EP0814744B1 - Therapy and training device - Google Patents

Abstract

Therapy and training equipment for constrained knee-joint movement with a lower leg accommodating arrangement, and a guiding arrangement, the arrangements being connected to one another via an articulated device, the guiding arrangement (12) cooperates with the lower leg accommodating arrangement (11, 25) in such a way that, on a rotational movement of one of the lower legs (14), the other lower leg (15) is constrained to move as a result of the knee-bending movement.

Description

The present invention relates to a therapy and training device for positively guided knee joint movement with one Lower leg mounting arrangement and a guide arrangement, which are pivotally connected to one another via a joint device are.

Knee injuries and related knee surgery often require long-term immobilization of the knee joint, leading to a general weakening of the leg muscles and leads to restricted movement. Therefore, at treatment of knee injuries or after knee surgery appropriate medical aids are used, should undo the movement restrictions or by performing certain movement exercises during training counteract movement restrictions.

Especially after a cruciate ligament surgery are used for joint rehabilitation so-called motor rails used. The motor rails serve to take up the diseased leg and are with provided a drive device that a pivoting Lower leg absorption compared to a thigh absorption enables. This essentially becomes one of weight loads free knee joint movement causes mobility of the knee without damaging the cruciate ligaments Weight loads is trained. As a disadvantage of the known Motor rail is felt that on the one hand in the Normally an electric drive is required to move the motor rail and on the other hand the healthy leg from the movement is excluded, so that especially in the case of longer periods Rehabilitation measures an inherently unnecessary weakening the muscles of the healthy leg. With a The motor track is therefore only a passive exercise of muscles and tendons possible. In addition, there are motor rails due to their motor drive expensive to buy, which one Implementation of such, generally desirable, rehabilitation measures outside of hospital facilities with high level of technical equipment and a corresponding Budget stands in the way. Motor rails also prove to be in their Handling and individual adaptation to the patient as expensive, so that for these activities usually the use by trained nursing staff.

As much simpler devices for exercise therapy can be used on a knee joint are cable pull arrangements known on a gallows device at the bedside are installable and coupled via a cable through the allow healthy leg triggered movements of the sick leg. With such cable pull arrangements, however, it turns out as a disadvantage that the coupling of motion between the healthy and the sick leg is not kinematically clear, so does not take place in a forced manner, but, for example, counter to it the direction of the rope force or even degrees of freedom of movement are given for the rehabilitation of the knee joint allow harmful movements. Therefore, such cable pull arrangements also unable to do the above to replace expensive motor rails.

From WO-A-93/04655 is an exercise apparatus for forced guidance Knee joint movement with a lower leg mounting arrangement and a guide arrangement known, the articulation device to transmit one caused by muscle strength Has pivot drive on the lower leg receiving arrangement. In the known device, the swivel drive caused by the muscular strength of the arms, so that the Joint device enabling power transmission between a Manual drive device and with the lower leg mounting arrangement connected guide arrangement.

From GB-A-2 096 006 an exercise apparatus is known, which for Drive one to pick up the legs of the person to be practiced provided lower leg receiving arrangement is used. Only in addition to the motor drive is the well-known training apparatus provided with a manual drive device, which by means of a Overrunning clutch the superimposition of the motor drive with a powered by the muscular strength of the arms.

The present invention has for its object a To propose a device that allows the legs to be exercised, in which the legs by one by the muscular strength of the Legs caused drive to be moved.

This task is accomplished by a device with the features of claim 1 solved.

The guide arrangement acts in the device according to the invention together with the lower leg mounting arrangement, that as a result of a pivoting movement of one lower leg The other lower leg is also forced to knee flexion becomes.

By coupling the lower leg receiving arrangement, which for The patient's lower leg is used, with a guide arrangement, a movement of the lower leg only along a given trajectory, a precisely defined knee joint movement, the harmful Excludes loads on the knee joint. In the inventive Therapy and training device is the drive to Force-relieved movement of the sick leg by a force-operated Movement of the healthy leg, so that on the one hand an external drive can be dispensed with, results in another a certain training effect at the same time on the healthy leg to strengthen the leg muscles, both the Movement of the sick as well as the movement of the healthy leg is an effective thrombosis prophylaxis.

The term "lower leg mounting arrangement" used here should also include the possibility of the lower leg to be fixed outside on a rail-like device. What is essential is a defined fixation of the lower leg, which enables the movement described above.

Advantageous embodiments of the device according to the invention are the subject of claims 2 to 4.

In the embodiment according to claim 5, the guide arrangement designed as a thigh socket and the lower leg socket is used for motion-linked recording of both Lower leg, such that when the one lower leg due to knee flexion the other lower leg is positively guided. With this therapy and Training device can therefore be a force-relieved movement of the sick leg through a power-operated movement of the healthy leg. About the coupling of movements between the healthy and the sick leg will move of the healthy leg with the sick leg.

This makes it possible, on the one hand, to drive a motor to perform a relieved movement of the sick To do without legs; secondly, by using the healthy leg to drive the sick leg at the same time Exercising the muscles of the healthy leg is achieved. In addition, there is a propioceptive benefit for the sensorimotor Control of the diseased knee joint.

In addition to being used for the therapy of a sick leg the therapy and training device can also be used as a pure or sports equipment to train the leg muscles use both legs.

If, as in a preferred embodiment of the Case is, the hinge device is arranged so that its Axis of rotation is coaxial to the pivot axis of the knee joints ensures that the knee joints are free of moments and Shear forces are caused by an offset of the axis of rotation Swivel axis occur.

It proves to be particularly advantageous if the lower leg receptacle in a heel area with a glide or Roller guide is provided so that it is possible to take the lower leg with a knee movement over one accordingly move trained underground. This training makes it possible to include the therapy and training device to use the patient's lying arrangement, in which the patient's buttocks and heels essentially in one Level and the movement of the sick leg over one Angling the healthy leg is achieved. Especially at Use a roller guide that has less demanding requirements the levelest possible formation of the subsurface, can the therapy and training device in a patient's bed to be used.

To set a specific knee flexion range, the proved to be particularly advantageous for the therapy of the sick leg proves, the joint device of the therapy and Exercise equipment with two variable angle stops his.

