EP1850824B1 - Methodes et appareils de readaptation et d'entrainement - Google Patents

Methodes et appareils de readaptation et d'entrainement Download PDF

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Publication number
EP1850824B1
EP1850824B1 EP06704564.1A EP06704564A EP1850824B1 EP 1850824 B1 EP1850824 B1 EP 1850824B1 EP 06704564 A EP06704564 A EP 06704564A EP 1850824 B1 EP1850824 B1 EP 1850824B1
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EP
European Patent Office
Prior art keywords
optionally
patient
motion
exemplary embodiment
rehabilitation
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Not-in-force
Application number
EP06704564.1A
Other languages
German (de)
English (en)
Other versions
EP1850824A2 (fr
EP1850824A4 (fr
Inventor
Richard M. Mahoney
Ester Zohar
Haim Einav
Omer Einav
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Motorika Ltd
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Motorika Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from PCT/IL2005/000135 external-priority patent/WO2005087307A2/fr
Priority claimed from PCT/IL2005/000138 external-priority patent/WO2005074370A2/fr
Priority claimed from PCT/IL2005/000137 external-priority patent/WO2005086574A2/fr
Priority claimed from PCT/IL2005/000136 external-priority patent/WO2005074369A2/fr
Priority claimed from PCT/IL2005/000140 external-priority patent/WO2005074371A2/fr
Priority claimed from PCT/IL2005/000139 external-priority patent/WO2005075155A2/fr
Priority claimed from PCT/IL2005/000906 external-priority patent/WO2006021952A2/fr
Priority claimed from US11/207,655 external-priority patent/US20060293617A1/en
Application filed by Motorika Ltd filed Critical Motorika Ltd
Publication of EP1850824A2 publication Critical patent/EP1850824A2/fr
Publication of EP1850824A4 publication Critical patent/EP1850824A4/fr
Application granted granted Critical
Publication of EP1850824B1 publication Critical patent/EP1850824B1/fr
Not-in-force legal-status Critical Current
Anticipated expiration legal-status Critical

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
    • A61H1/02—Stretching or bending or torsioning apparatus for exercising
    • A61H1/0274—Stretching or bending or torsioning apparatus for exercising for the upper limbs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
    • A61H1/02—Stretching or bending or torsioning apparatus for exercising
    • A61H1/0237—Stretching or bending or torsioning apparatus for exercising for the lower limbs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5007—Control means thereof computer controlled

