EP1768637A1

EP1768637A1 - Device for the reeducation of motory deficiencies, particularly deficiencies when walking, in patients

Info

Publication number: EP1768637A1
Application number: EP05773250A
Authority: EP
Inventors: Thierry Albert
Original assignee: Individual
Current assignee: ALBERT, THIERRY; SALAUEN, CHRISTIAN
Priority date: 2004-05-26
Filing date: 2005-05-24
Publication date: 2007-04-04
Anticipated expiration: 2025-05-24
Also published as: US20080070757A1; EP1768637B1; JP2008500083A; FR2870747A1; US8257232B2; WO2005117799A1; FR2870747B1

Abstract

The invention relates to a device for the reeducation of motory deficiencies, comprising means for reeducation, characterized in that said device also comprises: means for maintaining the user; means for lightening the body weight of the user (27, 27'), exerting vertical traction, wherein the suspension point of said lightening means on the means for maintaining the user are located at the level of the center of gravity of the user, i.e. therebelow; and means for preventing the user from falling (21, 21'). The invention can be used to rededucate people how to walk.

Description

DEVICE FOR REDUCING MOTOR DEFICIENCIES OF PATIENTS, PARTICULARLY OF THE MARKET

The present invention relates to a device for rehabilitating motor impairments of patients. It applies more particularly, but not exclusively, to gait rehabilitation.

In general, patients with neurological deficiencies following a lesion of the central nervous system (paraplegia and incomplete quadriplegia, hemiplegia of vascular origin ...) lose, among other functions, walking.

Depending on the severity of the neurological lesion, a certain degree of motor and sensitive recovery is possible and allows a certain functional recovery of walking, which however remains most often difficult.

The objective of the rehabilitation carried out by a physiotherapist is to stimulate the sensory-motor function and bodily coordination in order to improve the movements of the limbs and the trunk.

After a rehabilitation focusing on isolated movements such as flexion and extension of the knee, it is the function as a whole which is re-educated, for example the rehabilitation of walking.

The work of walking therefore begins after a certain delay and is done with the feet on the ground with a permanent gestural correction carried out orally and physically. Different tools such as a walker, canes, parallel bars, splints can be used at different stages of progression. For the past ten years, numerous medical studies have demonstrated the advantage of using a treadmill for gait rehabilitation in these people. In most of these studies, the treadmill is used to exercise more intensively and more repetitively than what is practiced in conventional rehabilitation. The presence of a therapist is useful at the beginning to help the disabled limbs to move over the mat while correcting movement defects. Walking on the mat is accompanied by a more or less significant reduction in body weight, this reduction is achieved by a traction system supporting the person via a harness worn at the level of the trunk (chest, abdomen and pool). By reducing body weight, the mass of the patient being constant, is meant a decrease in the bearing force corresponding to said mass on the mat. Part of the traction system is located above the user, therefore the currently existing devices are of large volume.

This system has advantages, in particular, the possibility of practicing a reeducation of walking much earlier and more intensively (in terms of speed and endurance) than what is done with a progression and a traditional technique. Indeed, the regular unfolding of the mat constrains a greater regularity of movements of the lower limbs during walking. The body weight can be more or less lightened in order to reduce, at first, the difficulties of equilibration.

The precocious and immediately centered character of walking is clearly understood by the person, which increases his interest and motivation.

The gait rehabilitation is done without risk of falling which reassures the patient who can concentrate all the better on the quality of the gesture. Medical studies tend to show that this new method is more effective than conventional rehabilitation techniques in terms of recovery of walking quality, that is to say speed, ease, distance traveled. This effectiveness is seen both in people who have been deficient for a long time and in those who have just undergone neurological damage. Over time, the persistence of the positive effect after stopping this type of rehabilitation is not known.

However, many disadvantages exist:

These systems are most often intended to be used by professionals and their costs are high, so only hospital services can acquire them. Liberal physiotherapists and even less individuals cannot own such devices.

In addition, long-term rehabilitation of people is also a problem.

Patients with a neurological incapacity to walk, after rehabilitation and once back at home, manage to walk more or less with difficulty during daily life.

Patients most often walk to make their essential trips and some, more motivated, walk more to perform a real exercise to better maintain, or even improve, their remaining walking abilities. At the same time to maintain these functional capacities, doctors prescribe physiotherapy sessions at home or in the office which, in practice, are sometimes too short and, after a certain time, limited in number by Social Security. In addition, it is common for patients to spend part of the sessions doing useful exercises, but often at the expense of the time devoted to the more specific work of walking.

In total, to progress in walking or simply maintain the acquired knowledge, you have to walk more than life inside the home requires (this is true for both ease and endurance). We notice in practice that, in many patients, this specific work is not intensive enough in terms of both duration and intensity.