Especially when using the therapy and training device in the patient bed it proves to be particularly advantageous if the hinge device with a locking device for variable adjustment of a fixed knee bending position is provided. This makes it possible to use the articulation device in a comfortable knee bend position for each patient to lock and thus define a rest position, in which the patient without any uncomfortable tension can also linger for a long time without the therapy and Exercise equipment to be removed beforehand and when resuming the movement therapy would have to be reinstalled. This proves turned out to be particularly important since such therapies are common in a so-called interval form with more or less large ones Movement breaks between the movement sections performed become.

If the joint device is equipped with a movement counter is, for example, as an inductive rotation angle sensor can be formed is a particularly simple possibility created that performed with the therapy and training device Monitor exercise training.

To get on the healthy leg during exercise training To be able to influence the acting load can be between the Acting on the thigh and lower leg a loading device that is particularly advantageous Is designed as a spring device to be arranged. The spring device allows by simply changing the Spring preload an exact specification of the movement training strain on the healthy leg.

In a particularly advantageous, since simple embodiment can the spring device as a tension spring, so as a spring elastic Rope, be trained. In another embodiment of the therapy and training device can be a compression spring be provided. So in the first case it is essentially possible strain the squat, and in the second case there is the possibility to strain the knee extensor and train accordingly so that it is on the healthy leg can perform a differentiated muscle training.

Both in terms of movement training for the sick leg or knee joint as well as regarding muscle training for the healthy leg can be the therapy or training effect improve even further if in addition to being particularly advantageous Load device designed as a spring device a damper device between the thigh intake and provided the lower leg receptacle is. This makes it possible to determine the speed of movement uniform, i.e. isokinetic movement perform.

For possible malpositions on the sick and / or healthy leg of the patient to be able to compensate for that in forced storage the lower leg could lead to tension in the knee area, can the lower leg with at least one in their arrangement changeable relative to the lower leg receptacle Leadership. This will result in knee flexion superimposed movements of the lower legs possible, so that the Lower leg not only in one swivel plane but also are movable across.

Both the lower leg mount and the thigh mount can be bowl-shaped, for example made of plastic be with guides for length-adjustable inclusion of swivel arms connected to the articulation device. Especially It is advantageous if the guides are integral in the lower leg receptacle and the thigh socket are. This reduces the number of parts on the one hand Therapy and training equipment. On the other hand, in corresponding amount of assembly work when assembling the Therapy and training equipment.

If the hinge device is designed so that two in Swivel joints arranged outside the knee are provided which each have two swivel arms for connection to the thigh mount or the lower leg receptacle are particularly torsion-resistant with minimal effort Structure of the therapy and training device enables.

It also proves with regard to a small number of parts as particularly beneficial if one is to fix the thigh Thigh fixation provided on the thigh mount is designed to be alternate for both Thigh can be used. The same applies to a lower leg fixation.

For setting a predetermined by the spring device Load can be made changeable at least one spring pivot point his.

The embodiment according to claim 22 has a guide arrangement on that as the hinge axis of a hinge assembly is trained. The pivot axis is in its relative arrangement changeable relative to a patient's hip pivot. There are lower leg mounts on the swivel arrangement articulated, which are so coupled in motion that a Pivotal movement of a lower leg receptacle around the axis of the swivel an oppositely directed pivoting movement of the other lower leg absorption. By including the The legs of the patient in the lower leg recordings are made Swiveling movement guided around the axis of rotation of the swivel joint arrangement, so that directions of force harmful to the knee joint be excluded. The changeability of the spatial Position of the swivel axis in relation to the hip pivot point one patient allows one with the knee pivot points congruent adjustment of the swivel axis and thus isometric conditions. This also helps harmful Loads such as those with an axial feed of the femur across the tibia (known as the "drawer effect") occur to keep away from the knee joint.

Since in this embodiment the pivoting movement of one Lower leg shot through an opposite direction Swiveling movement of the other lower leg holder causes a flexing movement of the healthy leg can become one appropriate bending movement of the sick leg can be used, without the need for a complex drive would. Due to the above-mentioned motion coupling, too the frequency of knee bends from patient to one Suspension of the swiveling movement can be influenced at any time, so that the commissioning of the device according to the invention at any time by the patient himself can. Nor does it have to monitor the operation of the device Nursing staff can be used as this at all times can be easily manipulated by the patient himself. by virtue of the lack of drive device or simple operation the device also proves to be much cheaper with regard to the acquisition or operating costs.

Instead of just a passive exercise, as with the known one Possible motor rail, the device enables an active Exercise with a natural, physiological movement. The reciprocal resulting from the coupling of movements Initiation of movement promotes cartilage and tendon formation.

Furthermore, the device can be changed without any changes both as a passive movement device and as an active training device use so that, for example, as it progresses Rehabilitation of the knee seamlessly on a Exercise can be changed by active movement of the knee joint can.

It proves to be particularly advantageous if the pivoting movement takes place in a swivel range that is a central position has, in which the lower leg mounts an identical Have swivel position. This makes it the device allows patients to use a special in the middle position to take a comfortable rest position in which the Lower legs are at the same height. It also becomes possible the device between successive treatment sequences to leave the patient without inconvenience would be connected for this. On the contrary an elevated leg position is often pleasant for the patient felt.

This also results in particularly good accessibility of knee joints and legs during treatment, causing For example, wound checks or the execution of a Cold therapy possible with the device remaining on the patient is.

Furthermore, it proves to be advantageous if the end positions of the swiveling range can be adjusted in relation to the central position are, so that the targeted rehabilitation of a Limitation of movement of the knee joint optimal swivel range of motion is adjustable.

If the middle position of the lower leg shots as an angle of rotation position related to the pivot axis of the pivot assembly is adjustable, a rest position for if necessary the patient's legs, in which both legs are bent to the same extent are free to choose according to individual patient needs to be able to take special account of.

It is also possible to determine the middle position and / or the end positions of the Lock swivel range to ensure if necessary that no knee bends from these Positions are possible.

If the motion coupling of the lower leg shots over a swivel joint arrangement designed as a gear takes place, is a particularly compact design of the entire device possible because the swivel joint arrangement as Power transmission device is used.

Especially when the device is not just a therapy device but also as a training device for building or restoring to be used by leg muscles, it proves proved to be particularly advantageous if a loading device is provided, at least in phases against the Swiveling movement on at least one lower leg holder acts. On the one hand, it is the one already described above Effect of the device reinforces that the muscles of the healthy leg used to propel the sick leg is trained. On the other hand, the effect is also increased, that by operating the healthy leg the sick leg passively practiced as a result of crossed exercise of the quadriceps becomes.

If the load device is also adjustable, this can be done in a particularly simple manner on the skills and adapt the patient's needs.

