EP1351643B1 - Therapeutic and training device for the shoulder joint - Google Patents

Abstract

The invention relates to a therapy and training device for the shoulder joint (43) with a trunk base (21), having a rotational joint base (22) two shoulder extensions (27), respectively associated with a shoulder, rotational around a vertical axis of a shoulder rotational joint means, having an arm extension, respectively spaced apart from the rotational joint base for connection with an arm (42, 48), which is rotationally connected with the shoulder extension (27) around a transverse axis (37) by an upper arm rotational joint means (30), wherein said shoulder extension and/or said arm extension are coupled in movement such that a rotational movement of one shoulder extension, or respectively, one arm extension, causes a rotational movement of the other shoulder extension, or respectively, the other arm extension.

Description

The present invention relates to a therapy and training device for the shoulder joint according to the preamble of claim 1.

Therapy and training equipment used to treat movement restrictions be used on one extremity and on the principle based that movement by moving the healthy limb which induces limb restricted in mobility has so far become therapy and exercise training for Knee joints used. Such a therapy and training device is known for example from DE 195 09 465 A1. The well-known therapy and training device serves to restrict movement on one Therapy of the knee joint is only essential as a result of this uniaxial joint formation of the knee joint relatively simple with only equipped with a swivel joint device that holds a lower leg and articulates a thigh joint, ideally, the swivel axis of the swivel joint device in therapy operation matches the patient's knee axis.

Although in practice due to the frequency of knee injuries and the associated knee operations a particularly high one Need for rehabilitation regarding restricted movement on the knee joint given. However, there are restrictions on the movement of joints basically always to be determined if after a surgical Intervention is a long immobilization of a joint was required. Of course, this also applies in particular to shoulder injuries or surgery on the shoulder too considerable Restrictions on movement in the shoulder area can result. Because of the complexity of the joint situation in the shoulder area, it is but not possible, the well-known therapy and training device for to use an appropriate therapy of a shoulder joint.

FR-A-1 257 091 is a therapy and training device for the Known shoulder joint, which has a trunk support attached to one Swivel base two each assigned to a shoulder, by means of a swivel articulated shoulder boom having. The shoulder brackets are spaced from the swivel base provided with an arm extension that runs around a transverse axis pivotable via an upper arm swivel joint device with the Shoulder boom is connected. The arm brackets are coupled in such a way that a pivotal movement of one arm arm a Swiveling movement of the other arm arm causes.

From FR-A-2 789 304 is a device for passive mobilization of the upper limbs with various motor devices for the Movement drive of a patient's arm is known.

US-A-5 613 928 shows a training device with two motion-coupled Arm levers for muscle building training.

From US-A 4 971 040 a portable massage chair is to be carried out a location-independent massage therapy known.

The object of the present invention is to provide a therapy and propose exercise equipment that will carry out a complex Movement therapy for the shoulder joint enables.

To solve this task, the therapy and training device has the Features of claim 1.

In the therapy and training device according to the invention Swivel joint device designed as a shoulder swivel joint device, such that the shoulder boom about a vertical axis of the shoulder swivel joint device pivotable and so motion-coupled are that a pivotal movement of one shoulder arm a Swiveling movement of the other shoulder arm causes.

The structure of the therapy and training device according to the invention takes special account of the shoulder anatomy, which leads to that shoulder movements usually include arm or at least upper arm movements induce and vice versa. For example, is already with a simple forward or backward movement of one shoulder, if one slight swivel movement of the upper arm connected. Such complex Movement relationships require a corresponding joint configuration on the therapy and training device. For the forward or backward movement is therefore the training of a therapy and training device Vertical axis necessary, as close as possible to the shoulder base is arranged. To the one superimposed with the forward and backward movement The training is to enable pivoting movement of the upper arm a correspondingly transverse to the vertical axis pivot axis required, which is a so-called ante- and retroversion of the arm, so a forward and backward swing.

