DE102016104252A1 - Foot shell for a movement therapy device and exercise therapy device - Google Patents

Abstract

The invention relates to a foot shell for a movement therapy device (2), comprising a receptacle (9) for connection to a rotation axis (10) of a movement therapy device (2) and to a support surface (3) for a foot of a patient. The support surface (3) is formed in several parts and comprises a heel segment (4) for supporting the heel and a forefoot segment (5) for supporting the forefoot of a patient, which are arranged to be movable relative to one another. Furthermore, the invention comprises a movement therapy device.

Description

The invention relates to a foot shell for a movement therapy device, with a receptacle for connection to a rotational axis of a movement therapy device and with a bearing surface for a foot of a patient. Furthermore, the invention relates to a movement therapy device with a foot shell according to the invention.

In particular stroke patients but also patients who have a herniated disc with compression of the nerve root in the area of the fourth lumbar vertebra (L4) or injury of the peroneal nerve in the region of the fibular head, often suffer from the phenomenon of so-called Fußheberschwäche, in which the activity of the muscle tibialis anterior or lower lying muscle groups are restricted or even completely paralyzed. This leads in the worst case to the fact that the patient's foot is continuously stretched - the so-called Spitzfuß - and a Dorsalflexion - ie a rotation of the foot in the direction of the lower leg to the upper ankle and thus an increase of the toes - is not possible , In particular, it is problematic for patients with dorsiflexion of the foot that they are no longer able to swing the leg forward in the running direction and, of course, roll it off, as is required during normal running. The resulting gait pattern is often referred to as a stepper gait, which means that patients must lift the affected leg higher when walking due to the drooping foot to avoid tripping. Patients with dorsiflexia also have an increased risk of falls. Also suffer in the case of a spastic-induced Fußheberschwäche the patients often suffer from severe pain and complete immobility. Furthermore, it has also proved to be disadvantageous that patients who have only an extremely low residual activity of the tibialis anterior muscle, get in the known therapies no feedback about the remaining activity remaining of the foot lifter.

For the treatment of Fußheberschwäche electrostimulation is often used, which has been shown to be only partially effective to specifically treat Fußheberschwäche, as this is only a very selective muscle. Even on the market therapy devices such as ergometers or steppers are not able to effectively treat the Fußheberschwäche because a targeted training of the tibialis anterior muscle and / or deeper muscles is difficult and the associated personnel costs are very high. In addition, these known therapies can be carried out by the patient himself only to a very limited extent in the home environment.

The underlying of the foot shell part of the task is thus to reduce the above-mentioned disadvantages and to provide a Fußschale for a movement therapy device, with the effective therapy of Fußheberschwäche is made possible. Furthermore, the object is to provide an improved exercise therapy device.

The part of the object relating to the foot shell is achieved according to the invention in a foot shell of the type mentioned above in that the support surface is formed in several parts and comprises a heel segment for supporting the heel and a forefoot segment for supporting the forefoot of a patient, which are arranged movably relative to one another ,

This makes it possible to decouple the movement of the forefoot from that of the heel area, which makes it possible for a patient to specifically control the anterior tibial muscle responsible for foot elevation (dorsiflexion) - ie, the tibialis anterior muscle - but also other deeper muscle groups work out. By the movable arrangement of the forefoot segment and the heel segment relative to each other, it is also possible to detect the relative displacement between the forefoot segment and the heel segment and thus to draw conclusions about the activity of the tibialis anterior muscle and / or deeper muscle groups, as the heel segment as a reference can be used. In this context, it has also proven useful, in particular, if the forefoot segment but also the heel segment are adapted to the anatomy of the human foot, since this promotes rotation of the upper ankle joint. In particular, it has proven in this context when the forefoot segment has a recess into which the heel segment protrudes with a corresponding bulge.

It has also proved to be advantageous if the heel segment and the forefoot segment are interconnected by a measuring means such that the forces acting on the forefoot segment can be measured. This makes it possible to detect residual activity of the tibialis anterior muscle, which has a positive effect on the patient's motivation. In particular, this can also be exploited by the human body immanent interaction principle of flexor and extensor to infer the force applied by the patient on the acting between the forefoot and the heel of the patient torque. It is thus possible to indirectly infer the muscle activity of the patient via the acting moments. Furthermore, it is also possible by the measuring means, the acting forces and opposing forces angle and depending on the position, which allows even more precise and individualized therapy.