Such a loading device can, for example, by a corresponding Spring or spring / damper device may be formed.

If the swivel assembly as a transmission for power transmission is formed between the lower leg receptacles it turns out to be particularly advantageous, the swivel assembly or to apply a gear load to the gear unit. This can be done for example by means of an integrated in the transmission Torque brake happen. Here too is one Adjustability of the gear load or the brake is an advantage.

If the swivel assembly with a height adjustment coupled, it is possible to the desired swivel range not only by setting the end positions of the Swiveling movement of the lower leg shots, but also through a height adjustment of the swivel arrangement or the swivel axis to influence.

It is also particularly advantageous if the relative arrangement the swivel axis longitudinally with respect to the hip pivot point a trajectory of the pivot axis is changeable. hereby it is possible to pivot the lower leg about the swivel axis or swiveling movements of the lower legs around the axis of rotation of the knee with swiveling movements the thigh to overlap around the axis of rotation of the hip joint thus particularly realistic movements, like them happen when walking or running, to be able to simulate.

To achieve an optimal congruency setting between the swivel axis and the knee joint axes can accommodate the lower leg in their orientation in relation to the swivel axis be changeable.

To ensure that the lower legs are particularly comfortable for the patient in the lower leg shots these can be changed in length.

In addition, the lower leg shots on your free end with footrests.

If the footrests around an axis transverse to the longitudinal axis of the lower leg mounts are pivotable, the Swiveling movements of the lower legs with swiveling movements of the Feet overlap around the ankle axis of rotation, creating an effective Thrombosis prophylaxis can be achieved because of the activation the calf pump promotes venous blood flow.

In addition, if the footrests are motion-locked, such that a pivoting movement of one footrest is opposite directional pivoting movement of the other footrest causes, it is also possible, for example, analogous to exercise therapy the device for movement therapy on a knee joint to be used on an ankle.

When the footrests are coupled to the lower leg mounts are such that a pivoting movement of a lower leg receptacle an opposite or one rectified pivoting movement of the lower leg in question arranged footrest causes, can the movement coupling of the lower leg shots at the same time use for the forced pivoting of the footrests.

The installation of the device on the patient is special relieved that the lower leg receptacles bowl-shaped are formed with at least one shell opening oppositely arranged fastening device. This makes it possible to insert the lower legs into the lower leg receptacles insert and with the help of the fastening device secure in this.

This can further increase the quality of use achieve that the fastener than laterally open bracket is formed so that a lateral insertion or removal of the lower leg is possible.

Fig. 1

eine erste Ausführungsform eines an einem Patienten installierten Therapie- und Trainingsgerätes in einer mittleren Kniebeugungsstellung;

Fig. 2

eine Seitenansicht des in Fig. 1 dargestellten Therapie- und Trainingsgeräts;

Fig. 3

eine in der Ansicht Fig. 2 entsprechende Darstellung einer weiteren Ausführungsform des in Fig. 1 dargestellten Therapie- und Trainingsgeräts;

Fig. 4

eine Draufsicht auf eine beim Therapie- und Trainingsgerät gemäß Fig. 3 verwendete Führungsanordnung;

Fig. 5

eine weitere Ausführungsform eines an einem Patienten installierten Therapie- und Trainingsgerätes in einer mittleren Kniebeugungsstellung;

Fig. 6

das Therapie- und Trainingsgerät nach Fig. 5 in einer separaten Darstellung entsprechend einer Kniebeugungsstellung von 0°;

Fig. 7

das Therapie- und Trainingsgerät gemäß Fig. 6 in einer Kniebeugungsstellung von 90°;

Fig. 8

eine Gelenkeinrichtung des Therapie- und Trainingsgeräts in Explosionsdarstellung;

Fig. 9

eine Oberschenkel- bzw. Unterschenkelfixierung zur Verwendung an dem Therapie- und Trainingsgerät gemäß Fig. 7;

Fig. 10

eine weitere Ausführungsform eines an einem Patienten installierten Therapiegerätes in einer maximalen Beugungsstellung;

Fig. 11

eine als Getriebe ausgebildete Drehgelenkanordnung des in Fig. 10 dargestellten Therapiegeräts;

Fig. 12

eine beispielhafte Ausführungsform des Therapiegeräts gemäß Fig. 10 in räumlicher Darstellung, wobei an der Drehgelenkanordnung angelenkte Unterschenkelaufnahmen sich in einer Mittellage befinden;

Fig. 13

das in Fig. 12 dargestellte Therapiegerät mit einer Darstellung der Unterschenkelauflagen in den Endlagen ihres Schwenkbewegungsbereichs;

Fig. 14

eine schematische Darstellung der kinematischen Verhältnisse bei einem Therapiegerät mit gegenüber der in Fig. 10 dargestellten Ausführung des Therapiegeräts auf einer Bewegungsbahn geführter Drehgelenkachse der Drehgelenkanordnung;

Fig. 15

eine schematische Darstellung einer die in Fig. 14 dargestellte Bewegungsbahn der Drehgelenkachse ermöglichenden Drehgelenkachsenführung.

Embodiments of the device according to the invention are explained in more detail below with reference to the accompanying drawings. Show it:

Fig. 1

a first embodiment of a therapy and training device installed on a patient in a middle knee bending position;

Fig. 2

a side view of the therapy and training device shown in Fig. 1 ;

Fig. 3

a view corresponding to the view in FIG. 2 of a further embodiment of the therapy and training device shown in FIG. 1 ;

Fig. 4

a plan view of a guide arrangement used in the therapy and training device according to FIG. 3 ;

Fig. 5

a further embodiment of a therapy and training device installed on a patient in a middle knee bending position;

Fig. 6

5 in a separate representation corresponding to a knee bending position of 0 °;

Fig. 7

6 in a knee bending position of 90 °;

Fig. 8

an articulated device of the therapy and training device in an exploded view;

Fig. 9

a thigh or lower leg fixation for use on the therapy and training device according to FIG. 7 ;

Fig. 10

a further embodiment of a therapy device installed on a patient in a maximum diffraction position;

Fig. 11

a swivel joint arrangement of the therapy device shown in FIG. 10 designed as a gear;

Fig. 12

10 shows an exemplary embodiment of the therapy device according to FIG. 10 in a spatial representation, lower leg receptacles articulated on the swivel arrangement being in a central position;

Fig. 13

the therapy device shown in Fig. 12 with a representation of the lower leg supports in the end positions of their pivoting movement range;

Fig. 14

is a schematic representation of the kinematic conditions in a therapy device with compared to the embodiment of the therapy device shown in Fig. 10 on a movement path guided hinge axis of the hinge assembly;

Fig. 15

14 shows a schematic illustration of a pivot axis guide which enables the pivot path of the pivot axis shown in FIG. 14 .