Clinical experience shows that most patients would be willing to do more to improve their walking ability, but the living conditions (lack of space to walk) and the dependence of a third party to go outside and walk outside. (apprehension, risk of falling, weather conditions, poor accessibility ...) often lead to confinement at home and very limited walking practice.

Faced with this observation, we can therefore think that many people could benefit from a treadmill walk training at home. This practice would increase walking time by using a tool that is increasingly proven in rehabilitation centers.

The practice of walking on a treadmill at home therefore has several potential advantages but, in a large number of cases, the use of a simple treadmill by the patient alone is not possible because there is no device to avoid a fall always possible on this type of device. In addition, these treadmills do not incorporate space-saving means of body relief that are compatible with a home.

Indeed, a treadmill associated with means of body lightening is a bulky material in particular in height because the points of traction and the ropes of attachment of the harness constituting the means of body lightening are located above each shoulder, this device therefore always includes a bulky part located above the head of the person. Part of the device is also located in front of or on the sides of the body, this size is a drawback in the case where the device is installed in a small room.

Such a device has the advantage of preventing any fall but also the disadvantage of over-securing the user who has no imbalance at catch up. However, walking is largely based on an ability to catch a fall forward in particular by the advancement of a foot and the swinging of the arms. Consequently, in this device, an important element of rehabilitation is not exploited.

The object of the invention is to solve these drawbacks by giving the user a certain freedom while securing him against falls.

To this end, it proposes a device for rehabilitating motor deficiencies comprising rehabilitative means proper, this device further comprising: - means for retaining a user, - means for reducing the body weight of the user exerting vertical traction, the point of suspension of said lightening means on the user holding means being located at or even below the user's center of gravity, - means for preventing falls of the 'user.

Said rehabilitation means may be a treadmill or any other rehabilitation device (staircase simulator, cross-country ski simulator, etc.).

Said user holding means may comprise a harness comprising a belt element, straps for holding and / or supporting the legs attached to said belt element and means for connection to the lightening means, these means being disconnectable and fixed. at the belt element.

Said belt element may be located at or below the user's center of gravity.

Said means of connection of the harness to the lightening means may be of the number of n distributed over the belt element. According to a first variant, said means for connecting the harness to the lightening means may be two in number, each being located on one side of the belt element so as to secure and lift the user while retaining a certain instability of the user favorable to rehabilitation.

According to a second variant, this instability may be more controlled: said harness connection means may be more than two in number, in particular the number of four distributed on the sides of the belt element so that two of the means are on one side, one in front, the other behind the user and that the other two are on the other side, one in front, the other behind the user. Thus, the vertical projection of the center of gravity of the user is inside in the vicinity of the center of a support polygon, that is to say a polygon formed by the vertical projection, in a horizontal plane, means for connecting the harness to the lightening means. In other words, the device according to the invention makes it possible to keep the user inside the polygon thus creating an area of reduced stability so as to retain a possibility of causing the user to make an effort to keep his balance.

Said means for holding the user may also include support bars which allow the user to take support with his upper limbs and thus increase his stability. They may be adjustable in height and / or in width.

Said bars may be mobile or fixed.

Movable bars from front to back will allow to reproduce a movement of advance and retreat of the arms as is the case in normal walking. These bars may include means on which the user, of his wheelchair, can bear to lift and settle in the device according to the invention.

Said means for lightening the user's body weight may include straps driven so as to exert an upward pulling force on the holding means. For example, the tensile force is applied by means of a reel around which one of the ends of the straps is wound, the other end being detachably attached to the user holding means.

Means for adjusting the traction force may be provided in order, on the one hand, to maintain a constant traction force during the exercise, the center of gravity moving during walking, and, on the other hand, adapt said tensile force to the user and / or to the therapeutic indication.

Said prevention means may include straps and / or bars in order to prevent any lateral and / or frontal and / or rear falls.

Removable marks may be provided on the surface of the treadmill to give an indication of where to put your foot during the walk, thus encouraging the user to take a certain length of step.

According to a first advantage, the device according to the invention is much less bulky than the devices of the prior art, it can therefore be installed and used in the patient's home.

Indeed, the height of the device does not exceed the height of the horizontal plane passing through the lower end of the sternum, there is therefore no structure of the device above the shoulders of the user which reduces its overall size.

In addition, with a harness, the installation constraints are less important than with a harness enveloping the pelvis, the abdomen and part of the thorax. According to a second advantage, it is easy for the patient to use with a third healthcare professional and later, depending on the progress, by the patient alone or with a family member.

According to a third advantage, its cost is much lower than that of existing devices.

According to a fourth advantage, the device according to the invention can be foldable and / or removable.