In this context, it has also been shown to be favorable if the measuring means is formed as a bending force sensor. This provides a simple and inexpensive way to capture the muscle activity of the patient. At the same time, this sensor can be made very thin, so that it is also possible to make the foot shell as thin as possible, whereby the weight of the foot shell can be reduced and a visually attractive foot shell can be produced. In addition, the bending force sensor also has a large measuring range, so that it can be ensured by such a bending force sensor that the muscle activity can be detected both by almost paralyzed patients but also by patients who have only a very slight or no limitation of the foot lifter.

It has also proven to be favorable if a securing means is provided in the region of the forefoot segment for securing the forefoot to the forefoot segment. This ensures that a movement of the forefoot is transmitted directly to the forefoot segment of the foot shell and therefore already a very low activity of the foot lifter can be detected and detected.

It has also proven to be particularly advantageous if the securing means comprises at least one belt. The use of a belt, such as a Velcro strap, has been proven because the straps do not cut and are relatively easy to handle, allowing the patient to attach the securing means themselves. In order to achieve an improved starting position for the rotation of the upper ankle joint, it has also proven in this context, if the slots for the implementation of the securing means are aligned so that they follow the natural external rotation of the patient.

Disturbance variables can be excluded in particular by the fact that the axis of rotation of the upper ankle of a patient can be arranged coaxially or approximately coaxially to the longitudinal axis of the receptacle. In this way, in particular, it is achieved that translation movements of the lower leg and / or the thigh are excluded, which would erroneously indicate an activity of the foot lifter and which could thus lead to misinterpretations of the results. Namely, the axis of rotation is located below the foot, as is common, for example, in bicycle pedals, the lower leg is inevitably raised and / or shifted by the resulting lever in the dorsiflexion. In this case, it has furthermore proven to be advantageous if the position of the receptacle associated with the heel segment can be changed in order to allow an adaptation to the anatomical conditions of different patients. Furthermore, in this context it is also possible to use different pads and / or pads to adjust the position of the upper ankle of a patient to the position of the recording.

It has also proven to be advantageous if at least one data line is provided for data transmission between the measuring device and an evaluation unit. The evaluation unit makes it possible to record the activity of the patient and to display it to the patient as biofeedback. In this case, it is also provided in the invention in particular that the data line is formed as a wireless data line, which is selected from a group that includes radio waves, Bluetooth or W-LAN. The term data line thus includes both data lines, in which the data transmission takes place via a cable, as well as wireless data transmission. This also makes it possible, in particular, to transmit the recorded measurement data directly and directly to a physician and / or a therapist via a telemedical interface, which in turn is then able to evaluate the exercise results but can also set new tasks or specific activity goals. which has a positive effect on the motivation and the drive of the patient.

In the context of the invention, it has also proven to be useful if the heel segment is associated with a heel sensor which is designed to measure the contact between the heel and the heel segment. In this way, it can be ensured in particular that a lifting of the heel induced by pulling up the thigh can be recognized by the heel segment and displayed to the user. Otherwise, this raising of the thigh would have a negative effect on the result of the force measurement, since its force contribution might not be distinguishable from that caused by the rotation around the upper ankle joint. The heel sensor thus ensures, in particular, that the patient does not cheat on a biofeedback application in order to achieve the target. Furthermore, the heel sensor can also be designed to detect the force acting on the heel segment force.

The object underlying the movement therapy device is achieved according to the invention by a movement therapy device having at least one rotation axis and at least one foot shell according to one of claims 1 to 7, wherein the receptacle of the at least one foot shell is arranged on the at least one rotation axis. This provides us with a training device, with which the Fußheberschwäche a patient can be specifically treated.

It has also proven useful if a limiter is provided for limiting the pivoting of the foot shell about the axis of rotation. This makes it possible that the patient's foot does not perform a rotational movement as in a bicycle ergometer, but rather only a pivoting movement, and it has also shown to be favorable in this respect, if the angle of pivoting is adjustable by the limiter. This makes it possible, on the one hand, to simulate the physiological pivoting of the upper ankle and to adjust the angle individually according to the requirements of the respective patient and thus to simulate the individual range of motion - the so-called range of motion.