1 shows a therapy and training device 10 in use on a patient. The therapy and training device 10 has a lower leg receiving arrangement 11, which is positively guided relative to a guide arrangement designed here as a guide rail 12 by means of a joint device 13 which connects the lower leg receiving arrangement 11 to the guide rail 12.

FIG. 2 shows the lower leg mounting arrangement 11 suitable here for parallel accommodation of both lower legs 14, 15 with the articulated device 13 arranged thereon, which engages in the guide rail 12.

The articulation device 13 has an articulated lever 16 which is double cranked here and which is rigidly connected at one end to a heel part 17 ( FIG. 1 ) of the lower leg receiving arrangement 11. At the other end of the articulated lever 16, a circular articulated disk 18 is arranged, which is rigidly connected to the articulated lever 16 in the example shown here, which has a particularly simple design. The articulated disk 18 is inserted into a guide slot 19 of the guide rail 12, which is designed here as a square tube with a longitudinal slot 20 for carrying out the articulated lever 16.

1 and 2 , the articulation device 13 enables horizontal longitudinal guidance in the direction of the double arrow 21, which can be superimposed with a pivoting movement about a central axis 22 of the articulated disk 18 in the direction of the double arrow 23. The therapy and training device 10 shown in FIG. 1 thus enables a sequence of movements as is necessary to carry out a flexion and extension of the legs of the patient shown in FIG. 1 , with no further movements, for example transversely to the longitudinal direction of the guide rail 12 possible are.

In contrast to the therapy and training device 10 shown in FIGS. 1 and 2 , which enables a parallel, rectified movement of the lower legs 14, 15, FIGS. 3 and 4 show a therapy and training device 24, which is a counter movement of the Lower leg 14, 15 allows.

For this purpose, as shown in FIG. 3 , the therapy and training device 24 has a lower leg receiving arrangement 25 with two lower leg receiving means 26, 27, each of which has a joint device 13 of the type shown in FIG. 2 on its heel parts 17. Both joint devices 13 are guided with their joint disks 18 in a respective guide rail 12, which are arranged lying against one another with their closed high sides 28, so that the longitudinal slots 20 for carrying out the joint levers 16 are each arranged on the outside.

As is clear from FIG. 4 , the lower leg receptacles 26, 27 are motionally coupled via a cable deflection device 29 connecting the articulated levers 16 of the lower leg receptacles 26, 27.

The cable deflection device 29 has two at one end a guide rail assembly 30 consisting of two guide rails 12 is formed, arranged deflection rollers 31, 32, over which a rope 33 is guided, the articulated lever 16 such connects with each other, regardless of the direction a longitudinal movement of the one articulated lever 16 in the associated Guide rail 12 an opposing longitudinal movement of the other articulated lever 16 in the associated guide rail 12 causes. This is triggered by a movement of the healthy leg picked up in the lower leg receptacle 26, a corresponding counter-movement of the sick, in the other Lower leg receptacle 27 induced leg.

In order to enable particularly smooth operation of the therapy and training devices 10, 24 shown in FIGS. 1 to 4 , the articulated disks 8 can be arranged on the articulated levers 16 with ball bearings or even designed as ball bearings themselves.

FIG. 5 shows a therapy and training device 110 that is installed on a patient lying in a lying position. The therapy and training device 110 shown here is in a middle knee flexion position with a knee flexion angle of approximately 110 °. The therapy and training device 110 has a thigh receptacle 111 for receiving both thighs 112, 113 and a lower leg receptacle 114 for receiving both lower legs 115, 116 of the patient. The thigh receptacle and the lower leg receptacle are connected to one another via swivel arms 117, 118 and 119, 120 of a joint device 121.

The lower leg receptacle 114 is in a heel area 122 provided with a roller guide 123, which is in a pivoting movement about an axis of rotation 124 of the joint device 121 Rolling the lower leg receptacle 114 back and forth on a surface 158 in the direction of arrow 125. The axis of rotation 124 is coaxial with a pivot axis 171 of the knee joints arranged. The underground 158 can be through a room floor or another underground can be formed, the a rolling of the roller guide 123 enables. So can a bed mattress serve as a base 158.

To rest the thighs 112, 113 and the lower leg 115, 116 on the thigh mount 111 or the lower leg mount 114 during the entire relative movement of the Lower leg mount 114 compared to the thigh mount 111, the thigh receptacle 111 has a Thigh fixation 126 and the lower leg fixture 114 a lower leg fixation 127.

As can be seen from the illustration according to FIG. 5 , between the thigh receptacle 111 and the lower leg receptacle 114, a spring device acting here as a tension spring in the form of a rubber-elastic rope 128 can be installed, which converts the therapy and training device 110 from a knee flexion in the direction of a Knee extension only possible by overcoming the spring force of the rope 128.

In the exemplary embodiment shown in FIG. 5 , a spring device 128 acting as a tension spring is provided, which forces the therapy and training device 110 from a knee extension position to a knee flexion position. In addition to the movement training for the sick leg, it is therefore possible to provide muscle training for the healthy leg, which primarily strains the thigh muscle called the extensor. If instead of a tension spring a compression spring is used for the spring device 128, it is possible to superimpose a muscle building training for the flexor of the healthy leg on the movement training of the sick leg.

In addition to the spring device 128, in the exemplary embodiment of the therapy and training device 110 shown in FIG. 5 , a damper device 129 is provided between the thigh receptacle 111 and the lower leg receptacle, which is shown only schematically here and makes it possible, regardless of the deflection of the Spring device 128 dependent spring force course to cause a uniform relative speed movement between the thigh receptacle 111 and the lower leg receptacle 114. 5 formed as separate add-on parts, it is also possible to integrate both the spring device 128 and the damper device 129 into the joint device 121.

6 and 7 , which show the therapy and training device 110 in a knee extension position ( FIG. 6 ) and a knee bending position ( FIG. 7 ), further details of the therapy and training device 110 become clear.

The thigh receptacle 111 and the lower leg receptacle 114 each have a thigh pad 130 or one Lower leg receptacle 131, which is designed to match and are roughly bowl-shaped. Different from the Thigh receptacle 111 has lower leg receptacle 114 next to the lower leg support 131 on a foot shell 132, the is removably connected to the lower leg support 131.

