CZ310036B6 - A rehabilitation sensor apparatus - Google Patents

Abstract

The rehabilitation sensor apparatus for the lower limb rehabilitation consists of the first support (5) for placing left foot and the second support (6) for placing right foot, whereas both supports (5 and 6) are placed on a moving part (3), which is connected to a fixed support part (2) using a rotary swinging flexible element (13). The first support (5) and the second support (6) have at least one sensory transmitter (9) assigned, whereas the sensory transmitter (9) is interconnected with a control and evaluation equipment (22), which is interconnected with a screen (23). On the moving part (3) there is a circular groove (4), on which the first support (5) is mounted on one side using the rotary front part (5.11) and the front part (6.11) of the second support (6), whereas the other sides of the first support (5) and the second support (6) are pivoted on an element (14), which is mounted on the moving part (3). The sensory transmitters (9) consist of the first sensor (9.1) for sensing the movement of the first toe of the leg in the direction of plantar flexion, the second sensor (9.2) for sensing the movement of the first toe of the leg to abduction, the third sensor (9.3) for sensing the movement of the internal rotation in hip joint, the fourth sensor (9.4) for sensing the external rotation in hip joint and the fifth sensor (9.5) for sensing plantar and dorsal flexion in the ankle joint, whereas the fifth sensor (9.5) is mounted below the flexible element (13) on the moving part (3) or on the fixed part (2).

Description

Rehabilitation sensory device

Field of technology

The invention relates to a rehabilitation sensory device using biological feedback, which is represented by software in a virtual game environment. It will be used especially by patients during comprehensive rehabilitation in the fields of internal medicine. Especially cardiology and obesitology or dialysis patients. Another large group will be patients with neurological or post-traumatic deficits in the area of the lower limbs.

Current state of the art

The main goal of rehabilitation in general is to set ideal conditions in the body so that the self-repairing forces of the individual can work with the highest possible efficiency. After that, it is purely up to the discretion of the physiotherapist which path he chooses. Since we work with the person as a whole, the treatment process cannot be generalized in any way. The treatment approach is strongly individual and multidisciplinary.

Various treatment methods are used to rehabilitate patients whose diagnoses are suitable for therapy with the described invention. Specifically, these are patients after myocardial infarction, cardiology operations and other clinical cardiology diagnoses associated with deconditioning, immobilization of the patient, people suffering from obesity or dialysis patients. Furthermore, there are post-traumatic conditions of the lower limbs with a persistent deficit of mobility or rehabilitation of patients after total endoprostheses of the hip or knee joints. In the field of neurology, this applies to patients with polyneuropathy, sensory deprivation of the feet, walking disorders or as prevention of falls in the elderly or as compensatory foot exercises for athletes.

Part of the rehabilitation treatment of the mentioned diagnoses are rehabilitation methods, such as manual techniques, kinesiotherapy, physical therapy and others. In the field of instrumental rehabilitation, these are complex robotic systems, myostimulation devices or devices using labile surfaces.

Such rehabilitation is carried out by trained physiotherapists who ensure that their patients perform movements physiologically, with the correct intensity and timing. If it is movement therapy, the learned exercises should be performed by the clients themselves at home in the prescribed frequency. During a personal meeting, the physiotherapist checks the correctness of the performed movements and recommends further exercise steps. In this procedure, when the patient practices the prescribed exercises at home, the correctness of their execution is not guaranteed. The result of the exercise is therefore individual and depends mainly on the will of the patient to correctly perform the agreed exercise unit.

Another method of choice for lower limb therapy is sensorimotor training, which is actually the activation of extero and intero tissue receptors that help the brain in creating an image of the lower limb. Thanks to the proper sensorimotor skills of the foot, a person is able to perceive uneven surfaces, react with the fingers when staggering, or quickly activate muscles, for example, when tripping, so that a person does not fall. Sensory walkways or carpets are used, for example, for sensorimotor training. A certain disadvantage of this rehabilitation is that the patient does not see his medical procedure, which motivates him to continue training.

Unstable platforms are also used to rehabilitate the lower limbs. One of the most used is the posturomed, on which you train while standing. This means a great demand for conscious work with a deep stabilization system. This aid is not interactive, again there is a lack of quality feedback and it is advisable to train with the participation of a physiotherapist.

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For example, the Propriofoot concept can be used for leg rehabilitation and training. Here, exercises are performed using small unstable plates placed under different parts of the sole of the foot. The muscle chaining here is also from the acre towards the center. However, it is not interactive, does not use biological feedback and takes place mainly while standing with the participation of a physiotherapist. Standing exercises also have increased demands on the functional center of the body.

