of Robotic-Assisted Treadmill Training and Chronic Quipazine Treatment Stepping in Spinally Transected Rats Journal 15 of neurotrauma, vol 23, pp 1147-1163, 2006; Nessler JA, Minakata K, Sharp K1 Reinkensmeyer DJ Robot-assisted hindlimb extension increases the likelihood of swing initiation during treadmill waiking by spinal cord contused rats Journal of Neuroscience Methods, vol. 159, 66-77, 2007; US6880487).

US2010298102 relates to a robotic device for promoting the rehabilitation of individuals with gait dysfunctions, which has two platforms, one for each foot, that move the lower limb, simulating gait. The present application differs from this document in that it uses the treadmill, because with the use of platforms the swing phase is changed, since the feet remain in contact with the ground all the time, so it is 25 a less faithful simulation of normal walking.

US7998040 relates to a physical rehabilitation device that promotes an assistive force to assist in propelling gait. The device that will provide the assistive force is attached to the patient's waist and its force can be adjusted. The present application differs from this document in that it presents a lower limb orthosis associated with the cams of the ankle kinematic trajectory in normal gait, providing assistance with the biomechanical alignment of the hip, knee and ankle joints.

Document W02008032967 relates to a device with a control system capable of monitoring patient gait parameters 5 in real time and also comprising a lower limb orthosis. The present application differs from this document in that it features a vertical support for partial weight support if necessary and also the cam system to ensure kinematic gait trajectory in a normal pattern.

US2010268129 relates to a device for guiding the

gait trajectory by two moving platforms, one for each foot. Each platform moves independently in the longitudinal direction. The present application differs from this document in that it uses the treadmill instead of the moving platforms, thus maintaining the swing phase of the march.

US2004097330 refers to a robotic exoskeleton and

a control system with sensors that provide feedback on leg movement when it deviates from the normal pattern, thus providing corrective pressure and facilitation. This application differs from this document in that it has a predefined trajectory,

not being able to deviate from it.

US6689075 relates to a structure capable of removing the patient from the wheelchair and positioning him / her on a treadmill. The device features a touch screen panel to control gait parameters as well as an orthosis that engages the lower limbs by moving them.

while walking, but keeping the ankle joint open kinetic chain, with no connection to the equipment. The present application differs from this document in that the desired movement will be guided by side heads and a long tutor that interfaces between patient and machine.

Document W02009145423 relates to a robot for training in

gait consisting of a lower limb orthosis, a treadmill, a partial weight bearing support and a controller. The control system is capable of storing gait information and displaying it numerically or graphically enabling joint speed, angles and torque to be checked. The present application differs from this document in that the movement guide is performed by means of the ankle joint 5.

CN102225033 and CN102225034 refer to robotic devices to promote the rehabilitation of individuals with gait dysfunction. Although these documents have a predefined trajectory, they are not attached to a treadmill and do not have a long tutor with hip, knee and ankle articulation. The long tutor of the technology claimed here is extremely important to help in delimiting the movements to be performed. The present application also differs from this document in that it uses the treadmill, since with the use of platforms the swing phase is altered, since the feet remain all the time in contact with the “ground”, so it is a less faithful simulation of normal walking.

None of the above documents refer to a robotic gait training brace consisting of a treadmill (2), two lateral heads (3) with ankle kinematic trajectory and a bilateral long tutor (9), which interfaces the patient. and machine.

DESCRIPTION OF THE FIGURES

Figure 1 represents a side and top view of the equipment, where it is possible to observe a person with long pelvic belt tutor (8), with hip joint (7) and knee (6), a thigh to accommodate the thigh and 25 a polypropylene track (short tutor) to position the machine ankle joint, treadmill (2), upper guides (4), gearmotors or stepper motors (1) and path forming chains (5) sides) (3).

Figure 2 shows a rear view of the equipment, where it is possible to see the lateral head (3), which determines the kinematic trajectory of the ankle, with the traction chain (5), pinion (10), gearmotors or motors. step (1) and upper guide (4) that enables the concave part of the path to be made.

Figure 3 is a front view of the patient's equipment using a long tutor (9) with a pelvic belt (8), hip joint (7) and knee (6) coupled to the machine, the treadmill (2). ), and gearmotors or stepping motors (1).

Figure 4 represents the physiological (normal) kinematic trajectory of the ankle that occurs during a human step and will be used to define the robotic orthosis cams.

Figure 5 represents the upper guide (4) which ensures that

perform the concave part of the corresponding trajectory during the gait cycle, lowering the thigh and extending the knee.

Figure 6 represents the optional mechanism capable of adjusting the step size. It consists of a side plate that plays the role of one of the chain links (5). The plate (11) consists of holes (12) at different heights that will be able to determine the pitch increase as they alter the coupling pin connection between machine and individual.

DETAILED DESCRIPTION OF TECHNOLOGY

The present patent application comprises a robotic orthosis for gait training of individuals with neurological dysfunctions consisting of a treadmill (2), two lateral heads (3) with ankle kinematic trajectory and a bilateral long tutor (9), which makes the interface between patient and machine. The robotic orthosis may have a vertical support for partial weight bearing, a side plate (11) for adjusting the size of the 25-step, and two height-adjustable handrails for patients to support their upper limbs (Figures 1 , 2 and 3).