Both the thigh pad 130 and the lower leg pad 131 have laterally outside on side wall areas 133, 134 guides 135, 136 for receiving the swivel arms 117, 118 or 119, 120 of swivel joints 137, 138 of the joint device 121 on. As exemplified by the swivel arms 118, 120, are the swivel arms with locking teeth 139 provided that when inserting the swivel arms 117-120 in the Guides 135, 136 with spring catches designed in the manner of a pivoting key 140 interact. The spring catches snap when inserted 140 automatically into the locking teeth 139. To pull out the swivel arms 117 - 120 from the guides 135, 136 the spring catches 140 must be pressurized on one side (as indicated by arrow 141) from their spring-loaded Engagement with the locking teeth 139 pivoted out become. This is an effective lever length a between which the Rotary joints 137, 138 connecting rotary axis 124 and the thigh support 130 and the lower leg support 131 easily changeable, so that without further ado and without any Tool quick and easy adjustments to the therapy and Training device to be performed on the patient anatomy can.

The swivel joints 137, 138 are each provided with two stop pins 142, 143 which, taken together, each form an angle stop 144 and 145 on a swivel joint 137 and 138, respectively. The stop pins 142, 143 can be arranged in any relative position on a swivel joint 137 or 138, so that in one case they can form an angle stop 144, 145 for a maximum knee bending position and in another case an angle stop 144, 145 for a minimum knee bending position. The respective limiting position is defined by the stop of the stop pins 142, 143 against one another. 6 shows the stop pins 142, 143 of the swivel joint 137 in a relative arrangement in which they form an angle stop 144 for the knee extension position, whereas the stop pins 142, 143 of the swivel joint 138 are in a relative arrangement in which they form an angle stop 145 form for the maximum knee bending position, as can be seen from FIG. 7 .

As further shown in FIG. 6 , both the thigh support 130 and the lower leg support 131 are provided with a spring linkage 146 and 147, which are designed to be essentially identical. As can be seen from the illustration of the thigh support 130, a bottom wall region 148 of the thigh support 130 and a corresponding bottom wall region of the lower leg support 131 have a total of six fastening bores 139, into which two fastening pins 150 of the spring linkage 146 can be inserted. Depending on the selection of two of the fastening bores 149 for receiving the fastening pins 150, a specific relative arrangement of the spring linkage 146 on the thigh support 130 or the lower leg support 131 can be selected. The prestressing of an elastic cable 128 arranged between the spring linkages 146 and 147 can thus be set.

In contrast to the spring linkage 146 on the thigh support 130 on the underside of the thigh pad 130 is arranged, the spring linkage 147 is located on the Lower leg support 131 on the top. Thus through the spring linkage 147 also a center guide for the Foot shell slidably disposed on the lower leg support 131 132 formed. In addition to the spring linkage serving as a central guide 147 serve the guides 135, 136 on the side wall areas 133, 134 of the lower leg support 131 for lateral Guiding the foot shell 132.

The foot shell 132 has a center console 155 which is pushed onto the spring linkage 147. The spring linkage 147 has at least one spring catch 152 which interacts with corresponding catch cutouts 153, 154 in the center console 155. Fig. 6 shows that the spring catch 152 of the spring linkage 147 is engaged in the front catch cutout 153 of the center console 155, so that the foot shell 132 is virtually in its extended position relative to the lower leg support 131. This creates a further possibility of adaptation to the patient's anatomy in the region of the lower leg receptacle 114.

The foot shell 132 is separated by the center console 155 two cup-shaped foot guides 156, 157 on the about a transverse to the axis of rotation 124 of the articulation device 121 The vertical axis 151 can be pivoted within the foot shell 132 are. This makes it possible to correct malpositions, such as an "X" or an "O" position, so that with exercise therapy no tension in the Knees of the patient occur.

The roller guide is in the heel area 122 of the foot shell 132 133 provided with three rollers 163. Rolls 163 are here relatively wide and are therefore particularly suitable for Unroll on a soft, compliant surface, like one Bed mattress.

6 and 7 , the thigh support 130 in the central bottom wall region 148 and on the top of the guides 135, 136 and the foot shell 132 on the center console 155 and on the top of their side consoles 159, 160 are provided with fastening holes 161, which serve to receive locking nipples 162 of the thigh fixation 126 or the lower leg fixation 127. In the present case, the thigh fixation 126 is identical to the lower leg fixation 127 and is shown in FIG. 9 .

The thigh fixation 126 or the lower leg fixation 127 has a base part 165 which extends over the locking nipple 162 into the top of the bottom wall portion 148 of the thigh pad 130 or the center console 155 of the foot shell 132 an elastic, releasable locking with the mounting holes 161 can be used.

The thigh fixation 126 or lower leg fixation 127 shown in FIG. 9 has, starting from the base 165, an elastic belt 166 which can optionally be strapped over one or the other thigh 112, 113 or one or the other lower leg 115, 116 of the patient ( Fig. 5 ), the locking nipples 162 at the end of the belt 166 for elastically releasable locking with the corresponding mounting holes 161 on the top of the guides 135, 136 of the thigh support 130 and the side panels 159, 160 of the foot shell 132. 9 , the thigh fixation 126 or the lower leg fixation 127 can also be provided with two belts, so that both thighs 112, 113 or both lower legs 115, 116 can be strapped onto the thigh support 130 or the lower leg support 131 ,

8 shows a possible embodiment of a swivel joint 137, 138 with the swivel arms 117, 119 and 118, 120 attached to it. The actual swivel joint 137 and 138 is formed by swivel eyes 167 formed on the swivel arms 117, 119 and 118, 120, 168 are formed, which are pressed against each other by inserting latching rings 169, 170 which engage with one another on both sides such that they can slide on one another. The locking rings 169, 170 are provided with the stop pins 142, 143 already described with regard to their function. It is clear from the illustration according to FIG. 8 that the function of the swivel arms provided with swivel arms is achieved with a minimal number of parts.

To the elastic snap connections described several times above on the embodiment of the therapy shown here and to be able to implement training equipment especially a version of the therapy and training device in Plastic.

10 shows a therapy device 210 with a pivot joint arrangement 212 arranged on a support device 211 and two lower leg receptacles 214, 215 arranged on a pivot axis 213 of the pivot joint arrangement 212, of which the lower leg receptacle 215 is only shown by its longitudinal axis for reasons of clarity.