In order to exclude translation effects, it has continued to be proven if at least one lower leg supported is provided. By the lower leg support, which is preferably associated with a frame or a housing of the movement therapy device or an auxiliary frame, it is possible to fix the lower leg of the patient, thereby avoiding disturbing effects that could be induced by the movement of the upper or lower leg. In this context, it has also proven to be advantageous if the position and orientation of the lower leg support can be adjusted relative to the auxiliary frame.

In order to increase the training motivation of the patient, it has also proven to be favorable when a signal generator is provided. Such a signal generator makes it possible, in particular, to directly indicate to the patient a residual activity of the foot lifter, which leads to improved motivation, in particular for patients whose foot lift activity is so limited that they do not recognize their activation themselves. In this context, it has proven particularly useful if biofeedback can be output to a patient with regard to the activity of the foot lifter. In this context, it has also proven to be particularly advantageous if the signal generator is designed as an acoustic signal transmitter and / or as an optical signal generator. This makes it possible for example to specify a desired value for the patient and, on the other hand, to record the actual value and to signal the patient of the two values or the deviation of the actual value from the desired value. Furthermore, it is also possible to display page-related values in order to display, for example, asymmetries of the patient with respect to foot-leg weakness of the right and left foot and counteract this specifically. In particular, it is also provided in the context of the invention in this regard, that the biofeedback in a game - for example, in a group game - is integrated, whereby the motivation of the patient can be further increased.

The training can be improved in particular in patients who have a paralysis, characterized in that a motor is provided for the motor adjustment of the foot shell. Thus, on the one hand it is possible for the patient to passively perform the movement of the foot lifter in the context of an isokinetic training. The passive movement alone creates a counter-moment to the pedal movement in people with increased muscle tone, which is measurable and allows conclusions to be drawn about the muscle groups involved. When measuring actively available muscle activity, the patient may also be encouraged to perform individual movement tasks. These can be specified either by the therapist or by biofeedback. This can be done either with or against the isokinetic motion of the engine. At the same time, the motor can thus be used to counteract the active foot lift movement of the patient's braking torque, which can intensify active training. The engine is used in this case as a counter-torque generator. Since the engine torque generated by the engine is known and serves as a counter-torque to the torque generated by the patient, it is thus indirectly possible to deduce muscle activity of the foot lifter. The counter-torque of the motor acts directly on the axis of rotation. Since the heel is stably connected to the heel segment of the pedal and the forefoot segment is connected to the heel segment only by the measuring means, the torque of the motor provides the counter-torque which leads to a deflection of the measuring means when the counter-torque applied by the motor is greater or less than is the torque produced by muscle activity. This result thus indirectly represents muscle activity. This is not possible with foot shells known from the prior art and can only be carried out by complex torque calculations in correspondingly elaborate measuring devices. It can also be detected by this possibly occurring spasticity of the patient and targeted counteracted this.

It has also proven to be advantageous if the foot shell is provided several times, in particular twice. Thus, a bilateral training of the foot lifter is possible, wherein it is provided here in the context of the invention in particular also that the training parameters of one side can be set independently of those of the other side. This applies in particular to a motor support or applied by the engine counter-torque.

In the following the invention will be explained in more detail in an embodiment shown in the drawing; show it:

1 a perspective view of the top of a foot shell according to the invention,

2 a perspective view of the underside of the foot shell of the 1 .

3 an exploded view of the foot shell according to the invention from the 1 .

4 a perspective view of a movement therapy device, and

5 a perspective view of an auxiliary frame with a lower leg support.

1 shows a perspective view of a foot shell according to the invention 1 for a movement therapy device 2 according to the present invention. The foot shell 1 has a support surface 3 for receiving a foot of a patient and is formed in several parts. The bearing surface 3 includes a heel segment 4 to support the heel and a forefoot segment 5 to support the forefoot of a patient. The two segments are arranged to each other so that the forefoot segment 5 relative to the heel segment 4 is mobile. Of the 1 is further evident that in the area of the forefoot segment 5 a securing agent 6 is provided to secure the forefoot on the forefoot segment 5 , Here, the securing means comprises 6 at least one strap 7 which passed through a slot 21 is and the forefoot of the patient on the forefoot segment 5 guaranteed. In the area of the heel segment 4 is also a heel support 8th formed by which the position of the heel can be determined. The heel segment 4 is still a recording 9 associated with the foot shell 1 on a rotation axis 10 a movement therapy device 2 can be attached. The recording 9 is in one arm 11 formed, whereby it is possible, the axis of rotation of the upper ankle of the patient coaxial with the longitudinal axis 12 the recording 9 to arrange. Furthermore, the 1 also a heel sensor 31 to see if the heel of the patient is in contact with the heel segment 4 the foot shell 1 located.