During hospital rehabilitation for patients in the acute phase after cardiac operations or myocardial infarction, rehabilitation begins lying down, as other stress positions are generally not tolerated. During the exercise, a physiotherapist must be present, whose time per patient per day is limited in hospitals. Pedal motomeds are used for independent exercise. During this exercise, the patient is tied to the pedal bike and pedals while lying down. The disadvantage of the motomed is that you pedal the bike without feedback. The exercise is not interactive in any way. Often unfunny.

For cardiorehabilitation in the post-acute phase, resistance training is also used, where patients also use classic exercise machines that are known from fitness centers (pulling pulleys with the upper limbs, bench press, etc.). The problem is that this rehabilitation does not address the rehabilitation side, only the hemodynamic side (load on the cardiovascular system). The vast majority of patients have a dysfunctional deep stabilization system of the body. During exercise, the diaphragm, oblique abdominal muscles, deep muscles of the spine and pelvic floor are not physiologically involved. In case of insufficient work of this system-deep stabilization system, resistance training is therefore strongly not recommended.

Stimulation of the quadriceps using myostimulation currents is also used to improve hemodynamics. These currents replace the free muscle activity of a person, when the electrically induced contraction of the thigh muscles is to achieve the return of blood back to the heart even without the active exercise of the patient. This is relatively inefficient as we are not progressing from the acral parts towards the distal parts. Again, the physiotherapist must be present and the patient may also find the stimulation unpleasant.

In recent years, there has been a growing development of robotic training devices (exoskeletons) that also use virtual reality. These devices are mainly focused on the upper limbs and can exercise with the patient even passively. They are used, for example, in neurorehabilitation for central paresis or plegia of the upper limbs in patients after cerebrovascular accidents. The general disadvantage of robot-assisted rehabilitation is its complexity, thus the high price and increased demands on technological and spatial facilities. For these reasons, they are not easily accessible to the common man.

WO 2013164364 by Hocoma describes a device that uses sensors to monitor movement. In this device, inertial measurement units (IMUs) are attached to the back of a person to measure their movements, and by moving the back, the person can, for example, control elements displayed on the screen and perform specific exercises. The disadvantage of the solution according to WO 2013164364 is that the physiotherapist must place and attach the sensors to specific parts of the person and remove them again after the exercise. The exercise is performed while standing.

The essence of the invention

The existing disadvantages of known means for comprehensive rehabilitation of the lower limbs are eliminated by the rehabilitation sensory device according to the invention. The essence of the invention is that it contains a first support for inserting the sole of the left foot and a second support for inserting the sole of the right leg. Both supports are placed on a movable part, which is connected to the fixed support part by a swinging and rotatable flexible element. At least one sensory sensor is associated with the first support and the second support, wherein the sensory sensor is connected to a control and evaluation device that is connected to the screen.

According to the first embodiment of the invention, a circular groove is placed under each support on the movable part, on which the first support is rotatably mounted on one side of the front part and the front part also

- 2 CZ 310036 B6 second support, whereby the second part of the first support and the second part of the second support are rotatably mounted on an element that is mounted on the movable part.

According to another advantageous embodiment of the invention, the sensory sensors consist of a first sensor for sensing the movement of the first toe in the direction of plantar flexion, the first sensor being located under the first toe on the inner side of the first and second supports, a second sensor for sensing the movement of the first toe into abduction, wherein the second sensor is located on the inner side of the first and second supports, the third sensor for sensing the movement of internal rotation in the hip joint, the fourth sensor for sensing the movement of external rotation in the hip joint, while the sensors for sensing the movement in the hip joint are located on the circular groove along the outer on the sides of the first support and the second support, a fifth sensor for sensing plantar and dorsiflexion in the ankle joint, wherein the fifth sensor is placed under the flexible element on the movable part or on the fixed part.

Another advantageous embodiment of the invention makes it possible to adjust the dimensions of both supports according to the size of the patient's foot. The adjustment is solved in such a way that the first support is divided into a first support part and a second support part, the second support is also divided into a first support part and a second support part, while the support parts of the first support and the support parts of the second support (6) are adjustable in the direction of the "x" axis and the "y" axis

According to another advantageous embodiment of the invention, flexible ropes are attached to the support part, the task of which is to occupy and stabilize the hands.

