EP1998725A2 - Orthose du coude - Google Patents

Orthose du coude

Info

Publication number
EP1998725A2
EP1998725A2 EP07758851A EP07758851A EP1998725A2 EP 1998725 A2 EP1998725 A2 EP 1998725A2 EP 07758851 A EP07758851 A EP 07758851A EP 07758851 A EP07758851 A EP 07758851A EP 1998725 A2 EP1998725 A2 EP 1998725A2
Authority
EP
European Patent Office
Prior art keywords
arm member
orthosis
joint
arm
set forth
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.)
Withdrawn
Application number
EP07758851A
Other languages
German (de)
English (en)
Other versions
EP1998725A4 (fr
Inventor
Boris P. Bonutti
Peter M. Bonutti
Kevin R. Ruholl
Glen A. Phillips
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Bonutti Research Inc
Original Assignee
MarcTec LLC
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 US11/687,679 external-priority patent/US7955286B2/en
Application filed by MarcTec LLC filed Critical MarcTec LLC
Publication of EP1998725A2 publication Critical patent/EP1998725A2/fr
Publication of EP1998725A4 publication Critical patent/EP1998725A4/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
    • A61F5/0102—Orthopaedic devices, e.g. splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations
    • A61F5/013—Orthopaedic devices, e.g. splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations for the arms, hands or fingers
    • 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
    • A61H1/0277—Elbow