The forward and backward movement of the shoulder blade with superimposed fore and fore The arm can be moved back by the articulated lever Trained shoulder boom that connects the Shoulder swivel device and the upper arm swivel device, that is, the vertical axis and the transverse axis. For transmission the one on one side of the body with the shoulder blade or arm or both swivel movements to the other side of the body is the shoulder arm assigned to the other side of the body or the arm extension assigned to the other side of the body with their Pendant coupled with movement.

In particular for repositioning the therapy and training device relative to the patient's upper body, it proves to be advantageous if the swivel base has a positioning device for Relative positioning assigned to the patient's spine is. This makes it possible even after an interruption of the Therapy to resume therapy the therapy and training device to position on the patient’s upper body without a Adaptation of the joint configuration of the therapy and training device to the individual anatomy of the patient would be necessary.

A particularly immediate type of positioning results when the Positioning device one adjustable in height along the fuselage beam has at the swivel base arranged neck receptacle. The Neck picking is also an arbitrary option or involuntarily while operating the therapy and Exercise device performed evasive movements of the upper body, the in particular the desired adjustment of the joint configuration of the Therapy and training device to the individual anatomy of the patient prevent. Basically you can do this of course, other appropriate devices are also provided become.

If the arm extension on the therapy and training device Includes upper arm extension and a forearm extension, the upper arm extension via the upper arm swivel joint device with the shoulder arm is connected and the forearm boom at least one a pivot axis comprising elbow joint device with the Upper arm extension is connected, it is also possible forearm movements to include. For this, in the simplest form, there are relative movements of the forearm in relation to the upper arm is sufficient without the movements of the forearm boom as the movements of the upper arm boom and the shoulder arm on the other side of the body would have to be transmitted coupled to motion. Because with a restricted movement Shoulder often relative movements of the forearm can be performed on the upper arm without restrictions, a corresponding movement coupling of the forearm extension both sides are eliminated. On the other hand, there are changed relative positions of the forearm versus the upper arm due to the associated Mass shift very well affects the movements of the shoulder can affect the relative mobility of the forearm boom have a positive effect on the success of therapy.

In addition, the elbow joint device has two pivot axes has, with a vertical axis transverse to the longitudinal extension of the Upper arm and a transverse axis in the direction of the longitudinal extension of the upper arm boom is a two-axis articulated device formed, which is essentially the actual anatomical proportions at the elbow joint.

In addition, when connecting the arm arm to an arm by means of a connecting device arranged on the forearm boom are done e.g. Longitudinal rotation of the upper arm in relation to the upper arm extension easily possible. Therefore, for example, on it be dispensed with to design the upper arm swivel joint device in such a way that longitudinal rotations of the upper arm are also possible.

In a particularly advantageous embodiment of the therapy and Training device is at least one forearm boom with an actuating device to trigger one on the upper arm swivel joint device acting locking device, wherein an actuation the actuating device takes place in that the assigned forearm is released from its connection with the forearm extension. This creates a kind of "emergency switch" that prevents the sick shoulder movements that are not performed by the healthy extremity of the opposite side or the healthy shoulder be so for example the sick arm after disconnecting the Forearms on the healthy side with the forearm extension not as a result of gravity fall from a raised position can.

A possible embodiment of such an "emergency switch" can consist, for example, that a switch Handle knob is provided at the free end of the lower leg receptacle, where the switch is operated by releasing the handle.

If the upper arm boom in its effective length between the Upper arm swivel device and the elbow joint device is changeable, it is possible by suitable length changes Deviations between the swivel axis of the upper arm swivel joint device and the actual pivot axis of the shoulder joint compensate for it without creating constraints when moving comes.

