EP1150637A1

EP1150637A1 - Splint for passive motion of an upper limb

Info

Publication number: EP1150637A1
Application number: EP00902709A
Authority: EP
Inventors: Laurent Beny; Laurent Oster
Original assignee: Smith and Nephew Kinetec SA
Current assignee: AbilityOne Kinetec SA
Priority date: 1999-02-08
Filing date: 2000-02-04
Publication date: 2001-11-07
Also published as: FR2789304A1; FR2789304B1; CA2360191A1; WO2000047156A1; AU2445600A; US6676612B1; JP2002538856A

Abstract

Rehabilitation of an upper limb. The splint comprises: an arm (8) that is supported by a frame (10) consisting of at least one upper extension (20) that is provided at the end of a pivot (21) of a substantially vertical axis, an arch that is mounted on the pivot by means of a flexion-extensional drive motor (26) for the upper member, and an upper structure (31) that supports the anti-brachial and brachial segments and is comprised of a housing (34) that is adapted onto said arch, an abduction-adduction drive motor for the upper arm and an arm (40) that links said motor to the brachial segment. The invention can be used for passive motion splints.

Description

PASSIVE MOBILIZATION SPLIT OF THE TOP MEMBER

TECHNICAL AREA :

The present invention relates to the field of joint and ligament rehabilitation of the upper limbs and it aims, more particularly, the rehabilitation of such members by the passive mobilization method.

One such method consists in placing the upper limb in a splint which is made up of articulated segments reproducing and materializing the complex scapulo-humeral articulation and the articulation, also complex, ulnar. The design of these articulated segments is chosen to allow the arm and forearm of the upper limb to move by means of motorized members at variable speeds over angular ranges determined in the main movements considered, carried out independently. or concomitantly, and which are the abduction-adduction, the horizontal flexion-extension, the internal-external rotation of the forearm, or even the pronation-supination of said forearm.

PRIOR TECHNIQUE:

The splints capable of meeting such requirements, taking into account the anatomical characteristics of the joints of the upper limb, are well known and can be considered as meeting the intended objectives.

Such splints are, generally and because of their functionality, heavy, relatively bulky and, for some, affected by their own functionality in relation to a right or left upper limb, only.

In practice and until now, the commissioning of such passive mobilization splints was generally carried out in a medical or paramedical environment, within specialized reception structures and by personnel specifically trained in this regard. The progress made in terms of servo-control, control and adjustment of the adapted motorization members on such splints has, it seems, opened a door to a different practice consisting in entrusting to the patient a splint of re-education by passive mobilization by adding a commissioning protocol that he can adapt himself.

As soon as such a proposal is made, the question arises of being able to make such a splint available to a patient, it being understood that in any event the putting into service of such a splint is temporary.

This is the reason why a tendency has emerged to be able to offer, in rental service, splints of mobilization of the upper limb so that each patient concerned can have, available and temporarily, the material which is necessary for him. to carry out the reeducation protocol that suits him. If such a practice of providing a passive mobilization splint appears satisfactory, it encounters, in practice, two main difficulties.

The first concerns the size and mass represented by such splints of passive mobilization of the upper limb, size and mass which generally obstruct a flexible, fast, efficient rental service and requiring little means of transport for the patients.

The second is to have equipment or a fleet of materials capable of meeting rental requirements that are difficult to plan for indifferent rehabilitation of the right or left upper limb.

These two obstacles appear to be a serious obstacle to the development of the rental practice.

The object of the invention is precisely to overcome the problems posed by current passive reeducation materials, by proposing a new splint for reeducation of the upper limb which is of relatively small size, of installation and of practical putting into service. , fast and which can be used, indifferently, subject to adjustment adjustment, for the rehabilitation of a right arm or a left arm. Such an adjustment adjustment is most often left to the care of the personnel responsible for the initial commissioning and who can thus respond, from a single fleet, to all rental requests that may arise in a totally random. PRESENTATION OF THE INVENTION:

To achieve the above objectives, the passive mobilization splint of the upper limb, of the type comprising an antebrachial segment and a brachial segment adjustable relatively in flexion-extension and adapted on a support and mobilization armature in independent movements and / or simultaneous flexion- horizontal extension of the upper limb, abduction-adduction of said limb, internal-external rotation of the forearm, or even pronation-supination, is characterized in that said armature comprises: • a bracket substantially vertical carried by a frame which is intended to be placed in relation to the rear part of an associated seat and which comprises at least one upper extension provided, at the end, with a pivot of substantially vertical axis, called bending- horizontal extension of the upper limb and oriented towards the front part of said seat,