Definitions

  • the present invention relates to an adjustable orthosis for stretching tissue in the human body.
  • the present invention relates to an adjustable orthosis which can be used for stretching tissue such as ligaments, tendons or muscles around a joint during flexion or extension of the joint.
  • joints move in two directions, flexion and extension. Flexion is to bend the joint and extension is to straighten the joint; however, in the orthopedic convention some joints only flex.
  • the ankle has dorsiflexion and plantarflexion.
  • Other joints not only flex and extend, they rotate.
  • the elbow joint has supination and pronation, which is rotation of the hand about the longitudinal axis of the forearm placing the palm up or the palm down.
  • ROM orthoses are devices commonly used during physical rehabilitative therapy to increase the range-of-motion over which the patient can flex or extend the joint.
  • Commercially available ROM orthoses are typically attached on opposite members of the joint and apply a torque to rotate the joint in opposition to the contraction. The force is gradually increased to increase the working range or angle of joint motion.
  • Exemplary orthoses include U.S. Patent Nos.: 6,599,263, entitled “Shoulder Orthosis;" 6,113,562, entitled “Shoulder Orthosis;”
  • the present invention provides an orthosis for stretching tissue around a joint of a patient between first and second relatively pivotable body portions.
  • the joint and the first and second body portions define on one side of the joint an inner sector which decreases in angle as the joint is flexed and define on the opposite side of the joint an outer sector which decreases in angle as the joint is extended.
  • the orthosis includes a first arm member affixablc to the first body portion.
  • the first arm member has a first extension member extending therefrom.
  • a second arm member affixable to the second body portion is also included.
  • the second arm member has a second extension member having an arcuate shape extending therefrom.
  • a third arm member including a third extension member, having an arcuate shape extending therefrom, is interposed between the first and second arm members.
  • the second and third arm members arc operatively connected, such that the third arm member travels along an arcuate path defined by the second extension member when the third arm member is moved from a first position to a second position relative to the second arm member.
  • the first arm member is slidingly connected to the third extension member, such that the first arm member slides along an arcuate path defined by the third extension member when the third arm member is moved from the first position to the second position relative to the second arm member.
  • the orthosis further includes a drive assembly for selectively moving the third arm member relative to the second extension member.
  • the drive assembly is mounted onto the third arm member, engaging the second extension member.
  • the drive assembly can be manually or automatically actuated to selectively move the third arm member relative to the second extension member.
  • FIG. 1 is a schematic diagram of the orthosis of the present invention in a flexed position
  • FIG. 2 is a schematic diagram of the orthosis of the present invention in an extended position
  • FIG. 3 is a second schematic diagram of the orthosis of the present invention in a flexed position
  • FIG. 4 shows an adjustable first extension member of the orthosis of the present invention
  • FIG. 5 shows the adjustable first extension member of FIG. 4 in a second position
  • FIG. 6 shows a segmented first extension member of the present invention
  • FIG. 7 shows an arcuate first extension member of the present invention
  • FIG. 8 shows an orthosis of the present invention
  • FIG. 9 shows a non-circular arcuate shaped second extension member of the present invention.
  • FIG. 10 shows an alternative arcuate shaped second extension member of the present invention
  • FIG. 11 shows a linear shaped second extension member of the present invention
  • FIG. 12 shows an exemplary drive assembly of the present invention
  • FIG. 13 depicts a first side view of another orthosis of the present invention for flexing and extending a joint in a patient;
  • FIG. 14 depicts an opposite side view of the orthosis of FIG. 13;
  • FIG. 15 depicts a first arm member of the orthosis of FIG. 13;
  • FIG. 16 depicts a second arm member of the orthosis of FIG. 13;
  • FIG. 17 depicts a third arm member of the orthosis of FIG. 13;
  • FIG. 18 depicts the drive assembly of the orthosis of FIG. 13;
  • FIG. 19 depicts the connectivity of the first, second, and third, arm members of the orthosis of FlG. 13;
  • FIG. 20 depicts the orthosis of FIG. 13 in a middle flexed position
  • FIG. 21 depicts the orthosis of FIG. 13 in a fully flexed position.
  • the present invention relates to an orthosis for moving a joint between first and second relatively pivotable body portions.
  • the joint and the first and second body portions define on one side (the flexor side) of the joint an inner sector which decreases in angle as the joint is flexed (bent) and on the opposite side (the extensor side) of the joint an outer sector which decreases in angle as the joint is extended (straightened).
  • the orthosis of the present invention is affixable to either the flexor or extensor side of the joint for treatment of flexion or extension contractures.
  • FIG. 1 a schematic of the orthosis 10 of the present invention.
  • the orthosis 10 includes a first arm member 12 attachable to the first body portion and a second arm member 14 attachable to the second body portion, wherein a joint axis of rotation 16 is interposed between and offset from the first and second arm members 12 and 14.
  • the first and second arm members 12 and 14 are operatively connected to each other offset from the joint axis 16,
  • the first arm member 12 of the orthosis 10 includes a first extension member 18, which extends at angle a from the first arm member 12.
  • the second arm member 14 of the orthosis 10 includes a second extension member 20 extending therefrom and having an arcuate shape.
  • the first and second extension members 18 and 20 are operatively connected at point "P," such that in operation the second extension member 20 travels along an arcuate path about and substantially through point "P.”
  • the arcuate shape of the second extension member 20 results in the second body portion rotating about the joint axis 16, when the second arm member 14 is moved from a first position to a second position relative to the first arm member 12.
  • the angle a between the first extension member 18 and the first arm member 12 and the radius of curvature of the second extension member 20 are a function of the joint to be treated and the degree of flexion or extension contractures.
  • the orthosis further includes a drive assembly 22 at point "P."
  • the drive assembly connects the first and second extension members 18 and 20 for applying force to the first and second ami members 12 and 14 to pivot the first and second body portions relative to each other about the joint.
  • the orthosis 10 of the present invention is shown having an angle of such that the operative connection, at point "P," of the first and second extensions 18 and 20 is located in a plane “A" passing through the joint axis 16, wherein plane “A" is substantially orthogonal to a longitudinal axis of the first arm member 12.
  • This position of point "P" provides an angle ⁇ between the second arm member 14 and the joint axis 16, wherein ⁇ is the maximum angle of flexion,