A particularly effective therapy for the rehabilitation of movement restrictions on an affected shoulder joint becomes possible if for coupling movement at least the shoulder swivel joint device and the upper arm pivot joint device with one side of the body each of the shoulder swivel device and the upper arm swivel device the other side of the body by means of a coupling device are coupled such that a joint movement on a Body side a defined joint movement of the corresponding joint device on the other side of the body. Depending on the training of the corresponding coupling device, the induced countermovement in the same direction, in the opposite direction or in a defined translation or reduction ratio.

For example, unwanted or even harmful movements To be able to prevent that on the therapy and training device provided joint devices at least partially with devices be provided to limit joint movements.

In one possible embodiment, the coupling device is for Movement coupling of the shoulder swivel joint device as a wheel gear trained, the wheel gear as a friction gear or gear can be trained.

In a further advantageous embodiment, the coupling device for coupling the movement of the upper arm swivel devices designed as a traction or pressure medium gear, so that a Power transmission with rope or hydraulic fluid can take place.

An advantageous modular training of the therapy and training device, which is easy to adapt to given conditions given when the fuselage carrier a connection device for connection with a seat frame or seating in general having.

The fuselage can also provide a seat frame itself be so that a self-sufficient from other environmental requirements Independent use of the therapy and training device possible is.

It proves to be particularly advantageous if the seat frame foldable is arranged on the fuselage carrier.

Fig. 1

eine Ausführungsform eines Therapie- und Trainingsgerätes für das Schultergelenk in perspektivischer Darstellung mit betriebsbereitem Sitzgestell und in Neutralstellung;

Fig. 2

das Therapie- und Trainingsgerät gemäß Fig. 1 mit eingeklapptem Sitzgestell;

Fig. 3

das Therapie- und Trainingsgerät mit einem gegenüber der Darstellung in Fig. 1 verlängertem Oberarmausleger;

Fig. 4

das Therapie- und Trainingsgerät mit um eine Querachse nach unten verschwenktem Oberarmausleger;

Fig. 5

das Therapie- und Trainingsgerät mit um die Querachse nach oben verschwenktem Oberarmausleger;

Fig. 6

das Therapie- und Trainingsgerät in Neutralstellung und Draufsicht;

Fig. 7

das Therapie- und Trainingsgerät mit um eine Hochachse eingeschwenktem Schulterausleger;

Fig. 8

das Therapie- und Trainingsgerät mit um die Hochachse ausgeschwenktem Schulterausleger;

Fig. 9

das Therapie- und Trainingsgerät mit um eine Querachse nach oben geschwenktem Unterarmausleger;

Fig. 10

das Therapie- und Trainingsgerät mit um die Querachse nach unten verschwenktem Unterarmausleger;

Fig. 11

das Therapie- und Trainingsgerät mit um eine Hochachse ausgeschwenktem Unterarmausleger;

Fig. 12

eine schematische Darstellung einer ersten Kopplungseinrichtung zur Bewegungskopplung beider Schulterausleger und einer zweiten Kopplungseinrichtung zur Bewegungskopplung beider Oberarmausleger des Therapie- und Trainingsgerätes.

An embodiment of the therapy and training device is explained in more detail below with reference to the drawings. Show it:

Fig. 1

an embodiment of a therapy and training device for the shoulder joint in a perspective view with an operational seat frame and in neutral position;

Fig. 2

the therapy and training device of FIG 1 with the seat frame folded.

Fig. 3

the therapy and training device with an extended upper arm compared to the illustration in FIG. 1 ;

Fig. 4

the therapy and training device with the upper arm arm pivoted downward about a transverse axis;

Fig. 5

the therapy and training device with the upper arm boom pivoted upwards about the transverse axis;

Fig. 6

the therapy and training device in neutral position and top view;

Fig. 7

the therapy and training device with the shoulder arm pivoted about a vertical axis;

Fig. 8

the therapy and training device with the shoulder arm swung out around the vertical axis;

Fig. 9

the therapy and training device with the forearm arm pivoted upwards about a transverse axis;

Fig. 10

the therapy and training device with the forearm boom pivoted downwards about the transverse axis;

Fig. 11

the therapy and training device with the forearm arm swung out about a vertical axis;

Fig. 12

a schematic representation of a first coupling device for coupling movement of both shoulder arms and a second coupling device for coupling movement of both upper arm arms of the therapy and training device.