Embodiments of the invention will be described below, by way of nonlimiting examples, with reference to the appended drawings in which: FIG. 1 represents an embodiment of the device according to the invention;

FIG. 2 represents a second embodiment of the device according to the invention;

Figure 3 is a representation of a sectional view along plane A of the device of Figure 1;

FIG. 4 represents a third embodiment of the device according to the invention;

Figure 5 is a representation of the device of Figure 4 in operation.

In the example of FIG. 1, the device comprises two lateral uprights 1 of parallelepipedal section located on either side of a treadmill 2 possibly connected together by a horizontal part 3 passing under the treadmill, this part 3 can extend or retract in order to allow the spacing of the two uprights to be adjusted as close as possible to the user's trunk.

In addition, these uprights 1 each have a bend 4 so as to bring their ends together and thus adjust the setting of the spacing between said uprights.

It should be noted that each of the uprights may comprise at least two parts that are movable in vertical translation relative to one another, one vertical 5 and the other angled 6, and comprising fixing means relating to different levels. to take into account the height of the user so that the upper end of the uprights is at the level of the navel.

Inside each of the uprights there is a strap 7, one end of which is placed in a reel 8 located at the base of the upright and the other end of which ends at a pulley or bar 9 located at the upper end of the upright, that is to say above the minimum positioning height of a harness Ba, this end comprises disconnectable connection means 10 complementary to disconnectable connection means 11 located on said harness whose equips the user (Figure 3). This harness Ba also includes a belt element C, support straps and / or leg support S attached to said belt element C.

Thus, the ends of the straps 1 are located slightly above the position of the harness so as to be able to exert a pulling force upwards on the harness.

It should be noted that an intermediate pulley 13 at the elbow 4 of the upright 1 may be provided.

Furthermore, each reel 8 may also be located at the upper end of the lateral uprights 1. These reels can be actuated and held in position using mechanical means or an electric motor.

Fall prevention means are also attached to the ends of the side uprights. They comprise at least two straps 14, an anterior, a posterior, one of the ends of each strap being fixed at the level of the upper end of a lateral upright 1 and the other end of each strap being fixed at the level of the upper end of the other side upright.

These straps 14 are positioned so as to be situated at the level of the umbilicus, one facing the lumbar region, the other facing the abdomen.

These straps each comprise disconnectable connection means 15 to allow easier installation for the user.

Lateral support bars or handles 16 or anterior 17 carried in front of the user may be provided, these bars or handles being mounted on the lateral uprights and the user can thus grasp them with the hands in order to take support there (Figure 2 ).

The example of FIG. 4 illustrates another embodiment of the device according to the invention.

In this example, the lateral uprights 18, 18 'are fixed relative to each other.

Each upright comprises two vertical bars 19, 19 ', 20, 20' connected to each other, at their vertices, by a horizontal bar 21, 21 'whose axis is collinear with the scroll axis x of a carpet rolling 22.

Each horizontal bar 21, 21 'has two double curvature bars, respectively anterior 23, 23' and rear 24, 24 ', vertically oriented, the lower ends of these double curvature bars are fixed on the horizontal bars 21, 21 'by means of a hinge 25 having an axis of "rotation" collinear with that of the horizontal bars 21, 21', the upper ends of these double curvature bars 23, 23 ', 24, 24' are also connected by a horizontal bar 26, 26 'by means of a hinge 25' identical to that already described, this bar being at a height greater than the minimum mounting height of the harness Ba.

The double curvature bars 23, 24 of a lateral upright 18 are located opposite two by two of the double curvature bars 23 ', 24' of the other lateral upright 18 '.

Traction straps 27, 27 'coming to be fixed on the harness to allow the weight of the user to be lightened each have one of their ends at the base of the lateral uprights which here constitute the base of the treadmill, this end being held in a reel 28, 28 'in order to be able to adjust the tensile force provided to support the harness of the user.

Each of the straps 27, 27 'is then passed around each horizontal bar 26, 26' which acts as a return pulley for the strap 27, 27 'towards the harness, the ends of the traction straps and the harness comprising disconnectable connection means 29 and 11 respectively.

Straps 30, 31 are also provided as prevention means in order to prevent the user from falling forward or backward. They comprise two parts 32, 33 connected by means of disconnectable connection means 34.

The anterior straps 30, that is to say located at the level of the umbilicus facing the abdomen, are fixed on the two double curvature bars 23, 23 ′ located opposite the front of the horizontal bars 21, 21 '. The posterior straps 31, that is to say located at the level of the umbilicus opposite the lumbar region, are fixed on the two double curvature bars 24, 24 ′ located opposite the rear of the horizontal bars 21, 21 '.

It should be noted that these straps 30, 31 can be replaced by rigid and curved arch-shaped bars fixed at one end to one of the lateral uprights by means of a vertically oriented articulation allowing them to be moved to the side during the user installation.