The Indian 2 illustrated perspective view of the underside of the foot shell according to the invention 1 it can be seen that between the forefoot segment 5 and the heel segment 4 the edition 3 a measuring device 13 is placed around the forefoot segment 5 to measure acting forces. In the in the 2 illustrated embodiment is the measuring means 13 as a bending force sensor 14 formed by a data line 15 with an evaluation unit 16 can be connected. The bending force sensor 14 is in a leadership 17 taken, whereby its position and position is defined and a measurement impairing slipping is prevented. The perspective view on the underside of the foot shell, which in the 2 is shown, it can be further seen that the arm 11 L-shaped and formed in an arm support 18 is secured to the heel segment 4 assigned.

As in particular in the 3 illustrated exploded view of the foot shell according to the invention 1 can be removed, is the bending force sensor 14 in the lead 17 and the arm 11 in the arm intake 18 by fasteners 19 secured in the embodiment shown as securing screws 20 are formed. 3 is also the heel sensor 31 in the heel segment 4 It is possible to check whether there is contact between the patient's heel and the heel segment 4 is made.

4 shows a movement therapy device 2 , with which a Fußheberschwäche a patient can be specifically treated. The exercise therapy device 2 has a rotation thing 10 on, on the foot shell of the invention 1 is attached. The foot shell 1 has this recording 9 on, in which the axis of rotation 10 is included. The recording 9 is doing so on an arm 11 arranged that the axis of rotation of the upper ankle of a patient coaxial or substantially coaxial with the longitudinal axis 12 the recording 9 is arranged. The data line 15 , with which of the bending force sensor 14 collected data, connects the bending force sensor 14 with the evaluation unit 16 attached to a housing 22 of the movement therapy device 2 is arranged. With the evaluation unit 16 is also a signal generator 23 connected in the embodiment shown as an optical signal transmitter 23 with an ad 24 is formed and the patient of the movement therapy device 2 an activity of the foot lifter, by the as bending force sensor 14 executed measuring equipment 13 is captured, visually represents.

The rotation axis 10 of the movement therapy device 2 and thus also the associated foot shell 1 are in the embodiment shown the 4 by a motor 25 between a Spitzfußposition in which the back of a patient's foot is substantially parallel to the lower leg, and a heel position pivoted in which the back of a patient's maximum is used to the lower leg. Here is also a limiter 26 provided by the pivoting of the foot shell 1 around the axis of rotation 10 can be limited. The limiter 26 is adjustable to the respective patient. By the engine 25 , which can be selectively activated and deactivated, becomes the rotation axis 10 and thus the foot shell 1 actively pivoted and / or generated a counter-moment, the patient offered a resistance against which the patient must work. The motor 25 and the limiter 26 are in the case 22 added.

5 shows lower leg supports 27 attached to an auxiliary frame 28 are attached. With these lower leg supports 27 can secure a lower leg of a patient to reduce the risk that the measurement results are distorted by a movement of the patient. For this purpose, the lower leg support 27 a leg rest 29 on, on the lower leg by suitable securing means - such as straps - can be secured. To the lower leg support 27 to adapt to the particular patient, this has an adjustment mechanism 30 on, with which the position and orientation of the lower leg support 27 relative to the auxiliary frame 28 can be adjusted.