1 shows a therapy and training device 20, which will be referred to below as a therapy device, with a trunk support 21, a swivel base 22 arranged on the trunk support 21 and a seat frame 23 also arranged on the trunk support.

The swivel joint base 22 serves to link a shoulder / arm joint system 24, the two symmetrical to the swivel base 22 or shoulder / arm joint units 25, 26 designed for torso support 21 , of which only the right shoulder / arm joint unit 25 is shown in more detail below. The shoulder / arm joint unit Like the shoulder / arm joint unit 26, which is not shown in detail in detail, 25 comprises a shoulder arm 27 which extends around a vertical axis 28 by means of a shoulder swivel joint device 29 the pivot base 22 is articulated. The one in the present case cranked shoulder bracket 27 is at its distal Provided at the end with an upper arm swivel joint device 30, such that can be pivoted about a transverse axis 31 to the arm arm 32 Shoulder boom 27 is articulated.

The arm arm 32 has one directly with the upper arm swivel joint device 30 connected upper arm boom 33 and one over a Elbow joint device 34 articulated forearm extension 35 on. The elbow joint device 34 enables a relative Swiveling the forearm extension 35 relative to the upper arm extension 33 around a vertical axis 36 and essentially in the direction of FIG Longitudinal extension of the upper arm boom 33 transverse axis 37.

1 and 2 it becomes clear that the seat frame 23, which is connected to the trunk support 21 via a hinge joint 38, is in the form of a folding frame with a seat plate 39 which can be pivoted against the trunk support 21 and a seat plate 39 which is connected via a hinge joint, not shown Support leg 41 provided.

To clarify the proportions and the relative arrangement of the individual parts forming the shoulder / arm joint system 24 or the shoulder / arm joint unit 25, a human body in the sitting position with right-hand extremities is indicated schematically in FIG. 3 , with a forearm 42 in one with the Forearm arm 35 is connected position, the right shoulder 43 is located below the shoulder arm 27 and an upper arm 48 extends on the inside to the upper arm arm 33 from the upper arm pivot joint device 30 to the elbow joint device 34.

3 further clarifies that the human body is positioned relative to the therapy and training device 20 via a positioning device, which in the present case is designed as a neck mount 44 and is part of the swivel joint base 22. The introduction of force for transmission of movement from the shoulder / arm area to the therapy and training device or the shoulder / arm joint system 24 and vice versa takes place via the connection of the forearm 42 to the forearm extension 35 by means of a connecting device 45. In addition, a comparison of FIG. 3 makes and 1 clearly shows that the shoulder / arm joint system 24 or the shoulder / arm joint unit 25 can be adapted to the upper body extremity by changing the effective length L of the upper arm boom 33, which for this purpose consists of two parts which can be displaced in the longitudinal direction, namely one Upper part 46 and a lower part 47. An adjustment of the length of the shoulder arm 27 to the individual body proportions is generally not necessary, but can of course also be provided.

Starting from the configuration of the shoulder / arm joint unit 25 shown in FIGS. 1 and 3 , here defined as the neutral position, the therapy device 20 in the present embodiment enables the relative positions or movements shown in the following FIGS. 4 to 11 .

4 and 5 illustrate the possibility, with the forearm 42 ( FIG. 3 ) connected to the forearm extension 35 via the connecting device 45 ( FIG. 3 ), a forward and backward movement of the entire arm with the forearm 42 angled relative to the upper arm 48 ( FIG 3 ) perform. In this configuration, the forearm extension 35 can be fixed relative to the upper arm extension 33 by setting the elbow joint device 34 in order to set a defined arm flexion angle. The upper arm pivot joint device 30 enables pivoting about the transverse axis 31. This forward and backward movement of the upper arm 48 causes a corresponding movement of a shoulder blade 49.