Definitions

  • the present invention relates to manipulation of a body, for example for physical rehabilitation and/ or training.
  • Such rehabilitation may include one or both of two elements, a physical rehabilitation portion, in which damaged or unused muscles, nerves and/or joints are brought back to full functioning (to the extent possible) and a cognitive rehabilitation portion, in which the cognitive ability to control the body is restored.
  • a physical rehabilitation portion in which damaged or unused muscles, nerves and/or joints are brought back to full functioning (to the extent possible)
  • a cognitive rehabilitation portion in which the cognitive ability to control the body is restored.
  • the damage to the body and/or brain is such that a patient needs to be trained in modified functionality (e.g., when one limb is made short) or even new functionality, for example, in the use of an artificial limb.
  • Physical therapy is currently provided mainly by personal attention of a physical therapist who monitors and instructs a patient in the performance of certain exercises. Thus, costs for rehabilitation are high and compliance after a patient leaves a treatment center is relatively low.
  • Some home physical therapy devices are known, for example a product called “backlife” provides CPM (Continuous Passive Motion) of the spine.
  • CPM Continuous Passive Motion
  • US patent 5,836,304 describes a cognitive rehabilitation utilizing a remote therapist.
  • WO 92/13504 describes six degree of freedom of movement resistance system.
  • WO 2005/074371 describes a rehabilitation device with a movement mechanism that is capable of interacting with the motion of a patient's limb in at least three degrees of freedom.
  • JP H01 316815A describes a three-dimensional indication device.
  • US patent 6 354 945 describes a controller with a stack portion and an integrally formed spherical portion.
  • a broad aspect of some embodiments of the invention as claimed relates to exercise and/or rehabilitation methods and apparatuses suitable for a wide range of situations, including, temporal, mental, cognitive, motor, location and/or other situations.
  • exercise and/or rehabilitation methods and apparatuses are used by injured, elderly, young, obese and/or other people requiring exercise.
  • exercise methods and apparatuses are used to promote patient "wellness”.
  • Wellness exercise is designed to enhance, or at least maintain, nominal daily activities and/or functions via physical and/or cognitive training. Wellness maybe useful for at risk segments of society, such as the elderly and/or people afflicted with debilitating diseases like Parkinson's and arthritis. It should be understood that, in general, all of the methods and apparatuses described herein are adaptable for providing wellness exercise.
  • An aspect of some embodiments of the invention relates to a rehabilitation and/or exercise apparatus which is provided with a variable resistance system.
  • the apparatus is used to provide wellness exercises to a patient.
  • the apparatus is used at home, in a clinic, in a hospital, at a rehabilitation facility and/or any place where exercise is possible.
  • a single motor is used to prevent and/or modify motion of the apparatus in the x, y and/or z axes using variable resistance.
  • the variable resistance system is manually actuated, for example via a control located on the apparatus.
  • the variable resistance system is automatically actuated, for example for safety considerations.
  • x and y axis motion is prevented by a brake which is advanced into contact with a curved surface underlying the apparatus mechanics.
  • z axis motion is prevented by a brake which is advanced into contact with a rotating disk, which is operatively connected to a z axis moving shaft.
  • at least one brake is tipped with a friction inducing substance, such as rubber.
  • at least one brake is biased to increase variable resistance power.
  • the motor and at least one brake are used to provide frictional force against the patient during exercise.
  • force is applied automatically.
  • force is set manually.
  • force is applied in accordance with patient ability.
  • a spring is provided to the variable resistance system to allow for inaccuracy between the motor and/or drive gears and the brakes.
  • the apparatus is provided with a sensor for detecting direction of motion. In some exemplary embodiments of the invention, when the motion direction detecting sensor senses inappropriate motion a force and/or varied resistance is applied counter to the inappropriate motion.
  • the exercise apparatus is provided with a handle, adapted to be grasped by at least the patient.
  • the exercise apparatus is provided with a display.
  • the display provides information regarding exercise to the patient using the apparatus.
  • An aspect of some embodiments of the invention relates to a rehabilitation and/or exercise apparatus or linked device on which more than one person can participate during exercise.
  • a patient and a therapist participate in an exercise.
  • the patient actively participates in the exercise and the therapist passively participates in the exercise.
  • the therapist actively participates in the exercise and the patient passively participates in the exercise, for example the patient "follows along" to get a feel for the exercise.
  • they both actively participate in the exercise for example the therapist moves one way and the patient moves in the opposite way after the therapist moves.
  • the therapist helps, guides, and/or resists the patient while the patient is performing exercise.
  • the therapist is capable of sensing the nature of the patient's exercise, such as quality and effort, by participating with the patient.
  • the therapist provides safety to the patient by participating during exercise.
  • they both passively participate in the exercise for example if the apparatus is automatically controlled.
  • a family member and/or a friend of the patient and the patient conduct exercises using the apparatus.
  • the apparatus is provided with a multi-user handle.
  • the patient uses one part of the handle and someone else uses another part simultaneously.
  • the apparatus is used without a motor as the non-patient can optionally provide motive force to the exercise.
  • An aspect of some embodiments of the invention relates to a rehabilitation and/or exercise device which guides a patient to perform a motion with a correct spatial trajectory, by the device applying one or more pushing, assisting, reminding, responding and/or resisting forces during a motion (or intent to move) by the patient.
  • the forces are applied by an actuator, for example, a robotic articulated arm or a spherically jointed lever.
  • the applied forces act as a force field, optionally continuous, which impedes and/or guides a patient.
  • orientation trajectories and/or speed trajectories are guided, supported and/or measured.
  • the device supports, for a given volume of space and a range of force strengths, substantially any 3D trajectory within that volume.
  • a device is provided which supports the range of motion of a healthy arm or leg in one, two or three dimensions. In some cases, a partial volume is sufficient, for example, 50% or 30% of such a volume.
  • the device is programmable with various trajectories (paths and/or velocities) and/or forces.
  • the forces at one point in the trajectory can vary responsive to an actual trajectory by the patient, possibly a same trajectory (e.g., at an earlier point thereof) and/or responsive to a rehabilitation plan and/or improvement of the patient.
  • the device learns the patient motion and repeats it with a correction (e.g. a smoothing of trajectory and or speed).
  • the device can learn a motion entered by a physiotherapist and replay it for the patient, with an optional adjustment (e.g. a limb size adjustment).
  • the trajectories and/or forces are defined for one or more points on the body, on same and/or different limb or body part.
  • a point is controlled (and/or measured) with 3, 4, 5 or 6 degrees of freedom.
  • the programming comprises programming an electronic controller. In an exemplary embodiment of the invention, the programming comprises mechanical programming.
  • an aspect of some embodiments of the invention relates to a rehabilitation and/or exercise device adapted for home use.
  • the device is portable in a home, for example, not permanently attached to any surface and/or including wheels.
  • the device is collapsible on a regular basis.
  • the device is light enough to avoid structural overloading of residential floors, for example the device can weigh less than 100 kg, less than 50 kg or less than 25 kg.
  • the device can be folded down to fit in a trunk of a standard sedan-type car, for example having a maximum dimension of less than 120 cm.
  • the device breaks down into parts which are light enough to be carried by a non-handicapped person.
  • the device ensures that a patient is correctly positioned.
  • the patient is notified to correct his position.
  • the device recalibrates itself to take the patient position into account.
  • a device is usable (e.g., by programming, attachments and/or setting) for a plurality of different treatments, for example, a plurality of different body sizes, a plurality of different ages, a plurality of different joints and/or a plurality of different appendages.
  • a rehabilitation device which is portable for various activities, for example, indoors and/or outdoors, such as, cooking, barbequing and eating at a table.
  • An aspect of some embodiments of the invention relates to rehabilitation and/or exercise of daily activities, for example, eating, pouring tea, knocking nails and cooking.
  • a kit including position sensors and/or other sensors is provided to attach to daily objects and track their use and provide feedback and/or instructions for exercise and/or rehabilitation.
  • feedback and/or guidance are provided mechanically by an exercise and/or rehabilitation robot.
  • a daily activities training pedestal includes one or more adjustable work spaces on which daily activities is carried out, for example one surface emulating a table and another emulating a saucer (e.g. for training of tea pouring).
  • wellness exercise comprises the exercise of daily activities.
  • an exercise and/or rehabilitation device is used for a long period of time, for example, months or years.
  • a same device is used both for rehabilitation and for training of a patient in correct motions.
  • an exercise and/or rehabilitation device is used for preventive training, for example, ensuring that a patient with developing arthritis does not start favoring a diseased joint.
  • a rehabilitation device is used to achieve a specific rehabilitation goal, such as rehabilitation of a particular limb.
  • the device is used for non-medical training, for example as a universal gym machine.
  • wellness exercise comprises long term training.
  • An aspect of some embodiments of the invention relates to multi-modal rehabilitation.
  • multiple body systems e.g., motor, visual, auditory, visual-motor
  • skills and/or senses are rehabilitated and/or exercised using a same system, for example, motor control, motor propreception, visual perception and sound generation.
  • coordination between such systems is trained.
  • hand-eye coordination is rehabilitated.
  • hand-leg coordination is rehabilitated.
  • paths of coordination which are damaged are targeted for rehabilitation.
  • the feedback includes feedback on carrying out of daily activities.
  • the feedback includes feedback from a remote therapist or automatic feedback, during an activity.
  • the feedback includes on a quality of the motion carried out by the patient.
  • An aspect of some embodiments of the invention relates to exercise and/or rehabilitation treatment methods.
  • training specifically in daily activities is carried out with the assistance of a rehabilitation and/or exercise device.
  • training to prevent deterioration is provided, for example, to prevent deterioration of Parkinson's disease caused by neglecting of arm/function.
  • training to provide long term improvement is carried out, for example, to provide improvement in cerebral palsy.
  • treatment to prevent disease is carried out, for example, training a patient to not neglect a joint just because it hurts.
  • An aspect of some embodiments of the invention relates to using an exercise and/or rehabilitation device for both rehabilitation and testing, diagnosing and/or monitoring.
  • the device is used to assess the abilities of a patient and then to rehabilitate that patient.
  • the device is used to measure the patient and calibrate future rehabilitation to those measurements.
  • Exemplary measurements include size, strength, range of motion and motion quality, mental state and/or cognitive and/or perceptive abilities.
  • An aspect of some embodiments of the invention relates to an exercise and/or rehabilitation method related to motion quality.
  • a quality of a motion is defined.
  • automated feedback is provided to the patient regarding the quality of his motion.
  • part of rehabilitation and/or training is teaching a patient the quality value for various motions.
  • an exercise and/or rehabilitation device is programmed with a correct movement.
  • a correct motion is programmed into the device by performing the correct motion and then storing the motion in a device-associated memory.
  • the motion is programmed in during a dedicated teaching mode or when the device is off-line. Alternatively, the device learns during usage by a patient.
  • the device is used to teach a patient what correct motion is, for example using template and/or using rules (e.g., a 2/3 power rule for motor control).
  • correctness of motion is evaluated as a parameter of exercise and/or rehabilitation and feedback is provided thereon.
  • An aspect of some embodiments of the invention relates to an exercise and/or rehabilitation device for daily activities, in which the exercise and/or rehabilitation device is configured to train and/or test patients in the carrying out of daily activities, for example in a wellness exercise plan.
  • the exercise and/or rehabilitation device can be used in proximity to real-life settings, such as a table or a counter.
  • An aspect of some embodiments of the invention relates to positioning of an exercise and/or rehabilitation device including a motion mechanism.
  • a motion mechanism has a limited range of motion and/or accuracy.
  • the rehabilitation device is optionally positioned to make maximum usage of this range of motion, e.g., by matching to a specific exercise.
  • the exercise and/or rehabilitation device includes a positioning element, for example a rail and/or one or more joints that can be used to fix the motion mechanism at a desired position and/or orientation.
  • the positioning element is motorized, for example, to allow automatic or non-manual motion of the motion mechanism.
  • an exercise and/or rehabilitation device allows simultaneous or parallel motion of two limbs, one damaged and one not, and uses the correct motion of an undamaged limb as a basis for force field definition for the damaged limb.
  • sequential motion by undamaged and then damaged limbs is provided.
  • the undamaged motion is modified, for example reduced in force, speed or range of motion.
  • the motion is mirror motion or synchronized motion (e.g., arm and leg during swimming).
  • a device which can hold two limbs is used.
  • the motion of the two limbs is linked.
  • An aspect of some embodiments of the invention relates to a multi-point exercise and/or rehabilitation device in which the exercise and/or rehabilitation device is attached to a human body at multiple points which can move relative to each other, which motion is part of exercise and/or rehabilitation.
  • the exercise and/or rehabilitation device attaches to two limbs, for example an arm and a leg or two arms.
  • the exercise and/or rehabilitation device separately allows motion in 3D space of two bones on either side of a joint.
  • the device mechanically limits motion for one or more of the points.
  • one or more of the points are tracked (in one or more dimensions) but their motion is not mechanically limited in some or any directions.
  • the exercise and/or rehabilitation device supports complex motion in which different parts of the body are called upon to carry out certain motions, for example, shoulder motion and wrist motion.
  • the device comprises an arm mounted on a joint, with a body attachment point, for attachment to or holding by a patient, mounted on the arm.
  • the joint acts as a spherical joint, allowing movement of the arm along substantially any path on the surface of a sphere, within a range of angles, for example, ⁇ 90 degrees relative to the center of the joint, in either of phi and theta directions (e.g., in spherical coordinates).
  • the center of rotation for such motions is substantially a same center of rotation for all the paths.
  • the joint and/or the arm as a whole lack singularity points in the range of motion.
  • the resistance to motion of the joint is substantially uniform, substantially independently of the spherical motion.
  • the spherical joint comprises a ball in socket joint, with the arm attached to the ball or to the socket.
  • the other one of the ball or socket is optionally attached to a base, for example, a base which stands on a floor or is attached to a wall or a ceiling.
  • the device includes a weight attached to said ball opposite of said arm and serving to balance the motion of said arm.
  • the motion of the arm is substantially balanced over the entire range of motion thereof.
  • the balancing includes prevention of a resting torque.
  • balancing includes correction for an existing moment of inertia or an expected moment of inertia during use.
  • the device is configured to include a resting force which tends to stabilize or destabilize the device, depending on the embodiment.
  • one or more guiding plates are provided.
  • a pin attached to the ball, optionally part of the weight is constrained to travel within a slot (e.g., a rectangle or other shape) defined in a guide plate.
  • the slot is elastic.
  • one or more motors are provided to rotate the ball and/or apply force in a desired direction.
  • one or more directional brakes are provided to selectively stop motion of the ball in a desired direction.
  • one or more uni-directional brakes are provided to selectively stop motion of the ball in any direction.
  • two or more joints having a shared center of rotation are provided instead of a ball, for example a universal joint.
  • the arm is extendible along its axis.
  • a motor is provided for selectively moving or apply force to resist motion of the extension along the axis.
  • one or more brakes are provided to selectively resist motion of said extension along said axis.
  • the extension is balanced, so that it has no self motion.
  • the extension even when extended to various extents does not affect a balance of said arm.
  • a rehabilitation device is positionable at various orientations.
  • the device includes a joint between its base and an articulating portion thereof.
  • An aspect of some embodiments of the invention relates to a ball joint with selective locking.
  • a chuck is provided to selectively lock rotation of the ball joint.
  • a plurality of directional brakes are provided.
  • one or more sensors generates an indication of a direction of force application and a controller selects which directional and/or uni-directional brakes to release responsive to the force direction.
  • An aspect of some embodiments of the invention relates to a telescoping element, optionally used as part of an exercise and/or rehabilitation device.
  • a telescoping element optionally used as part of an exercise and/or rehabilitation device.
  • at least three portions are provided, two ends and a center, with extension or retraction forces being applied to the central portion.
  • the central portion is attached to the two end portions using a rack and pinion (one rack on each end portion and the two pinions at either end of the central portion.
  • a belt interconnects the two pinions so that they move in concert.
  • An aspect of some embodiments of the invention relates to a force-feedback control mechanism including a spring. Changes in compliance are provided by changing an effective length of the spring.
  • the spring is a flat spiral spring and the compliance is in a direction perpendicular to the plane of the spring.
  • An aspect of some embodiments of the invention relates to a force control mechanism for a human-movable element.
  • a spring is provided to counteract force applied by a human.
  • the degree of force is adjustable, optionally by preloading the spring (or other resilient element).
  • the human movable element is also moved by a motor and said compliance is optionally provided to said human motion.
  • a damping element for example viscous cushioning, is provided.
  • the resilient element is configurable, optionally on the fly, to provide a desired degree of resistance to the movement.
  • the resilient means is re-adjusted to follow actual motion of the element.
  • the motor moves the handle using one joint and a second joint is used for the force compliance.
  • the force compliance is provided by one resilient element to a plurality of axes simultaneously, substantially without coupling between the axes.
  • movement of the element in spherical rotation axially compresses a resilient element which then provides compliance.
  • power is provided to the element using a gear system which cannot be back-driven.
  • gear system which cannot be back-driven.
  • back-driving is detected, it is mechanically shunted to a resilient element, which provides compliance.
  • a mechanical diode design in which a motion is imparted to a lever using a gear and in which the lever cannot move the gear.
  • the diode comprises a gear or lever engaging a worm gear with a low enough lead angle (i.e., not back driven) a motor turns the worm gear, thereby moving the gear and/or a lever attached thereto. Due to the low lead angle, when the gear rotates, the worm gear moves axially rather than rotates.
  • the worm gear sits on springs or another elastic element which provide a degree of resiliency to motion of the gear.
  • the springs are pre-stressed to a desired amount.
  • the worm gear is rotated to follow motion of the lever and maintain a desired tension and/or symmetry in the elastic element(s).
  • An aspect of some embodiments of the invention relates to a manual manipulator which moves or controls movement of a human body using at least one wire and optionally one or more robotic elements, so that motion in 3D of at least one point of the body is constrained by the manipulator.
  • the manipulator is configured for use as an exercise and/or rehabilitation device.
  • one or more motors are provided to move the at least one point.
  • one or more resilient elements are provided to allow some slack with resiliency to be provided in one or more wires.
  • three wires are provided to constrain 3D motion.
  • An aspect of some embodiments of the invention relates to patient positioning in an exercise and/or rehabilitation system.
  • the system determines patient position using an imaging system.
  • a location of a chair or other support for the patient, relative to the system is determined.
  • a spring-loaded wire system is used to measure the relative positions.
  • a pressure sensitive mat is used.
  • the patient is instructed to perform one or more motions and the relative positions are determined from the trajectories of the motions.
  • position is determined in 2D, rather than in 3D.
  • 3D position and/or orientation information is determined.
  • a moving part of the system itself or a light pointer portion of the system are used to mark and/or note a correct positioning.
  • one or more exercises are modified to take into account the relative positions.
  • the exercise and/or rehabilitation device includes one or more mechanical fuses which selectively tear when shear, strain and/or torque on a replaceable element (such as a pin) increase above a threshold.
  • a replaceable element such as a pin
  • an adjustable magnetic pin may be used, in which two parts of a pin attach to each other based on magnetic attraction. The attraction level is optionally set by moving a magnet inside one of the parts of the pin. Torque is optionally detected by providing a serrated connection between the pin parts which links relative rotation of the pin parts and separation of the parts.
  • a wire is provided in the pin so that tearing of the wire can be detected by the device electrically.
  • a dead-man switch for a patient in which if a patient lets go of the switch, the device stops or goes into a predefined or dynamically determined safe mode and/or position.
  • the dead-man switch is on a wireless element held by a good limb or body part, for example, being stepped on, held by hand or held in a mouth.
  • a voice activated shut-off is provided, for example to allow a patient to stop the rehabilitation by shouting.
  • the exercise and/or rehabilitation device analyses motions and/or forces applied by the patient, to detect problems. For example, any gross irregularities will cause the rehabilitation device to stop.
  • the device includes at least one moving element which includes resiliency when moving so that there is slack, with increasing resistance as amount of slack used increases.
  • the slack serves to allow a user to not perform a motion according to the movement of the element, while providing sufficient time to detect that the motion is incorrect and that applied forces are reaching a safety limit.
  • An aspect of some exemplary embodiments of the invention relates to determining patient exercise capability.
  • patient exercise capability is determined in relation to an exercise performance prediction.
  • predicted exercise performance includes movement trajectory, a target destination of movement, movement velocity, movement acceleration, and/or other exercise performance related measurables.
  • patient performance is measured using the sensor and/or feedback apparatuses and methods described herein.
  • predicted patient performance is compared to previously recorded and/or analyzed patient performance.
  • the comparison is used to gauge various aspects of the patient's exercise and/or rehabilitation.
  • a performance prediction is derived from data collected from other sources besides the patient; for example, data collected from other patients.
  • exercise is presented to the patient in the form of a game, such as those described herein.
  • a range of treatment lengths are supported, including for example, goal oriented treatment, short term treatment, long term treatment and/or preventive activities.
  • treatment over multiple stages in rehabilitation, possibly an entire rehabilitation process are supported, in some cases with a same device.
  • multiple body parts may be exercised and/or rehabilitated, either simultaneously or separately, in some cases, with a same device.
  • multiple modalities are rehabilitated, either together or using a same device, for example, motor control, motor feedback, vision, audio ability and/or speech.
  • a range of complexities and hierarchies of motion are supported by some embodiments, for example, simple motion of one joint and complex planning of multi-limb motion.
  • Multiple treatment locations are supported by some embodiments of the invention, for example, ICU, bed, clinic, home and/or outdoor,
  • Multiple activity types are supported in some embodiments of the invention, for example, dedicated rehabilitation exercises, training exercises, daily activities, outdoor activities and/or diagnosis activities.
  • multiple body positions are supported, for example, lying down, standing and/or sitting.
  • a range of mental, cognitive and/or motor ability states are supported. It should be noted that not all the embodiments of the invention support all the various ranges and the extents of the ranges described above.
  • an exercise and/or rehabilitation apparatus with at least three degrees of freedom of motion, comprising: a plurality of brakes; a motor, wherein the motor is operationally connected to the brakes; a plurality of surfaces, wherein each of a plurality of the surfaces correlates to a brake; and, wherein when the motor is activated, the brakes are selectively advanced to make contact with the surfaces causing friction between the brakes and the surfaces and thus causing variable resistance in the three degrees of freedom to the apparatus based on the extent of advancement of the brakes.
  • variable resistance on a first surface causes variable resistance on at least one axis.
  • variable resistance is provided by a magnetic force applied between at least one brake and at least one corresponding surface.
  • variable resistance on a second surface causes variable resistance on at least a second axis.
  • the apparatus further comprises a handle adapted to be grasped by at least one user.
  • the apparatus further comprises at least one pedal adapted and constructed to be operated by a foot.
  • the motor is activated manually by a patient using the apparatus.
  • the motor is activated automatically.
  • the first surface is a curved surface.
  • the second surface is a rotating disk which is operatively connected to a z axis moving shaft.
  • At least one brake is tipped with a friction inducing substance.
  • the friction inducing substance is rubber.
  • at least one brake is biased to provide additional variable resistance power.
  • the motor and at least one brake are used to provide frictional force against a patient during exercise.
  • the frictional force is applied in accordance with patient ability.
  • the apparatus further comprises a spring to compensate for inaccuracy between the motor and at least one of the brakes.
  • the apparatus further comprises a display.
  • the apparatus further comprises a controller in operative communication with the motor and programmed with software to provide exercise for a user of the apparatus.
  • the controller is programmed with at least one wellness exercise.
  • the controller is programmed with software to predict exercise performance of the user.
  • an apparatus with at least three degrees of freedom of motion comprising: a handle adapted and constructed to be used simultaneously by a plurality of users during an exercise; a motorized actuator adapted to support a movement by the plurality of users via the handle by at least one of resisting motion, guiding motion and causing motion; a controller configured to control the actuator; and, wherein, the controller is programmed to provide exercising for at least one of the plurality of users in at least one of the at least three degrees of freedom.
  • the user is a patient.
  • the user is a therapist.
  • the user is a family member of a patient.
  • the user is a friend of the patient.
  • the user actively participates in the exercise and a user passively participates in the exercise.
  • the users actively participate in the exercise.
  • the users passively participate in the exercise.
  • the user provides motive force for the exercise.
  • the user is elderly.
  • the controller is programmed to provide at least one wellness exercise.
  • the controller is programmed to predict the exercise performance of at least one of the plurality of users.
  • the apparatus further comprises a display.
  • a method of exercising a patient using an apparatus provided with at least three degrees of freedom comprising: commencing patient exercise on the apparatus; activating a motor located on the apparatus, wherein the motor is operatively connected to a plurality of brakes, each brake associated with a surface and at least one the degree of freedom; selectively advancing at least one brake using the motor to create friction between the brake and the surface and to resist movement in at least one degree of freedom.
  • advancing at least one brake is based on patient ability.
  • advancing at least one brake is based on a predetermined exercise program.
  • advancing at least one brake is based on measured patient performance.
  • the patient is elderly.
  • the patient exercise is a wellness exercise.
  • a method of determining patient exercise capability comprising: collecting performance data pertaining to an exercise; predicting a patient's exercise performance based on the collected performance data; comparing the patient's actual performance with the predicted performance; and, classifying the patient's exercise capability pursuant to the comparing.
  • the predicting is performed by a controller programmed with software to predict the patient's exercise performance.
  • the comparing is performed by a controller programmed with software to compare the patient's predicted exercise performance with the actual exercise performance.
  • the classifying is performed by a controller programmed with software to classify the patient's exercise performance.
  • the performance data is collected from a single patient.
  • the performance data is collected from a plurality of patients.
  • the patient is presented with an exercise in the form of a game.
  • parameters of the game are modified in response to preferences indicated by a professional exercise attendant.
  • the comparison is conducted using a least squares method.
  • the classifying is used to determine what exercise plan will be provided to the patient.
  • an exercise and/or rehabilitation apparatus with at least three degrees of freedom of motion, comprising: a handle adapted and constructed to be used simultaneously by a plurality of users during an exercise; a motorized actuator adapted to support a movement by the plurality of users via the handle by at least one of resisting motion, guiding motion and causing motion; a controller configured to control the actuator; and, wherein, the controller is programmed to provide rehabilitation exercising for at least one of the plurality of users in at least one of the at least three degrees of freedom.
  • a user is a patient.
  • a user is a therapist.
  • a user is a family member of a patient.
  • a user is a friend of the patient.
  • a user actively participates in the rehabilitation exercise and a user passively participates in the rehabilitation exercise.
  • the users actively participate in the rehabilitation exercise.
  • the users passively participate in the rehabilitation exercise.
  • a user provides motive force for the exercise.
  • a method of rehabilitating a patient using an apparatus provided with at least three degrees of freedom comprising: commencing patient exercise on the apparatus; activating a motor located on the apparatus, wherein the motor is operatively connected to a plurality of brakes, each brake associated with a surface and at least one degree of freedom; selectively advancing at least one brake using the motor to create friction between the brake and the surface and to resist movement in at least one degree of freedom.
  • advancing at least one brake is based on patient ability.
  • advancing at least one brake is based on a predetermined exercise program.
  • advancing at least one brake is based on measured patient performance.
  • a method of rehabilitation using an actuator type that includes a movement mechanism capable of applying a force that interacts with a motion of a patient's limb in a volume of at least 30 cm in diameter, in at least three degrees of freedom of motion of the actuator and capable of preventing substantial motion in any point in any direction in said volume, comprising:
  • said first and said second exercising are performed using a same rehabilitation apparatus.
  • said motion mechanism is motorized.
  • said motion and said force are controlled by a controller.
  • said motion mechanism is capable of applying a force of at least 10 Kg to a tip of said actuator.
  • said motion mechanism is capable of applying a force of different magnitudes in different directions of motion said actuator.
  • said motion mechanism is adapted to apply selective resistance to motion of said actuator.
  • said actuator is adapted to interact with said motion in a plurality of modes including at least causing said motion, guiding said motion and recoding said motion.
  • said first and said second exercising use different motion interaction modes.
  • At least one of said first and said second exercising are performed in water.
  • said first and said second exercising are performed on a same limb.
  • said first and said second exercising are different exercises.
  • the method comprises keeping track of progress of said patient including said first and said second exercising, in a same controller coupled with said second actuator.
  • said actuator is rigid.
  • a method of rehabilitation using an actuator that includes a movement mechanism capable of applying a force that interacts with a motion of a patient's limb in a volume of at least 30 cm in diameter, in at least three degrees of freedom of motion of the actuator and capable of preventing substantial motion in any point in any direction in said volume, comprising:
  • the method comprises replacing an attachment to said patient of said rehabilitation device between said exercising.
  • the actuator comprises a controller which controls said interaction.
  • said controller is programmed with a plurality of different exercises for different limbs
  • the method comprises adjusting at least one of a spatial position and orientation of said actuator relative to said patient, between said exercises.
  • a rehabilitation kit comprising:
  • At least one of said attachments is powered via said actuator.
  • at least one of said attachments is capable of rotation in three axes of rotations.
  • a device for rehabilitation comprising:
  • said controller is configured to provide instructions in a selectable one of at least three information presentation modes and complexity levels.
  • said controller is configured to provide support for motor activity of said patient in a selectable one of at least three levels of assistance.