  • the second extension member includes a stop 24.
  • the stop 24 acts to limit the angle of maximum extension ⁇ between the second arm member 14 and the joint axis 16. An increase in the length of the stop 24 will decrease the angle of maximum extension ⁇ . A decrease in the length of the stop 24 will increase the angle of maximum extension ⁇ .
  • the maximum flexion angle can be increased by increasing the angle a.
  • An increase in the angle a will move the point "P" to a location "in front of the plane “A.”
  • This position of point “P” provides an angle ft between the second arm member 14 and the joint axis 16 in maximum flexion, wherein ⁇ is greater than ⁇ .
  • the greater the angle a the greater the angle of maximum flexion.
  • a decrease in the angle a will move the point "P" to a location "behind” the plane “A.”
  • This position of point “P” provides an angle ft between the second arm member 14 and the joint axis 16 in maximum flexion, wherein ft is less than ft.
  • the smaller the angle a the smaller the angle ⁇ of maximum flexion.
  • the first extension member 18 is selectively, pivolally connected at location 26 to the first arm member 12.
  • the pivotal connection 26 of the first extension member 18 permits the angle a between the first extension member 18 and the first aim member 12 to be selectively increased and decreased, increasing and decreasing the range of motion.
  • a first position 28 the first extension member 18 is positioned at an angle ct ⁇ , wherein the operative connection, at point "P," of the first and second extension members 18 and 20 is located in a plane "A" passing through the joint axis 16, wherein plane "A" is substantially orthogonal to a longitudinal axis of the first arm member 12.
  • the first position 28 of point "P" provides a maximum angle of flexion of ft.
  • the second extension member stop 24 acts to limit the angle of maximum extension 7 1 between the second arm member 14 and the joint axis 16.
  • a second position 30 the angle a is increased to an angle Ot 2 , positioning the point "P" to a location "in front of the plane "A.”
  • the second position 30 of point "P” provides a maximum angle of flexion of ft, wherein ft is greater than ft.
  • the second extension member stop 24 acts to limit the angle of maximum extension ⁇ 2 between the second arm member 14 and the joint axis, wherein 72 is less the 71.
  • the selective pivotal connection 26 of the first extension member 18 to the first arm member 12 can have a plurality of selectable positions.
  • the angle a between the first arm member 12 and the first extension 18 can be selectively increased to move the point "P", on, "in front of or “behind” the plane "A.” It is also envisioned that a positioned can be selected to increase the angle a between the first arm member 12 and the first extension 18 sufficiently to move the point "P" "in front of plane "A” and "above” the longitudinal axis of the first arm member 12, maximizing the maximum angle of flexion ft
  • the orthosis 10 of the present invention can be connected to the flexor side of the first and second body portions of the joint, which results in a decrease in angle as the joint is flexed (bent) and an increase in angle and the joint is extended (straightened).
  • orthosis 10 of the present invention can be connected to the extensor side of the joint, which results in a decrease in angle as the joint is extended straightened and an increase in angle as the joint is flexed (bent).
  • first extension 18 having a substantially linear shape, extending at an angle a from the first arm member 12.
  • first extension member 18 can be any shape extending from the first arm member 12 which positions the point "P" in the desired relationship to the plane "A.”
  • a segmented fist extension member is shown, including a first extension member segment 18a and a second extension member segment 18b.
  • the first and second extension member segments 18a and 18b extend from the first arm member 12, positioning the point "P" at an angle ⁇ from the first arm member 12.
  • an arcuate first extension member 18c is shown.
  • the arcuate extension member 18c extends from the first arm member 12, positioning the point "P" at an angle a from the first arm member 12.
  • the orthosis 10 of the present invention includes a first arm member 12 attachable to the first body portion and a second arm member 14 attachable to the second body portion, wherein the joint axis 16 is interposed between and offset from the first and second arm members 12 and 14.
  • the first and second arm members 12 and 14 are connected with each other offset from the joint axis 16.
  • the first arm member 12 of the orthosis 10 includes a first extension member 18, which extends at angle a from the first arm member 12.
  • the second arm member 14 of the orthosis 10 includes a second extension member 20, having an arcuate shape.
  • the first and second extension members 18 and 20 are operatively connected a point "P," such that in operation the second extension member 20 travels along an arcuate path about and substantially through point "P.”
  • the arcuate shape of the second extension member 20 results in the second body portion rotating about the joint axis 16, when the second arm member 14 is moved from a first position to a second position relative to the first arm member 12.
  • the angle a is
  • first cuff 32 is attached to the first arm member 12, wherein the first cuff 32 is positionable about the first body portion.
  • the first cuff 32 is attached to the first body portion by cuff straps.
  • the first cuff 32 secures the first body portion to the first arm member 12.
  • a second cuff 34 is attached to the second arm member 14, wherein the second cuff 34 is positionable about the second body portion.
  • the second cuff 34 is attached to the second body portion by cuff straps.
  • the second cuff 34 secures the second body portion to the second arm member 14.
  • the orthosis 10 is operated to extend a joint in the following manner.
  • the first cuff 32 is fastened about the first body portion tightly enough that the first arm member 12 may apply torque to the first body portion without having the first cuff 32 slide along the first body portion.
  • the second cuff 34 is fastened securely around the second body portion so that the second arm member 14 may apply torque to the second body portion without the second cuff 34 sliding along the second body portion.
  • the orthosis 10 is attached to the first and second body portions in a first position.
  • the second arm member 14 is rotated from the first position to a second position, relative to the first arm member 12, rotating the second body portion about the joint axis 16 stretching the joint.
  • the second extension member 20 travels along an arcuate path about and substantially through point "P."
  • the orthosis 10 is maintained in the second position for a predetermined treatment time providing a constant stretch to the joint.
  • the orthosis 10 may alternatively be configured to impart a constant force or load on the joint or may utilize the techniques of Static Progressive Stretch as described in co-pending application serial no. 1 1 /203,516, entitled “Range of Motion System and Method", and filed on August 12, 2005, the entirety of which is incorporated by reference.
  • the second extension member 12 can be made of a substantially rigid but flexible material, such that while the second extension member 12 is in the second position, the second extension member 12 acts like a spring, providing dynamic stretch to the connective tissue of the joint.
  • the second arm member 14 is moved back to the first position, relieving the joint.