FIG. 12 shows a coupling device 50, which transmits the forward and backward movement carried out with the right body extremity, that is to say here with the upper arm 48, by means of the shoulder / arm joint system 24 to the left upper body extremity, not shown in FIG. 3, and thereby also allows movement induction in the left shoulder. For this purpose, the coupling device 50 acts between the upper arm extension 33 of the right shoulder / arm joint unit 25 shown in FIG. 3 and an upper arm extension 51 of the left shoulder / arm joint unit 26 assigned to the left upper body extremity. As FIG. 12 shows, the coupling device 50 comprises two as Deflection rope systems 52, 53 designed power transmission devices. The deflecting rope system 52 acts between two rope pulleys 54, 55, which are arranged on the transverse axis 31 of the upper arm pivot joint device 30 in a rotationally fixed manner with the upper arm extension 33 or rotatably on the torso carrier 21. The rope pulley 55 is designed as a double rope pulley and is in a non-positive connection via the deflection rope system 53 with a further rope pulley 56, which, like the rope pulley 54 on the transverse axis 31 of the upper arm swivel joint device 40 of the left shoulder / arm joint unit 26, is connected in a rotationally fixed manner to an upper arm bracket 57. By means of the coupling device 50, a pivoting movement of the upper arm arm 33 in the direction of an arrow 58 is thus transmitted via the deflecting cable system 52 to the cable pulley 55 and from the cable pulley 55 via the deflecting side system 53 to the cable pulley 56 which is non-rotatably connected to the upper arm arm 57. In the present case, accordingly, a pivoting movement of the right upper arm induces a pivoting movement of the left upper arm in the same direction. The induction of an opposing pivoting movement is easily possible, for example by means of a crossed cable arrangement of one of the two deflecting cable systems 52, 53.

6 to 8 show a forward and backward movement of the shoulder arm 27 with the forearm arm 35 fixed in its flexion position relative to the upper arm arm 33. In this case, the shoulder arm 27 is pivoted about the vertical axis 28 of the shoulder swivel joint device 29. To transmit this swivel movement starting from the right shoulder / arm joint unit 25 to the left shoulder / arm joint unit 26 ( FIG. 1 to 6), which is not shown in more detail in FIGS ) a coupling device 59 shown in FIG. 12 can be used. To transmit the pivoting movement of the right shoulder arm 27, which is pivotably pivoted about the vertical axis 28 in the shoulder pivot joint device 29 to the pivot joint base 22, a bearing end 60 of the shoulder arm 27 is provided with a gear segment 61, which is in engagement with a further gear segment 62, the is formed on a bearing end 63 of a shoulder arm 64 of the left shoulder / arm joint unit 26. Analogously to the bearing end 60, the bearing end 63 of the shoulder arm 64 is mounted in a shoulder swivel joint device 65 of the swivel joint base 22.

The coupling device 59 thus enables the transmission of a swiveling movement 66 from the right shoulder arm 27 to the left shoulder arm 64, so that a corresponding swiveling movement 67 of the left shoulder can be induced on the basis of a movement of the right shoulder via the coupling device 59. 9 and 10 illustrate the pivotability of the forearm extension 35 about the transverse axis 37 of the elbow joint device 34. This pivoting movement can be carried out by means of a coupling device, not shown here, from the right shoulder / arm joint unit 25 to the left shoulder / arm joint unit (not shown in FIG. 9). Arm joint unit 26 are transmitted. But even a motion-decoupled pivotability of the forearm extension 35 of the shoulder / arm joint units 25, 26 enables advantages in the operation of the therapy device 20, since the pivotability of the forearm extension 35 about the transverse axis 37 of the elbow joint devices 34 as well as a pivotability of the forearm extension about the vertical axis 36 ( FIG 11 ) of the elbow joint devices 34 enable the patient to freely choose the relative position of the forearms relative to the upper arms which is comfortable for him.