  • said controller is configured to provide incentive feedback to said patient in a selectable one of at least three levels of incentive.
  • said motion mechanism has different motion limitations in different spatial direction and wherein said multiple relative placements include changing an orientation of said mechanism.
  • said joint comprises a linear joint.
  • said joint comprises a swiveling joint.
  • said frame is curved.
  • said joint is motorized.
  • the device comprises a controller that controls said joint according to an exercise stored in said controller to be performed.
  • the device comprises at least one sensor that reports a position of said joint.
  • a method of setting up a rehabilitation system including an actuator that includes a movement mechanism capable of applying a force that interacts with a motion of a patient's limb in a volume of at least 30 cm in diameter, in at least three degrees of freedom of motion of the actuator and capable of preventing substantial motion in any point in any direction in said volume, comprising:
  • the method comprises automatically adjusting said position.
  • the method comprises automatically reporting to a user said desired position.
  • a rehabilitation device comprising:
  • said radial extension is balanced such that said point remains stable if no force is applied and moves if force is applied by said person.
  • said balancing can be varied to match a weight of an attachment selectively attached to said extension.
  • said balancing can be varied by said controller along a path of motion to match a change in moment on said point.
  • said balancing can be set to provide a neutral buoyancy to said limb.
  • said joint is a ball joint.
  • said joint comprises two orthogonal hinges with a common center of rotation.
  • said controller comprises a mechanical controller.
  • said controller comprises an electrical controller.
  • the device comprises at least one brake adapted to selectively resist said freedom motion.
  • said brake is continuously controlled by said controller.
  • said brake is uni-directional in only one of said Phi and Theta directions.
  • said brake is operative in both said Phi and said Theta directions.
  • the device comprises at least one motor adapted to move said joint.
  • said motor is adapted to apply at least 10 Kg of force at said point.
  • said motor is continuously controlled by said controller.
  • said motor cannot be back-driven by said extension.
  • the device comprises at least one resilient element adapted to provide resilient compliance when said person moves said point in a trajectory other than a trajectory for which motion is controlled to move by said controller.
  • said controller sets a degree of said resilient compliance.
  • said element is extendible.
  • element includes a conduit for electrical power.
  • the device comprises at least one position sensor which reports on a angular position of said joint.
  • the device comprises at least one force sensor which reports on a force applied to said joint.
  • said controller is configured to control said motion and provide at least one of assisting motion by said patient limb, resisting motion by said patient limb, guiding motion by said patient limb, nudging said patient limb to move and moving said patient limb.
  • said controllers stores thereon a plurality of different rehabilitation exercises.
  • a balanced rehabilitation device comprising an actuator that includes a movement mechanism capable of applying a force that interacts with a motion of a patient's limb in a volume of at least 30 cm in diameter, in at least three degrees of freedom of motion of the actuator and capable of preventing substantial motion in any point in any direction in said volume; and at least one weight that balances said actuator such that no force is required to maintain said actuator in space.
  • said compliance is provided by variable resistance and/or braking.
  • said compliance is provided by at least one resilient element.
  • the method comprises tracking said motion of the patient with said compliance.
  • a different force of resistance is provided at different points in space along the motion.
  • a different force of resistance is provided at different direction at a same point in space.
  • said compliance is at least 1 cm.
  • said spring provides said resilience only when said lever is moved different from motion caused by the motor.
  • attempted back-driving of said motor applies force to said spring.
  • said spring has a controllable pre-load.
  • the device comprises a damping element in parallel with said spring.
  • said spring is mounted on said slot.
  • a multi-axis resilient element for rehabilitation comprising:
  • said resilient element has a settable pre-load.
  • said compliance is set by a controller.
  • said setting is continuous.
  • said spring is a flat spring having a settable effective length.
  • said device is taken apart for said second configuration.
  • said device comprises at least one quick-connection.
  • said device folds down.
  • said device folds flat to fit in a car trunk.
  • said device weighs less than 30 Kg.
  • said device is wheeled
  • a rehabilitation device comprising:
  • said element comprises a tearing pin.
  • said element comprises a separable joint.
  • said element is connected between a body of said lever and an attachment mounted on said lever.
  • a rehabilitation device comprising:
  • said device comprises an actuator that includes a movement mechanism capable of applying a force to said lever which lever interacts with a motion of a patient's limb in a volume of at least 30 cm in diameter, in at least three degrees of freedom of motion of the lever.
  • said controller identifies said safety problem by detecting a shout by said patient.
  • said controller identifies said safety problem by calculating at least one position of a point of the body of said patient and comparing the result of the calculation to one or more allowed value.
  • said port is adapted to engage a wheelchair.
  • said port is adapted to engage a bed.
  • said station is mobile.
  • said station includes at least one port for attachment of a second actuator thereto.
  • a rehabilitation device comprising:
  • the device comprises a distance sensor for determining said relative positions.
  • the device comprises an imaging sensor for determining said relative positions.
  • said controller relates to the relative placement of said patient and said actuator.
  • said controller assumes the relative positions differ only in two dimensions.
  • the device comprises a pointer which indicates a desired patient placement
  • said controller is configured to use said actuator to determine said relative placement.
  • said controller is configured to use said actuator to indicate a desired relative placement.
  • said controller is configured to adjust said exercise on the fly, during an exercise session and in response to patient movement.
  • a rehabilitation device comprising:
  • a rehabilitation device comprising:
  • the controller modifies a selection of future exercises according to a measured quality of motion.
  • the controller modifies a selection of parameters for future exercises according to a measured quality of motion.
  • the quality of motion measure used is defined as the degree of matching to a 2/3 power law.
  • the methods and apparatus of some embodiments of the invention provide for controlled, partially controlled or directed motion of portions of the body.
  • the following sections describe this equipment by first describing the design of an exemplary device (an articulated arm), followed by various rehabilitation methods and then additional rehabilitation device designs and uses.
  • the invention should not be considered as being limited to particular devices used to illustrate particular methods. Rather, many of the methods can be practiced with a variety of devices and many of the devices can be used to practice a variety of methods.
  • the exemplary methods and apparatuses described herein are designed to work across all points of care and provide a method for standardizing the treatment that people receive at each point of care. Presently, a person starts all over every time they go from one location to the next. In an exemplary embodiment of the invention, restarting is avoided because a person's progress is optionally tracked in detail throughout the whole continuum of care.
  • Fig. 1 is a schematic showing of an articulated-arm based rehabilitation device 100, in accordance with an exemplary embodiment of the invention.
  • device 100 is referred to even though other devices described herein would suit just as well.
  • system is used in some places instead of referring directly to device 100 and may also include multiple devices and monitors.
  • Device 100 comprises an articulated arm 102 that projects upwards out of a table or other pedestal 104.
  • a tip 108 of arm 102 serves as a controlled point which can travel various 3D trajectories.
  • pedestal 104 is not attached to a floor but is instead weighted by an optionally weighted base 106 (which may be located elsewhere than shown), to prevent tipping or capsizing of device 100 during use.
  • base 106 includes electronics used to power the arm.
  • weight 106 is a temporary weight, for example a water-filled bladder.
  • Other exemplary general layouts are shown below.
  • arm 102 is an articulated arm, which supports movement in 3D space.
  • Alternative designs for example based on a single joint and an extending arm, are described below.
  • arm 102 comprises a plurality of sections 1.10 interconnected by a plurality of joints 112.
  • each joint is motorized, for example as known in the art of robotic arms.
  • each joint is selectively lockable, for example as described below.
  • angular position sensors are provided at each joint and/or a position sensor at tip 108, so the position in space of arm 102 and/or of tip 108 can be determined.
  • the joints may be joints with one, two, three or more degrees of freedom.
  • arm 102 (e.g., its locking and/or force application and/or movement) is controlled by a controller 114, for example a personal computer or a dedicated embedded computer.
  • a controller 114 for example a personal computer or a dedicated embedded computer.
  • a display 116 and/or a user input device 118 are used for interaction with a user.
  • display 116 comprises (or is limited to) an audio display, for example for providing audible and/or speech instruction and/or feedback.
  • controller 114 is programmed with software designed to control device 100.
  • a software programmed controller is used in combination with any of the devices described herein.
  • An external connection 120 for connection to a remote computer and/or other units, is optionally provided, for example for use as described in Fig. 2 below.
  • device 100 includes no computer. Some implementations require no electrical power.
  • a mechanical computer is used to control the device parameters.
  • resistance to motion is provided using a brake system.
  • various exercise and/or rehabilitation methods in accordance with exemplary embodiments of the invention require different types of motion and/or responsiveness from arm 102 or other devices as described below.
  • the use of device 100 for exercise and/or rehabilitation places certain constraints on device 100, with respect to, for example, smoothness of motion, responsiveness, coupling between axes, balancing and/or supported range of motion.
  • some types of exercise and/or rehabilitation in accordance with exemplary embodiments of the invention require a patient to move tip 108 along a trajectory. Resistance may be predefined along the trajectory or possibly no resistance at all is provided. In any case, it may be desirable that device 100 not adversely affect motions by the patient, at least if they are correct. In a particular example, tip 108 provides no resistance to motion along a certain trajectory and strongly resists motion not along the certain trajectory. Such a tip is termed a neutral directed motion tip.
  • arm 102 is optionally required to not have singularity points in a predefined and useful range of motion, for example a sphere of radius of 0.8 meters or less, for example, 0.5 meters or less.
  • singularity is used to define a point and arm position where moving to an adjacent point passes the limits of one or more joints and requires a relatively large change in joints position, which is generally time consuming and is exhibited to a patient as a sudden resistance or delay.
  • providing neutral motion means that a uniform (and desirably zero) resistance can be provided at any point in a desired range of motion.
  • arm 102 provides a counter-force or even provides motion. Uniformity and controllability of such force is required in some embodiments of the invention.
  • tip 108 is configured to support a limb of a patient, so that the limb feels buoyant.
  • arm 102 can apply and/or resist depend on the rehabilitation methods with which it is to be used. For example, one rehabilitation type will require arm 102 to resist absolutely an incorrect motion, up to a force of, for example, 100 Kg applied at tip 108. In another example, it is sufficient that arm 102 resists motion up to a force level at which it is certain that the patient feels the resistance, for example, 1 Kg. A reminding force may be useful in some embodiments, for example, 10 Kg, which may ensure that a patient does not inadvertently move tip 108 against the force.
  • the range of motion of tip 108 covers a volume of 50x50x50 cm. In other embodiments, a smaller or larger volume is provided. The volume need not be rectangular. Optionally, the volume also includes rotation of tip 108 around one, two or three axes. In some embodiments, the volume of movement of the tip is one or two dimensional (i.e., in a plane or along a line).
  • arm 102 is expected to respond to a patient's activity in a manner which will seem natural or at least not interfere with the rehabilitation motion.
  • the responsiveness of arm 102 is faster than 10 ms or better than 5 ms.
  • a general property of many mechanical systems is that due to manufacturing tolerances, sensing tolerances, design and/or non-optimality of the construction some uncontrollable freedom of motion is available.
  • the amount of uncontrolled motion in device 100 is less than 5 mm or less than 2 mm.
  • a spring-loaded mechanism is used to prevent unrestrained backlash motion.
  • controller 114 controls arm 102 in a passive, active or a responsive manner to achieve these objectives.
  • active control of arm 102 results in compensation for at least 80% or more of the moment of inertia of arm 102. It should be noted that different values may be required for different situations, for example a greater or lesser responsiveness or a greater or lesser uncontrollable freedom.
  • Arm 102 is, for example, 1 meter, 0.8 meters, 0.5 meters, 0.3 meters or any greater smaller or intermediate length.
  • the motion which is controlled is that of a single point, i.e., tip 108.
  • tip 108 may be connected, for example to a bone, to a joint or to a different part of the body.
  • the attachment may be rigid, for example using a strap or it may depend on cooperation of or action by the patient, for example, as a handle or a rest.
  • Specific attachment devices for example for a hand, arm, elbow, knee, ankle and/or shoulder may be provided.
  • multiple tips 108 (optionally with individual arms 102) may be provided for attachment at different points of the body, on a same or different body part.
  • exercise and/or rehabilitation device 100 can provide one or more of Isokinetic, Isotonic and Isostatic exercises.
  • one, some or all of the above types of motion are used to provide wellness exercise to a patient.
  • a definition of a trajectory which tip 108 is to follow can include speed parameters (e.g., trajectory of path, trajectory of velocity, trajectory of force).
  • speed parameters e.g., trajectory of path, trajectory of velocity, trajectory of force.
  • a user may be assisted, or urged, or expected, to move tip 108 at a certain speed.
  • the speed may be, for example, absolute, or relative (e.g., requiring a uniform speed or the speed to match a non-uniform profile).
  • an angular trajectory is defined, which places constraints on an angular orientation of tip 108.
  • the constraint is one dimensional. In others it is two or three dimensional.
  • Speed, angles and spatial trajectories in a particular rehabilitation scenario may each belong to a different one of the above motion types.
  • spatial trajectory may be of a force field type, while speed trajectory is free or assisted.
  • the type of trajectory and/or its parameters may also vary along the trajectory, as a function of time and/or as a function of previous performance. For example, a smaller assistance at a later part of a trajectory may be provided for a type of motion which was properly (or better than expected) executed in an earlier part of the trajectory.
  • Trajectories may be absolute, for example, defined as a function of a resting point or a different point on device 100.
  • the trajectories are purely relative, for example, requiring a patient to move an arm in a straight line, regardless of starting point.
  • a trajectory is partially relative, in that once motion starts, this determines the shape of the rest of the trajectory, for example, a start of a trajectory indicating if a patient is standing or sitting, and thus what type of hand motion is expected.
  • the motion types of each point may be of different types.
  • what is defined is a trajectory as a function of two or more points in space. For example, if two points are used to define an elbow configuration (e.g., angle between bones), the trajectory constraints may be defined on the motion of the elbow. Such motion may be relative in space (e.g., a comparison of the two points) and not absolute (e.g., compared to a device reference point).
  • different limitations are provided for different points, for example, angular limitations at one point and velocity limitations of another.
  • a tensor or tensor field is provided, as each point in space can have associated with it a speed, a force and/or a rotation, all of which can be scalar or a vector.
  • different modes are defined for different parts of a trajectory or for different parts of space (e.g., for a particular arm).
  • a mode may be triggered based on the actual performance. For example, if motion velocity is below a certain threshold, a more assistive mode is provided. Similarly, a pause of over a threshold may imply a more assistive mode. An exact motion may imply a less assistive mode.
  • modes may be changed automatically, for example, when nearing a patient motor limit (e.g., range of motion) or when nearing a cognitive limit (e.g., spatial neglecting zone or time neglect zone such as for long motions).
  • a patient motor limit e.g., range of motion
  • a cognitive limit e.g., spatial neglecting zone or time neglect zone such as for long motions.
  • Fig. 4A is a flowchart 400 of a method of using device 100, in accordance with an exemplary embodiment of the invention.
  • device 100 is powered on (for electrical devices).
  • device 100 turns on when arm 102 is touched or moved a certain amount.
  • motion of arm 102 may provide power for device 100.
  • device 100 optionally downloads instructions, for example what activities to suggest and/or what progress was expected and/or results from physical therapy at other locations.
  • a patient identifies himself to device 100, for example, using a code, selecting a name form a list or using a smart card or a magnetic card with user input 118.
  • rehabilitation information of a patient is stored or indexed on such a magnetic card or smart card or on a portable flash memory device or portable hard disk.
  • an activity to be performed is selected.
  • the selection may be, for example automatic or by a patient from a displayed list of options.
  • a patient may follow a chart provided to him by a rehabilitation center or by a guiding therapist.
  • arm 102 is optionally moved to a start position thereof, for example by device 100 or by the patient (e.g., directly or by permitting device 100 to do so). It should be noted that in some trajectories no start position is predefined. Instead, the actual starting position is used to define the rest of the trajectory.
  • the position of the patient relative to the system is indicated or measured (e.g. by vision system, by mechanical attachments) and the program is adjusted accordingly.
  • device 100 is adjusted in another manner.
  • a particular handle may be attached at tip 108, or legs of the device may be raised or lowered.
  • the device may be set up.
  • such setting up is carried out before activating device 100.
  • an optional warm-up session is carried out on the patient, to ensure that he is ready for the activity.
  • one or more physiological sensors for example a muscle temperature sensor (e.g., skin surface) are used to ensure (e.g., as a safety feature) that the patient is sufficiently warmed up.
  • the patient is optionally tested to confirm an expected current ability.
  • the results of the test are optionally used to modify one or more parameters of the selected activity or to select a different activity, for example, due to an under- or over-achievement of the patient during testing.
  • exemplary modifications include: slowing down expected speed, reducing expected or resistive force, reducing expected or allowed range of motion and reducing number of repetitions.
  • the activity is carried out, for example, continuous passive motion at 20 repetitions or motion (by patient) with resistance of 0.5 Kg, along the entire trajectory.
  • the resistance grows as a function of speed, or if the speed is higher or lower than a defined speed trajectory, optionally using a mode or combination of modes as described above.
  • various measurements which are optionally made during the activity are optionally logged. Such logging may also be carried out concurrently with the activity.
  • feedback may be provided based on the activity, for example, to the patient, a rehabilitation expert and/or to device 100.
  • feedback is provided on a patient physiological condition as well, for example, determining fatigue based on increased irregularities of motion and/or based on pulse rate or other physiological parameters.
  • a decision is optionally made to repeat an activity and/or to select a new activity. Such a decision may be made, for example, based on patient progress and/or fatigue.
  • device 100 automatically generates CPT codes or other reports used for billing.
  • a report is generated which a human therapist approves and/or modifies.
  • the patient's progress is used to assess future expected payments and/or exercises and/or suggested human guidance.
  • future factors, patient improvement, time elapsed and/or motivation of the patient in using and improving using the system are used to decide on future financial support by a health care provider.
  • billing for use of exercise and/or rehabilitation apparatuses and/or systems described herein is based on a per exercise and/or a timed basis.
  • billing is based on the measured effort of a patient.
  • a decision can be made to stop the financial support.
  • the treatment support can be extended.
  • the therapy payer may insist on minimum system usage (for example if a system was delivered to the patient home). By reviewing an on going usage report (possibly on line) the payer can decide to extend or stop usage.
  • the system can simply generate codes and/or reports, for example using a look-up table (each exercise can have an associated code) using table and also automatically generate reports regarding other factors, such as motivation and completion of plan.
  • Fig. 4B is a flowchart 430 of a long term use of device 100, in accordance with an exemplary embodiment of the invention.
  • a new patient who is identified as needing rehabilitation and/or wellness exercise is tested, possibly using device 100.
  • tests may include range of motion tests, tests of maximum applied force at different points in space, and/or tests of fineness of force control and motion control.
  • device 100 calculates limb size (or detects them using a camera) and uses the limb size to adjust pre-stored exercises, for example to adjust their trajectories and/or starting point.
  • the results of the tests are analyzed to determine the needs of the patient and to formulate objectives of the rehabilitation and/or wellness exercise. This act may be, for example, manual, automated or manual with support from device 100.
  • a plan is drawn up, including, for example one or more of an expected progress chart, various allowed and/or required exercises and exercise parameters for different parts of the plan, definitions of increased and decreased difficulty levels for the exercises, allowed and/or required exercise sequences, number of cycles for each exercise, warm-up requirement, list of data to log, list of patient-modifiable information, one or more safety parameters which should not be passed and/or one or more parameter alert values at which an alert should be provided to the patient and/or a rehabilitation expert monitoring the patient's progress.
  • plan is a known activity
  • such a plan is special, for example, taking into account one or more of the possibility of long term activity, the possibilities involved in having a device available at a home for multiple short sessions, the provision of multiple activities with a single device, the needs of remote monitors and/or the programmability and responsiveness of a device in accordance with some embodiments of the invention.
  • the plan may be generated manually, automatically or manually with the assistance of device 100, for example an initial plan generated automatically and then annotated or approved by a human.
  • the plan is carried out, while being monitored.
  • the monitoring is manual.
  • at least some of the monitoring is automatic.
  • the plan may be modified in response to the monitoring, for example, if slow progress is detected, the plan time frame may be changed.
  • plan progresses, new problems may come up or become emphasized.
  • plan may be modified (440).
  • testing may be repeated (442), generally to a lesser extent than when the patient was initially evaluated.
  • periodic testing (for example on device 100 at the patient's home) is part of the plan. Such evaluative testing may also be used to determine when rehabilitation and/or wellness exercise is complete.
  • rehabilitation is mostly completed and a training plan is optionally made, for example to ensure maintenance of the rehabilitation and/or the wellness of the patient or for other reasons (such as prevention of worsening or prevention of limb or joint neglecting).
  • long term monitoring of the patient may be performed, for example, testing the patient's abilities once a week or once a month.
  • new needs of the patient may be identified, for example based on the monitoring or based on a periodic general test.
  • a patient being rehabilitated for stroke may be determined after a time to need rehabilitation for a progressing arthritic condition.
  • a personal profile is created for a patient.
  • such a profile may include a series of items to work on, for example smoothness of motion, which can be tackled one by one over time or if a certain threshold value is detected during testing (e.g., quality of motion went below a threshold).
  • device 100 may be used over a wide range of situations, including long range treatment, wellness exercise and/or following a patient from initial rehabilitation through follow-up rehabilitation (e.g., to maintain an ability) and diagnosis.
  • wellness exercise can be generally described as exercise designed to enhance, or at least maintain, nominal daily activities and/or functions via physical and/or cognitive training. Therefore, all of the examples of rehabilitation and/or exercise described herein qualify as wellness exercise.
  • the ability and/or progress of a patient are scored.
  • scoring is used as an aid in deciding on the need and/or type of future exercise and/or rehabilitation.
  • scoring is used to monitor the effect of rehabilitation and/or exercises and/or help select between options for rehabilitation and/or exercises.
  • scoring is used to ensure that a patient's needs (e.g., personal rehabilitation needs or need for balanced rehabilitation) are met.
  • scoring is used to identify areas where progress was made and areas where additional therapy or modified therapy may be needed, due to lack of progress.
  • one or more of the following measures are used to score a patient's ability and/or progress.
  • scoring of the patient is calibrated to other patients, for example, using a database of similar injuries, or using scores of patients that are being exercised and/or rehabilitated at a same time. Alternatively or additionally, scoring is carried out between a healthy and a non-healthy limb.
  • scoring is used as an aid in diagnosis.
  • scores are generated (e.g., by providing suitable exercises) for individual body part abilities and for general abilities.
  • device 100 can analyze a patient's abilities by generating experiments and then analyzing the results.
  • device 100 tests whether a patient will respond better to one type of exercise or to another by generating a series of exercises including both types of exercises.
  • the results of the patient's performance are then analyzed to extract trends which indicate which of a controlled variable had a better or a desired effect on the patient.
  • a human therapist selects the initial possible exercises.
  • a human therapist determines what percentage of time may be spent on such exercises.
  • the scoring method or resolution may be adjusted by the therapist per the patient condition for example, adjusting the accuracy of measurement or the dynamic range of the score or the expected results (e.g., for qualitative measures).
  • a patient may show an increase in a muscle strength score but not show a corresponding increase in accuracy (correspondence may be, for example according to a table or according to a previous trend of the same patient, possibly with a same limb).
  • the exercise plan for the patient may be modified to include more accuracy-focused exercises and fewer muscle building exercises. It is noted that not all rehabilitation plans aim for concurrent improvement in multiple measures. In some plans, one measure is focused on and once a desired improvement in that measure is achieved, a different measure is focused on.
  • a score in progress is used to estimate a time to reach a goal.
  • such estimation is based on one or more of the following variables: motivation, innate ability and current disability.
  • innate ability is estimated by tracking the progress.
  • a set of results and estimated times for different situations are stored in a database and used to generate an estimate.
  • a neural network is used.
  • Motivation is optionally estimated using methods as described below.
  • manual estimation may be provided.
  • a time estimation also includes thresholds of different scores which must be met. For example, an estimate may be conditioned on a certain motivation being maintained. Detection of a reduction in motivation may be used to prompt an update in expected progress or suggest certain treatment.
  • device 100 is adapted for home use.
  • Such adaptation may include one or more of the following features:
  • device 100 is connected to home appliances such as a TV or HiFi system.
  • the patient can be instructed from the TV or the user can play with the system using the TV as feedback.
  • a set-top box is used as a local processor and/or a communication port to a remote station.
  • rehabilitation activities are designed to cover a larger part of the day than is possible at an institute, for example, half or all of a day, while still allowing a patient to have a life with non-rehabilitation activities.
  • a rehabilitation plan can call for ten 5-minute sessions spread over an entire day, spaced by an hour.
  • device 100 interacts with real-life activities and/or using real-life objects, as described in more detail below.
  • this allows a rehabilitation and/or wellness exercise plan to show (and achieve) a real progress in the patient's ability to deal with real life situations, such as eating and getting dressed.
  • devices in separate houses are interconnected, for example, within a family or between friends.
  • one of the participants may interact using a computer, rather than a device 100 (e.g., using mouse motions to emulate device manipulation, or as a player in a game using standard computer interfaces).
  • device 100 communicates with an outpatient clinic so that home activities and clinic activities are synchronized.
  • the patient carries a memory unit (e.g., a USB memory card) that includes his personal data.
  • a memory unit e.g., a USB memory card
  • the home system generates reminders to the patient to exercise, for example, audio reminders or e-mail or SMS reminders.
  • Fig. 2 shows an exemplary distributed exercise and/or rehabilitation system 200.
  • a network 202 for example an Internet, a cable network, a cellular network or a telephone network, connect device 100 to a remote site.
  • a remote site is a rehabilitation center including a computer station 204 with a display 206 and a user input 208.
  • a single station 204 can monitor multiple devices 100, optionally in real time.
  • a plurality of stations 204 may be provided, at the same or different sites.
  • a plurality of stations 204 are used to monitor a single device 100.
  • each device 100 may have a low level monitoring by a semi-skilled person, who shows difficult problems to a skilled monitor who is in charge of or associated with many unskilled monitored.
  • an optional portable connection 212 for example using a laptop computer.
  • an optional remote database 210 may store data for one or more patients, for example, 100 or 1000 patients or more. While the database may be at the rehabilitation site, this is not required. In some cases the database is distributed, for example, among rehabilitation sites and/or user devices 100.
  • a group of patients are collected into a network based on them having similar (or overlapping) aliments, treatment and/or prognosis and/or according to personal matching.
  • the progress of members of the group is presented to other members, possibly spurring competition.
  • a support group may be provided, for example, one in which the patient is more advanced than other members or one in which a group effort is being carried out instead of a competition.
  • each of a plurality of patients has a role in a role playing game.
  • the difficulty of each patient/role may be set according to the patient's ability.
  • a group leader may be selected.
  • each player is required to copy the movements and/or instructions of the group leader.
  • each player is protected from over-reaching his abilities by his device 100.
  • a patient's general practitioner physician or a family member or caregiver may be able to log on and review a patient's progress.
  • Remote exercise and/or rehabilitation can follow several paths, for example, one or more of:
  • virtual reality methods for example goggle mounted displays are provided at the remote location, to help the remote operator feel in better control. Alternatively or additionally, the operator can manipulate his viewpoint.
  • various sensors for example as described below are used to move a model of the patient, for remote and/or local feedback.
  • Device 100 in some embodiments thereof may be used in other ways than described above.
  • a supervised group in which one or more therapists watch/monitor/support a plurality of patients, each on a different device.
  • one or more of the following scenarios may be acted out:
  • a linked-system scenario is carried out.
  • two devices are connected using a master-slave relationship for example using a wired or wireless (e.g., BlueTooth, Cellular or WiFi) connection between them, or using a network connection between them.
  • a master can be, for example, a son (or daughter) and the slave is an aged parent whom the son is assisting in rehabilitation.
  • This allows a paretic parent to use the rehabilitation exercises as a means for maintaining contact with the family.
  • the paretic parent may receive support from family members. Such support may also include advice on how to use the system and/or on what exercises to try.
  • linked devices 100 Another exemplary usage of linked devices 100 (or a single device with multiple arms 102) is for child play.
  • a paretic child plays with a healthy child, each child manipulating a separate arm or device.
  • the motor abilities of the paretic child are compensated for by device 100, for example, providing speed enhancement or providing periodic automated action.
  • device 100 can supplement the abilities of the paretic child, while still allowing the child some control over the game, for example, allowing the paretic child to actually perform 20% of the moves.
  • Device 100 can control the level of support for the paretic child to ensure a level playing field.
  • linked devices are used by a therapist and a patient in a combination active and/or passive mode.
  • a patient actively performs exercises using a device while the therapist follows passively along with a linked device.
  • the therapist assists the patient with movement during exercise.
  • the therapist actively uses the linked device to demonstrate to the patient how to perform the exercise while the patient passively gets the "feel" of the exercise by holding on to the device during the therapist's movements.
  • the exercise utilizes actions by both the therapist and the patient, wherein one is responsible for movement during a portion of the exercise and the other is responsible for movement during another portion of the exercise.
  • the therapist and the patient move simultaneously.
  • the therapist helps, guides, and/or resists the patient while the patient is performing exercise.
  • the therapist is capable of sensing the nature of the patient's exercise, such as quality and effort, by participating with the patient.