Finally, the operation of the invention with reference to in the 4 shown movement therapy device 2 described again. The foot of a patient is first in one and then in the other foot shell 1 positioned. Care must be taken that the forefoot in the forefoot segment 5 and the heel in the heel segment 4 is stored. The forefoot of the patient is then worn by the strap 7 formed securing means 6 with the forefoot segment 5 firmly connected. In a further step, the individual range of movement (ROM) of the patient is then first determined and in the evaluation unit 16 deposited. After that become the exercise therapy device 2 and the evaluation unit 16 started and started depending on the patient different exercise programs. In a patient who has only a very low residual activity of the foot lifter, then by the engine 25 the foot shell 1 pivoted, this movement through the limiter 26 is limited. The patient is shown on the display 24 , the part of the optical signal transmitter 23 is the muscle activity of the foot lifter applied by the patient himself.

On the other hand, if the activity of the patient's foot lifter is limited only to a limited extent, it is caused by the engine 25 generates a counter-torque directed counter to the movement and the patient on the display 24 represented as a target value next to the actual value actually applied by the patient in order to give the patient a biofeedback.

LIST OF REFERENCE NUMBERS

1

 Fußschale

2

 Movement therapy device

3

 bearing surface

4

 heel segment

5

 Vorfußsegment

6

 securing means

7

 belt

8th

 heel support

9

 admission

10

 axis of rotation

11

 Arm signal generator

12

 longitudinal axis

13

 measuring Equipment

14

 Bending force sensor

15

 data line

16

 evaluation

17

 guide

18

 arm receiver

19

 fastener

20

 locking screw

21

 slot

22

 casing

23

 signaler

24

 display

25

 engine

26

 limiter

27

 Lower leg support

28

 subframe

29

 adjustment

30

 leg rest

31

 heel sensor

Claims (15)

Foot shell for a movement therapy device ( 2 ), with a recording ( 9 ) for connection to a rotation axis ( 10 ) of a movement therapy device ( 2 ) and with a support surface ( 3 ) for a foot of a patient, characterized in that the support surface ( 3 ) is formed in several parts and a heel segment ( 4 ) to support the heel and a forefoot segment ( 5 ) for supporting the forefoot of a patient, which are arranged to be movable relative to one another. Foot cup according to claim 1, characterized in that the heel segment ( 4 ) and the forefoot segment ( 5 ) by a measuring means ( 13 ) are connected to each other in such a way that they are placed on the forefoot segment ( 5 ) acting forces can be measured. Foot cup according to claim 1 or 2, characterized in that the measuring means ( 13 ) as a bending force sensor ( 14 ) is formed. Foot cup according to one of claims 1 to 3, characterized in that in the region of Forefoot segment ( 5 ) a securing means ( 6 ) is provided for securing the forefoot to the forefoot segment ( 5 ). Foot cup according to claim 4, characterized in that the securing means ( 6 ) at least one strap ( 7 ). Foot cup according to one of claims 1 to 5, characterized in that the receptacle ( 9 ) is arranged such that the axis of rotation of the upper ankle of a patient is coaxial or approximately coaxial with the longitudinal axis ( 12 ) of the recording ( 9 ) is arranged. Foot cup according to one of claims 2 to 6, characterized in that at least one data line ( 15 ) is provided for data transmission between the measuring means ( 13 ) and an evaluation unit ( 16 ). Exercise therapy device with at least one rotation axis ( 10 ) and at least one foot shell ( 1 ) according to one of claims 1 to 7, wherein the receptacle ( 9 ) of the at least one foot shell ( 1 ) on the at least one axis of rotation ( 10 ) is arranged. Exercise therapy device according to claim 8, characterized in that a limiter ( 26 ) is provided for limiting the pivoting of the foot shell ( 1 ) around the axis of rotation ( 10 ). Exercise therapy device according to claim 8 or 9, characterized in that at least one lower leg supported ( 27 ) is provided. Exercise therapy device according to one of claims 8 to 10, characterized in that a signal transmitter ( 23 ) is provided. Exercise therapy device according to claim 11, characterized in that the signal transmitter ( 23 ) is designed such that a biofeedback can be output to a patient. Exercise therapy device according to claim 11 or 12, characterized in that the signal transmitter ( 23 ) as an acoustic signal transmitter and / or as an optical signal transmitter ( 23 ) is executed. Exercise therapy device according to one of claims 8 to 13, characterized in that a motor ( 25 ) for motor adjustment of the foot shell ( 1 ) is provided. Exercise therapy device according to one of claims 8 to 14, characterized in that the foot shell ( 1 ) is provided several times, in particular twice.

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