  • the second arm member 14 can be rotated to a third position, increasing the stretch on the joint.
  • the second arm member 14 can be rotated at discrete time intervals to incrementally increase the stretch of the joint through the treatment cycle. After completion of the treatment cycle, the second arm member is returned to the first position for removal of the orthosis 10.
  • the first and second arm members 12 and 14 are rigid members made of, for example, aluminum, stainless steel, polymeric, or composite materials.
  • the arms are rigid so as to be able to transmit the necessary forces. It should be understood that any material of sufficient rigidity can be used.
  • the components of the orthosis 10 of the present invention arc made by injection molding.
  • tool and die metal molds of the orthosis 10 components are prepared. Hot, melted plastic material is injected into the molds. The plastic is allowed to cool, forming components. The components are removed from the molds and assembled.
  • the cuff portions 32 or 34 can be individual molded and attached to the arm members 12 or 14. Alternatively, the cuff portions can be molded as an integrated part of the arm members 12 or 14.
  • the orthosis 10 can be connected to the flexor side of the first and second body portions of the joint, which results in a decrease in angle as the joint is flexed (bent) and an increase in angle as the joint is extended (straightened).
  • orthosis 10 of the present invention can be connected to the extensor side of the joint, which results in a decrease in angle as the joint is extended straightened and an increase in angle as the joint is flexed (bent).
  • the orthosis 10 includes a first cuff 32 for attachment to a first body portion, and a second cuff 34 for attachment to a second body portion.
  • the first body portion is joined to the second body portion at a joint, around which is located, as is well known, soft tissue.
  • Each of the first and second cuffs 32 and 34 includes loop connectors for receiving straps extending around the body portions to clamp the cuffs 32 and 34 to the body portions.
  • the first cuff 32 is mounted for sliding movement on the first arm member 12 and is slidable along the first arm member 12 in a manner as described below.
  • the second cuff 34 is mounted for sliding movement on a second arm member 14 and is slidable along the second arm member 12 in a manner as described below.
  • the orthosis 10 starts at a more flexed position.
  • the first and second cuffs 32 and 34 are clamped onto the first and second body portions, respectively, by straps, tightly enough so that the cuffs 32 and 34 can apply torque to the body portions to extend the joint.
  • the second arm member 14 is rotated from the first position to a second position, relative to the first arm member 12, rotating the second body portion about the joint axis 16 stretching the joint.
  • the second extension member 20 travels along an arcuate path about and substantially through point "P.”
  • the orthosis 10 is maintained in the second position for a predetermined treatment time providing a constant stretch to the joint.
  • the first and second cuffs 32 and 34 move along the first and second arm members 12 and 14.
  • the first cuff 32 moves inwardly along the first arm member 12.
  • the second cuff 34 moves inwardly along the second arm member 14. Because the cuffs 32 and 34 are clamped onto the first and second body portions as described above, the outward pivoting movement of the first and second arm members 12 and 14 and the cuffs 32 and 34 causes the joint to be extended as desired. However, this extension of the joint can place strong distractive forces on the soft tissues around the joint.
  • the sliding movement of the cuffs 32 and 34, inwardly along the first and second arm members 12 and 14, helps to limit these distractive forces by counteracting the outward movement of the first and second arm members 12 and 14.
  • the cuffs 32 and 34 slide inwardly along the first and second arm members 12 and 14 a distance far enough so that the joint is only slightly distracted during extension.
  • the orthosis 10 starts at a more extended position.
  • the first and second cuffs 32 and 34 are clamped onto the first and second body portions, respectively, by straps, tightly enough so that the cuffs 32 and 34 can apply torque to the body portions to extend the joint.
  • the second arm member 14 is rotated from the first position to a second position, relative to the first arm member 12, rotating the second body portion about the joint axis 16 stretching the joint. ⁇ s the second arm member 14 is rotated to the second position the second extension member 20 travels about and substantially though point "P," along an arcuate path.
  • the orthosis 10 is maintained in the second position for a predetermined treatment time providing a constant stretch to the joint.
  • the first and second cuffs 32 and 34 move along the first and second arm members 12 and 14.
  • the first cuff 32 moves outwardly along the first arm member 12.
  • the second cuff 34 moves outwardly along the second arm member 14. Because the cuffs 32 and 34 are clamped onto the first and second body portions the inward pivoting movement of the first and second arm members 12 and 14 and the cuffs 32 and 34 causes the joint to be flexed as desired. However, this flexion of the joint can place strong compressive forces on the soft tissues around the joint.
  • the sliding movement of the cuffs 32 and 34, outwardly along the first and second arm members 12 and 14, helps to limit these compressive forces by counteracting the inward movement of the first and second arm members 12 and 14.
  • the cuffs 32 and 34 slide outwardly along the first and second arm members 12 and 14 a distance far enough so that the joint is only slightly compressed during flexion.
  • the detrimental effects of strong compressive forces normally generated in forced flexion of a joint are avoided, being replaced with the beneficial effects of limited and controlled compression.
  • the second arm member 14 is shown having a non-circular arcuate shaped second extension member 44.
  • the non-circular arcuate shaped second extension member 44 provide an axis of rotation which changes as the second arm member 14 is moved from the first position to the second portion. As such, as the second arm member 14 is moved from the first position to the second portion the second body portion will exhibit both a rotational motion, about the joint axis 16, and a translational motion, distracting or compressing the joint.
  • the arcuate shape of the second extension member 20 or 44 as shown have concave radius of curvature relative to the joint 16.
  • the second extension member 20 or 44 can have a convex radius of curvature relative to the joint 16.
  • the convex arcuate shape of the second extension member 20 or 44 results in the second body portion rotating about the joint axis 16, when the second arm member 14 is moved from a first position to a second position relative to the first arm member 12,
  • the second arm member 14 of the orthosis 10 includes a second extension member 46 extending therefrom and having a linear shape.
  • the first and second extension members 18 and 46 are operatively connected at point "P," such that in operation the second extension member 46 travels along a linear path through point "P.”
  • the linear shape of the second extension member 46 results in the second body portion being translated with respect to the first body portion.
  • the translational movement of the second arm member 14 results in a distraction or compression of the joint when the second arm member 14 is moved from a first position to a second position relative to the first arm member 12.