  • the therapist provides safety to the patient by participating during exercise.
  • the therapist is in physical contact with the patient while they both exercise.
  • a family member and/or a friend and a patient use linked devices.
  • a linked device is a single device with a plurality of controls (e.g. handles), such as depicted in Fig. 15F .
  • motion of a device by the therapist or family member assists rehabilitation without the use of a motor to move the patient.
  • the linked device is provided with a control which signals to a device control that controls exercise start/stop.
  • the linked device is given operational commands by a controller, such as a personal computer, via a mechanical actuator to which the handles are operationally attached.
  • speech is part of the rehabilitation process.
  • device 100 responds to or expects voice commands.
  • device 100 generates voice instructions.
  • Simple interfaces may be required for some users.
  • instructions to a user are simple red/green lights, to indicate go and stop.
  • a plurality of different types of cues may be provided to indicate a need to act by the patient, for example, audio, tactile, vibration (of device 100 or of a patch), motion of opposite limb, visual (e.g., flashing screen) and/or change of speed.
  • a jolt for example an audio blast (or shout) is used to alert an otherwise non responding patient, for example.
  • a dummy body is used to show the patient the effect of the motion of device 100 (e.g., arm 102) on the patient.
  • the complexity of the interface used increases as the patient rehabilitation progress and the patient's cognitive abilities improve and/or the patient has more attention to spare.
  • the user interface is used for performing concurrent cognitive, perceptive and motor exercise and/or rehabilitation, for example, by selecting the interface used to match an ability of the patient and/or train the patient in certain non-motor activities.
  • a dosage unit is at least one of force, power, work, and/or time.
  • the progress of exercise and/or rehabilitation, or just about any activity, of any particular patient typically depends on one or more of the following: cognitive ability (if the patient cannot think clearly, motor planning is difficult or impossible), mental ability (if the patient has no motivation, rehabilitation is difficult) and motor capabilities.
  • one or more of these may be measured and/or supported by device 100.
  • changes in the degree and/or type of support are determined by system 100.
  • changes in support are determined by a user, or a plan of how to change support according to scores, is set by a user.
  • Cognitive abilities is, for example, by providing a simple display, multiple modes of presentation of information, reminders and/or multiple cues.
  • Cognitive abilities may be tested, for example, by providing tests or by assessing performance in games where cognitive ability is required. In some cases a distinction is made between cognitive abilities and perceptive abilities.
  • the patient is required to execute a motor task (e.g. move forward) his ability to understand the task depends on the cognitive capabilities.
  • a motor task e.g. move forward
  • the ability to see a target on the screen or actually receive the instructions depends on his perceptive abilities.
  • Measurement of motor capabilities is, for example, by providing exercises having a standard range of results and placing the results on a known scale.
  • a patient's performance on a task is compared to the patient's performance (e.g., range of motion, speed accuracy) in a game.
  • the patient's performance e.g., range of motion, speed accuracy
  • differences in performance between a game and an exercise may indicate the degree of motivation difference between desired and undesired tasks.
  • device 100 is used to measure the range of a patient's abilities, for example, ROM (range of motion), pain limit and the like. It is assumed that a diagnosis session can be trusted to provide relatively accurate information about the patient's ability, at least for the reason that the patient knows the diagnosis session is limited in scope. Thereafter, exercises at the edge of the patient's ability are provided to the patient and a determination is made of the number and success of attempts to reach the edge of the range. This determination may be used as an indication of motivation (e.g., willingness to achieve what is known the patient can achieve). In an exemplary embodiment of the invention, the exercise comprises providing performance targets to the patient and the patient is expected to reach for the targets.
  • ROM range of motion
  • a patient plays a game in which some of the targets are at the range of the patient's ability. As this ability might not be known in advance, a variety of targets of different levels of difficulty, are provided.
  • motivation is assessed by analyzing the game to determine, first, what the patient's abilities are and, second, how often the patient tries to reach the edge of his abilities.
  • Another method of measurement is tracking how hard a patient works (e.g., how long are rest periods). Another method is determining the hardest a patient works in any particular exercise. Another method is determining if a patient provides attention, involvement and/or activity in a free-play session, where a patient can exercise if he wants to, to any degree of difficulty the patient wants. Attention is optionally determined by comparing trajectories of motion at different times, for example to see the range of variability (e.g., does a patient suddenly slow down - maybe his attention wandered). Involvement is optionally determined by tracking modifications requested by the patient, for example in exercises where a patient can select one of several trajectories.
  • mental state is estimated by analyzing handwriting or gross motor movements, for example, detecting unusual tremors, ticks or other signs of tension and/or lack of control (e.g., as compared to other times). It should be noted that mental states, in some cases, may be provided as a relative state rarer than absolute values.
  • pain is optionally factored into rehabilitation exercise in some exemplary embodiments of the invention. For example, a patient's pain level in relation to the patient's motion is learned in order to gauge the limits of patient exercise and/or the progress of the patient's rehabilitation. In some exemplary embodiments of the invention, the patient's pain levels and/or threshold are determined and a treatment regime is created as a result of the determination.
  • the patient is asked to exercise near the limits of the patient's pain threshold and/or a certain pain level.
  • the patient is asked, with or without warning of imminent pain, to exercise in excess of the pain threshold and/or a certain pain level.
  • Physiological measurement of pain optionally includes one or more of monitoring heart rate, temperature, perspiration, muscle tension and other physiological parameters known to be associated with pain.
  • pain measurements recorded during exercise are correlated to exercise performance. Based on the correlation, the progress of the patient is optionally determined and/or a further exercise regime is optionally planned.
  • existing exercise and/or rehabilitation exercises are used for device 100.
  • various measures can be provided not currently available.
  • the exercise is modified to take into account limitations of device 100 or abilities of device 100.
  • correct motions are determined with exactitude and/or with a degree of control not possible manually.
  • some exercises are described herein which are not possible without robot support (or other techniques described herein).
  • exercises are modified manually.
  • exercises are recorded by a therapist and then annotated (e.g., to mark desired measurements).
  • exercises are directly programmed into device 100.
  • device 100 suggests limitations or additions to exercises, for example, safety limitations or device limitations and/or suggest where a less supportive or more supportive motion mode may be appropriate (for example at an end of a motion a more supportive mode may be advisable).
  • a reaching exercise is performed by the patient.
  • various muscle groups can be trained and various levels of difficulty can be provided.
  • reaching movements are defined by one or more of the following exemplary parameters:
  • a particular "Reach” is defined by the starting location and the ending location of the hand as defined by its distance, direction, and height. Any reach may also be further understood in terms of the involvement of the arm joints and the ability of the patient to individuate the joints to achieve the reach.
  • a reach training comprises the following general steps:
  • the patient will attempt to perform the reach independently.
  • Device 100 will measure the intention and assist the patient to move. Over time, the amount of assistance will be reduced as the patient is able to move more independently.
  • Another exemplary exercise is mimicking of daily activities, such as moving a full cup between points and/or lifting a book.
  • various aspects of an exercise and/or rehabilitation process can be planned and inputted as instructions to a computer (e.g., device 100), including, one or more of:
  • Permissions may be different for different users of system 200 and/or device 100, for example, different permissions may be allowed for one or more of adding new, copy, modify, delete and/or edit. These activities may apply, for example, to one or more of patient data, activity, plan, statistics and/or data logs.
  • Particular activity parameters which may be created and/or modified in accordance with exemplary embodiments of the invention include: trajectories, locations and ranges (e.g., minimum and maximum speed and angles); force parameters, number of repetition cycles, stop decision(s) and/or rest periods length and frequency.
  • one or more libraries are provided as a basis for modification and for storing programs, for example, a plan library, a per-patient library and/or an activity library.
  • entering a new trajectory is by physically manipulating tip 108 (e.g., by a patient with a good hand or by a therapist).
  • the resulting trajectory(s) are then edited on a computer.
  • a 3D CAD/CAM program may be used, optionally one in which a human body is modeled and various constraints can be placed on movement of points on the body and/or a desired or allowed range of motion for such points defined.
  • a graphic design program is used, for example, with a user indicating a few points of a trajectory and the program completing them with a line or a curve.
  • a user may define various geometrical shapes, such as a circle, for example by providing points and/or a formula.
  • a user may make a drawing and scan it into system 200 (e.g., at a station 204 or at device 100).
  • an exercise is calibrated for a particular patient and/or situation.
  • Such calibration may include, for example, one or more of:
  • editing includes one or more of smoothing, adding points and/or path sections, converting the motion into primitive motions elements,
  • Table I describes an exemplary high-level programming language which is optionally used to program device 100, in lieu of learning a robotic programming language.
  • this language is used by the therapist and/or other user.
  • existing exercises are storable and modifiable.
  • This high-level language is based on library of Icons (each representing a command) that can be dragged into a program area in order to build (or edit) a program.
  • Each icon represents a command; with 3 types of command defined (more may be added):
  • each path section may include one or more triggers, which, upon activation, execute short sections of code.
  • a trigger activated when a user varies his speed more than 10%, in which case a warning is provided or a more assistive motion mode is provided.
  • Table II is a sample program, using the language shown in table I.
  • a program structure has several columns; the first one is the main command that are sequential, the second and third columns are for commands which operate in parallel.
  • start and stop commands When a new program is started, the start and stop commands optionally are provided automatically. Other commands are manually inserted between the start and stop.
  • Table II is a sample program of a path having 3 straight lines (can be rectangular), with a delay in between, and during the second line an external device is operated (for example - waiting for input from handle). All data during the second and third lines is recorded and the entire program is repeated 5 times. Modifiers for the repetition (e.g., increase speed, increase required accuracy) are optionally provided as parameters. General program parameters, such as type of scoring, expected quality of motion are optionally provided as well.
  • a particular type of control provided in accordance with some embodiments of the invention is spatial programming control.
  • this type of control certain gestures or positions in space of tip 108 are translated into commands for device 100.
  • such gestures may be used by a therapist or by a patient to fast forward past an exercise section.
  • wrist movements of a therapist will be translated into arm (or other limb) motions, thus allowing the therapist to make smaller motions and only with his hand, rather than the limb whose motion is being programmed.
  • a patient may be strapped to a chair (e.g., the shoulder of the patient) and/or a rest may be provided for an elbow. This restricts possible motions by a hand holding tip 108.
  • Fig. 5 illustrates a system 500 including limb position sensing and/or restricting, in accordance with an exemplary embodiment of the invention.
  • Correct motion of other parts of the body than the hand that contacts tip 108 may be provided, for example, by detecting the positions and providing feedback, for example, audio or visual feedback, to the patient.
  • a patient 506 sits in a chair 514 and uses device 100 (or a device as described below in which the arm is mounted on a ball).
  • One or more cameras 502 image the arm and/or other parts of patient 506 and determine the spatial position and/or velocity thereof.
  • one or more cameras 516 are mounted on device 100 for such imaging.
  • a reference position is provided on device 100 and/or on tip 108.
  • position sensors are used for determining the state of device 100, instead of or in addition to mechanical sensors in device 100.
  • mechanical based position sensing for example using an articulated arm, may be used.
  • no arm 102 is provided, instead position sensors of some type are used.
  • Feedback is optionally provided via virtual reality type displays and feedback (e.g., vibration to emulate force). However, this may not allow direct force feedback and resistance to be applied, as desired in other exemplary embodiments of the invention.
  • patches 504 are used to provide feedback or cuing to a patient.
  • a patch includes a wireless receiver, an optional power source and a stimulator, for example a vibrator, pin-prick, a pincher or a heating element.
  • a stimulator for example a vibrator, pin-prick, a pincher or a heating element.
  • patch 504 can provide a stimulation to the patient.
  • Patch 504 may be wired instead of being wireless.
  • sensed positions of body points are used for one or more of:
  • physiological sensors may be provided, for example one or more of pulse measurement sensors as known in exercise machines and grip and/or pinch force sensors in tip 108.
  • one or more physiological sensors may be provided on the patient, for example, breath rate sensors.
  • a body rest 508 may be provided for one or more body parts.
  • rest 508, attached to chair 514 by a (optionally adjustable) bar 510 prevents motion of the chest and/or shoulder.
  • one or more straps are used to hold body parts.
  • reverse kinematics method are used to estimate the motion and/or dimension of a patient's joints and/or bones. For example, if a limb is fixed to rest 508, movement of tip 108 can be used to estimate the actual motion of the joint. When harness 508 used to lock the elbow is in a fully extended position, the distance from the shoulder to wrist can be calculated as the patient moves the arm. If the handle of Fig. 15F is used and patient is restricted by a shoulder harness then the forearm length can be determined Alternatively or additionally, a force field can be used to restrict the motion in a manner which will guarantee that limb dimension can be determined.
  • a model of the patient is constructed for use in such reverse kinematics calculation.
  • safety calculations such a model may be used.
  • a motion may be prevented as being unsafe if a patient can possibly reach a configuration of joints where the motion is unsafe.
  • the reach of each joint may be dependent, for example, on fixation of the patient (e.g., harnesses), measured ROM and assumed ROM.
  • chair 514 is fixed to device 100, possibly in an adjustable manner, for example, using a fixation bar 512.
  • an initial calibration process is carried out, for example when first doing a new activity or during device setup.
  • bar 512 includes graduations and during calibrations the correct setting of the chair relative to the graduations is determined.
  • device 100 comes with a built-in chair 514. Exemplary positioning of a movable chair is described below.
  • positioning sensing is to better than 1 cm, 5 mm, 2mm or 1 mm, over the entire working volume of the device. In some embodiments, a lower absolute positioning accuracy is tolerated if a relative accuracy, within an exercise is maintained.
  • accuracy of force control is better then 100 gr, 50 gr, 10 gr or better.
  • the balancing of the arm is within these values. Similar accuracies may be provided for measurement.
  • sampling rate of better than 10Hz, 50Hz, 100Hz or more is provided.
  • the patient position is not important.
  • correct targeting of a certain joint, tendon and/or muscle group may require precision in motion of tip 108 relative to the patient and/or in the posture of the patient and or other body part.
  • straps, a harness and/or rest 508 are provided to set the position of the patient.
  • one or more bars 512 links chair 514 to device 100.
  • reference 512 represents a spring-loaded wire, which includes a position sensor to indicate its retraction and thus the position of chair 514 relative to device 100.
  • a plurality of retractable wires are used.
  • each wire includes a ring into which a leg of chair 514 is placed.
  • the exercises are corrected on the fly to account for the new relative position of chair 514 and device 100.
  • the exercises are adapted to reflect the new position.
  • a plurality of typical static postures of the patient are learned and the system uses these learned postures to distinguish ongoing motion from semi-permanent postures.
  • change in posture is detected by changes in pressure on various pressure sensors, or using cameras which image the chair, device and/or patient.
  • changes are detected by detecting changes in the actual trajectory followed by tip 108.
  • mat 518 is provided.
  • mat 518 is a pressure sensitive mat for detecting positions of chair legs or patient legs.
  • calibration is performed for the chair that the patient actually uses.
  • the mat is used to allow manual entry of relative position.
  • the mat includes markings that are recognizable by a camera that images the mat.
  • tip 108 is used to determine the position of chair 514.
  • tip 108 is used as a digitizer by contacting points on chair 514 and/or the patient. In some cases an adaptor tip may be placed at tip 108.
  • tip 108 is moved by device 100 to indicate a desired position of chair 514 or the patient.
  • a laser or light pointer is attached to tip 108 (or other part of arm 108 or device 100) and serves to generate a light marking of a desired location for a chair and/or patient part.
  • Device 100 optionally converts between the coordinate systems of the pointing device, arm 108 and/or chair.
  • it is not tip 108 which has to be at a certain position, but the patient's hand or finger.
  • a dummy hand is placed in device 100 and used for such calibration.
  • positioning methods as described herein may also be used for positioning other parts of the rehabilitation system, for example, a table, a glass, a second device 100 or a kit for daily living, for example as shown in Fig. 19H .
  • patient positioning is determined by patient kinematics.
  • the patient once a patient is positioned, the patient performs one or more exercises and the patient position is determined based on the actual trajectories followed. In some cases, a previous ability of the patient, for example, joint range of motion, needs to be known in order to determine the patient position.
  • the patient performs swinging of the arm, without bending the elbow.
  • the radius of the motion indicates the position of the shoulder joint. If the patient cannot straighten his elbow (or keep it straight) this information is optionally used.
  • patient movement between sessions is mainly translational motion in a 2D plane, so only one motion of the arm is sufficient for position calibration.
  • two arms are moved, to assist in detecting body twist.
  • an initial set of patient movements are used to extract basic information about the patient, such as range of motion and freedom of motion.
  • device 100 first applies or suggests a series of exercises meant to warm up muscles and joints, before taking measurements.
  • tip 108 is held in a patient's hand.
  • other means may be used.
  • a strap or elastic ring is provided at end 108 instead of a ball-like handle.
  • a rod-like handle is provided instead of a ball-like handle.
  • Fig. 6 shows an elbow holder 600, in accordance with an exemplary embodiment of the invention.
  • Such an elbow holder can be used, for example, when the motion required is of the shoulder, so an elbow 616 is what moves along a trajectory.
  • a base 602 is adapted for attachment at tip 108.
  • a hinge 604 allows relative motion between a first part 606 and a second part 608 on which an arm 614 rests.
  • Optional straps 610 and 612 optionally attach arm 614 more firmly to holder 610.
  • joint 604 has a varying resistance, for example settable by the patient and/or by device 100.
  • joint 604 includes an actuator for applying force to close or open elbow 616.
  • joint 604 includes an angle sensor.
  • holder 600 can vibrate the elbow, for example as a therapeutic effect or to help prevent freezing of the joint. Such vibration may be applied to other joints and body parts as well, for example, using suitable attachments.
  • holder 600 functions as a spastic harness in one example, joint 604 is locked (or is not a joint) and arm 614 is forced open and held by straps 610 and 612.
  • parts 608 and 606 are raised so that joint 604 has a center of rotation which is substantially the same as elbow 616, in one or more planes.
  • attachment to other points on the body is provided.
  • what is constrained is a joint, while in other, what is constrained is a bone or a certain location on a bone.
  • various types of constraints can be provided, for example, constraints on angular and/or spatial dimensions. Additional attachments are described with reference to Fig. 16 below.
  • the attachment includes a coded circuit or other means so that when attached to arm 102, device 100 is aware of the type of attachment.
  • the attachment is fitted with a quick connecting elements made out of two mechanical quick connect parts (e.g., spring loaded pin and slot arrangement) and an electrical quick connect (e.g., spring loaded small needle contacts), this allows a fast change over from exercise to exercise or from patient to patient.
  • each attachment includes a chip and receives power form the connector and sends data (if any) on a bus, for example a packet-type bus.
  • the electrical connector is used to directly interface measurement means (e.g., a potentiometer) of the attachment, to device 100.
  • Device 100 can provide instructions to a user in many modes, including, one or more of (for various embodiments of the invention):
  • rehabilitation includes teaching a patient quality aspects of motions and/or what motions are correct.
  • one or more of the following qualities of a motion are of interest:
  • quality of motion is judged using a power law, which characterizes motions by healthy individuals. Paretic individuals are optionally characterized as to how closely they reach this law and for which joints and/or motion types it is reached.
  • 'Healthy movement' is described by basic kinematic characteristics that define quality of motion.
  • one such characteristic is a smooth transition of the hand from one point to another following roughly the shortest path between the two points.
  • a second characteristic is that the velocity of the hand is constrained by the curvature of the path ( Viviani P, and Terzuolo C. Trajectory determines movement dynamics. J Neurosci 7, 1982: 431-437 . The larger the curvature of the path, the slower the movement of the hand is, at a constant ratio of 2/3.
  • power law fitting is determined by providing the patient with a range of motions, at different speeds and extracting power-law information from the results.
  • the law may be applied to other joints and limbs, such as lower limbs.
  • Another law which may be applied relates to the relative motion of each joint in a coordinated motion. In healthy persons such motion takes into account the relative distances of the various joints from the target of motion and the different accuracies of such joints. Another law which may be applied is Fits law which relates a size of target to a time to hit the target.
  • such qualities of a motion are taught to a patient by example, for example, leading an arm through correct and incorrect motions.
  • Such motions may be entered for example by the therapist or by the patient or be pre-programmed.
  • a patient motion is recorded and corrected and then the patient is paced through the incorrect and the corrected motions.
  • the motion may be calibrated for the particular user, for example for the user's size.
  • a threshold of correctness is defined, for a patient to attempt to keep all his motions as being of a quality (in one or more parameters) above the threshold.
  • a substantial part of rehabilitation comprises exercising a patient in motions which are correct or teaching the patient how to know if a certain motion he has performed is of a higher or of a lower quality.
  • a patient may be trained to not ignore a damaged limb.
  • a patient may be trained to use a damaged joint as part of "correct" motion, so as not to reduce a range of motion of the joint.
  • the relative motion expected between an elbow and a wrist is known (e.g., or is inputted by a therapist, such as by example) for certain motions, such as moving objects on a table surface. If a patient deviates by a certain amount (e.g., defined by the therapist) feedback is provided.
  • motion with a good arm limb is used to train a bad limb.
  • a good arm can be used to trace a circle and then the bad arm is trained to trace the circle.
  • One advantage of such training is the intimate feedback that a patient receives by better understanding exactly which joints and muscles are used for each motion.
  • the "good" motion is provided by a therapist or other caregiver.
  • Fig. 7 and Fig. 8 shows two handle devices 700 and 800 respectively, in which two arms can be moved simultaneously, with optional coupling.
  • this is used to have one arm passively move the other arm, for example so the patient can sense with the good arm what a bad arm is doing, or vice versa.
  • one handle is moved by the device, so the patient can see what is expected of him.
  • two arm devices are used for children, for example as a game between paretic children and healthy children or grownups.
  • two separate rehabilitation devices 702 and 704 are optionally attached by a base 706 and coupled by computer, electrically and/or mechanically, so that an arm 708 of one mimics the motion of an arm 710 of the other.
  • the arm moving mechanism is optionally a ball based mechanism as described below.
  • a single joint links two arms 808 and 810.
  • arms 808 and 810 are extendible (as described below, for example) and are linked together so that they both lengthen and shorten together, for example, the two arms including extensions that are engaged on opposite sides of a gear with a fixed center of rotation (e.g., a rack and pinion mechanism).
  • mirrored motion is provided using other devices.
  • mirrored motion is provided by a user holding one mouse in either hand (or in a same hand sequentially) and applying the above transfer of motion form one hand to the other.
  • one or two force-feedback joysticks are used. It should be noted that for this and other embodiments a plurality of devices may be used. In particular, for specific applications, relatively simple and/or standard hardware can be used, for example force feedback joysticks or haptic displays.
  • Fig. 9A illustrates a rehabilitation device 900 comprising two sections, a first section 902 associated with motion of a wrist and a second section 904 associated with motion of an elbow.
  • Sections 902 and 904 can be ball-based devices as described below.
  • a rigid and optionally adjustable connection 910 fixes the relative position of sections 902 and 904.
  • a connection 912 optionally interconnects a wrist holder 906 and an elbow holder 908.
  • Device 900 is used to exemplify control of multiple points on a limb (e.g., arm or leg) during rehabilitation.
  • each of holders 908 and 906 can be controlled in three spatial dimensions and optionally in angular dimensions as well, thus allowing more complex motions to be tested, trained and/or provided.
  • the possibility of restricting certain motions is useful from a safety point of view, for example, preventing certain rotations of the joints.
  • a point is controlled in 3, 4, 5, or 6 degrees of freedom of motion.
  • the control in some of the degrees of freedom is different than in others.
  • motion in one axis may have resistance associated therewith, while an angular motion may be assisted motion with device 900 supplying some of the force.
  • trajectories may be defined as relative trajectories in which the actual position of the device 900 is less important than the relative positions and movement in space of holders 906 and 908.
  • Fig. 9B illustrates a rehabilitation device 920, including a single section 928 with an arm 932, on which is mounted an arm holder 930.
  • Holder 930 restrains both an elbow using an elbow holder 924 and a wrist, using a wrist holder 922.
  • An optional rotation mechanism 926 is shown for rotating holder 930 perpendicular to arm 932 while an optional rotation mechanism 940 rotates holder 930 around arm 932.
  • a similar mechanism (not shown) is optionally provided for rotating holder 930 around its axis.
  • a rehabilitation device in accordance with an exemplary embodiment of the invention requires synchronized motion of several body parts, for example, an arm and a leg.
  • the device is based on a universal joint, from which extends a rigid arm, which is optionally changeable in length.
  • the universal joint is implemented as a ball in socket joint.
  • Fig. 10 shows an exemplary rehabilitation device 1000, using a ball-in-socket joint. This reference number is used in the general sense for several ball-based devices as described herein, for conciseness.
  • Device 1000 comprises a base 1004, for example a table containing a plate 1016, with an aperture 1017 defined therein and enclosing a ball 1010.
  • Ball 1010 optionally rests on a plurality of rollers 1012.
  • rollers 1012 are replaced by a bottom plate 1015 with an aperture 1013 defined therein which supports ball 1010.
  • An arm 1002 extends from ball 1010 and is optionally balanced by a counter-weight 1018 attached by a rod 1022 to an opposite side of ball 1010.
  • Rod 1022 optionally passes through a slot in an optional guide plate 1020, described in greater detail below.
  • ball 1010 turns and/or rotates, allowing a tip 1008 of arm 1002 to define various trajectories in space.
  • arm 1002 is extendible, so that the trajectories fill a volume of space.
  • arm 1002 includes a motor or brake 1024 (e.g., an oil brake), to actively move or passively resist such extension.
  • a motor or brake 1024 e.g., an oil brake
  • a brake 1014 is provided for ball 1010.
  • torque at the surface of the ball for example as required for braking or moving arm 1002 is generally smaller than required for smaller joints, possibly allowing the use of smaller or cheaper motors or other mechanical elements.
  • positional control of such motors and/or sensitivity of position sensors can be smaller, while still allowing for sufficiently precise control and feedback.
  • Device 1000 can be provided in various configurations. In a simplest configuration, the device is completely passive and a user can merely set plate settings (described below) and resistance settings on the brakes. In a more advanced configuration, resistance can be varied in real-time by a computer control. In another advanced configuration, sensing of ball and/or arm position is provided (e.g., using sensors, not shown). In another advanced configuration, directional resistance can be varied (e.g., using a directional brake, not shown). In another advanced configuration, motive force, optionally directional can be set or varied, for example using a plate and/or using multiple directional motors (which can also be used to provide resistance).
  • multiple motors are used to control motion and/or force of arm 1002.
  • the motors optionally include optical position encoders, to determine an arm position.
  • stepper motors or servo motors are used.
  • a separate sensor for example, one which reads optical markings off of ball 1010, is used.
  • rollers 1012 are replaced by motors which rotate wheels. If one wheel is in a direction (relative to the surface of ball 1010) perpendicular to another such wheel, selective motion in one or both directions can be achieved (e.g., if motion perpendicular to the wheel is low-friction slipping motion).
  • only one roller is replaced by a motor with a turning wheel, wherein the wheel is turned to a direction of motion desired and then rotated to achieve the motion.
  • Directional resistance is optionally achieved using the motor.
  • such resistance is achieved by a combination of the motor applying force or resistance and a general resistance applied by brake 1014.
  • one or more strain sensors are provided or integrated in the motor(s), to assess a direction of force being applied to arm 1002. Then, the motors can respond with a counter-force, or an assisting force or a diverting force (e.g., with a component perpendicular to the applied force), as required.
  • brake 1014 is operated by raising and lowering the brake towards the equator of ball 1010, when the brake has an inner diameter of less than that of the ball.
  • the brake is inflated and deflated as needed.
  • a circumference of the brake is modified, for example, by it being formed of shape memory alloys which are heated to cause momentary expansion and/or shrinkage of the brake.
  • a perpendicular brake is used which is pressed onto the surface of ball 1010 and towards the center thereof.
  • directional brakes may be used, for example, rubber blades-like pads which resist motion of the ball along the blade by bend with relatively low friction to allow motion perpendicular to the blade.
  • forces applied to point 1008 generally include also a component along the axis of arm 1002, to which brake or motor 1024 may respond and which is optionally taken into account in the response of ball 1010.
  • Fig. 11 shows a balancing of device 1000, in accordance with an exemplary embodiment of the invention.
  • Fig. 11 shows a variant of device 1000, in which ball 1010 is supported by plate 1015.
  • Weight 1018 is optionally designed to exactly cancel the moment of arm 1002. Alternatively, it may be designed, or modified (e.g., by changing its distance from ball 1010 or by adding or removing a modular weight), to provide a force which return arm 1002 to a resting position or a force which tends to move it away from such a resting position. In some cases, balancing may be adjusted to correct for a weight of an attachment, or of the patient's limb.
  • the extending part when arm 1002 is extendible, the extending part includes a moving counter-weight that extends away from the center of ball 1010 in a manner which maintains the center of gravity of ball 1010. This motion may be solely inside of ball 1010.
  • balancing of ball 1010 is provided by active balancing by the motors and/or brakes. Such active balancing may also be used to effectively reduce or cancel out the moment of inertia of ball 1010 and arm 1002.
  • handle 1008 includes one or more contacts and/or circuitry which match one or more contacts or circuitry in a mating part of the attachment. This allows device 1000 to detect which attachment is being added and suitably move weight 1018 to compensate. Suitable tables are optionally downloaded from a remote site.
  • the attachment includes a peg of suitable length which pushes into tip 1008 and thereby moves an arm balancing weight inside of ball 1010. Movement of weight 1018 is optionally by a motor (not shown) and may be, for example, along a rod 1022 and/or away from a line connecting rod 1022 and arm 1002.
  • device 1000 self calibrates by detecting an applied torque moment and moving weight 1018 (or other weights) to compensate.
  • the balancing is designed relative to an expected weight or force applied by a person during an activity.
  • Fig. 11 also shows rod 1022 being constrained to travel in a straight line by a slot 1030 in plate 1020.
  • Fig. 12 illustrates a drive system for a plate-based rehabilitation device, in accordance with an exemplary embodiment of the invention.
  • a first, optional, motor 1046 is attached to a gear 1048 which rotates plate 1020 to allow motion of rod 1022 in other than a straight line.