The lower leg receptacles 214, 215 are coupled to one another via the swivel joint arrangement 212 in such a way that an upward pivoting movement of the lower leg receptacle 214, as indicated in FIG. 10 by the arrow 216, necessarily a downward pivoting movement of the lower leg receptacle 215, as indicated in FIG. 10 by the arrow 217 causes. The same applies to a downward pivoting movement of the lower leg receptacle 214, which inevitably brings about an upward pivoting movement of the lower leg receptacle 215.

As a result of the articulated articulation of the lower leg receptacles 214, 215 to the pivot joint arrangement 212, the lower leg receptacles 214, 215 are guided over an entire pivoting movement range 218 in two mutually parallel pivoting planes 219, 220 ( FIG. 11 ), so that no transverse loads which are harmful to the knee joints can occur.

The lower leg receptacles 214, 215 are designed such that when patient legs 221, 222 are received, an arrangement of knee joint axes KG of the patient legs that is congruent with the pivot axis 213 of the therapy device 210 results or can be adjusted. Such a setting can be achieved in the therapy device 210 shown in FIG. 10 by a receiving shell 225 of the lower leg receptacle 214 which can be changed in its position relative to the pivot axis 213. Otherwise, the lower leg receptacles 214, 215 can be dimensioned such that, with average limb anatomy, a largely congruence between the patient's knee axis of rotation KG and the axis of rotation 213 of the therapy device 210 can be achieved from the outset, that is to say without the need for adjustment.

In the basic embodiment of the therapy device 210 shown in FIG. 10 , the spatial position of the swivel axis 213 is fixed via the support device 211, which can be changed horizontally in its position, so that with a congruent arrangement of the swivel axis 213 and knee joint axes KG, these are arranged spatially fixed next to a hip joint axis of rotation HG of the patient are and a change in the knee bending angle α only by pivoting the lower leg receptacles 214, 215 about the pivot axis 213 of the pivot assembly 212 via the pivoting movement range 218. The limits of the swivel movement range 218 are defined by a lower end position U and an upper end position O of the lower leg receptacles 214, 215. In a central position M, the lower leg receptacles 214 and 215 move in opposite directions in the therapy device 210 shown in FIG. 10 in a common plane parallel to a surface defined, for example, by a bed mattress 228, so that a comfortable rest position for the patient is possible in this central position ,

As a result of the arrangement of the lower leg receptacles 214, 215 A common hinge axis 213 are by weight the patient's lower leg around the swivel axis 213 acting load moments compensated, so that movement the lower leg over the swivel range 218 with the least possible Force is executable.

FIG. 11 shows a schematic representation of the functional principle of the swivel joint arrangement 212 used as a transmission in the therapy device 210. In the embodiment of the swivel joint arrangement 212 shown in FIG. 11 , it is designed as a bevel gear transmission with two torsionally rigid arms 229, 230 of the lower leg receptacles 214 , 215 connected drive wheels 231, 232, which are mounted on the hinge axis 213 in the housing 233 of the hinge arrangement 212. For torque transmission between the drive wheels 231 and 232, a transmission wheel 234 is arranged on a transmission axis 235 arranged perpendicular to the swivel axis 213 in the housing 233. As is clear from the illustration according to FIG. 11 , a clockwise swiveling movement of the swivel arm 230 about the swivel axis 213 triggered by the patient's healthy leg causes a corresponding counterclockwise swiveling movement of the swivel arm 229, taking the in the patient's sick leg accommodated in the lower leg receptacle 215 connected to the swivel arm 229. The movements of the swivel arms 229, 230 are positively guided via the swivel joint arrangement 212, so that each swivel movement of one swivel arm 229 or 230 results in an opposite swivel movement of the other swivel arm 229 or 230.

In addition to a design of the swivel joint arrangement as a bevel gear, for example with toothed or friction wheels, are also other transmission principles that the previously described positively driven Enable motion coupling, can be used.

The swivel joint arrangement 212 shown in FIG. 11 is also provided with an adjustable loading device 236, which makes it possible to superimpose an oppositely directed load torque 238 as a transmission load on the transmission torque 237 transmitted by the transmission wheel 234. In the exemplary embodiment shown here, the loading device 236 has a brake disk 239 which is rigidly connected to the transmission wheel 234 and which is provided with brake shoes 240, 241, the action of which on the brake disk 239 can be adjusted via an actuating device 242 arranged on the outside of the housing 233.

Furthermore, on the outside of the housing 233 there is an adjustable stop device 243 with two stops 244, 245, which are set such that they limit the swivel deflection of the swivel arm 230 in both directions and thus the end positions O and U ( FIG. 10 ) of the lower leg receptacles 214, Define 215. The entire housing 233 can be designed to be pivotable about the pivot axis 213 in order to adjust the central position M shown in FIG .

12 and 13 show in a further embodiment a therapy device 246 in a central position configuration ( FIG. 12 ) and an end position configuration ( FIG. 13 ). The therapy device 246 has a base-shaped support device 247 with V-shaped feet 248, 249 and a base 250 arranged thereon, which is provided with a lockable lifting device (not shown in FIGS. 10, 12 and 13) and thus a change the height h of the hinge axis 213 of the hinge arrangement 212 above the surface formed, for example, by the bed mattress 228.

In the embodiment shown here, the housing 233 of the hinge arrangement 212 in a base connecting part 251 tubular, so that they are adjustable in height in Socket 250 can be performed. One arranged on the outside of the base Locking device 252 is used to lock the selected Height h.

On the pivot axis 213 are on both sides of the pivot assembly 212 the swivel arms 229, 230 articulated.

Receiving shells 254, 255 are attached to the swivel arms 229, 230 via a releasable connecting device 253, each of which forms a lower arm receptacle 256, 257 with a swivel arm 229 or 230. In the exemplary embodiment shown here, the connecting device 253 has a clamping screw 258 screwed into the swivel arms 229, 230, which penetrates a clamping slot 259 arranged laterally in the lower leg receptacles 256, 257, so that when the clamping screw 258 is loosened, a relative movement of the receiving shells 254, 255 both in Longitudinal direction of the pivot arms 229, 230 (arrow 260) and a pivoting movement of the receiving shells 254, 255 about the clamping screw 258 (arrow 261) is possible. By bracing the receiving shells 254, 255 with the swivel arms 229 or 230 with the clamping screw 258 screwed in, a freely chosen relative position of the receiving shells 254, 255 with respect to the swivel arms 229, 230 or the swivel axis 213 can be locked, so that the with reference to Fig 10 the already explained congruent alignment between the pivot axis 213 of the pivot arrangement 212 and the knee pivot axes KG of the patient can be easily adjusted at any time.