  • the hand pad can be mounted for translational and rotational movement on the base member,
  • the drive assembly 22 of the orthosis includes a gear system.
  • the components of the orthosis, including the drive assembly 22, can be made by injection molding a polymer.
  • the drive assembly 22 is supported in the first extension member 18, including a gear 50 rotatable about point "P."
  • a shaft 52, attached to the gear 50, extends from first extension member 18.
  • a knob 54 is connected to the shaft 52, opposite the gear 50, for manually rotating the gear 50.
  • the second extension member 20 includes a series of teeth 56 along an inner surface 58. The second extension member 20 is threaded through the first extension member 18, such that the teeth 56 on the second extension member 20 engage the gear 50.
  • the rotation of the knob 56 causes the gear 50 to rotate, pushing or pulling the second extension member 20 through the first extension member 18,
  • the drive assembly 22 includes a locking or breaking mechanism which prevents the gear 50 from rotating absent any applied force rotation of the knob 56.
  • a lock or breaking mechanism can include a compression washer or other known gear locking or breaking mechanisms.
  • the drive assembly 22 is described as utilizing a gear system. However, it is contemplated that other known drive systems can be used to move the second extension member 20 through the first extension member 18, for example a friction type drive system. Regardless of the drive system used, the joint orthosis of the present invention can act as a brace, restricting the relative movement of the first and second body portions to one degree of freedom (e.g, flexion and extension about the joint). Thus, drive assembly 22 can be configured to allow free motion in one degree of freedom. This can be achieved in a number of different ways. For example, gear 50 can be positioned such that it does not engage teeth 56.
  • the drive assembly 22 of orthosis 10 in accordance with the present invention can be actuated by a motor instead of by a manually actuatable member.
  • the motor may be configured an adapted with gearing that causes the orthosis to cycle through a range of motion in a predetermined manner, or alternatively maybe controlled by a programmable logic controller (PLC).
  • PLC programmable logic controller
  • an electric motor is mounted, to the shaft 52 for rotation of the gear 50.
  • a battery provides electric power to the motor, Alternatively, the motor can be supplied, with external power.
  • a microprocessor controls the operation of the motor. The microprocessor and motor together can be used to cycle the first and second arm members 12 and 14 through extension and flexion; to move the first and second arm members 12 and 14 in one pivotal direction a certain amount, hold there while tissue stretches, then move further in that direction; or in any other manner.
  • the orthosis can be set to cycle to one end of the joint's range of motion and hold there for a predetermined period of time, then cycle to the other end of the joint's range of motion and hold there.
  • the programming and control of the microprocessor is within the skill of the art as it relates to driving the motor to control the first and second arm members 12 and 14 to move in known manners.
  • This embodiment is ideally suited for continuous passive motion exercise, because the orthosis is portable and because the motor can be programmed with the desired sequence of movements.
  • an orthosis 80 of the present invention includes a first arm member 82 attachable to the first body portion and a second arm member 84 attachable to the second body portion, wherein the joint axis 86 is interposed between and offset from the first and second arm members 82 and 84.
  • a third arm member 88 is interposed between the first and second arm members 82 and 84, where the first and second arm members 82 and 84 are connected to the third arm member 88, offset from the joint axis 86.
  • the first arm member 82 of the orthosis 80 includes a first extension member 90, which extends from the first arm member 82.
  • the second arm member 84 of the orthosis 80 includes a second extension member 92 having an arcuate shape.
  • the first and second extension members 90 and 92 are operatively connected to the third arm member 88, where the second extension member 92 is operably connected to the third arm member 88 at a point "P," such that in operation the third member 88 travels along an arcuate path of the second extension member 92.
  • the arcuate shape of the second extension member 92 results in the first body portion rotating about the joint axis 86, when the First and third arm members 82 and 88 are moved from a first position to a second position relative to the second arm member 84.
  • the radius of curvature of the second extension member 92 is a function of the joint to be treated and the degree of flexion or extension contractures.
  • first cuff 94 is attached to the first arm member 82, wherein the first cuff 94 is positionablc about the first body portion.
  • the first cuff 94 is attached to the first body portion by cuff straps.
  • the first cuff 94 secures the first body portion to the first arm member 82.
  • a second cuff 96 is attached to the second arm member 84, wherein the second cuff 96 is positionable about the second body portion.
  • the second cuff 96 is attached to the second body portion by a cuff strap(s) 98.
  • the second cuff 96 secures the second body portion to the second arm member 84.
  • the cuffs 94 and 96 can be provided in a variety of sizes or have adjustable sizes to fit about the body portions. (The term "cuff as used herein means any suitable structure for transmitting the force of the orthosis 80 to the limb portion it engages.).
  • the first cuff 94 can be slidingly connected to the first arm member 82.
  • a sliding bar 100 is affixed to the first cuff 94, where the sliding bar 100 includes channels 102 positioned on opposite sides of the sliding bar 1 10.
  • the first arm member 82 includes a main channel 106 configured to slidingly receive the sliding bar 100.
  • Pins 108 are positioned though opposite sides of the main channel 106 of the first arm member 82 and into the channels 102 to slidingly secured the sliding bar 100 in the main channel 106.
  • An adjustable member 1 10 can be threaded though the first arm member 82, into a channel 102 to adjustably secure the position of the sliding bar 102 in the main channel 106.
  • the position of the first cuff 94 can be adjusted with respected the first arm member 82, the position being secured with the adjustable member 110.
  • the first cuff 94 can be free to slide with respect to the first arm member 82, thereby allowing the position of the first cuff 94 to self adjust during operation of the orthosis 80,
  • the second cuff 96 can be slidingly connected to the second arm member 84.
  • the second extension member 92 has an arcuate shape, where the radius of curvature of the second extension member 92 is a function of the joint to be treated and the degree of flexion or extension contractures.
  • the second extension member 92 includes an inner surface 1 12 have a plurality of teeth 114 thereon.
  • the second extension member 92 can include channels 115 disposed on opposite sides thereof.
  • the third arm member 88 includes a third extension member 1 16 has an arcuate shape, where the radius of curvature of the third extension member 1 16 is a function of the joint to be treated and the degree of flexion or extension contractures.