A hoop mounted on the pivot by means of a motor, known as the horizontal flexion-extension drive of the upper limb,

• and an upper structure supporting the anterior-brachial and brachial segments and comprising a housing adapted on the arch, a motor, called abduction-adduction drive of the upper limb, mounted in the housing and an arm connecting said motor to the segment brachial. Various other characteristics will emerge from the description given below with reference to the appended drawings which show, by way of nonlimiting examples, embodiments of the subject of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS:

Fig. 1 is an elevation of the splint according to the invention in a first embodiment.

Figs. 2, 3 and 4 are perspectives, corresponding to FIG. 1 and highlighting, at different scales, constructive details. Fig. 5 is a perspective, substantially similar to FIG. 2, but illustrating an alternative embodiment.

Fig. 6 is a plan diagram showing certain structural characteristics of the splint. Fig. 7 is a perspective showing more precisely the structure of the splint.

Figs. 8 and 9 are partial views, on a larger scale, showing construction details.

Fig. 10 is a partial perspective, similar to FIG. 5, but illustrating a functional characteristic.

Fig. 11 is a partial perspective showing an alternative embodiment.

Fig. 12 is a side elevation taken, on a larger scale, schematically, substantially relative to the plane XII-XII of FIG. 11. Fig. 13 is a partial perspective showing, more clearly, the construction according to FIG. 12.

Fig. 14 is a partial diagram illustrating a functional characteristic of the means according to FIGS. 11 to 12.

BEST WAY TO IMPLEMENT THE INVENTION:

On the basis of the exemplary embodiment illustrated by FIGS. 1 to 4, the passive mobilization splint according to the invention comprises a support and mobilization armature 1, in independent and / or simultaneous movements, of an assembly 2 constituted by an antebrachial segment 3 and by a brachial segment 4 which are linked by a cubital articulation 5 which can be immobilized in an adjustable angular position. For the example illustrated, the segments 3 and 4 are immobilized in an orthogonal orientation in correspondence with the support of a left upper limb, by means of a gutter 6 for holding the forearm and a gutter 7 arm support. The frame 1 consists of a bracket 8 which comprises a column 9 carried by a frame 10 with respect to which said column can be adjusted in the double direction of the arrow fi, for example by means of a screw system 11.

In the example illustrated, the frame 10 is an integral part of the base 12 of a seat 13 carrying a seat 14 and a backrest 15 and reserved for the occupation of a seated patient whose left upper limb, in this case, must be subject to a reeducation protocol.

It should be considered, within the meaning of the invention, that the frame 10 could rise from a clean base 16, as illustrated in FIG. 5, such a base then being independent of the seat 13.

In the main objective of the invention, it is planned to implement means so that the frame 1 can be placed, indifferently, in relation to the left side of the seat 13, as illustrated in the drawings, or in relationship with the right side, so that, by means subsequently described in connection with the subject of the invention, the mobilization splint can assume its rehabilitation function, indifferently, for the left or right arm of a patient.

In the context of the variant according to FIG. 5, such means are apparent from the very design of the independent nature of the base 16 which makes it possible to place the column 9 of the bracket 8, either to the left or to the right of the seat 13. In the case of embodiment in which the frame 10 is an integral part of the base 12, it is provided, as illustrated by FIGS. 1 to 4, to make this frame have one or more horizontal slides 17 on which one or more frames 18 is adapted which provides support for the column 9 by means of a drum 19. above, it becomes possible to place the stem 8 to the right or to the left, relative to a median anteroposterior plane P of the seat 13

("G. 3).

The bracket 8 comprises at least one upper extension 20 which, relative to the frame 10, is oriented towards the front part of the associated seat 13. The extension 20 defines, at the end, a pivot 21 of axis xx 'substantially vertical and which can be placed directly above the right or left scapulo-humeral articulation head of a patient occupying seat 13.

Preferably, the stem 8 is also provided with a lower extension 22 which meets the same characteristics as the extension 20, so as to have a pivot 23 coaxial with the pivot 21 for the materialization of a single axis x-x '.