As can also be seen from FIGS. 12 and 13 , the receptacle shells 254, 255 also have foot receptacles or foot supports 262, 263 in addition to the lower leg receptacles 256, 257. In the area of the foot supports 262, 263, approximately L-shaped holding brackets 264, 265 are arranged at a distance from the inner surface of the lower leg receptacles 256, 257, which securely transmit power between the patient's leg and the respective lower leg receptacle 214 or 215, even during an active upward movement should ensure. The holding brackets 264, 265 are open to the outside, so that after the spacing of the holding brackets 264, 265 from the lower leg receptacle 256 or 257 has been adjusted once, they no longer have to be released and an entry or exit for the patient into the lower leg receptacles 214 , 215 is easily possible by lateral insertion or removal of the lower leg in the lower leg receptacle 256, 257.

As is particularly clear from FIG. 13 , the shell-shaped lower leg receptacles 256, 257 have recesses 268, 269 in a calf area which enable the lower legs to be particularly conveniently stored in the lower leg receptacles 256, 257 for the patient.

The illustrations in FIGS. 12 and 13 also make it clear that, because of the relatively small number of parts, a particularly inexpensive manufacture of the therapy device is possible. This applies in particular to the case in which the stand configuration shown in FIGS . 12 and 13 with a pedestal-shaped support device 247 is chosen for the arrangement of the therapy device on the bed of a patient, but a hanging configuration in which the swivel arrangement with one above the patient bed or connected to this, not shown here, gallows device. It is only essential that a position of the swivel axis 213 defined in its relative arrangement to the hip joint axis of rotation HG is created.

14 shows the kinematic relationships in a therapy device 270 which has a pivot axis 271 which can be moved concentrically about the hip pivot axis HG of the patient. The kinematics shown in FIG. 14 make it possible to use the pivoting movement of the lower leg about the pivot axis 271 at the same time for a displacement of the pivot axis 271 on a movement path 280 which is concentric with the patient's hip pivot axis HG, in order to be able to simulate the movement sequence of running. To simplify the illustration, a lower leg receptacle 272 is shown in FIG. 14 only with its longitudinal axis as a straight line between the pivot axis 271 or the knee pivot axis KG and the ankle pivot axis FG of the patient in various pivoting movement phases, namely the central position M of the upper end position O and the lower end position U , the pivoting movement range is shown. In the therapy device 270, the lower leg receptacle 272 is connected by rods 273, 274 via a slide guide 275 to a stationary guide rod 276, which here runs horizontally. Instead of the rods 273, 274 shown in FIG. 14 , it is of course also possible to connect a rigid arm, not shown here, to the lower leg receptacle 272 and to articulate it to the sliding guide 275 in order to achieve the same result kinematically.

It is clear from FIG. 14 that when the lower leg receptacle 272 is pivoted starting from the central position M into the lower end position U via the sliding guide 275, a lifting movement (arrow 281) of the swivel axis 271 inevitably takes place. The lower leg receptacle 272 now extends on the straight line between the knee pivot point in the lower end position KG _U and the ankle pivot point in the lower end position FG _U. The same applies correspondingly when the lower leg receptacle 272 is pivoted into the upper end position O (straight line between the knee joint pivot point in the upper end position KG _o and the ankle pivot point in the upper end position FG _o ).

From Fig. 14 it is also clear that due to the superimposed pivoting movements between the thigh, which extends on the connecting straight line between the hip joint pivot point HG and the knee pivot point KG, and the lower leg compared to one, as shown for example in Fig. 10 , fixed locally Pivot axis 213 can achieve an approximately equal knee movement angle α with a significantly lower swivel deflection 218 of the lower leg receptacle.

FIG. 15 shows a schematic representation of a possibility of forming a support device 277, which enables kinematics as shown in FIG. 14 with movement of the pivot axis 271 on a movement path 280 concentric to the hip pivot axis HG of the patient. For this purpose, the pivot axis 271 is received in a horizontally acting slide guide 278, the slide guide 278 being guided in a base 280 so as to be vertically displaceable via a lifting rod 279.

Claims (38)