  • the third extension member 1 16 includes channels 1 18 disposed on opposite sides thereof.
  • a drive housing 120 is positioned proximal to a guide channel 122.
  • a drive assembly 124 is positioned in the drive housing 120 of the third arm member 88.
  • the drive assembly 124 includes a drive gear 126 and a main gear 128, where the teeth of the drive gear 126 engage the teeth 130 of the main gear 128.
  • a drive shaft 132 is connected to the drive gear 126, extending through the cover plate 134.
  • a knob 133 can be affixed to the drive shaft 132 to facilitate rotation thereof.
  • a rotation of the drive shaft 132 rotates the drive gear 126, which in turn rotates the main gear 128.
  • the main gear 128 is sized such that a portion of the gear teeth 130 protrudes into the guide channel 122 of the third arm member 88.
  • the second extension member 92 is positioned in the guide channel 122, such that the gear teeth 132 of the main gear 128 engage the teeth 3 14 on the inner surface 112 of the second extension member 92.
  • a rotation of the dive shaft 132 rotates the drive gear 126, which in turn rotates the main gear 128, driving the second extension member 92 through the guide channel 122.
  • the cover plate 134 is positioned over the guide channel 122, securing the second extension member 92 in the guide channel 122 and defining a passage through which it travels.
  • Guide pins 135 can be positioned in the channels 115 of the second extension member 92, engaging on one side the third arm member 88 and on an opposite side the cover plate 134.
  • the guide pins 135 can be used to secure the second extension member 92 in the passage and control the tacking of the third arm member 88 along the second extension member 92.
  • the drive mechanism 22 can further include a locking mechanism.
  • the locking mechanism can be used to secure the position of the second arm member 84 with respect to the third arm member 88.
  • the locking mechansm can prevent the actuation of the drive assembly 124, securing the position of second and third arm members 84 and 88.
  • the locking mechanism can secure the second and third arm members 84 and 88, preventing an actuation of the drive mechanism 124 from moving the second and third arm members 84 and 88.
  • the locking mechanism can be utilized such that the orthosis 80 can be used as a static splint.
  • the first arm member 82 can be sliding affixed to the third arm member 88,
  • the first extension member 90 is positioned about the third extension member 88, where an end portion 136 of the first extension member 90 is slidingly connected about the third extension member 118.
  • Pins 140 are positioned through pin holes 142, provided on opposite sides of the end portion 136 of the first extension member 90, into the channels 118 of the third extension member 88, thereby allowing the end portion 136 of the first extension member 90 to slide along the arcuate path defined by the channels 118, rotating the first arm member 82 about the joint axis 86.
  • the first arm member 82 can slide freely with respect to the third extension member 1 16.
  • a push pin 144 can be positioned through the end portion 136 of the first extension member 92 into push pin hole 146 in the channels 118 of the third extension member 116. (See also FlG. 14). The push pin 144 prevents relative movement of the first arm member 82 with respect to the third arm member 88.
  • the orthosis 80 is operated to extend a joint in the following manner.
  • the first cuff 94 is fastened about the first body portion tightly enough that the first arm member 82 may apply torque to the first body portion without having the first cuff 94 slide along the first body portion.
  • the second cuff 96 is fastened securely around the second body portion so that the second arm member 84 may apply torque to the second body portion without the second cuff 96 sliding along the second body portion.
  • the orthosis 80 is attached to the first and second body portions in a first position.
  • the first and second arm members 82 and 84 are rotated from the first position to a second position, relative to the second arm member 84, rotating the first body portion about the joint axis 86 stretching the joint.
  • the third arm member 88 travels along an arcuate path along the second extension member 92.
  • the orthosis 80 is maintained in the second position for a predetermined treatment time providing a constant stretch to the joint.
  • the second extension member 92 can be made of a substantially rigid but flexible material, such that while the first arm member 82 is in the second position the second extension member 92 acts like a spring, providing dynamic stretch to the connective tissue of the joint.
  • the first arm member 82 is moved back to the first position, relieving the joint.
  • the first arm member 82 can be rotated to a third position, increasing the stretch on the joint.
  • the first arm member 82 can be rotated at discrete time intervals to incrementally increase the stretch of the joint through the treatment cycle.
  • the first a ⁇ n member 82 is returned to the first position for removal of the orthosis 80.
  • the push pin 144 is removed from the first and third arm members 82 and 88, such that as the first and third arm members 82 and 88 are moved from a first position to a second position, with respected to the second arm member 84, the first arm member 82 can slide along the arcuate path of the third extension 1 16 of the third arm member 88.
  • This can be utilized to increase the range on motion of the orthosis 80. It is contemplated that the orthosis 80 can have a range of motion from around 15 degrees to around 145 degrees.
  • the first, second, and third arm members 82, 84, and 88 are rigid members made of, for example, aluminum, stainless steel, polymeric, or composite materials.
  • the arms are rigid so as to be able to transmit the necessary forces. Tt should be understood that any material of sufficient rigidity can be used,
  • the components of the orthosis 80 of the present invention are made by injection molding.
  • tool and die metal molds of the orthosis 80 components are prepared. Hot, melted plastic material is injected into the molds. The plastic is allowed to cool, forming components. The components are removed from the molds and assembled.
  • the cuff portions 92 or 96 can be individual molded and attached to the arm members 82 or 84. Alternatively, the cuff portions can be molded as an integrated part of the arm members 82 or 84.
  • the gears 132 and 134 are rigid members made of, for example, aluminum, stainless steel, polymeric, or composite materials.
  • the gears 132 and 134 are rigid so as to be able to transmit the necessary forces.
  • the orthosis 80 In operation of the orthosis 80 to flex an elbow joint, the orthosis 80 starts at a more extended position.
  • the first and second cuffs 94 and 96 are clamped onto the forearm and biccp portions of the arm, respectively, by straps, tightly enough so that the cuffs 94 and 96 can apply torque to the body portions to flex the joint.
  • the first and second arm members 82 and 84 are rotated from the first position to a second position, relative to the second arm member 84, rotating the forearm about the elbow joint axis 86 stretching the joint.
  • the third arm member 88 travels along the arcuate path of the second extension member 92.
  • the orthosis 80 is maintained in the second position for a predetermined treatment time providing a constant stretch to the joint.
  • the first and second ami members 82 and 884 are moved back to the first position, relieving the joint.