The pivot 21 and the pivot 23, if any, are reserved for mounting a hoop 25 substantially in the shape of a "U", which can be immobilized or driven in rotation, by means of a drive member 26, called d 'flexion training - horizontal extension of the upper limb.

The motor 26 is designed, as shown schematically in FIG. 6, so as to be capable of causing the angular displacement of the arch 25, that the bracket 8 is arranged in left or right lateral placement, either in the direction of the arrow fi over an angular range of 30 °, or in the direction of the arrow f ₃ over an angular range of 130 °.

The arch 25 consists of two branches 27 and 28 which, in a so-called neutral position, extend parallel to the extensions 20 and 22, from the pivots 21 and 23 and from a core 30 connecting said branches to be placed, in the same reference position, substantially parallel to the column 9. The hoop 25 is responsible for carrying the assembly 2 by means of a structure 31 occupying a substantially higher position on the core 30 below the branch 27, so as to be able to be situated substantially at the base of the right or left shoulder of a patient occupying the seat 13. Such a vertical shoulder adjustment can be provided by means of the means 11 offering a possibility of move according to the arrow fi as said previously, the column 9 relative to the frame 10.

The structure 31, more particularly highlighted by FIGS. 5 and 7, comprises a support 32 which is preferably constituted in the form of a console or a yoke oriented parallel to the branches 27 and 28. The support 32 defines a pivot axis y-y ', substantially vertical , for a housing 34 mounted on the support 32 by a pivot 33 and by means of orientation means 35 which are more precisely illustrated in FIG. 8. Such means 35 include, for example in the upper branch of the yoke or of the support 32, a semi-circular lumen 35 centered on the pivot axis yy 'and which is capable of receiving and guiding a locking button 36 carried by the housing 34. The lumen 35 covers an angular range of the order of 180 °, so that it is possible, by operating the locking member 36, to orient the housing 34 in one or the other of two stable positions at 180 ° from each other.

The housing 34 houses a motor member having an output shaft 37 whose axis is orthogonal to the axis yy 'and which extends, in one or the other of the orientation positions of the housing 34, always parallel the branches 27 and 28 of the hoop 25. The output shaft 37 drives one, or preferably two, members 38 extending transversely to the plane of the hoop and carrying a plate 39, called reversal, ensuring the support of the assembly 2 by means of an arm 40. The plate 39 is associated with adjustment means 41, said to be in reversal, of the arm 40. These means 41, as illustrated by the fig. 9, comprise a plate 42 mounted on an axis of rotation 43 presented by the plate 39 and having a semi-circular light 44 capable of accommodating a fixing and adjustment member 45, for example carried by the plate 39. The light 44 covers an angular range of 180 °, so that it becomes possible to adjust, by turning, the orientation of the arm 40 in one or the other of two positions, the first being for example the position illustrated by the fig. 9 and the second that illustrated, in the same figure, in phantom and the need for which follows from the following.

The arm 40 is composed of a half-arm 46, called the posterior, secured to the plate 42 and of a half-arm 47, called the anterior, which carries the brachial segment 4 of the assembly 2. The half-arms 46 and 47 are associated by a locking nut 48 which is combined with a bearing 49 for free rotation of the half-arm 47 in the case of unlocking the nut 48.

The motor housed by the housing 34 is designed so that it can be driven in reversible rotation, at variable speed, over an angular range capable of causing an adduction movement over a range of 20 ° and an abduction movement over a range close to 150 °. The mobilization splint described above is put into service as follows.

As regards, for example, the passive mobilization of a left upper limb, the bracket 8 is arranged in the left part of the seat 13, as shown schematically by the letter G in FIG. 6, via the frame 10, behind the backrest 15 of the seat 13 and laterally to the latter, so that the axis x-x 'corresponds substantially to the head of the scapulo-humeral articulation of the upper left arm.

Then, the housing 34 is adjusted by means 35 and 36, so as to immobilize this housing in an orientation such that the members 38 are oriented and directed to the left, as illustrated in FIGS. 1 to 5 and 7.

The means 44 and 45 of the turning plate 30 are put into service to orient the arm 40 in the opposite direction to that of the frame 10, that is to say towards the front of the seat 13, so as to place the assembly 2 in a favorable situation for receiving and maintaining the forearm and the upper limb arm in the gutters 6 and 7.