  • a second, optional motor 1040 is attached to a threaded rod 1042 on which a rod coupler 1044 travels. As coupler 1044 travels, it moves (or resists) rod 1022 along slot 1030. Other mechanisms can be used as well.
  • FIG. 13A illustrates an exemplary coupling device 1300 for replacing coupler 1044, and which has this property.
  • Coupling device 1300 includes a body 1314 having an inner threaded section 1302 for mounting on threaded rod 1042.
  • Body 1314 further comprises an apertured element 1306 having an aperture 1304 which engages rod 1022.
  • One or more spring elements 1308 couple element 1304 to body 1314.
  • the tension in spring element 1308 can be adjusted, for example by a screw 1310.
  • a linear displacement sensor 1312 is provided to measure the error in the position of rod 1022.
  • Elements 1308 can be provided, for example, in the direction of slot 1030 and/or perpendicular to it.
  • Other exemplary force control mechanisms are described with reference to Figs. 22-26 .
  • Fig. 13B shows an elastic guide 1340, formed of two halves 1342 and 1344 coupled by one or more springs 1352 and 1354.
  • a slot 1346 formed between two edges 1348 and 1350 of the halves has some elastic give.
  • edges 1348 and 1350 are made at least partially elastic, for example, of rubber.
  • Figs. 14A illustrates a variant device, in which two guide plates are used in tandem, an upper guide plate 1020 and a lower guide plate 1402. Separate motors are optionally provided for rotating each guide plate.
  • Fig. 14B shows a guide plate with several slots.
  • the solid areas are provided to prevent the cut-outs from falling out.
  • Other methods for example, out-of-plane bridges, may be used instead.
  • Fig. 14C shows a guide plate with an "X" shaped slot.
  • Other shapes can be provided as well, for example a circle with a cross inside, or curved slots.
  • programming device 1000 includes replacing slots and/or setting resistance.
  • a slot in inserted it is recognized by device 1000, for example, using a contact based detection scheme as described above or using a wireless or RF communication, for example, by embedding a smart card circuitry in the plate.
  • Fig. 15A shows a wrist attachment 1500, which provides control and/or feedback for one or more degrees of motion of a hand, in accordance with an exemplary embodiment of the invention.
  • a forearm is supposed to rest on a rest 1510, while a grip 1502 is grasped by the hand. Grip 1502 is gimbaled in one or more axes relative to rest 1510.
  • handle 1502 is mounted on a base 1503 which includes a rod 1504.
  • a joint section 1506 can optionally rotate around the axis of rod 1504 and/or travel along it.
  • an optional rod 1508 interconnects rest 1510 and joint section 1506 and allow rotation around rod 1508.
  • an optional rod 1512 meets joint section 1506 at a direction perpendicular to the other two rods and allows rotation around that third axis.
  • wrist attachment 1500 is attached to tip 1508 at rest 1510 or at a base section 1514 attached to rod 1508.
  • one or more of the relative motions described is supported by one or more motors and/or controllable brakes.
  • one or more springs the handle to the exercise and/or rehabilitation device so as to provide the varying resistance shown in Figs. 3A and 3B , in one or more dimensions.
  • Fig. 15B shows a wrist attachment 1520, according to an exemplary embodiment of the invention and generally following the form of device 1500.
  • a handle 1522 is gripped by a patient, while the patient's arm rests on an arm rest 1524.
  • one or more straps are provided (not shown) which can attach via one or more strap slots 1526.
  • a base 1542 affords attachment via a connector 1528 to an arm 102 (not shown, but exemplified in Fig. 15C ).
  • a universal connector is used which is suitable for multiple attachments as described herein, for example.
  • the connector provides one ore more of mechanical fixation, power (e.g., electrical power) and data transfer.
  • the connector also provides identifying information about the attachment to device 100.
  • three wrist rotations are supported, by mechanical joints 1530, 1532 and 1534.
  • the resistance at one or more of the joints is adjustable.
  • the adjustment is manual, for example using one or more of knobs 1536, 1538 and 1540.
  • an internal adjustment for example, using a small electric motor, is provided.
  • the resistance may be, for example, of a friction type or of a resilient (e.g., spring) type.
  • rotation sensors are provided for each joint, for example potentiometers.
  • handle 1522 is replaceable, for example, using a pull-pin 1544 to selectably unlock handle 1522 for removal.
  • Fig. 15C shows a different version, of a wrist attachment 1550, similar to wrist attachment 1520 (e.g., a knob 1552 is at a different place from knob 1538) and shown from an opposite side. Also shown is the mounting of the wrist attachment on an arm 102.
  • the mounting comprises a ball and socket joint, optionally with friction resistance.
  • the socket joint is designed to disconnect if it experiences torque above a certain level, for example as a safety feature.
  • this safety level is settable.
  • the joint comprises a ball held between two plates, with the plates interconnected by springs with a settable resistance.
  • a wire interconnecting the plates is optionally provided and may generate a signal is torn (e.g., springs over strained).
  • a safety tether is provided to keep the parts of the joint together.
  • Another difference is that instead of a single arm rest 1524, two arm rests, 1558 and 1556 are shown. Optionally, straps are provided only for the far arm rest (1558). Optional padding 1560 is also shown.
  • Fig. 15D shows a non-vertical handle attachment 1560. While a 90 degree angle is shown in a bend 1562, other angles, for example 45 degrees may be provided. Optionally, the angle allows better control over which muscles will act and/or may make some motions easier. Optionally, bend 1562 is adjustable, for example to preset angles, such as 0, 45 and 90 degrees.
  • Fig. 15E shows a grip 1570 in which optional finger indentations 1572 are shown.
  • An optional button 1574 for input form the patient is shown. Additional buttons may be provided and buttons may be provided in other embodiments as well.
  • a body 1576 of handle 1570 is squeezable (as it may be in other embodiments as well).
  • One type of squeezable body includes a gas-filled bladder.
  • the compression of the gas can be varied to change the resistive force.
  • body 1576 is formed of two panels separated by one or more springs.
  • Fig. 15F shows a two handle embodiment 1580 including two handles 1582 and 1586, which are optionally changeable via pins 1584 and 1588.
  • This embodiment may be useful, for example, when it is desired for one hand to assist the other hand in a motion.
  • the two handles actually used need not be identical.
  • An optional universal connector 1590 is shown.
  • a cup like attachment is used.
  • a patient can hold the cup as a glass or hold it using a pinching action by its handle.
  • Various sensors to measure pinching force and or grip force may be provided.
  • attachments known in the art can be used, optionally being modified to include a universal connector and/or suitable sensors.
  • an attachment with a strap to hold the hand is provided.
  • the attachment used provides a sensation to the patient, for example, vibration, pricking, pinching or a surface texture.
  • Electrical power may be provided to the attachment, as well as data, to generate and control such sensation.
  • Surface texture may be varied, for example, by providing a smooth layer with an underlay that is bumpy. Extending the bumps or the bumpy layer, will vary the surface texture.
  • attachments are described for the arm, it should be appreciated that such attachments can be provided to other limbs and to the head and neck.
  • a pedal is provided as an attachment for a foot.
  • the various rotations of the wrist attachments may also be provided for the foot.
  • a head and neck attachment may be designed to hold the support various rotations and/or movements of the chin relative to the neck.
  • Figs. 16A-16D illustrate various methods of elbow support in accordance with exemplary embodiments of the invention.
  • device 100 supports the weight of the limb so that a patient can focus on moving the limb and not on holding it in space.
  • device 100 may be set to prevent the patient from leaning on the device, for example, with device 100 providing exactly the force expected to be applied by the limb (optionally with some leeway).
  • the degree of force changes along the trajectory, for example, as the limb extends.
  • Fig. 16A shows an elbow support 1604 attached by wires to a frame 1602, fixed to the rehabilitation device.
  • frame 1602 is collapsible.
  • frame 1602 is designed to allow entry of a wheel chair so that a patient on a wheelchair is not required to leave the chair for rehabilitation.
  • One or more foot pedals 1609 are provided for exercising and/or other rehabilitation activities of the legs.
  • the pedals are used to support coordinated exercises between arms and legs.
  • Pedals that move in more than one degree of freedom may be provided, as well as various sensors as described herein.
  • a perpendicular motion mechanism 1606 is shown, which may provide room for the knees of a patient sitting in a wheelchair.
  • wires 1605 are set (e.g., their length) to a desired elbow location.
  • three wires are used so that elbow support 1604 can be fixed in space.
  • more wires for example, four wires are provided, so that even when not occupied, support 1604 does not move.
  • wires may be used to set an elbow support, such wires may also be used to support other body parts.
  • multiple sets of wires are provided, for supporting multiple body parts.
  • a wire based system is used instead of an arm 102 or 1002 to control the position of a tip (or attachment) or point on a body.
  • a wire system is used for measurement of a position in space.
  • a wire 1605 recoils and is attached to a measurement device such as an encoder. Interpolation can be used to provide XYZ coordinates of support 1604.
  • wires are used to measure a relative position of a chair and a rehabilitation device (e.g., frame 1602).
  • a wire mechanism is attached between two limbs and used to determine their relative distance. Multiple wires may be used to determine more than just a distance value.
  • a wire system is used for measuring additional parameters, for example, force applied to a limb (optionally including direction) and speed of motion. It should be noted that a combined system including (for a same point or tip 108) both robotic elements and wire elements, may be provided.
  • a wire system is controlled, for example using a motor, to maintain a certain tension.
  • this is used to allow floating support of a limb.
  • motors are used for controlling or assisting motion, for example with a motor being used to shorten a wire or allow a wire to play out at a certain speed or if a certain force is sensed.
  • a wire 1605 provides compliance against tension, for example, by providing a spring attached to a wire 1605 (e.g., at a point 1608, where a motor may be provided as well).
  • the tension in the spring may be varied, for example, using an electric motor.
  • the spring is used to provide cushioning in general.
  • Fig. 16B shows elbow support 1604 supported by an arm 1610 which extends from the rehabilitation device.
  • arm 1610 includes a linear extension measurement element and two rotary measurement elements, to indicate the position of support 1604.
  • Other embodiments described herein may also include such sensors so device 100 can calculate the position.
  • force sensors may be provided, to assist in analyzing the forces applied by the patient to support 1604.
  • Fig. 16C shows elbow support 1604 supported by a jointed arm 1620 which extends from the rehabilitation device.
  • Fig. 16D shows elbow support 1604 supported by a member 1630 which extends out of (and/or is mounted on) arm 1002.
  • the extending arms and members are configurable.
  • the arms include motors and/or variable resistance elements.
  • the arms and links include position, orientation, displacement and/or force sensors.
  • the actual position of various parts of the arm may be determined based on the fact that one or more parts of the arm are fixed and the length is known. If any joints are provided, the angle of the joint may be measured.
  • FIG. 19 An additional elbow support example is shown in Fig. 19 , below, in a docking station.
  • Fig. 17A shows a rehabilitation device 1700, including a joint 1702 between a base 1704 thereof and a movement mechanism 1706 thereof, which can assume multiple orientations.
  • one of the above described rehabilitation devices may be mounted on a surface other than the floor or on legs with uneven lengths.
  • rollers such as rollers 1012 are provided above ball 1010 as well, so that they can support ball 1010, when device 1000 is on its side or upside down. Mounting is achieved, for example, by screws or using an adhesive.
  • One potential advantage of a varying orientation rehabilitation device is the ability to rehabilitate a patient in varying positions. For example, some exercises, for example those including reaching and balance may be usefully practiced while standing up. Some exercises, must be practiced while lying down, as the patient is bed-ridden. Some exercises may be practiced sitting and others while kneeling.
  • Another potential advantage is that a same system may be used to rehabilitate different body parts with a same device.
  • a varying orientation rehabilitation device Another potential advantage of a varying orientation rehabilitation device is that many arm motion mechanisms are limited in their range of motion, coupling between axes and/or other mechanical considerations. Varying the orientation of the device allows the motion mechanism to be placed at a more optimal position. It should be noted that in some varying orientation devices, the controlled tip 108 of the device can stay in a same location even though the motion mechanism has moved. This allows, for example, that a patient remain in a wheelchair during a change in exercise.
  • one or more motors are used to effect the change in orientation.
  • One or more angle sensors may be provided to detect the actual rotation of joint 1702 (in one or two directions).
  • Fig. 17B and Fig. 17C show an alternative varying orientation exercise and/or rehabilitation device 1710, in two orientations.
  • a support slab 1724 positions a motion mechanism 1720 and an arm 1722 relative to a base 1712.
  • one or more extendible legs 1714 are provided for stability.
  • a wheelchair guide 1716 optionally extendible, is provided.
  • guide 1716 is slotted to allow a wheel to enter therein.
  • chucks are added on either side of the wheel to lock the wheel in place.
  • an optional bracket based locking mechanism in which one or more pins or brackets engages the wheel from one or both sides thereof, for example along the wheel axis. Such a mechanism may be electrically actuated, for example, by the patient himself.
  • This wheelchair locking mechanism may be used in other embodiments of the invention as well.
  • slab 1724 can be positioned at various angles.
  • Fig. 17B shows an angle of about 45 degrees.
  • Fig. 17C shows a 90 degree angle.
  • a second support slab 1726 attached by a lockable hinge 1728 to support slab 1724.
  • slab 1726 is flat against base 1712. Additional possible modes are a 0 degree angle, in which slabs 1724 and 1726 lay flat in a recess 1734 of base 1712.
  • a hinge 1730 is used to rotate motion mechanism 1720 so that it faces upwards.
  • motion mechanism 1720 is coupled to hinge 1730 via a rotatable base 1721.
  • Another exemplary position is with slab 1724 lying flat in a recess 1732, so that rotatable base 1721 also lies in recess 1732.
  • This is a transport mode, in which arm 1722 may be detached and the whole of device 1710 may fit, for example, in a trunk of a car.
  • Slab 1726 is optionally attached to base 1712, by another lockable hinge (not shown).
  • Fig. 17D shows an alternative rehabilitation device 1740 with an adjustable position of a motion mechanism 1748 thereof.
  • a rail 1744 extends from a base 1742 and motion mechanism 1748 is coupled to a traveler 1746 which rides on rail 1744.
  • motion mechanism 1748 is attached by a hinge to traveler 1746, to better utilize the range of motion of mechanism 1748 (e.g., allowing an arm 1750 of device 1740 to be centered in a center of a motion space using traveler 1746, rather than using mechanism 1748).
  • Rail 1744 optionally folds for travel.
  • Rail 1744 optionally includes an in-built data and power bus for transferring at least power to mechanism 1748.
  • a flexible cable (not shown) is used.
  • Base 1742 (as other bases shown herein) may optionally include wheels.
  • multiple limbs can be trained together, for example, for exercising and/or rehabilitating synchronized motion.
  • multiple modules such as used in device 1000 are attached in various configurations to achieve this effect
  • the attachment can be, for example, structural (e.g., preventing undesired relative motion, but possibly adjustable), mechanical, for example transmitting motion from one module to another, and/or controlled, for example, modifying the interaction at one module in response or in synchrony with interaction at another module.
  • Fig. 18 shows an exercise and/or rehabilitation device 1800 for an arm and a leg, in accordance with an exemplary embodiment of the invention.
  • Device 1800 includes a first section 1804 for exercising an arm, for example using a mechanism of device 1000, and a second section 1802 for exercising a leg, for example also using the mechanism of device 1000.
  • One exemplary use for this type of device is to rehabilitate a stroke victim with one side paralysis.
  • Another exemplary use is to train synchronized motions, such as required for walking.
  • FIG. 19A shows an exercise and/or rehabilitation device 1900 with four mechanism modules.
  • a pair of modules 1902 and 1904 is used to control the movements of a right arm and a pair of mechanism modules 1906 and 1908 is used to control the movements of a left arm.
  • the two pairs of modules can be synchronized and/or used for teaching, for example, as described above.
  • one or more modules are added for exercising each leg.
  • one or more pedals 1910 such as in Fig. 16A are provided.
  • devices with a greater degree of freedom can be used.
  • gait training mechanisms for example as described in US provisional application no. 60/633,428 filed on December 7, 2004 , also filed as PCT application on February 4, 2005 and by the same applicant, entitled “Gait Rehabilitation Methods and Apparatuses", now published as WO 2005/074370 are used.
  • such mechanism includes a support which attaches to an ankle and can rotate and/or translate the ankle (e.g., foot) in various (e.g., 2,3,4, or more) directions so as to rehabilitate walking.
  • one or more mechanism modules are provided for training hip motion, even while sitting.
  • a tread-mill or training bicycle is provided for the patient to walk on while exercising his upper body.
  • Motion of the treadmill is optionally synchronized to rehabilitation exercises and actual performance by the patient.
  • gait training includes individual training of different parts of the body and then training them together for a complete (or partial) gait.
  • device 1900 is used with a wheelchair and not a standard chair.
  • support attachment 2700 is shown which is optionally used in conjunction with any of the rehabilitation devices described herein.
  • support attachment 2700 is adjustable around at least one rotational axis 2702, in length 2704 and in/or width 2706.
  • support attachment 2700 is rotatable around a vertical axis 2712.
  • support attachment is lockable, for example with a pin.
  • support attachment 2700 is provided with a rest cushion 2708 to provide comfort for the patient 2710.
  • rest cushion is ergonomically designed to accommodate patient's 2710 arm.
  • support attachment 2700 allows full or partial arm support.
  • support attachment 2700 allows for the rolling and/or sliding of the body part being supported.
  • a counterweight is used by support attachment to balance against the weight of patient's 2710 arm.
  • a spring is used as a counter balance.
  • an air spring is used as a counter balance.
  • a motor is used for counter balance. Any of the above counter balances are optionally used to apply force to the patient.
  • support attachment 2700 is adapted and constructed to be used with either the right or the left arm of patient 2710.
  • support attachment 2700 is attached directly to a rehabilitation device.
  • support attachment 2700 is free standing.
  • force and/or position and/or other patient sensors are located on support attachment 2700.
  • sensed information is used for gauging patient performance, progress and/or physiological status.
  • support attachment sensors are in communication with a computer which analyzes sensor data, such as position.
  • support attachment 2700 is used in an upside down orientation.
  • a plurality of support attachments are used.
  • support attachment 2700 is used with a gooseneck.
  • support attachment 2700 is used to limit and/or force patient to move in a proscribed manner, for example to enforce a range of movement.
  • At least one motor is used as a counter balance and/or patient nudging (for cuing) and/or to manipulate the patient into a desired position.
  • limits e.g. mechanical hard stops
  • limits are incorporated to prevent the patient from moving in an unsafe manner.
  • Fig. 19B shows a docking station 1920
  • Fig. 19C shows docking station 1920 occupied by a wheelchair 1922.
  • docking station is meant a structure to which a patient can be brought and locked into place and then exercised and/or rehabilitated. From a functional point of view it is generally desirable that only a minimum of manipulation of the patient be required for rehabilitation work to start.
  • the patient can stay in the wheelchair and optionally instead of adjusting the patient's position (e.g., initially and when exercises change) the rehabilitation device moves, optionally autonomously, to ensure correct relative positioning.
  • two varying orientation modules 1924 and 1926 are provided on a track 1928.
  • the modules are moved by hand.
  • motors (not shown) change the configuration of the modules and/or move them along track 1928.
  • Track 1928 optionally provides power and/or data to the modules. Also non-varying orientation modules or other rehabilitation devices may be attached.
  • An optional wheel-chair holding mechanism 1932 is shown positioned on a track 1930.
  • the position is changed manually.
  • the position is changed using a motor (not shown).
  • the wheelchair-engaging mechanism can be manual or motorized.
  • a set of foot pedals 1934 is shown, but it could be replaced by other foot-training devices.
  • elbow support 1936 is shown, attached to a joint 1938.
  • elbow support 1936 is floating with respect to the person, optionally adjusted to compensate for the weight of the patient.
  • the floating is in a plane, for example in a plane parallel to the floor.
  • the location of the elbow is measured by the support and can be used for various feedbacks such as measurement of quality of motion.
  • Support 1936 is optionally on a telescoping and/or articulating arm, for example as described in Fig. 16 .
  • a display 1940 is optionally provided, for example for use of a therapist and/or the patient.
  • An input system 1942 for example a keyboard and a joystick may be provided as well.
  • the input and output devices 1940 and 1942 can be swiveled to different positions, so that the therapist can access them while docking station 1920 is occupied.
  • Display 1940, input 1942 and/or joint 1938 are optionally mounted on a column, optionally a telescoping column.
  • a display 1946 (audio and/or visual) dedicated to the patient is provided.
  • a similar docking station may be provided for a gurney, for example with four motion mechanisms, one for each limb.
  • the rehabilitation device is made portable enough so that it may be brought to a bed-ridden patient.
  • a feature of some embodiments of the invention is that an exercise and/or rehabilitation device is provided which is mobile. There are various levels of mobility and various embodiments of the invention, as described herein can achieve these levels.
  • mobility of an exercise and/or rehabilitation device is used to move the device within a ward or between hospital wards.
  • Fig. 19D shows mobile rehabilitation devices 1950 positioned near a bed 1951, in accordance with an exemplary embodiment of the invention.
  • a motion mechanism 1952 is mounted on a rail 1958, for example a curved rail with a base 1960. Wheels, optionally lockable and/or extending legs (not shown) may be provided on base 1960.
  • Rail 1958 optionally includes one or more tracks 1962 (slots shown) for adjusting the position of mechanism 1952. Two different attachments are shown, 1954 for an arm and 1956, for a leg. Optionally, the wheels are used to move device 1950 into storage. Collapsible devices were described above, for example in Fig 17B .
  • Fig. 19E shows an alternative mobile exercise and/or rehabilitation device 1964, coupled to bed 1951, in accordance with an exemplary embodiment of the invention.
  • One or more attachment mechanism 1972 lock device 1964 to bed 1951. Wheels are optionally provided.
  • Device 1952 may be used, for example for rehabilitation from above.
  • device 1964 comprises a frame 1970 on a top part 1966 of which a movement mechanism 1952 is mounted.
  • device 1952 can move along the frame.
  • a ball grip attachment 1968 is shown.
  • Mobility may also be useful in other settings, for example, at home or in a small clinic. Also, as noted above, a mobile rehabilitation device may be carried by a therapist on home-calls.
  • exercise and/or rehabilitation is performed in water (or a steam bath), or with water supporting the patient and/or providing heat and/or massage.
  • Fig. 19F exemplifies the use of mobile exercise and/or rehabilitation devices 1972 in a bathtub 1976, in accordance with an exemplary embodiment of the invention.
  • a wheeled base 1978 is shown, but other base types, including a fixed base, may be used.
  • two arm attachments 1974 with extended connections are used and the patient may be sitting or lying down.
  • Exercise and/or rehabilitation may also be carried out in a swimming pool, with device 1972, for example, being attached to a ceiling above the pool.
  • the rehabilitation device is kept outside the water, but attachments are made waterproof.
  • the device itself is made waterproof or at least splatter-proof.
  • the rehabilitation device is made battery operated, to prevent electric-shock hazard.
  • pneumatic or hydraulic motors are used instead of electric motors.
  • low-voltage e.g., 24, 12, 5 volts or less
  • a device without motors that includes brakes is used
  • the mobility of the rehabilitation device is used for exercise and/or rehabilitation in the outdoors, for example in a person's garden (e.g., on grass) or in nature.
  • an exercise and/or rehabilitation device is used for a recreational activity such as barbequing.
  • the device can be used to help guide, diagnoses and train a patient in flipping hamburgers, for example.
  • large wheels are provided for better traveling over soft surfaces.
  • the rehabilitation device is used to rehabilitate outdoor activities such as golf or fishing.
  • special attachments are provided for such activities, to match the range of motion of the movement mechanism used to the activity.
  • the rehabilitation device can assist for example in holding a fishing rod, generating range of motion in the shoulder to through a fly and in resisting the pull of a fish (which is a varying force).
  • Exemplary attachments are an attachment to a fishing rod and an attachment to a tip of the rod (e.g., simulating a fish). In some exemplary embodiments of the invention, these activities constitute wellness exercise.
  • a leveling mechanism is provided for uneven surfaces.
  • This mechanism for example, similar to that of Fig. 17A includes an inclination sensor which detects the level plane and adjusts the motion mechanism to be arranged suitably.
  • a tip and or tilt detection mechanism is provided.
  • the unit when tipping is detected (e.g., acceleration of the base of a rehabilitation unit), the unit generates a warning signal.
  • any attachments to the patient are released, to prevent damage to the patient.
  • the base includes collapsible sections so that if tipping is detected, the base can collapse one section thereof and cause the device to fall away from the patient.
  • a mobile exercise and/or rehabilitation system for use out side of a sterile environment is made easier to clean and/or proof against spills, dirt and some weather conditions.
  • the electronics and motion mechanisms are sealed.
  • joints are covered with flexible rubber so that fewer bumps and cracks are present.
  • a wipe-clean plastic covering is provided on the device.
  • the exercise and/or rehabilitation system is mounted on a wheelchair, for example on its side or in back, or in a car, for example, in the seat near a driver.
  • the device can be fitted in the back of a van and the van is configured to be used as a mobile rehabilitation unit, where a patient can enter (possibly in a wheel chair, possibly using a lift) and exercise.
  • the rehabilitation system is self-propelled.
  • a patient is optionally moved between a plurality of rehabilitation locations and positions using a self-propelled rehabilitation system.
  • the self-propelled system is used as transportation by the patient, to move around in the patient's home, for example.
  • the rehabilitation system is provided with wheels.
  • the rehabilitation system is provided with at least one tread.
  • the rehabilitation system is located on a rail, ceiling or floor.
  • an exercise and/or rehabilitation device optionally features modular design.
  • modular design may manifest itself in one or more of the following manners:
  • an exercise and/or rehabilitation device is used to help specifically exercise and/or rehabilitate a patient to achieve or maintain or improve performance of daily activities, such as opening doors, eating at a table, reading a book, getting dressed, brushing teeth and washing dishes.
  • wellness exercises mimic motions performed while conducting daily activities.
  • Fig. 19G shows an exercise and/or rehabilitation device 1980 configured for use for daily activities, in accordance with an exemplary embodiment of the invention.
  • a rehabilitation module 1952 is mounted upside down over a table 1986 set with various eating utensils.
  • An elbow rest 1984 is optionally provided.
  • table 1986 is attached to a frame 1988 which supports mechanism 1952.
  • frame 1988 may be wide enough to surround an existing table or other home element.
  • a hand of the patient is strapped to a movable tip 1982 of device 1980 and the user attempts to or is guided through a daily activity such as picking up a fork.
  • a glove with force-feedback is used to selectively rehabilitate individual fingers.
  • Such gloves are known in the art.
  • device 1980 is used for one or more of training a patient to do activities related to daily life, testing the patient's current ability to do such activities and/or monitoring a patient's ability.
  • testing and/or monitoring are used by insurance companies to decide on compensation or assistance required.
  • Such testing can be repeated over a period of time so that attempts to cheat may be detected by sudden spikes in ability.
  • a spillage indicating cup is provided, which includes an inclination sensor.
  • a whiteboard with ability to detect a pen position is used in rehabilitation exercises involving writing on a wall. The detected position and/or pressure is reported to the exercise and/or rehabilitation device which optionally holds, supports and/or guides the hand of a patient.
  • an implement of daily living is turned into an attachment by providing one or more patches, for example stickers which include a sensors, for example a position or a pressure sensors, and attaching the patch to a daily use implement, such as hammer or a wall.
  • the exercise and/or rehabilitation device optionally includes a position determining means, for example, a wireless unit which communicates with position sensors on the patches or a camera which images the patches, so that the rehabilitation device can determine relative positions and/or orientations of the daily use objects.
  • rehabilitation and/or diagnosis is carried out using the methods described herein but without mechanical support or kinesthetic feedback.
  • vibration or other feedback is provided to a patient by attaching a vibrating patch (under control of the rehabilitation device) to a limb which is being rehabilitated.
  • Fig. 19H shows a device 1990 for assisting in training for activities of daily living, in accordance with an exemplary embodiment of the invention.
  • device 1990 includes two settable points 1992 and 1993 connected to a base 1994.
  • a pair of adjustable arms, for example goose-neck arms 1996 can be used to adjust their position in space.
  • set points 1992 and 1993 are positioned to emulate a situation, for example pouring tea.
  • a patient is required to move a cup (e.g., helped by an exercise and/or rehabilitation device, not shown) from point 1992 to point 1993.
  • the trajectory is then evaluated.
  • Set point 1993 is shown as a flat surface, on which items may be placed. Other structures and attachments, such as hooks, may be used.
  • set points 1992 and 1993 include sensors, for example proximity sensors (to detect human or rehabilitation robot), contact sensors, pressure sensors and/or position sensors.
  • the set points may also provide feedback, for example, lights, sound or vibration.
  • the relative positions of points 1992 and 1993 may be determined, for example, using position sensors or cameras.
  • tip 108 is used to register their position to the rehabilitation device, by contacting points 1992 and 1993 in turn by tip 108.
  • a dummy arm is mounted on the rehabilitation device to calibrate the relative expected position of tip 108 and a set point, when the set point is actually being touched by a part of the user, such as a finger.
  • a joint in an articulated arm is configured to provide selective and/or directional resistance.
  • Fig. 20 is a cross-sectional view of such a joint between a rod 2004 and a rod 2002.
  • a chuck 2006 fits into a flaring end 2008 of rod 2004 and engages a ball 2012 attached to rod 2002. If chuck 2006 is retracted towards rod 2004, it tightens around ball 2012 and increases the resistance thereof.
  • one or more strain sensors and/or optical sensors is provided between chuck 2006 and ball 2012, so that a direction of force being applied to joint 2000, can be determined.
  • one or more electrically activated brake elements are provided, for example piezoelectric elements, which can selectively modify a degree of resistance. This may be provided instead of or additional to a retracting chuck mechanism.
  • Fig. 21 shows an alternative exercise and/or rehabilitation device 2100, in which a ball joint is not used.
  • An arm 2102, optionally extendible is optionally balanced by an optional counter-weight 2110 around an axle 2106.
  • Counter-weight 2110 may include a motor or variable brake for controlling extension of arm 2102.
  • a motor 2108 is optionally provided to rotate arm 2102 around axle 2106.
  • a second hinge 2112 is provided to allow rotation around an axis perpendicular to arm 2102 and axle 2106.
  • motor 2108 includes a weight so that it balances arm 2102 relative to hinge 2112.
  • a slot 2114 is provided in a base section 2104 of device 2100, for functioning as plate 1020 and slot 1030 above. A similar structural arrangement may be used as well.
  • a rotatable plate 2116 is provided for carrying slot 2114.
  • a motor (not shown) is optionally provided for rotation around joint 2112.
  • joint 2112 is raised to have an axis crossing the axis of axle 2106.
  • Figs. 22A shows an alternative gimbaled device 2200 for use as a motion mechanism in accordance with an exemplary embodiment of the invention.
  • Fig. 22B shows a configuration of device 2200 including motors and/or brakes.
  • Device 2200 includes a gimbaled section 2202, an optionally removable z-axis element 2204 and an optionally replaceable handle 2206 attached thereto.
  • a modular connector 2208 for example as shown in Fig. 15 may be used.
  • a release pin 2210 is user to selectively take off z-axis element 2204, for example,, for replacement or for storage.
  • Gimbaled section 2202 optionally includes a frame 2212 including a first hinge 2214.
  • a guiding frame 2216 is attached to hinge 2214 that provides a first stationary axis and includes a guide pathway for guiding an extension (or cam follower or pin) 2218 (described below).
  • a second stationary axis is provided by a hinge 2220 also on frame 2212.
  • handle 2204 is optionally rigidly attached to a frame 2222 which includes extension 2218.
  • extension 2218 includes a balancing weight (not shown).
  • Fig. 22B shows device 2200 in an exemplary deployed configuration, with two braking mechanisms 2232 and two force control mechanism 2230 attached.
  • a practical device can be constructed with only one of resistance and force control. Force control mechanisms 2230 are described below in greater detail.
  • a disc braking mechanism in which a disc (or part of a disc) 2240 is selectively constrained by a friction element (not shown).
  • a motor 2250 selectively sets the pressure applied by the friction element on the disc.
  • Other friction mechanisms may be provided as well.
  • the following mechanism is used to couple motor 2250 to disc 2240.
  • a coupling 2248 converts rotational motion of motor 2250 into axial motion of a rod 2247.