  • the first and second arm members 82 and 84 can be rotated to a third position, increasing the stretch on the joint, The first and second arm members 82 and 84 can be rotated at discrete time intervals to incrementally increase the stretch of the joint through the treatment cycle. Referring to FIG. 20, the treatment cycle can continue until the third arm member 88 traverses the second extension member 82. After completion of the treatment cycle, the first and second arm members 82 and 84 are returned to the first position for removal of the orthosis 80.
  • the first arm member 82 can be released to move along the third arm member 88.
  • the first and third arm members 82 and 88 are rotated from the first position to a second position, relative to the second arm member 84, rotating the forearm about the joint axis 86 stretching the joint.
  • the third arm member 88 is rotated to the second position, the first arm member 82 can travel along an arcuate path of the third extension member 1 16, thereby increasing the range of motion.
  • the first cuff 94 When an elbow joint is to be bent in extension, the first cuff 94 is connected with the forearm and the second cuff 96 is connected to the bicep.
  • the first and second cuffs 94 and 96 are clamped onto the forearm and biceps respectively, by straps, tightly enough so that they can apply torque to flex the joint.
  • the first and third arm members 82 and 88 are rotated from the first position to a second position, relative to the second arm member 84, rotating the forearm about the elbow joint axis 86 stretching the joint.
  • the orthosis 80 is maintained in the second position for a predetermined treatment time providing a constant stretch to the joint.
  • the first and second arm members 82 and 84 are moved back to the first position, relieving the joint.
  • the first and second arm members 82 and 84 can be rotated to a third position, increasing the stretch on the joint.
  • the first and second arm members 82 and 84 can be rotated at discrete time intervals to incrementally increase the stretch of the joint through the treatment cycle.
  • the first and second arm members 82 and 84 are returned to the first position for removal of the orthosis 80.
  • the first arm member 82 can be released to move along the third arm member 88.
  • the first and third arm members 82 and 88 are rotated from the first position to a second position, relative to the second ami member 84, rotating the second body portion about the joint axis 86 stretching the joint.
  • the third arm member 88 is rotated to the second position, the first arm member 82 can travel along an arcuate path of the third extension member 1 16, thereby increasing the range of motion.
  • the second and/or third extension members 92 and 116 are shown and described as having a substantially circular arcuate shape, positioning the axis of rotation at the joint axis 86. However, it is contemplated that the second and/or third extension members 92 and 116 can have alternative shapes.
  • the drive assembly 124 is described as utilizing a gear system. However, it is contemplated that other known drive systems can be used to move the first extension member 90 with respect to the second extension member 92 for example a friction type drive system.
  • the joint orthosis of the present invention can act as a brace, restricting the relative movement of the first and second body portions to one degree of freedom (e.g. flexion and extension about the joint).
  • drive assembly 124 can be configured to allow free motion in one degree of freedom. This can be achieved in a number of different ways.
  • gear 128 can be positioned such that it does not engage teeth
  • the drive assembly 124 of orthosis 80 in accordance with the present invention can be actuated by a motor instead of by a manually actuatable member, such as the knob 133.
  • the motor may be configured and adapted with gearing that causes the orthosis to cycle through a range of motion in a predetermined manner, or alternatively maybe controlled by a programmable logic controller (PLC).
  • PLC programmable logic controller
  • an electric motor is mounted to the shaft 132 for rotation of the gear 128.
  • a battery provides electric power to the motor.
  • the motor can be supplied with external power.
  • a microprocessor controls the operation of the motor. The microprocessor and motor together can be used to cycle the second and third arm members 84 and 88 through extension and flexion; to move the first and second arm members 82 and 84 in one pivotal direction a certain amount, hold there while tissue stretches, then move further in that direction; or in any other manner.
  • the orthosis can be set to cycle to one end of the joint's range of motion and hold there for a predetermined period of time, then cycle to the other end of the joint's range of motion and hold there.
  • the programming and control of the microprocessor is within the skill of the art as it relates to driving the motor to control the second and third arm members 84 and 88 to move in known manners.
  • This embodiment is ideally suited for continuous passive motion exercise, because the orthosis is portable and because the motor can be programmed with the desired sequence of movements.
  • the particular physical arrangement of the motor, the battery, and the microprocessor is not the only possible arrangement of those elements.
  • the invention contemplates that other arrangements of these or similarly functional elements arc quite suitable, and thus, the invention is intended to cover any such arrangement.
  • another type of power source other than an electric motor, can also be used.
  • the use of a hydraulic or pneumatic motor as the drive mechanism is contemplated.
  • the present invention can further include a monitor for use with the orthosis 10, 80, which provides assurances the patient is properly using the orthosis 10, 80 during his/her exercise period.
  • the monitor can have a position sensor, a temperature sensor, a force sensor, a clock or timer, or a device type sensor for monitoring the patient's implementation of a protocol.
  • the information obtained from these monitoring devices may be stored for later analysis or confirmation of proper use or may be transmitted in real-time during use of the device.
  • the data obtained from the monitor can be analyzed by a healthcare professional or technician and the protocol can be adjusted accordingly.
  • the components of the present invention are rigid members made of, for example, aluminum, stainless steel, polymeric, or composite materials.
  • the member and extensions are sufficiently rigid to transmit the necessary forces. It should be understood that any material of sufficient rigidity might be used.
  • some components can be made by injection molding. Generally, for injection molding, tool and die metal molds of the components are prepared. Hot, melted plastic material is injected into the molds. The plastic is allowed to cool, forming components. The components are removed from the molds and assembled.
  • the components can be made of polymeric or composite materials such that the device can be disposable.
  • the components can be made of a biodegradable material such as a biodegradable polymer.
  • a biodegradable material such as a biodegradable polymer.
  • PHAV poly (hydroxyacids)
  • PLA polyactic acid
  • PGA polyglycolic acid
  • the device can be made of a nonmagnetic material.
  • the device can be used as a positioning device for use in imaging devices, such as a MM device. It is also contemplated that the device can be used as a positioning device for use during surgical procedures, where it may be necessary to adjust and hold the position of the joint.