In such a position, it is possible to command a rehabilitation by passive mobilization in horizontal flexion-extension of the left upper arm by controlling the supply of the motor 26 responsible for moving the arch 25 over an angular range of 30 ° in the direction of arrow f ₂ and over a range of 130 ° in the direction of arrow f ₃ .

It is also possible to command a passive reeducation mobilization of the upper arm in adduction and abduction movement by controlling the suitable and appropriate sequential supply of the abduction-adduction drive motor housed by the housing 34.

It is, of course, possible to ensure the concomitant control of the two movements, by adopting speeds and amplitudes which are, each time, predetermined and programmable.

The examples of rehabilitative movements which have just been mentioned take into account a position of the upper arm maintained and immobilized by the segments 3 and 4 which occupy, depending on the adjustment of the ulnar joint 5, a relational position substantially at 90 °. bending. It is obvious that the above movements can be programmed with maintaining the upper arm in full extension by acting, beforehand, on the adjustment of the ulnar joint 5.

Assuming that it is appropriate to set up the mobilization splint for the rehabilitation of a right arm, it suffices to place the stem 8 in relation to the straight position, such as that shown by the letter D in FIG. . 6. Such an installation is carried out directly by means of the base 16 or by adjusting the chassis 18 on the slide (s) 17.

Then, the members 35 and 36 are put into service to control the change in orientation of the housing 34 on the axis y-y ', so as to orient the arm 40 towards the outside on the right side of the seat 13. Finally, the means 44 and 45 are controlled to cause the assembly 2 to turn over and bring it back towards the front part of the seat 13, so that the splint then occupies the position, as illustrated in FIG. 10, in which the same movements as those described above, can be controlled individually or concomitantly.

The object of the invention involves, in addition, means, designated as a whole by the reference 50 and able to maintain an internal-external rotational movement of the forearm of the upper limb, such a rotational movement occurring concomitantly with the movement of abduction-adduction maintained by the motor of the housing 34.

Fig. 11 and fig. 12 show that the means 50 comprise a yoke 51 capable of being adjusted in position on a slide 52 presented by the housing 34. The yoke 51 offers a fixing point 53 which can be placed, depending on the adjustment on the slide 52, either coincident with the axis of the output shaft 37, or in vertical offset with respect to the latter and, more particularly, in vertical downward movement. The fixing point 53 is intended for the attachment of the end of a cable 54 supported by a guide sheath 55, so that its opposite end can be fixed, in an adjustable manner, to an integral branch 56 of the half-arm 47. By providing for unlocking the nut 48, the means 50, as described above, make it possible to achieve the following results. When the yoke 51 is adjusted so that the attachment point 53 coincides with the axis 37, the angular displacement of the members 35 has no effect on the useful length of the cable 54.

On the other hand, if the adjustment of the yoke 51 brings the attachment point 53 into position such as 53a illustrated in FIG. 12, then, the angular movement in one or the other direction of the arrow f ₄ of the members 35 results in a corresponding variation in the useful length of said cable between the point of attachment and the entry of the guide sheath -cable 55, so that this cable controls, through the branch 56 the rotation, in one or the other direction of the arrow fs, of the half-arm 47, as illustrated in FIGS. 12 and 14. As a result, concomitantly with the abduction-adduction movement, an external-internal rotational movement applied to the forearm of the upper limb, when the latter is placed in a semi-flexing state .

In the case where the prior adjustment of the assembly 2 places the segments 3 and 4 in alignment for an extension of the upper limb, then the adjustment, as taken into account previously, results in the creation, simultaneously with the movement of abduction -adduction, of a movement of supination-pronation, which makes it possible to offer an additional possibility of passive mobilization, possibly combined with a horizontal flexion-extension.

INDUSTRIAL APPLICATION;

The invention finds an interesting application in the field of passive mobilization splints which are reserved for rental services.

Claims

CLAIMS:

1 - Splint of passive mobilization of the upper limb, of the type comprising an antebrachial segment (3) and a brachial segment (4) adjustable relatively in flexion-extension and adapted on a frame (1) of support and mobilization in independent movements and / or simultaneous horizontal flexion-extension of the upper limb, abduction-adduction of said limb, internal-external rotation of the forearm, or even pronation-supination, characterized in that said reinforcement comprises:

• a substantially vertical bracket (8) carried by a frame (10) which is intended to be placed in relation to the rear part of an associated seat (13) and which comprises at least one upper extension (20) provided, at the end a pivot (21) with a substantially vertical axis, known as the horizontal flexion-extension of the upper limb and oriented towards the front part of said seat, • an arch (25) mounted on the pivot by means of a motor

(26), known as the horizontal flexion-extension training of the upper limb,

• and an upper structure (31) supporting the anterior-brachial and brachial segments and comprising a housing (34) adapted on the arch, a motor, known as the abduction-adduction drive of the upper limb, mounted in the housing and a arm (40) connecting said motor to the brachial segment.