  • rod 2247 is spring-loaded so that absent power to motor 2250, the pin moves to a locked or an unlocked position, where the friction on disc 2240 is maximal or minimal (depending on the implementation).
  • a rest 2246 is thereby selectively lifted or pushed down by rod 2247.
  • the friction element while not shown, is coupled to a rotatable element 2242 that converts rotation thereof to motion of the friction element towards or away from disc 2240.
  • element 2242 is a screw.
  • Element 2242 includes an trans-axial lever 2244 which is engaged by rest 2246 and thereby rotates element 2242 when rest 2246 is moved.
  • Rotatable element 2242 is optionally spring-loaded.
  • brake mechanisms can be used, for example as known in the art of brakes, for example, electrical, fluid, magnetic and/or mechanical brakes.
  • coupling between motion in the various axis is reduced by providing a single uni-directional brake.
  • the brake comprises a spherical segment which is selectively pressed against pin 2218.
  • a sensor 2234 is coupled to the axis of hinge 2220 and report when handle 2204 is rotated to its limit(s).
  • a sensor 2236 reports when the handle is in a reference (or home) position.
  • a sensor 2238 for example a rotatary potentiometer or encoder reports on the angle of rotation of hinge 2220. Similar sensors may be used for the hinge 2214.
  • the brake mechanism is used for one or more of providing safety by stopping motion, providing programmable resistance (even in a system without active motion of the device) and/or balancing (e.g., by providing friction when needed to counteract external forces).
  • the braking action in the two modules 2232 is coupled to provide for uniform braking behavior independent of whether the motion of handle 2204 is along one of the stationary axes or not.
  • Fig. 23 shows a cantilevered gimbaled mechanism 2300 in accordance with an exemplary embodiment of the invention.
  • a frame 2302 is coupled (rigidly or not, as will be described in Fig. 25 ) to a handle (not shown) which is optionally attachable to a drive system 2304 (e.g., for selectable extension and resistance to axial motion of the handle).
  • Frame 2302 is rotatably coupled to a frame 2306.
  • relative rotation between frames 2302 and 2306 is provided by a motor 2316.
  • motor 2316 couples the frames using a worm gear 2314 and pinion 2312. Other connections methods may be provided.
  • the worm gear has a lead angle small enough to prevent motion of the handle from back-driving the motor. Possibly a worm gear is cheaper, quieter and/or allows a lower cost motor to be used, as compared to using a precise motor and/or gear-box.
  • Frame 2306 is optionally coupled to a base bracket 2307 using a similar mechanism, of which only pinion 2308 and worm 2310 are shown.
  • braking is provided as described in the previous embodiment.
  • Fig. 24A shows a force and drive control mechanism 2400, in accordance with an exemplary embodiment of the invention.
  • mechanism 2400 includes a drive section and a force feedback section.
  • One or both of these sections may be omitted in some embodiments.
  • an axle (not shown) of hinge 2220 or 2214 is coupled to an inner pinion section 2402 of a pinion 2404, for example via a gear section formed on the axle.
  • Pinion 2404 is rotated by a worm gear 2406 which turns on an axis 2407.
  • power is provided by a motor 2414 via a set of two pulleys 2408 and 2410 connected by a belt 2412.
  • Other power trains may be used as well.
  • worm gear 2406 has a lead angle small enough so that it cannot be back-driven by pinion 2404. Instead, force (e.g., from the handle) which counteracts the force applied by motor 2414 will cause worm gear 2406 to move axially along axis 2407.
  • force e.g., from the handle
  • a viscous braking mechanism and a resilient resistance mechanism are provided to counteract this force.
  • Various combinations of settings may be provided, for example resulting in what is shown in Fig. 3B .
  • Axial movement of worm gear 2406 results in displacement of one of the two levers marked 2422 (the figure shows a mirror-imaged mechanism).
  • Viscous cushioning is optionally provided by a cushion 2440 resisting motion of lever 2422.
  • Cushion 2440 is optionally adjustable, for example by hand or by the rehabilitation device.
  • a linear potentiometer or other position sensor, are optionally used to detect the offset of worm gear 2406.
  • a spring 2420 resists the motion of lever 2422.
  • spring 2420 can be selectably preloaded by a motor 2424.
  • a set of pulleys 2426 and 2430 and a belt 2428 cause the rotation of a threaded shaft 2432.
  • a nut 2434 rides on the screw and converts its rotation into preload of spring 2420.
  • shaft 2432 is threaded in opposite directions on its two ends. It should be appreciated that separate preloading for each of the two springs 2420 may be provided, for example if an asymmetric force resistance is desired, or to counter-balance for gravity.
  • manual adjustment of preloading is provided by a nut 2438, possibly used for initial calibration and setting.
  • a pin 2436 is provided to limit the axial extent of motion of worm gear 2406. It should be noted that if the preload is above zero, axial motion of worm gear 2406 will not occur until this force is overcome. This corresponds to F min in Fig. 3B .
  • the force mechanism is set up so that there is more resistance to extending motion (away from the body) than to motion towards the body.
  • springs 2420 can sit on axis 2407.
  • motor 2424 and the associated pre-load setting mechanism can be replaced by a single spring coupled between the two levers 2422.
  • This structure can provide various modes of operation for example:
  • a potential advantage of the spring-motor combination is that velocity and/or range limitations on motion can be provided. Another potential advantage is that gradual (e.g., resilient) stopping can be provided, even in an emergency stop. Another potential advantage is that the viscous damping can provide a dynamic feeling.
  • Fig. 24B is a flowchart 2460 of the operation of mechanism 2400 when two such mechanisms are attached to the device of Fig. 22B , in a free-hand mode, in accordance with an exemplary embodiment of the invention.
  • a similar process may be used for implementation with force control in three axes.
  • Flowchart 2460 describes how the magnitude and direction of force applied by a user is measured and then used to guide the motion of the handle. Acts 2462 through 2476 are described only for Phi, but are carried out for all axes (e.g., Theta), as well.
  • filtering is applied, for example low pass filtering which smoothes the signal and/or removes noise.
  • a scaling operation is optionally performed, for example to match calibration and control parameters.
  • a noise gate is optionally applies where signals below a threshold are converted to zero.
  • the magnitude and/or direction of the change in position are optionally extracted.
  • a position command is optionally generated using a gain factor.
  • the position command is optionally clamped to be at least a minimal value, for example, to overcome friction and/or noise levels.
  • an absolute position command is optionally generated.
  • the velocities of Phi and Theta axes are calculated.
  • acceleration is calculated as well.
  • a composite vector of correction is found.
  • the composite vector is a maximum of phi and theta rather than a vector combination, this may serve to stabilize the system and/or prevent mechanical problems.
  • a gain smaller than 1 is optionally applied, possibly increasing the stability.
  • the angle of the velocity vector is optionally calculated.
  • a command for the motive source (e.g., motors) is generated.
  • Fig. 25 shows an alternative force control mechanism 2500 in which Phi and Theta axes are coupled using a single spring mechanism. A handle 2502 is moved using axes not shown.
  • mechanism 2500 comprises an inner mechanism of the embodiment described in Fig. 23 (where external Phi and Theta axes are shown).
  • An axis 2504 (and a matching orthogonal axis, not shown) comprise inner Phi and Theta axes which handle 2502 rotates around a small amount when force control is applied.
  • a bottom part 2506 contacts a plate 2508.
  • the small amount of rotation causes plate 2508 to be depressed by part 2506 (other shapes may be provided, but part 2506 is optionally rounded at its circumference).
  • This depression is resisted by one or more springs 2510, for example four springs.
  • the pre-load of the springs may be set using a motor 2522 which using a driver train comprising pulleys 2520 and 2516 and a belt 2518 can rotate a screw 2514 which compresses springs 2510 by lifting a base 2512. Alternatively or additionally, manual pre-loading may be practiced
  • linear motion of plate 2508 is ensured using a bushing 2524 or other means as known in the art.
  • a mechanical stop may be provided to the relative motion of cap 2508 and base 2512, so that sufficient preload of springs 2510 prevents any mechanical motion.
  • the rounding of the edges of part 2506 may be calculated to ensure a linear relationship between angle of rotation and displacement.
  • the axes of inner rotation may be congruent with the axes of external rotation, however, this is not required.
  • the axes may not be co-planar and/or the axes may not be parallel.
  • Various measurement means may be provided, for example, a linear potentiometer measuring spring displacement and/or rotary potentiometers measuring Phi and Theta rotation.
  • a linear potentiometer measuring spring displacement and/or rotary potentiometers measuring Phi and Theta rotation.
  • different load cell and/or pressure and/or strain gauging and/or force and/or movement detecting sensors can be used in conjunction with rehabilitation apparatuses such as those described herein. Measured values may be used with the flowchart of fig. 24B .
  • spring 2510 is used to also provide compliance in the Z-direction.
  • spring 2510 when handle 2502 is depressed, spring 2510 provides resistance.
  • the hinge at axis 2504 is optionally placed in a slot is that z-axial motion of the hinge is possible.
  • Fig. 26A and 26B shows a z-axis motion and force response mechanism 2600, in accordance with an exemplary embodiment of the invention.
  • the mechanism comprises a three part telescoping rod comprising a central portion 2604, a top portion 2608 and a bottom portion 2606.
  • An external motor e.g. 2304 from Fig. 23
  • the use of an external motor optionally helps modularity as a z-axis mechanism can be made lower cost and interchangeable with other z-axis mechanisms.
  • a coupling 2610 for example a nut converts the rotary motion into axial motion of central portion 2604.
  • the telescoping of portions 2604, 2606 and 2608 is optionally guided by a pair of linear bearings, 2614 for portion 2608 and 2612 for portion 2606.
  • the linear bearings lie in cannels 2613 and 2611, respectively.
  • a combined rack and pinion and timing belt mechanism is used to synchronize the extension of portions 2606 and 2608, as follows.
  • Each of the channels 2611 and 2613 also includes a rack defined thereon and portion 2604 includes two pinions 2616 and 2618, one on either end.
  • rack 2611 causes pinion 2616 to rotate.
  • a timing belt 2620 which is connected between pinions 2616 and 2618 (on co-axially coupled belt pulleys of same effective diameter) causes pinion 2618 to rotate in synchronization. Pinion 2618 then moves rack 2613, causing telescoping of portion 2608.
  • telescoping allows the z-axis mechanism to be compact and assist in portability. Also, it allows motions near to the center of rotation of the motion mechanism. In an exemplary embodiment of the invention, telescoping allows a range of 2:1 or close to 3:1 of z-axis length. Additional telescoping potions can be provided for a greater extension ratio.
  • an exchangeable handle 2630 is shown. Axial motion of handle 2630 is optionally shown by motion of a linear measurement potentiometer 2638. Optionally, handle 2630 is attached using a quick connect mechanism.
  • a spring 2632 provides resilient resistance to axial motion of handle 2630, for example using the logic as described above in Fig. 24 .
  • spring 2632 is a spiral spring, whose resistance can be changed by changing its effective length, for example by moving a sliding stop 2636 which determines a length of the leaves of spring 2632.
  • This sliding stop is optionally moved manually, for example by rotating a housing 2634.
  • an internal motor may be provided.
  • This change in leaf length is generally comparable to a change in preload.
  • Minimal force setting may be provided by actually preloading spring 2636, for example by axial motion thereof, or by providing another spring to resist axial motion. Preload may also be achieved by rotating spring 2632 itself, thereby tensing the spring.
  • the range of motion of the force control mechanisms can be, for example, 3 cm, 5 cm, 10 cm, 15 cm, 20 cm or intermediate, smaller or greater ranges, depending on the implementation.
  • gear-reduction ratios allows lower power and/or lower cost motors to be used.
  • force in the Z-axis can be transferred using a flexible or a bent coupling.
  • the z-axis element can be a 90 degree elbow in which only the far portion extends.
  • goose-neck like mechanism is used to define shape in space for the z-axis element.
  • an alternative exercise and/or rehabilitation apparatus 2800 including a handle 2802 and/or pedals 2804 is depicted in accordance with an exemplary embodiment of the invention.
  • apparatus 2800 is self-powered.
  • apparatus 2800 uses batteries.
  • apparatus 2800 is powered by a therapist or the patient.
  • exercise and/or rehabilitation apparatus 2800 is suited for use outside of a large scale environment, such as at home, due to it's modest size.
  • exercise and/or rehabilitation apparatus 2800 weighs less than 100 kg.
  • exercise and/or rehabilitation apparatus 2800 weighs less than 50 kg. in some exemplary embodiments of the invention, rehabilitation apparatus 2800 weighs less than 25 kg.
  • exercise and/or rehabilitation apparatus 2800 is provided with as few parts as possible to simplify maintenance.
  • exercise and/or rehabilitation apparatus 2800 includes a variable resistance system (shown in Fig. 29 ).
  • handle 2802 is provided with a variable resistance system control.
  • the variable resistance system is automatically activated by the apparatus 2800.
  • handle 2802 is used by a patient to perform exercises.
  • a therapist uses handle 2802 alternatively or in addition to the patient.
  • the handle is adapted and constructed to enable the patient and someone else to grip the rehabilitation apparatus.
  • An exemplary dual handle is depicted in Fig. 15F .
  • movement of handle 2802 is translated down shaft 2806 to the apparatus mechanics 2900, for example as depicted in Fig. 29 .
  • the apparatus 2800 imparts motion to the patient using mechanics 2900 and the shaft 2806/handle 2802.
  • Motion of handle 2802 optionally occurs in the x, y and/or z axes.
  • handle 2802 rotates about the shaft's 2806 longitudinal axis.
  • pedals 2804 are provided to the patient for exercise.
  • pedals 2804 rotate like bicycle pedals.
  • pedals 2804 operate similarly to those depicted in Fig. 16A .
  • Pedals 2804 are optionally engaged with apparatus mechanics 2900 which either assist or resist motion of pedals 2804 by the patient.
  • a dragging handle 2808 is provided to apparatus 2800 for facilitating movement of apparatus 2800.
  • apparatus 2800 is provided with a display to provide patient with information.
  • information is related to the exercise being performed by the patient, for example level of performance and/or compliance with an exercise plan.
  • information is comprised of an exercise aid, such as the graphics of a game designed to encourage exercise.
  • apparatus 2800 is used to provide wellness exercise to a patient.
  • the patient is elderly.
  • the patient is suffering from a physically impairing ailment, such as arthritis.
  • the patient is suffering from a cognitive disorder.
  • Exemplary wellness exercises provided to the patient include "reach" exercises, such as described below.
  • wellness exercises are exercises which mimic motions conducted in everyday life, such as lifting an object, bending over, standing/sitting, eating, walking, biking, stair climbing and the like.
  • wellness exercises are provided by any of the devices described herein.
  • wellness exercises are provided to a patient over a long-term with a goal being at least the maintenance of an ability of the patient.
  • wellness exercises have a cognitive aspect, such as described herein.
  • Fig. 29 shows a configuration of exemplary mechanics 2900 for apparatus 2800 (or other systems), in accordance with an exemplary embodiment of the invention.
  • movement of handle 2802 in the z axis is accomplished by moving handle 2802 and thus shaft 2806 up and/or down, shaft 2806 optionally being a ball screw which translates z-axis motion to the rotational motion of a disk 2912.
  • shaft 2806 optionally being a ball screw which translates z-axis motion to the rotational motion of a disk 2912.
  • a different mechanism is used for translating z-axis movement.
  • Variable resistance to movement of handle 2802 in the x, y and/or z axes is provided to apparatus 2800 in an exemplary embodiment of the invention.
  • shaft 2806 rotates around it's longitudinal axis and/or is directly linked to disk 2912.
  • a single motor applies pressure to brake pads operationally connected to x, y and/or z axis moving members in order to resist movement along those axes.
  • a motor 2902 is used to drive a worm gear 2904 which in turn causes a gear 2906 to rotate, in accordance with an exemplary embodiment of the invention.
  • Gear 2906 rotation drives brakes 2908 and/or 2910 forward, instigating contact with an underlying curved surface 2914 (in the case of x, y brake 2908) and disk 2912 (in the case of z brake 2910).
  • x, y brake 2908 contacts underlying surface 2914 the friction created between them resists movement of shaft 2806 and therefore handle 2802 in the x and y axes.
  • the z brake 2910 contacts disk 2912 which is in turn connected to the ball screw. Friction between z brake 2910 and disk 2912 resists the rotation of disk 2912 and therefore movement of the ball screw and movement of shaft/handle in the z-axis.
  • z movement is provided linearly (in contrast to rotary movement), such as by direct z movement of shaft 2806 by motor 2902.
  • brake 2910 directly engages shaft 2806 to resist movement in the z-axis.
  • resistance movement includes stopping movement.
  • brakes 2908 and/or 2910 are tipped with a friction inducing substance, such as rubber.
  • braking is achieved by using magnetic brakes.
  • x, y brake is a magnetic substance selectively having one charge and underlying surface 2914 is a second magnetic surface selectively having an opposite charge, in accordance with an exemplary embodiment of the invention.
  • magnetic attraction between brake 2908 and underlying surface 2914 is adjustable by selectively applying a variable electric field to one or both of them.
  • brakes 2908 and/or 2910 are biased in relation to apparatus 2800 to strengthen their variable resistance capability.
  • biasing is performed using a spring.
  • bias is calibrated by changing brake length. It should be noted that in an exemplary embodiment of the invention, such as depicted in Fig.
  • a cable is operationally connected to brakes 2908 and/or 2910 which pneumatically or hydraulically instigates friction using the brakes.
  • a cable is mechanically controlled by motor 2902 to resist movement in the x, y and/or z axes.
  • motor 2902 is optionally used to set a programmable friction level so the resistive force can be changed and adapted to the patient's capability.
  • resistive force is modified depending on the exercise.
  • resistive force is modified depending on the movements of the patient.
  • additional motors are used to allow selective axis variable resistance.
  • a simple mechanical lever and/or handle is used to set the friction level manually, optionally or additionally a spring is placed in mechanics 2900 to compensate for inaccuracy between the drive gears and the brake and to allow better force control.
  • sensors are used to detect information pertaining of the components, such as shaft 2806, of apparatus 2800 (or other apparatuses described herein).
  • Information optionally includes position of a component, force exerted by a patient on the component, force exerted by apparatus 2800 on a component, and/or rotation of a component.
  • Sensors such as potentiometers, position encoders and/or any other sensors known to those skilled in the art are optionally used.
  • gathering of this information is used to provide feedback to the patient using the apparatus.
  • information is provided to a control system for analysis and/or implementation of further exercise for the patient.
  • information gathered from components of apparatus 2800 is used as an input to software, such as game and/or exercise software, which directs the exercise of a patient in response to the feedback.
  • software such as game and/or exercise software
  • information gathered about apparatus 2800 is used in combination with information gathered about the patient for analysis and/or implementation of further exercise for the patient.
  • game-types are provided: role playing games (adventure and D&D games), kinetic games (shoot-em-up), board games and simulation games (e.g., soccer and tennis). ,
  • Games may be played, for example, one-on-one, against a human opponent or against a machine opponent.
  • games are played against a plurality of human and/or machine opponents.
  • device 100 serves as an input device, for example replacing a joystick.
  • device 100 is used as a VR input device, for example to read limb positions.
  • specialized input modes may be defined, for example, spatial positions of arm 102 may be mapped to virtual positions on the screen or in the game world, or to velocities and/or accelerations thereof.
  • Gestures may be defined for various controls, for example, "fire", "lift” and “put" commands may each have an associated gesture.
  • Child games are provided, for example for encouraging paretic or CP children to avoid neglecting body parts.
  • Device 100 may also be used as a social focal point for preventing the paretic child from becoming an outcast.
  • a game is fitted to the ability of the patient, for example, limiting the ROM required, providing enhancement of patient motion, changing the game speed and changing the visual field which needs to be attended.
  • the game is selected to match a motivation level of the patient, for example, a simple game selected for low-motivation patients.
  • At least one game is presented to a patient that stimulates cognitive and/or motor skills and/or assists with exercise and/or rehabilitation.
  • An exemplary game includes presenting to the patient, optionally via a display such as those described herein, a representation of at least one reach point to which the patient should move using an exercise and/or rehabilitation apparatus.
  • a reach point is optionally any location within or even outside the range of motion of the patient that serves as a target for the patient to attempt to reach. Multiple reach points optionally vary from each other in the x, y and/or z axes.
  • a plurality of reach points are presented to the patient, wherein it's the patient's responsibility to move to each reach point in the same order they were presented to the patient.
  • at least one reach point is presented randomly.
  • at least one reach point is presented at a predetermined point. In some exemplary embodiments of the invention, this is an example of a wellness exercise.
  • reach points are individually coded.
  • a game optionally presented to the patient includes presenting at least one individually coded reach point and then using a code indicator, such as a bar at the bottom of a display, which demonstrates to which coded reach point the patient should endeavor to move.
  • a code indicator such as a bar at the bottom of a display, which demonstrates to which coded reach point the patient should endeavor to move.
  • a plurality of individually-coded reach points are presented to the patient and as the code indicator changes codes, the patient is expected to change the target reach point to correspond to the new code being indicated.
  • the code indicator is displayed for a predetermined amount of time.
  • the predetermined amount of time is very short, and the patient is responsible for remembering the code after the code indicator is no longer available.
  • the code is comprised of at least one color.
  • the code is comprised of at least one geometrical shape.
  • the code is a design.
  • the code is a pictorial representation.
  • code complexity is selected to train coordination between vision, cognitive and/or motor function.
  • code complexity is selected according to patient ability.
  • a reach point is presented to a patient briefly prior to the patient commencing movement of the exercise and/or rehabilitation apparatus.
  • the reach point is presented to the patient on a display.
  • the patient is expected to memorize the location of the reach point shown on the display in relation to the patient's range of motion. Once the reach point disappears from the display, the patient moves the rehabilitation apparatus to the location memorized by the patient and ideally as shown on the display.
  • a subsequent reach point is optionally displayed to the patient.
  • the subsequent reach point is displayed in a similar manner, for a brief time prior to patient movement, to allow the patient to memorize the location of the subsequent reach point.
  • a plurality of reach points are presented to the patient in sequence.
  • the plurality of reach points are displayed simultaneously for a brief time and the patient is expected to memorize the location of the reach points and move the rehabilitation apparatus from one reach point to the next in one run.
  • a reach point is presented to a patient and a plurality of movement paths for reaching the reach point are suggested to the patient optionally via a display such as those described herein.
  • the plurality of movement paths are assigned point values, awarded to the patient for successfully traversing the path to reach the reach point.
  • the movement paths vary in difficulty to the patient.
  • point values are determined based on the difficulty to the patient.
  • the object of a game optionally played by a patient is to collect points by navigating to a reach point along as many of the paths as possible.
  • the game is timed.
  • Another reach point is presented to the patient.
  • quality of motion in addition to path of motion is monitored and points are optionally awarded for attaining certain levels of quality of motion.
  • points are not awarded for following a suggested path unless the patient meets a minimum movement quality threshold.
  • patient strength and/or endurance are tested by having the patient positively (causing the apparatus to move) and negatively (preventing the apparatus from moving) apply force to an exercise and/or rehabilitation apparatus.
  • the patient is asked to apply force to the rehabilitation apparatus in at least one direction.
  • the patient is asked to apply force in a plurality of directions.
  • the amount of force requested of the patient is varied.
  • the patient is asked to hold the rehabilitation apparatus in a fixed position in space while at least one force is applied to the rehabilitation apparatus in an attempt to move it from the fixed position.
  • a plurality of forces is applied either separately or in combination.
  • the amount of force applied to the patient via the exercise and/or rehabilitation apparatus is variable. In some exemplary embodiments of the invention, this is an example of a wellness exercise.
  • the patient is expected to maintain the exercise and/or rehabilitation apparatus in a position in space while being measured against a "target" centered on the position in space. If the patient permits movement of the apparatus away from the center of the target, performance is thus judged to be less than if the apparatus had been held steady at the center.
  • the target has gradations of performance, for example 1 cm of movement in any direction could constitute the center ring, movement from the center between 1 cm and 2 cm could constitute the next ring of performance and so on.
  • the position in space is predetermined.
  • a patient using the exercise and/or rehabilitation apparatus optionally receives feedback from the apparatus regarding the initial positioning of the apparatus in relation to the predetermined position in space.
  • the feedback is a visual signal, such as lights, which indicates when the apparatus is properly positioned at the position in space.
  • the apparatus locks when properly positioned at a start position.
  • each axis is separately lockable as the apparatus attains the correct coordinate in each axis.
  • visual or audible instructions are given to patient to assist with apparatus positioning.
  • apparatus positions itself automatically in an initial position in space.
  • a goal is set for the patient which predefines a force threshold to be resisted by the patient.
  • a plurality of positions in space are presented to the patient.
  • Forces applied in any of the games described herein can optionally include torsion, rotation, and movement in the x, y and/or z axes.
  • forces applied by the patient and to the patient are measured by the exercise and/or rehabilitation apparatus. Measurements are optionally analyzed and/or used for signaling the progress of the patient and/or devising treatment programs for the patient.
  • a patient uses an exercise and/or rehabilitation apparatus to match similar icons presented on a display.
  • a plurality of icons is shown on the display opposite a second set of icons, each icon being grouped with a same icon in the opposing set.
  • a game played by the patient is to connect an icon from the first set with the corresponding same icon in the second set using an exercise and/or rehabilitation apparatus.
  • connecting is by dragging the first icon to the second icon using the rehabilitation apparatus.
  • the icons are geometric shapes.
  • the icons are varied in color.
  • a pair of matching icons is comprised of related objects and not identical icons, for example a toothbrush and a toothpaste tube.
  • children play the game to develop cognitive and/or motor skills.
  • the patient moves the rehabilitation apparatus in response to feedback from the rehabilitation apparatus.
  • a reach point is defined by the apparatus but is not revealed to the patient.
  • the patient then begins movement in a direction chosen by the patient. If the movement is away from the reach point, the patient is notified via feedback. Similarly, if the movement is towards the reach point, the patient is notified via feedback.
  • the patient is expected to find the reach point by responding to the feedback.
  • the feedback is audible, for example increasingly slower beeping when moving away from the reach point and increasingly faster beeping as the patient gets close.
  • the feedback is visual.
  • the speed and/or quality of motion which the patient employs to find the reach point is measured and/or analyzed.
  • one or more safety features are provided to prevent injury to a patient.
  • one or more of the following safety mechanism may be used:
  • an exercise and/or rehabilitation module is used for balance training.
  • a seat is attached to tip 1008 and a patient sits on the seat.
  • a non-rotating plate 1020 with a slot sets the direction in which the seat is allowed to roll and the resistance level sets the difficulty.
  • a handle bar is provided.
  • a foot rest and/or pedals are provided for the feet.
  • one or more rehabilitation modules for the arms are provided.
  • a virtual reality type display or a television display is provided to enhance the sense of reality.
  • Such a virtual reality display may be provided in other embodiments of the invention, for example to show feedback, to show instructions or to make the activity more interesting.
  • device 100 is used to train balance while standing. For example, a patient performing a reaching exercise to arm 102, when tip 108 is at various spatial positions; some positions requiring only arm extending and some positions requiring torso bending.
  • device 100 can be used for providing exercise and/or rehabilitation in modes other than motor.
  • the displays audio and/or visual
  • a single device can be used for multiple rehabilitation types (e.g., at home) and serve as a single point of contact both for the patient and for the therapist. If multiple therapists exist, the device can serve to coordinate between the various therapies and/or track general parameters, such as general progress, motivation and/or cognitive level.
  • device 100 selectively applies an exercise in one of several modalities, for example, for load balancing and/or for interest.
  • device 100 is used to rehabilitate the coordination between modalities and/or using the exercise and/or rehabilitation of one modality to help rehabilitate other modalities.
  • One example is eye-hand coordination, where a patient is shown a target on a screen and the aim is to move tip 108 to tack it.
  • Another example is timing where a patient needs to provide a command at a certain timing, possibly in an auditory modality.
  • Another example is spatial planning, where a patient is provided with verbal instructions of gradually increasing complexity with regard to spatial motions.
  • progressively more complex visual instructions, motor acts and feedback are provided to the patient.
  • progressively more complex audio, kinesthetic, haptic, and smell (using scent release attachments) feedback and/or instructions are provided.
  • speech recognition is exercised and/or rehabilitated in concert with motion for example requiring speech to be understood fast enough to perform the motion in time, or respond to verbal instructions.
  • a user may be required to provide speech utterances which match his motions.
  • a speech recognition module may be provided.
  • visual stimuli is made more complex as visual rehabilitation progresses, for example, starting with a light, then a light at a position, then a speed of blinking, then text which must be read, all of which are used to prompt motor action or serve as feedback (e.g., for progressively complex motor tasks: moving arm, moving to a direction, moving to a particular area).
  • a particular advantage of some embodiments of device 100 is mechanical feedback and support is provided to the patient.
  • some of the methods described herein for motor exercise and/or rehabilitation are used for non-motor exercise and/or rehabilitation, for example, measuring motivation, remote exercise and/or rehabilitation, group activities and support by a computer of user activities (for example for group participation).
  • reproductive exercise is used to exercise and/or rehabilitate a patient's kinestatic capabilities.
  • Feedback is optionally provided to the patient alternatively or additionally to the patient's natural sensory capabilities.
  • the patient optionally performs an accuracy/repeatability test wherein the patient moves from a first point to a second point, with various feedback input.
  • the patient optionally repeats the movements, in some exemplary embodiments with diminishing levels of feedback.
  • Results are measured and/or recorded and/or analyzed for various factors including improvement over time.
  • Feedback is optionally visual in nature.
  • feedback is audible.
  • these exercises and/or measurements are used to decide what accuracy to expect form patient during rehabilitation therapy.
  • some movements during exercise are open loop, meaning that they are according to a pre-planned patient motor program.
  • some movements during exercise are closed loop, meaning that the client needs feedback in order to determine what movement to do next.
  • different types of feedback such as direct vision, are provided selectively to the patient.
  • an exercise apparatus such as those described herein, is provided with a controller programmed with software to predict patient exercise performance.
  • patient exercise capability is determined based on an exercise performance prediction as compared to actual exercise performance.
  • the controller is not physically a part of the exercise and/or rehabilitation apparatus, but is used in conjunction with the apparatus.
  • predicted performance includes movement trajectory, a target destination of movement, movement velocity, movement acceleration, and/or other exercise performance related measurables.
  • patient performance is measured using the sensor and/or feedback apparatuses and methods described herein.
  • predicted patient performance is compared to previously recorded and/or analyzed patient performance.
  • the comparison is conducted by the controller.
  • the comparison is used to gauge patient progress, maintenance or regression.
  • the comparison is used to gauge the effectiveness of exercises being performed by the patient.
  • the comparison is used to determine patient exercise capability.
  • a performance prediction is derived from data collected from other sources besides the patient; for example, data collected from other patients.
  • exercise is presented to the patient in the form of a game, such as those described herein.
  • the same game is used for a plurality of patients and/or multiple times for the same patient, for collecting performance data to be used in a comparison.
  • parameters of a game and/or exercise presented to the patient are modified in response to preferences indicated by a professional exercise attendant, such as a physio or occupational therapist.
  • the comparison is conducted using a least squares method.
  • the patient's exercise capability is placed into a classification by the controller.
  • a classification is used to determine what exercise plan will be provided to the patient.
  • kits which include sets of a device, one or more tearing pins, one or more attachments and/or software.