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  • Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Rehabilitation Therapy (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Pain & Pain Management (AREA)
  • Epidemiology (AREA)
  • Nursing (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)

Abstract

L'invention concerne un orthose permettant d'étirer le tissu autour de l'articulation d'un patient entre une première partie et une seconde partie du corps pivotables par rapport à l'autre. L'orthose comprend un premier élément de bras que l'on peut fixer à la première partie du corps et comportant un premier élément d'extension s'étendant à partir de celui-ci. Un second élément de bras que l'on peut fixer à la seconde partie du corps est également inclut et possède un second élément d'extension présentant une forme arquée s'étendant à partir de celui-ci. Un troisième élément de bras comprenant un troisième élément d'extension présentant une forme arquée s'étendant à partir de celui-ci est interposé entre le premier et le second éléments de bras. Le troisième élément de bras est connecté de manière opérationnelle aux premier et second éléments de bras, de telle sorte que le premier et le troisième éléments de bras circulent le long d'un trajet arqué défini par le second élément d'extension lorsque le troisième élément de bras passe d'une première position à une seconde position par rapport au second élément de bras. De plus, le premier élément de bras peut circuler le long du troisième élément d'extension tandis que le troisième élément de bras passe de la première position à la seconde position par rapport au second élément de bras.
EP07758851A 2006-03-20 2007-03-20 Orthose du coude Withdrawn EP1998725A4 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US78389606P 2006-03-20 2006-03-20
US11/687,679 US7955286B2 (en) 2006-03-20 2007-03-19 Elbow orthosis
PCT/US2007/064341 WO2007109638A2 (fr) 2006-03-20 2007-03-20 Orthose du coude

Publications (2)

Publication Number Publication Date
EP1998725A2 true EP1998725A2 (fr) 2008-12-10
EP1998725A4 EP1998725A4 (fr) 2010-03-10

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CA (1) CA2646887A1 (fr)
WO (1) WO2007109638A2 (fr)

Families Citing this family (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6503213B2 (en) 2000-12-01 2003-01-07 Peter M. Bonutti Method of using a neck brace
US8066656B2 (en) 2005-10-28 2011-11-29 Bonutti Research, Inc. Range of motion device
US7452342B2 (en) 2004-03-08 2008-11-18 Bonutti Research Inc. Range of motion device
US8012108B2 (en) 2005-08-12 2011-09-06 Bonutti Research, Inc. Range of motion system and method
EP2107896A4 (fr) * 2007-02-05 2010-03-10 Bonutti Res Inc Orthèse de genou
US8905950B2 (en) 2008-03-04 2014-12-09 Bonutti Research, Inc. Shoulder ROM orthosis
US9402759B2 (en) 2013-02-05 2016-08-02 Bonutti Research, Inc. Cervical traction systems and method
RU2636179C1 (ru) * 2016-08-10 2017-11-21 Добрыня Леонидович Силиванов Аппарат силиванова д.л. для разработки локтевого сустава

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5503619A (en) * 1990-07-30 1996-04-02 Bonutti; Peter M. Orthosis for bending wrists
US5611764A (en) * 1990-07-30 1997-03-18 Peter M. Bonutti Method of increasing range of motion
US6502577B1 (en) * 2000-09-18 2003-01-07 Peter M. Bonutti Method for moving finger joints
US20050197605A1 (en) * 2004-03-08 2005-09-08 Bonutti Boris P. Orthosis

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5848979A (en) * 1996-07-18 1998-12-15 Peter M. Bonutti Orthosis

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5503619A (en) * 1990-07-30 1996-04-02 Bonutti; Peter M. Orthosis for bending wrists
US5611764A (en) * 1990-07-30 1997-03-18 Peter M. Bonutti Method of increasing range of motion
US6502577B1 (en) * 2000-09-18 2003-01-07 Peter M. Bonutti Method for moving finger joints
US20050197605A1 (en) * 2004-03-08 2005-09-08 Bonutti Boris P. Orthosis

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of WO2007109638A2 *

Also Published As

Publication number Publication date
WO2007109638A3 (fr) 2008-02-28
CA2646887A1 (fr) 2007-09-27
EP1998725A4 (fr) 2010-03-10
WO2007109638A2 (fr) 2007-09-27

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