In order to avoid undesired extension of the legs from the left and right backrest during exercise, securing elements are attached to the raised edge of the swivel element in the first backrest and to the second backrest in the area where the heel of the foot rests. These securing elements are guided in the vertical direction from the movable part, while the ends of each securing element are fixed with securing means, e.g. Velcro, which secure the patient's legs in both supports.

The advantages of the invention can be summarized as follows:

The patient does not necessarily need to be accompanied by a physiotherapist during exercise. The exercise takes place lying on the back without increased demands on the training of the individual. Another great advantage of the invention is that the control of the therapeutic game software displayed on the screen is performed using the movements of the patient's finger, foot, heel. It is therefore such a controller that is controlled by the movements of the lower limbs. Another advantage is the use of biological feedback, which can correct the patient's efforts and motivate them to perform better. Another advantage is that the device has no weight limit. It is therefore also suitable for patients with morbid obesity who are unable to exercise in normal positions.

Clarification of drawings

The invention will be explained in more detail in the attached figures, where:

Giant. 1 is a perspective view of the rehabilitation device attached to the bed.

Giant. 2 perspective view of the rehabilitation device.

Giant. 3 top view of the rehabilitation device.

Giant. 4 detail from Fig. 3.

Giant. 5 section guided by the footrest and the movable part.

Giant. 6 detail from Fig. 5.

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Giant. 7 side view of the support part.

Examples of implementation of the invention

The rehabilitation sensory device 100 (hereinafter referred to as the device 100) for training the lower limbs, which uses the activation of the myofascial chains of the lower limbs, is shown in Fig. 1 to 5. The rehabilitation exercise with the device 100 takes place while lying on the back.

The device 100 consists of a fixed support part 2, e.g. in the shape of a rectangle, to which a movable part 3 of the same shape is connected, while both parts 2 and 3 are connected on the two shorter sides by hinges 17. The hinge 17 is connected by the sides to which exercises direct the patient's heels. Between the front side 2.1 of the fixed support part 2 and the bottom side 3.1 of the movable part 3, a flexible element 13 consisting of a spring is fixed (the area where the fingers of the lower limbs are during exercise). This flexible element 13 provides a swinging connection between the fixed support part 2 and the movable part 3. This swinging connection by means of the flexible element 13 enables the lower limbs to perform a rotational movement around the "Y" axis during rehabilitation, as will be further described and explained. The first support 5 for inserting the sole of the left leg and the second support 6 for inserting the sole of the right leg are placed on the swinging part 3. In terms of shape, both supports 5 and 6 are designed in such a way that the left and right leg can be inserted into them, while they show a raised edge 18 around the perimeter, which holds the limb in the exercise position.

The first support 5 is divided into a first support part 5.1 and a second support part 5.2. The second support 6 is divided into a first support part 6.1 and a second support part 6.2. The support parts 5.1, 5.2 of the first support 5 and the support parts 6.1 and 6.2 of the second support 6 are positionable in the direction of the "x" and "y" axes to adjust the size depending on the size of the patient's feet. The supporting parts 5.1, 5.2, 6.1 and 6.2 of the supports 5 and 6 are also rotatably positionable for performing a rotational movement during exercise around the "z" axis.

To ensure the longitudinal positionability of the supports 5 and 6, two first guide grooves 11 are fixed parallel to each other in the direction of the "x" axis (the direction of the foot position during exercise) on the movable part 3 under the first support parts 5.1 and 6.1. In the first guide groove 11, the a first guide element 11.1, e.g. a screw, which is fixed on the underside of the first support parts 5.1 of the first support 5 and on the bottom side of the first support parts 6.1 of the second support 6. These first guide grooves 11 are guided under both first support parts 5.1 and 6.1 and they also partially extend under the second support parts 5.2 of the first support 5 and under the second support part 6.2 of the second support 6. Under the second support parts 5.2 and 6.2 of each support 5 and 6, a second guide groove is fixed on the movable part 3 in a direction perpendicular to the first guide grooves 11 12. The second guide element 12.1 is guided in the second guide groove 12, which is attached to the bottom side 5.21 of the second support part 5.2 of the first support 5 and to the bottom side 6.21 of the second support part 6.2 of the second support 6 (Fig. 5,7).

In order to ensure the rotational positionability of the supports 5 and 6, a circular groove 4 is fixed on the swinging movable part 3 under the first support parts 5.1 and 6.1 of the support 5 and 6. In the circular groove 4, a guide element 4.1 is guided, which is firmly connected to the lower sides of the first support parts 5.1 and 6.1 support 5 and 6 (fig. 1, 4, 6). In order to allow the supports 5 and 6 to rotate along the circular groove 4, the second support parts 5.2 and 6.2 are rotatably mounted on the element 14, e.g. a pin (Fig. 5, 7).