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  • Health & Medical Sciences (AREA)
  • Epidemiology (AREA)
  • Pain & Pain Management (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Rehabilitation Therapy (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Rehabilitation Tools (AREA)

Claims (23)

  1. Appareil (2800) configuré avec des organes mécaniques (2900) pour fournir au moins trois degrés de liberté de mouvement, comprenant :
    un ou plusieurs freins d'axe, x et d'axe y (2908) correspondant à un axe x et à un axe y de mouvement de l'appareil ;
    un ou plusieurs freins d'axe z (2910) correspondant à un axe z de mouvement de l'appareil ;
    un moteur (2902), dans lequel ledit moteur (2902) est raccordé de manière opérationnelle audit un ou plusieurs freins d'axe x, d'axe y et d'axe z (2908, 2910) ;
    une ou plusieurs surfaces (2914, 2912), dans lequel une surface de mouvement incurvée d'axes x et y (2914) est corrélée aux un ou plusieurs freins d'axe x et d'axe y (2908), et une surface d'axe z (2912) est corrélée aux un ou plusieurs freins d'axe z (2910) ; et
    lorsque ledit moteur (2902) est activé, un ou plusieurs freins d'axe x, d'axe y et d'axe z (2908, 2910) sont sélectivement avancés par ledit moteur (2902) pour établir le contact avec lesdites une ou plusieurs surfaces d'axe x, d'axe y et d'axe z (2914, 2912) provoquant la friction entre lesdits un ou plusieurs freins d'axe x, d'axe y et d'axe z (2908, 2910) et lesdites une ou plusieurs surfaces d'axe x, d'axe y et d'axe z (2914, 2912) et provoquant ainsi une résistance variable dans au moins deux desdits au moins trois degrés de liberté dudit appareil (2800) en fonction de l'étendue d'avancement desdits freins d'axe x, d'axe y et d'axe z (2908, 2910).
  2. Appareil selon la revendication 1, dans lequel la résistance variable sur une première surface (2914) desdites une ou plusieurs surfaces provoque la résistance variable sur lesdits au moins deux axes de mouvement.
  3. Appareil selon la revendication 1, dans lequel la résistance variable est produite par une force magnétique appliquée entre au moins un frein desdits freins et au moins une surface correspondante desdites surfaces.
  4. Appareil selon la revendication 1, dans lequel la résistance variable sur une seconde surface (2912) desdites une ou plusieurs surfaces provoque la résistance variable sur au moins un troisième axe.
  5. Appareil selon la revendication 1, comprenant en outre une poignée (2802) adaptée pour être saisie par aux moins un utilisateur.
  6. Appareil selon la revendication 1, comprenant en outre au moins une pédale (2804) adaptée et construite pour être actionnée par un pied.
  7. Appareil selon la revendication 2, dans lequel ledit moteur (2902) est positionné au-dessus d'une surface incurvée (2914) desdites une ou plusieurs surfaces.
  8. Appareil selon la revendication 1, dans lequel ledit moteur (2902) est activé automatiquement.
  9. Appareil selon la revendication 4, dans lequel ladite seconde surface (2912) est un disque rotatif qui est raccordé de manière opérationnelle à un arbre mobile d'axe z.
  10. Appareil selon la revendication 1, dans lequel au moins un frein desdits un ou plusieurs freins est incliné avec une substance d'induction de friction.
  11. Appareil selon la revendication 10, dans lequel ladite substance d'induction de friction est du caoutchouc.
  12. Appareil selon la revendication 1, dans lequel au moins un frein desdits un ou plusieurs freins est sollicité pour fournir la puissance de résistance variable supplémentaire.
  13. Appareil selon la revendication 1, dans lequel ledit moteur et lesdits freins sont configurés pour fournir la force de friction contre un patient pendant l'exercice.
  14. Appareil selon la revendication 13, dans lequel ladite force de friction est configurée pour être appliquée selon la capacité du patient.
  15. Appareil selon la revendication 1, comprenant en outre un ressort pour compenser le manque de précision entre le moteur et au moins l'un desdits freins.
  16. Appareil selon la revendication 1, comprenant en outre un affichage.
  17. Appareil selon la revendication 1, comprenant en outre un organe de commande en communication opérationnelle avec ledit moteur et programmé avec un logiciel pour fournir un exercice à un utilisateur dudit appareil.
  18. Appareil selon la revendication 17, dans lequel ledit organe de commande est programmé avec au moins un exercice de bien-être.
  19. Appareil selon la revendication 17, dans lequel ledit organe de commande est programmé avec un logiciel pour prévoir la performance de l'exercice dudit utilisateur.
  20. Appareil selon la revendication 1, dans lequel ledit moteur active deux freins séparés.
  21. Appareil selon la revendication 1, dans lequel ledit moteur active lesdits un ou plusieurs freins en tendant un ressort qui pousse un frein vers sa surface correspondante.
  22. Appareil selon la revendication 1, comprenant un élément en forme de tige configuré pour fournir un mouvement en coordonnées sphériques autour d'un point de pivot au-dessus d'une surface incurvée, dans lequel lesdits un ou plusieurs freins sont montés sur ladite tige.
  23. Appareil selon la revendication 22, dans lequel ledit moteur est un moteur unique utilisé pour empêcher et/ou modifier le mouvement de ladite tige dans lesdits trois degrés de liberté en utilisant la résistance variable.
EP06704564.1A 2005-02-04 2006-02-05 Methodes et appareils de readaptation et d'entrainement Not-in-force EP1850824B1 (fr)