Claims (14)

1. A therapy and training device (20) for the shoulder joint with a trunk body (21), having on a rotational joint base (22) two shoulder extensions (67, 64) respectively associated with a shoulder, coupled rotationally by means of a shoulder rotational joint means, respectively having an arm extension (32) spaced apart from the rotational joint base for connection with an arm, which is rotationally connected with the shoulder extension around a transverse axis (31) by an upper arm rotational joint means (30, 40), wherein the arm extensions (32) are coupled in movement such that a rotational movement of one arm extension causes a rotational movement of the other arm extension,
   characterized in that
   the rotational joint means is formed as a rotational shoulder joint means (29, 65), such that the shoulder extensions (27, 64) are rotational around a vertical axis (28) of the rotational shoulder joint means (29, 65) and coupled in movement such that a rotational movement of one shoulder extension causes a rotational movement of the other shoulder extension.
2. The therapy and training device according to claim 1,
   characterized in that
   the rotational joint base (22) has a positioning means (44) associated thereto for the relative positioning vis-à-vis the spinal column of a patient.
3. The therapy and training device according to claim 2,
   characterized in that
   the positioning means has a neck receptacle (44) along the trunk base (21) adjustable in height and arranged on the rotational joint base (22).
4. The therapy and training device according to one of the preceding claims,
   characterized in that,
   the arm extension (22) comprises an upper arm extension (33) and a lower arm extension (35), wherein the upper arm extension is connected with the shoulder extension (27) by the upper arm rotational joint means (30), and the lower arm extension is connected with the upper arm extension by an elbow joint means (34) comprising at least one rotational axis (36, 37).
5. The therapy and training device according to claim 4,
   characterized in that
   the elbow joint means (34) has two rotational axes (36, 37), wherein a vertical axis (36) runs transverse to the longitudinal extension of the upper arm extension (33) and a transverse axis (37) in the direction of the longitudinal extension of the upper arm extension.
6. The therapy and training device according to one of the preceding claims,
   characterized in that
   a connection means (45) is provided on the lower arm extension (35) for connection of the arm extension (32) with an arm.
7. The therapy and training device according to one of the preceding claims,
   characterized in that
   at least one lower arm extension is provided with an actuating means to trigger a locking means operative on the upper arm rotational joint means, wherein an actuation of the actuating means ensues when the associated lower arm is released from its connection with the lower arm extension.
8. The therapy and training device according to one of the preceding claims,
   characterized in that
   the upper arm extension (33) is adjustable in its effective length between the upper arm rotational joint means (30) and the elbow joint means (34).
9. The therapy and training device according to one of the preceding claims,
   characterized in that
   for the coupling of movement at least the shoulder rotational joint means (29) and the upper arm rotational joint means (30) of one side of the body are coupled with respectively the shoulder rotational joint means (65) and the upper arm rotational joint means (40) of the other side of the body by means of a coupling means (50, 59) such that a joint movement of one side of the body effects a defined joint movement of the corresponding joint means on the other side of the body.
10. The therapy and training device according to claim 9,
    characterized in that
    the coupling means (59) for a coupling movement of the shoulder rotational joint means (29, 65) is formed as a wheel gear (61, 62).
11. The therapy and training device according to claim 9,
    characterized in that
    the coupling means (50) for the coupling movement of the upper arm rotational joint means (30, 40) is formed as a traction mechanism or pressurizing gear (52, 53).
12. The therapy and training device according to one of the preceding claims,
    characterized in that
    the base body has a connecting means for connection with a seat frame.
13. The therapy and training device according to one of claims 1 to 11,
    characterized in that
    the trunk body (21) is provided with a seat frame (23).
14. The therapy and training device according to claim 13,
    characterized in that
    the seat frame (23) is arranged to be folded down on the trunk body (21).

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