The treadmill (2) will be synchronized with the gearmotors or stepping motors (1) that will traverse the ankle. On the sides of it can be fixed two handrails with height adjustment, so that patients can support the upper limbs and thus remain more stable. Two side heads (3) will be used, one for each lower limb. Each head shall consist of: a drive chain (5) following a guide (Figure 4), a gearmotor or stepper motor (1), a drive pinion (10) for moving the chain (5) and sensors that will determine

5 the various stages of the stride, with different times (speeds), being the support phase and the swing phase.

The vertical support will partially support the patient through a pelvic vest, through a pantograph mechanism supported by pneumatic cylinder of adjustable force. By means of a pneumatic cylinder with 10 adjustable pressure, it will be possible to adjust the percentage of sustained weight. The literature suggests that in the first sessions, about 40 to 50% of body weight is sustained and that support decreases as the patient progresses in treatment (CHING et al., 2010; BRADY, K .; HIDLER, J. ; NICHOLS, D;; RYERSON, S. Clinical training and competency guidelines for 15 using robotics devices. 2011 IEEE International Conference on Rehabilitation Robotics. Rehab Week Zurich, ETH Zurich Science City, Switzerland, June 29 July 1,2011).

The guide (Figure 4) uses a cam system that serves as a track for the chain (5). The cams represent the actual ankle trajectory (walking trajectory without dysfunction) for children between 7 and 10 years old.

The actual kinematic trajectory of treadmill gait for healthy adult subjects was determined in a study that aimed to analyze Lokomat trajectory deviations from it (HIDLER et al., 2008).

The kinetic and kinematic parameters of gait of a child with 7

years of age are similar to those of adults, differing only at the moment generated by the ankle, explained by the difference in the size of the foot length (GANLEY, KJ; POWERS, CM) Gait kinematics and kinetics of 7-years-old children: a comparison to adults using age-specific 30 anthropometric data (Gait & Posture 2005; 21: 141-145). Therefore, although the trajectory is not described in the literature for children, but knowing that the step of children between 7 and 10 years old measures 0.43 ± 0.04 m, and that the kinematic pattern is similar to that of adults, the same was determined by calculations (DUSING, SC; THORPE, DE The normative sample of temporal and spatial gait parameters in children using the GAITRite electronic walkway. Gait

& Posture. 2007; 25: 135-139).

The trajectory determined for children between 7 and 10 years old can be

shown in Figure 4.

A single reel traction chain (5) will be used. So that the chain does not friction the track, it will be equipped with two single row ball bearings, coupled to each side of it. Each bearing will have its own track that comes with the camshaft of the inner chain roller. The chain will be required to perform the cam path, which faithfully represents the ankle path in normal gait.

The chain pull (5) will be effected by a pinion (10). The pinion will be driven by a variable speed gearmotor or stepper motor (1), with one rotation for the stance phase and one for the swing phase of the gear, as the perimeters and times of the chain paths differ in each phase.

Support and swing phase speeds are compatible with swing times 38% and support 62% of total stride time.

In addition, the stride support mat has speed

tangential adjustable according to the speed of the support phase.

In order to achieve the concave part of the path corresponding to the lower thigh and knee extension, we will have an upper guide (4) (Figure 5).

The long Tutor (9), which interfaces between patient and machine, is

It consists of a pelvic belt (8), hip (7) and knee (6) joint, thigh to accommodate the thigh and a polypropylene rail to position the ankle joint. At the pivot point of the ankle, at the level of the lateral malleolus, a pin will be attached that will interface with the machine. To prevent full knee extension, the orthosis may have a mechanical limiter such as an auxiliary spring that may be inserted into the long tutor (9) in the knee joint region (6). This robotic orthosis is provided with a mechanism capable of regulating the size of the step by means of a side plate (11) which plays the role of one of the chain links (5). In this plate there are holes (12) at different heights that determined the step increase, since it changes the connection height of the pin that makes the interface between the machine and the individual (Figure 6). In choosing a higher hole, the trajectory increases in both the concave and convex length and radii of curvature, as the coupling pin will now be connected to the side plate (11) and no longer to the link pin. chain.

Claims (9)

1. Robotic walking training orthosis, characterized by comprising a treadmill (2), two lateral heads (3), which have a cam system which is a track for the chain (5), upper guides (4), pinion (10). ), which pulls the chain (5) and will be driven by gearmotors or step motors (1) with variable traction, and a bilateral long tutor (9), consisting of a pelvic belt (8), hip joint (7) and knee (6), thigh and gutter to position the ankle joint. Robotic gait training orthosis according to claim 1, characterized in that the motorredures or stepping motors (1) alter the speeds (revolutions), defining the swing and support phases of the gait. Robotic gait training orthosis according to claim 1, characterized in that the long tutor (9) has a coupled pin at the ankle pivot point at the lateral malleolus, which will interface the patient and the machine. Robotic walking training orthosis according to claim 1, characterized in that it has sensors at various points along the path which will determine the various stride phases with different times (velocities), being the stance phase and the swing phase. . Robotic walking training orthosis according to claim 1, characterized in that it has a stride support mat with tangential velocity adjustable to the speed of the support phase. Robotic gait training orthosis according to claim 1, characterized in that it optionally has a vertical support for partial support of the individual, preferably by means of a pantograph mechanism supported by a pneumatic cylinder of adjustable force. Robotic walking training orthosis according to Claim 1, characterized in that it has, optionally, a chain-engaging side plate (11) and individual machine-coupling pin with holes (12) at different times. Robotic walking training orthosis according to Claim 1, characterized in that it has two height-adjustable handrails on the side of the treadmill (2). Robotic walking training orthosis according to claim 1, characterized in that the orthosis optionally has a mechanical limiter of the maximum knee extension, such as the auxiliary spring.