The operation of the device shown in Figures 1 or 5 is as follows:

Each part of the device makes it possible to exercise an action on the subject, the principle of which is as follows:

The harness Ba is attached to the straps 27 on each side of the subject, at a point A located above the greater trochanter, approximately at the level of the iliac crest.

Each strap 7, 27, 27 ′ is then directed towards a point B defined by a precise position in the extracorporeal space, it is located laterally a few centimeters from the abdomen, in a frontal plane and at a height situated slightly at above the navel.

On a subject standing in an anatomical position, point B towards which the strap points is between the elbow and the trunk.

Materially, point B is included in the bar or pulley 9, 26, the strap 7, 27, 27 'is supported there to change direction to join a reel 8, 28 located at the base of the lateral upright 1, 18, 18 '.

This reel comprises a spiral spring and means for more or less banding said spiral spring (not shown in the figures) so to exert a tensile force on the straps (7, 27, 27 '), depending on the mass of the user and / or the therapeutic indication.

This tensile force can also be kept constant during exercise.

Said means for more or less banding said spiral spring may be manual or electric such as an electric motor.

This strap pulling device can be located anywhere on the device as long as it makes it possible to exert, at point A, an upward pulling force in the frontal plane in order to raise the pelvis. The pelvis is lifted bilaterally which allows the device to support part of the subject's body mass.

The other specific characteristic of the device is to ensure the restraint of the subject in the event of a fall. The wearing of the harness and the upward traction of the pelvis already allows a fall to be retained, but only partially, in fact the body can still tilt forwards or backwards around an axis connecting the two points A.

The straps 14, 30, 31 prevent complete tilting by retaining the body back and forth. Indeed, they join the two points B while passing in front and behind the subject at the level of the navel.

The invention is not limited to the examples previously described.

In fact, the horizontal bars 21, 21 ′ may have a shape allowing the user in his wheelchair to take support in order to lift and settle in the device according to the invention. It could be a C-shaped extension.

Claims

claims

1. Rehabilitation device for motor deficiencies comprising rehabilitation means proper, characterized in that it further comprises: - means for maintaining (Ba) of the user, - means for lightening the body weight of the 'user (7, 27, 27') exerting vertical traction, the point of suspension of said lightening means on the user holding means being located at, or even below, the user's center of gravity , - means for preventing the user from falling (14, 16, 17, 21, 21 ', 30, 31).

2. Device according to claim 1, characterized in that said rehabilitation means are a treadmill (2, 22) or a staircase simulator or a cross-country ski simulator.

3. Device according to claim 1, characterized in that said means for holding the user comprise a harness (Ba) comprising a belt element (C), support and leg support straps (S) attached to said element belt (C) and connection means (10, 29) to the lightening means, these means being disconnectable and fixed at the level of the belt element (C).

4. Device according to claim 3, characterized in that said belt element (C) is located at or below the user's center of gravity.

5. Device according to claim 3, characterized in that said connection means (10, 29) of the harness to the lightening means are the number of n distributed on the belt element (C).

6. Device according to claim 3, characterized in that said connection means (10, 29) of the harness to the lightening means are two in number, each being located on one side of the belt element (C).

7. Device according to claim 3, characterized in that said harness connection means are four in number distributed on the sides of the belt element (C) so that two of the means are on one side, l one in front, the other behind the user and that the other two are on the other side, one in front, the other behind the user, their vertical projection in a horizontal plane forming a support polygon.

8. Device according to claim 1, characterized in that said user holding means further comprise support bars (16, 17, 21, 21 ').

9. Device according to claim 8, characterized in that said support bars are adjustable in height and / or in width.

10. Device according to claim 8, characterized in that said support bars are movable.

11. Device according to claim 8, characterized in that said support bars are movable from front to back.

12. Device according to claim 8, characterized in that said support bars bars include means on which the user, from his wheelchair, is supported to lift and settle.

13. Device according to claim 1, characterized in that said means for lightening the user's body weight comprise straps (7, 27, 27 ') driven so as to exert an upward pulling force on the means holding.

14. Device according to one of claims 1 and 13, characterized in that it comprises means for adjusting the tensile force.

15. Device according to claim 14, characterized in that said means for adjusting the traction force are manual or electric such as an electric motor.

16. Device according to claim 13, characterized in that the tensile force is applied by means of a reel (8, 28) around which is wound one of the ends of the straps (7, 27, 27 '), the other end being detachably attached to the user holding means.

17. Device according to one of claims 14 and 16, characterized in that said reel comprises a spiral spring and means for adjusting the tensile force to more or less band said spiral spring.

18. Device according to claim 1, characterized in that said prevention means comprise straps and / or bars in order to prevent any lateral falls (14, 16, 21, 21 ') and / or frontal and / or rear (17 , 30, 31).

19. Device according to claim 1, characterized in that removable marks on the surface of the treadmill give an indication of where to put the foot during walking.