Locking elements 7 are attached to the first support 5 and to the second support 6 in the area of the heel of the foot in the raised edge 18 on the rotating element 7.1. These locking elements 7 are guided in the vertical direction from the movable part 3 (in the direction of the patient's calf during exercise). On each securing element 7, securing means 8 are fixed, e.g. Velcro fasteners, with which the patient's calves are secured in supports 5 and 6 during exercise. The patient's feet are also secured in both supports 5 and 6 with securing means 8.1, e.g. Velcro fasteners.

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The first sensor 9.1 and the second sensor 9.2 are placed on the inner sides of the supports 5 and 6 (the sides where the patient's feet are placed). The movement of the toe in the direction of plantar flexion, i.e. in the direction of the "x" axis, is sensed by the first sensor 9.1 located under the toe on the inner side 5.12, 6.12 of the first and second supports 5, 6. The movement of the toe in the direction of plantar abduction, i.e. in the direction of the "z" axis is sensed by the second sensor 9.2 located on the inner side 5.13, 6.13 of the first and second supports 5, 6. A third sensor 9.3 is placed on the circular groove 4 on the outer sides of the first support 5 and the second support 6 for sensing the movement of the internal rotation in the hip joint and a fourth sensor 9.4 for sensing external rotation in the hip joint. For sensing the movement of plantar and dorsiflexion in the ankle joint, a fifth sensor 9.5 is placed under the flexible element 13 on the movable part 3 or on the fixed part 2 (Fig. 2, 3, 4)

On the fixed support part 2, an element 24 is fixed for holding two flexible ropes 10, the task of which is to stabilize the patient's hands during exercise, since the human brain will tend to control the virtual environment with the hands and not with the feet. The ability to consciously control the fine motor skills of the leg is significantly weakened. In addition, these flexible ropes 10 protect the patient from undesired upward movement of the bed, which could occur during strenuous plantar flexion in the ankle joint.

Figure 1 shows the use of the device 100 in the rehabilitation or training of the lower extremities. The device 100 is attached to the frame structure 1.1 of the positionable bed 1 by means of the fastening part 15. Sensory sensors 9 are connected to the control and evaluation unit 22 connected to the screen 23. The patient performs the exercise lying on his back. This means that the training of the legs can take place with very little demands on the condition and the general condition of the patient, even though the training takes place at a high intensity. Therapy is active. The patient must be conscious, able to cognitively understand the virtual environment and have at least partial motor innervation of the lower limbs preserved. The therapist prepares the patient for the device by inserting the patient's feet into the supports 5 and 6, by moving the first support 5 and the second support 6 along the first guide groove 11 and the second guide groove 12, he sets the dimensional size of both supports 5 and 6 according to the size of the feet the patient. The therapist then secures the position of the sliding supports 5 and 6 with screws 23 located inside the guide grooves 11 and 12. The operator also secures both legs of the patient with securing means 8 and 8.1 (e.g. Velcro). During exercise, the patient performs movements of the toes in the direction of plantar flexion and abduction, as well as plantar and dorsiflexion in the ankle and rotation in the hip joint. These movements are detected by sensors 9.1, 9.2, 9.3 and 9.4 and transmit the signals from them to the control and evaluation unit 22, which converts the individual's movements into individual commands of the virtual environment. These commands are presented to the patient in the form of therapeutic games as feedback from the performed exercise. Everything is displayed on the screen 23, which can be freely adjusted via the telescopic rod 21. With the device 100, imaging using 3D glasses or smart phones or tablets can also be considered.

As another example of the use of the invention, it can be applied in the rehabilitation of a patient who has to go on dialysis due to kidney failure. Such a person goes to dialysis 3 times a week and spends 4 to 6 hours in the dialysis center at each session. So around 15 hours a week. The dialysis process takes place lying down, and you can exercise on the machine during dialysis. For such patients, exercise during dialysis can be the only source of exercise, and with a subsidy of 15 hours per week, we can consider it a very high-quality training plan. The patient is therefore connected to the dialysis unit, lies on a couch and the device is installed on the patient's feet. On screen 23, a therapeutic game is selected, the goal of which is to achieve better blood return from the periphery, therefore a game is selected that contains elements of vascular gymnastics to promote venous return and tissue perfusion.