1. Therapy and training equipment for constrained knee-joint movement with a lower leg accommodating arrangement (11, 25, 114) and a guiding arrangement (12, 111, 213), as well as an articulated device (13, 121, 212) for transmission of a rotational drive produced by muscle power to the lower leg accommodating arrangement, characterised in that the articulated device (13, 121, 212) connects the guiding arrangement (12) to the lower leg accommodating arrangement (11, 25) in such a way that, driven by a rotational movement of one lower leg (14), the other lower leg (15) is constrained to move as a result of the knee bending movement.
2. Therapy and training equipment according to claim 1, characterised in that the guiding arrangement is formed as a guide rail (12) and is connected to the lower leg accommodating arrangement (11, 25) via a rotation device (13) longitudinally displaceably guided in the guide rail (12).
3. Therapy and training equipment according to claim 2, characterised in that the lower leg accommodating arrangement (11) serves for the movement-coupled accommodation of both lower legs (14, 15) in such a way that on a rotational movement of the one lower leg (14) the other lower leg (15) is moved in the same direction.
4. Therapy and training equipment according to claim 2, characterised in that the lower leg accommodating arrangement (25) has two lower leg receptacles (26, 27) to accommodate in each case a lower leg (14, 15) and each lower leg receptacle (26, 27) is connected by means of a rotation device (13) to the guide rail in such a way that a rotational movement of the one lower leg receptacle (26) causes a rotational movement in the opposite direction of the other lower leg receptacle (27).
5. Therapy and training equipment according to claim 1, characterised in that the guiding arrangement is formed as a thigh receptacle and the lower leg accommodating arrangement (114) serves for the movement-coupled accommodation of both lower legs (115, 116) in such a way that on a rotational movement of the one lower leg (115) the other lower leg (116) is constrained to move as a result of the knee-bending movement.
6. Therapy and training equipment according to claim 5, characterised in that the articulated device (121) is arranged so that its rotational axis (158) is coaxial with the rotational axis (171) of the knee-joints.
7. Therapy and training equipment according to claim 5 or 6, characterised in that the lower leg accommodating arrangement (114) is provided with a sliding guide in a heel region (122).
8. Therapy and training equipment according to claim 5 or 6, characterised in that the lower leg accommodating arrangement (114) is provided with a roller guide (123) in a heel region (122).
9. Therapy and training equipment according to one or more of the preceding claims, characterised in that the articulated device (121) has two variable angle stops (144, 145) for adjusting a knee-bending range.
10. Therapy and training equipment according to one or more of the preceding claims, characterised in that the articulated device (121) has a locking device for the variable adjustment of a fixed knee-bending setting.
11. Therapy and training equipment according to one or more of the preceding claims, characterised in that the articulated device (121) is provided with a movement counter that is preferably in the form of an inductive rotational angle sensor.
12. Therapy and training equipment according to one or more of claims 5 to 11, characterised in that a spring device (128) is actively arranged between the thigh receptacle (111) and the lower leg accommodating arrangement (114).
13. Therapy and training equipment according to claim 12, characterised in that the spring device is in the form of a cable pull spring (128).
14. Therapy and training equipment according to claim 12, characterised in that the spring device is in the form of a compression spring.
15. Therapy and training equipment according to one or more of claims 5 to 14, characterised in that a damping device (129) is actively arranged between the thigh receptacle (111) and the lower leg accommodating arrangement (114).
16. Therapy and training equipment according to one or more of the preceding claims, characterised in that the lower leg accommodating arrangement (114) is provided with at least one guide (156, 157) that can be altered in its relative arrangement with respect to the lower leg accommodating arrangement (114), in order to compensate incorrect positions of the leg.
17. Therapy and training equipment according to one or more of the preceding claims, characterised in that the lower leg accommodating arrangement (114) and the thigh receptacle (111) are formed as capsules with preferably integrally formed guides (135, 136) for the longitudinally variable accommodation of rotating arms (117, 118, 119, 120) connected to the articulated device (121).
18. Therapy and training equipment according to one or more of claims 5 to 17, characterised in that the articulated device (121) has two rotating joints (137, 138) arranged in the outer region of the knee, on which joints are in each case arranged two rotating arms (117, 118 and 119, 120) for connection to, respectively, the thigh receptacle (111) and the lower leg accommodating arrangement (114) .
19. Therapy and training equipment according to one or more of claims 5 to 18, characterised in that the thigh receptacle (111) is provided with a thigh fixing device (163) that can preferably be used alternately for both thighs (112, 113).
20. Therapy and training equipment according to one or more of the preceding claims, characterised in that the lower leg accommodating arrangement (114) is provided with a lower leg fixing device (164) that can preferably be used alternately for both lower legs (115, 116).
21. Therapy and training equipment according to one or more of claims 12 to 20, characterised in that at least one spring coupling point (146, 147) of the spring device (128) can be altered.
22. Therapy and training equipment according to claim 1, characterised in that the guiding arrangement is formed as a rotating joint axis (213) of a rotating joint arrangement (212), and the rotating joint axis (213) can be altered as regards its relative arrangement with respect to the hip-joint rotation point (HG) of a patient, lower leg receptacles (214, 215; 256, 257; 272) being coupled to the rotating joint arrangement (212) to form the lower leg accommodating arrangement, which receptacles are coupled as regards their movement so that a rotational movement of the one lower leg receptacle (214; 256; 272) about the rotating joint axis (213) effects a rotational movement in the opposite direction of the other lower leg receptacle (215; 257; 272).
23. Therapy and training equipment according to claim 22, characterised in that the rotational movement takes place in a rotational movement range (218) that has a mid position (M) in which the lower leg receptacles (214, 215; 256, 257; 272) have an identical rotational position.
24. Therapy and training equipment according to claim 23, characterised in that the end positions (O, U) of the rotational movement range (218) can be adjusted relative to the middle position (M).
25. Therapy and training equipment according to claim 23 or 24, characterised in that the middle position of the lower leg receptacles (214, 215; 256, 257; 272) can be adjusted as regards the rotational angle position relative to the rotating joint axis (213) of the rotating joint arrangement (212).
26. Therapy and training equipment according to one or more of claims 23 to 25, characterised in that the mid position (M) and/or the end positions (O, U) can be fixed.
27. Therapy and training equipment according to one or more of the preceding claims, characterised in that the movement coupling of the lower leg receptacles (214, 215; 256, 257; 272) is effected via the rotating joint arrangement (212) formed as a gear mechanism.
28. Therapy and training equipment according to one or more of the preceding claims, characterised in that a preferably adjustable loading device (236) is provided that acts at least in a phase-wise manner against the rotational movement on at least one lower leg receptacle (214, 215; 256, 257; 272).
29. Therapy and training equipment according to one or more of claims 22 to 28, characterised in that the rotating joint arrangement (212) can be acted upon by a preferably adjustable gear load (237).
30. Therapy and training equipment according to one or more of claims 22 to 29, characterised in that the rotating joint arrangement (212) is coupled to a height adjustment device.
31. Therapy and training equipment according to one or more of claims 22 to 29, characterised in that the relative arrangement of the rotating joint axis (213) can be altered along a movement path (280) with respect to the hip-joint rotation point (HG).
32. Therapy and training equipment according to one or more of claims 22 to 31, characterised in that the lower leg receptacles (214, 215; 256, 257) can be altered in their alignment with respect to the rotating joint axis (213).
33. Therapy and training equipment according to one or more of claims 22 to 32, characterised in that the lower leg receptacles (214, 215; 256, 257) are provided at their free ends with foot rests (262, 263) .
34. Therapy and training equipment according to claim 33, characterised in that the foot rests (262, 263) can rotate about an axis transverse to the longitudinal axis of the lower leg receptacles (214, 215; 256, 257; 272).
35. Therapy and training equipment according to claim 34, characterised in that the foot rests (262, 263) are coupled as regards their movement in such a way that a rotational movement of one of the foot rests causes a rotational movement in the opposite direction of the other foot rest.
36. Therapy and training equipment according to claim 34, characterised in that the foot rests (262, 263) are coupled as regards their movement to the lower leg receptacles (214, 215; 256, 257; 272) in such a way that a rotational movement of one lower leg receptacle produces a rotational movement in the same or opposite direction of the foot rest arranged in the respective lower leg receptacle.
37. Therapy and training equipment according to one or more of claims 22 to 36, characterised in that the lower leg receptacles (256, 257) are formed as capsules with at least one securement device (264, 265) arranged opposite a capsule opening.
38. Therapy and training equipment according to claim 37, characterised in that the securement device is formed as a laterally open retaining strap (264, 265).

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