2 - Splint according to claim 1, characterized in that the bracket (8) is carried by the frame which rises from a base (10). 3 - Splint according to claim 1, characterized in that the bracket (8) is carried by the frame (10) which is an integral part of the seat (13).

4 - Splint according to one of claims 1 to 3, characterized in that the bracket (8) is mounted vertically adjustable relative to the frame.

5 - Splint according to one of claims 1 to 4, characterized in that the bracket (8) has an upper extension (20) and an extension lower (22) carrying coaxial pivots (21, 23) of axis (x-x ') on which the arch (25) is mounted.

6 - Splint according to one of claims 1 to 5, characterized in that the bracket (8) is mounted on the frame (10) via a barrel (19) linked to a frame (18) adapted to adjustable manner on at least one horizontal slide (17) forming part of the frame (10) and extending over a length such that the axis (x-x ') of the pivot of the bracket can be placed, reversibly, at plumb with the head of the right or left scapulo-humeral articulation of a subject occupying the associated seat (13).

7 - Splint according to one of claims 1 to 6, characterized in that the bracket (8) carries the arch (25) which is provided with an upper support (32) provided, for mounting the housing, an orientation pivot (33) with an axis parallel to the flexion-horizontal extension axis of the upper limb and in that the link arm (40) between the abduction-adduction motor and the brachial segment (4) comprises a turning plate (39) with an axis orthogonal to that of the orientation pivot. 8 - Splint according to claim 7, characterized in that the orientation pivot (33) comprises means (35, 36) for immobilizing the housing in one or the other of two positions located at 180 ° one on the other and in each of which the turning plate (39) is oriented, respectively to the left and to the right, relative to the associated seat and in that said plate is provided with means (44, 45) for immobilizing the set of antebrachial and brachial segments in one or the other of two positions established in correspondence of the two orientation positions of the housing and in each of which the brachial segment is oriented towards the front of the associated seat.

9 - Splint according to claim 1, 7 or 8, characterized in that the orientation box (34) carries the motor which comprises an output shaft (37) oriented in an anteroposterior direction relative to the associated seat, in one and the other position that said housing can adopt, such a shaft driving at least one frame (38) linked to the turning plate (39) on which the arm (40) is mounted by a plate (42) angularly adjustable . 10 - Splint according to claim 9, characterized in that the abduction-adduction drive motor can be driven by a reversible rotation at variable speed over an adjustable angular range.

11 - Splint according to claim 1, characterized in that the motor (26) for flexion-horizontal extension drive of the upper limb can be driven by a reversible rotation at variable speed over an angular range such as the arch (25 ) can be moved, from a neutral alignment position parallel to the anteroposterior plane (P) of the associated seat, in external rotation over a range of 30 ° and in internal rotation over a range of 130 °. 12 - Splint according to claim 1 or 7, characterized in that the arm (40) consists of a half-arm (46), said posterior, connected to the plate (42) of the turning plate (39) and by a half-arm (47), called anterior, carrying the brachial segment (4), the half-arms being joined by a locking nut (48).

13 - Splint according to claim 12, characterized in that the nut (48) is associated with a bearing (49) of free rotation of the front half-arm which is provided with a branch (56) capable of being actuated by adjustable means for moving the anterior half-arm in internal-external rotation of the forearm of the upper limb, concomitantly with at least the abduction-adduction movement of said upper limb. 14 - Splint according to claim 13, characterized in that the means for driving in internal-external rotation of the forearm of the upper limb comprise:

• a yoke (51) mounted adjustable in position on a slide (52) carried by the housing (38) and providing a fixing point (53) which can be placed in coincidence with the axis of the output shaft (37) of the abduction-adduction drive motor or vertically offset with respect to said axis,

• a guided cable (54) which is linked to the fixing point and mounted adjustable in length on the branch (56) of the front half-arm.