The patient is now playing a game. Anatomically, the patient performs plantar and dorsiflexion in the ankle joint, which is sensed by sensor 9.5, and performs rotations in the hip joint, which is sensed by sensors 9.3 and 9.4. As feedback, the patient sees a game on the screen, for example car racing. This avatar car moves forward if the fifth sensor 9.5 for plantar flexion in the ankle joint is activated, i.e. compression of the flexible element 13 under the movable part 3. The toy car brakes if the fifth sensor 9.5 for dorsiflexion in the ankle joint is activated, i.e. release compressed elastic element 13 under the movable part 3. Rotation sensors 9.3 and 9.4 are used for turning to the right and left, which the patient activates by means of internal and external rotation in the hip joints. The patient is motivated

- 5 CZ 310036 B6 to perform in a competitive environment where they compete either against computer-controlled opponents or against paired other patients who will use the same therapeutic game during dialysis. It is this that can make a lengthy dialysis process fun, therapeutic with a significant psychological and social superstructure. Similarly, one can imagine patients with chronic cardiovascular disease with deconditioning, obese patients who cannot handle standing exercises or exceed the weight limits of e.g. exercise bikes, or athletes who work in inappropriate footwear (hockey players, soccer players...) as a form of compensatory exercises.

In general, rehabilitation training circuits can be performed on the device 100, e.g.

• Functional activation of the planta pedis muscles • Therapy and prevention of hallux valgus et hallux rigidus • Increased coordination of the left versus right lower limb • Strength training of the leg and lower leg muscles at several levels • Strength training of the muscles of the entire lower limb at several levels • Strength training of the hip joint rotators • Exercise of eccentric contraction of the dorsal muscle chain of the lower limbs • Vascular gymnastics • Sensorimotor training of the legs accompanied by a significant cognitive component.

Claims (6)

1. Rehabilitation sensory device (100) for the rehabilitation of the lower limbs, characterized in that it contains a first support (5) for inserting the sole of the left leg and a second support (6) for inserting the sole of the right leg, wherein both supports (5 and 6 ) are stored on the movable part (3), which is connected to the fixed support part (2) by means of a rotatably swingable flexible element (13), while at least one sensor (9) is assigned to the first support (5) and to the second support (6), while the sensory sensor (9) is connected to the control and evaluation device (22), which is connected to the screen (23). 2. Sensory rehabilitation device (100) according to claim 1, characterized in that a circular groove (4) is mounted on the movable part (3), on which the first support (5) and the front part (6.11) the second support (6), while the other sides of the first support (5) and the second support (6) are rotatably mounted on the element (14), which is mounted on the movable part (3). 3. The rehabilitation sensory device (100) according to claim 1, characterized in that the sensory sensors (9) consist of a first sensor (9.1) for sensing the movement of the first toe in the direction of plantar flexion, while the first sensor (9.1) is located below the first with the toe on the inner side (5.12) of the first support (6) and on the inner side (6.12) of the second support (6), the second sensor (9.2) for sensing the movement of the first toe into abduction, while the second sensor (9.2) is placed on the inner on the side (5.13) of the first support (5) and on the inner side (6.13) of the second support (6), the third sensor (9.3) for sensing the movement of internal rotation in the hip joint, the fourth sensor (9.4) for sensing the external rotation in the hip joint , while the sensors (9.3, 9.4) are located on the circular groove (4) on the outer sides of the first support (5) and the second support (6), the fifth sensor (9.5) for sensing plantar and dorsiflexion in the ankle joint, while the fifth sensor ( 9.5) is placed under the flexible element (13) on the movable part (3) or on the fixed part (2). 4. Sensory rehabilitation device (100) according to claim 1, characterized in that the first support (5) is divided into a first support part (5.1) and a second support part (5.2), the second support (6) is divided into a first support part (6.1) and to the second support part (6.2), while the support parts (5.1, 5.2) of the first support (5) and the support parts (6.1 and 6.2) of the second support (6) are positionable in the direction of the "x" axis and the " y" 5. Sensory rehabilitation device (100) according to claim 1 and 2, characterized in that flexible ropes (10) are connected to the support part (2). 6. Sensory rehabilitation device (100) according to claim 1, characterized in that to the first support (5) and to the second support (6) in the area where the heel of the foot is placed, locking devices are connected to the raised edge (18) on the rotating element (7.1) elements (7), wherein these securing elements (7) are guided in the vertical direction from the movable part (3), and wherein securing means (8) are fixed on each securing element (7).