Applications Claiming Priority (16)

Application Number Priority Date Filing Date Title
PCT/IL2005/000139 WO2005075155A2 (fr) 2004-02-05 2005-02-04 Reeducation de commande motrice precise
PCT/IL2005/000136 WO2005074369A2 (fr) 2004-02-05 2005-02-04 Methodes et appareils d'exercice et d'entrainement de reeducation
PCT/IL2005/000137 WO2005086574A2 (fr) 2004-02-05 2005-02-04 Reeducation faisant appel a la musique
PCT/IL2005/000140 WO2005074371A2 (fr) 2004-02-05 2005-02-04 Methodes et appareil de reeducation fonctionnelle et d'exercice
PCT/IL2005/000135 WO2005087307A2 (fr) 2004-02-05 2005-02-04 Stimulation neuromusculaire
PCT/IL2005/000141 WO2005074372A2 (fr) 2004-02-05 2005-02-04 Procedes et appareil pour la reeducation et l'entrainement
PCT/IL2005/000138 WO2005074370A2 (fr) 2004-02-05 2005-02-04 Methodes et appareils de reeducation de la marche
PCT/IL2005/000142 WO2005074373A2 (fr) 2004-02-05 2005-02-04 Procedes et appareil pour la reeducation et l'entrainement
US66588605P 2005-03-28 2005-03-28
US66613605P 2005-03-29 2005-03-29
PCT/IL2005/000442 WO2005105203A1 (fr) 2004-02-05 2005-04-28 Stimulation neuromusculaire
US68699105P 2005-06-02 2005-06-02
PCT/IL2005/000906 WO2006021952A2 (fr) 2004-08-25 2005-08-18 Entrainement moteur impliquant la plasticite cerebrale
US11/207,655 US20060293617A1 (en) 2004-02-05 2005-08-18 Methods and apparatuses for rehabilitation and training
US73544705P 2005-11-10 2005-11-10
PCT/IL2006/000140 WO2006082584A2 (fr) 2004-02-05 2006-02-05 Methodes et appareils de readaptation et d'entrainement

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EP1850824A4 EP1850824A4 (fr) 2009-08-12
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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
IT201700095013A1 (it) * 2017-08-22 2019-02-22 S M Scienzia Machinale S R L Apparecchiatura per la riabilitazione degli arti superiori di un individuo in grado di assicurare elevati standard di sicurezza per l’utilizzatore
IT201700095005A1 (it) * 2017-08-22 2019-02-22 S M Scienzia Machinale S R L Apparecchiatura per la riabilitazione degli arti superiori di un individuo provvista di dispositivi di sicurezza altamente affidabili
WO2019038633A1 (fr) * 2017-08-22 2019-02-28 S.M. Scienzia Machinale S.R.L. Appareil de rééducation des membres supérieurs d'une personne
US11278786B2 (en) 2018-09-28 2022-03-22 Hill-Rom Services, Inc. System and method for incentivizing and quantifying patient mobility

Families Citing this family (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
TR201513356A2 (tr) * 2015-10-26 2017-05-22 Muhammed Kilinc Bir norm bulma sistemi.
CN110180138A (zh) * 2019-07-11 2019-08-30 合肥工业大学 具有轨迹识别功能的砂磨板
CN110523060B (zh) * 2019-08-29 2021-09-24 深圳市问库信息技术有限公司 肌力恢复与姿势纠正辅助装置
IT202000003563A1 (it) * 2020-02-20 2021-08-20 Giuseppe Carbone Dispositivo portabile per la riabilitazione degli arti superiori
IT202100003941A1 (it) * 2021-02-19 2022-08-19 Univ Della Calabria Dispositivo per la riabilitazione degli arti
EP4106707A1 (fr) * 2020-02-20 2022-12-28 Università della Calabria Dispositif pour la rééducation de membres
CN112336986A (zh) * 2020-11-19 2021-02-09 日照市精神卫生中心(日照市荣军康复医院) 一种精神科医疗康复用腿部刺激装置
CN113524147B (zh) * 2021-08-02 2022-05-24 北京深度奇点科技有限公司 一种基于3d相机的工业机器人示教系统及方法
CN113842311A (zh) * 2021-08-19 2021-12-28 南京市乐境医疗生物科技有限公司 一种基于中医五行音乐理论的沉浸式vr推拿系统
CN114272077A (zh) * 2021-12-10 2022-04-05 宁波慈溪生物医学工程研究所 一种双臂训练机器人及双臂训练方法

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH01316815A (ja) * 1988-06-17 1989-12-21 Nippon Telegr & Teleph Corp <Ntt> 三次元指示装置
US6354945B1 (en) * 1998-05-20 2002-03-12 Alps Electric Co., Ltd. Controller

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5201772A (en) * 1991-01-31 1993-04-13 Maxwell Scott M System for resisting limb movement
US5755645A (en) * 1997-01-09 1998-05-26 Boston Biomotion, Inc. Exercise apparatus
US5830160A (en) * 1997-04-18 1998-11-03 Reinkensmeyer; David J. Movement guiding system for quantifying diagnosing and treating impaired movement performance
WO2005074372A2 (fr) * 2004-02-05 2005-08-18 Motorika Inc. Procedes et appareil pour la reeducation et l'entrainement

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH01316815A (ja) * 1988-06-17 1989-12-21 Nippon Telegr & Teleph Corp <Ntt> 三次元指示装置
US6354945B1 (en) * 1998-05-20 2002-03-12 Alps Electric Co., Ltd. Controller

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
IT201700095013A1 (it) * 2017-08-22 2019-02-22 S M Scienzia Machinale S R L Apparecchiatura per la riabilitazione degli arti superiori di un individuo in grado di assicurare elevati standard di sicurezza per l’utilizzatore
IT201700095005A1 (it) * 2017-08-22 2019-02-22 S M Scienzia Machinale S R L Apparecchiatura per la riabilitazione degli arti superiori di un individuo provvista di dispositivi di sicurezza altamente affidabili
WO2019038633A1 (fr) * 2017-08-22 2019-02-28 S.M. Scienzia Machinale S.R.L. Appareil de rééducation des membres supérieurs d'une personne
US11278786B2 (en) 2018-09-28 2022-03-22 Hill-Rom Services, Inc. System and method for incentivizing and quantifying patient mobility

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