EP2032035A1

EP2032035A1 - Method and device for the rehabilitation and/or correction of postural symmetry in static or dynamic situations

Info

Publication number: EP2032035A1
Application number: EP07788978A
Authority: EP
Inventors: Nicolas Vuillerme; Yohan Payan; Jacques Demongeot
Original assignee: Centre National de la Recherche Scientifique CNRS; Universite Joseph Fourier Grenoble 1
Current assignee: Centre National de la Recherche Scientifique CNRS; Universite Joseph Fourier Grenoble 1
Priority date: 2006-06-09
Filing date: 2007-06-11
Publication date: 2009-03-11
Also published as: WO2007141461A1; AU2007255225A1; WO2007141462A1; JP2009539455A; US20100056957A1; CA2654606A1

Abstract

The invention relates to a method for the rehabilitation or correction of the postural symmetry of a person in static or dynamic situations, said method comprising the following steps: at least one parameter of at least one body part is monitored; it is detected whether the parameter and/or a combination of parameters falls short of, or exceeds, a threshold value; and, if this is the case, the person is warned by means of a lingual electrostimulation signal and informed of a postural response to carry out in order to bring the value back to the threshold value.

Description

METHOD AND DEVICE FOR REEDUCATION AND / OR CORRECTION OF POSTURAL SYMMETRY IN STATIC OR DYNAMIC SITUATIONS

Field of the invention

The present invention generally relates to a device for correcting a static or dynamic posture. More particularly, the present invention relates to the correction or rehabilitation of an otherwise stable posture so as to increase its postural symmetry. Presentation of the prior art

In the practice of many activities, controlling the balance of the body is wrongly considered as the only determining factor.

Thus, when practicing sports activities, an important element of performance optimization lies not so much in the acquisition of a stable equilibrium position as in the optimization of a non-traumatic positioning of various segments. body parts, including arms, forearms, hand, trunk, legs ... An optimization is obtained today by the practice of training during which a correction of the posture is carried out most often by a person distinct from the athlete, based on statistical data. This correction, which also takes into account the reactions of the athlete's body, is not rapid, however, and long learning. In addition, this correction is individualized only slowly and does not guarantee the absence of lesions.

The problem is further accentuated after a trauma such as a rupture of a ligament, a muscle tear, a sprain or a fracture of a joint or a bone, when after a long immobilization the athlete must find an optimal position which may be distinct from its optimal position before the trauma. In addition, the athlete must also manage a psychological reluctance most often unconscious to use the body segment.

In general, any person, sporty or not, can, following a traumatism, have to follow a reeducation aiming either to correct a position at the origin of the trauma or to learn to master his body again after a particular trauma serious such as amputation.

Today, such re-education or correction of position is intended to ensure the stability, the balance of the individual to prevent him from falling. They do not take into account the high probability of lesions sometimes occurring outside the trauma area.

Apart from a post-traumatic frame, as was mentioned previously in the case of an athlete, a bad positioning of the body segments can cause in the exercise of many professional activities lesions.

For example, surgeons are required during interventions to take stable postures that they must maintain many times for periods that can be long. Stabilizing their posture is done in a natural way or acquired through experience. However, a position of stable equilibrium can be at the origin of trauma especially in the spine or upper limbs given the constraints of movement over an operating field that can be difficult to access. Another category of people who may be harmed, even though they have acquired a stable balance posture, are wheelchair users. They must find in their chair a stable position of their own. This can be found quickly enough. However, it is frequently observed that such a position, even recommended by care staff is causing deformities of the spine.

Similarly, people with skeletal conditions, including the spine, such as scoliosis, low back pain or neck pain, unconsciously tend to adopt a posture that prevents the compensation of their pathology or even accentuates. Frequently, the unconscious position taken by such people is at the root of other pathologies, including the formation of plantar ulcers.

Other people likely to resort to posture correction are individuals, especially elderly people, with impaired sense of perception that reaches their sense of balance. To provide these people with the use of a walker while allowing them to stay at home, fall detection devices have already been proposed. However, these devices only detect whether a person has fallen or is at risk of falling. These devices do not detect the appearance or the risk of appearance of lesions due to a bad position otherwise perfectly stable and not presenting any risk of falling for the individual. In addition, such a poor position may seem optimal to both the individual and those around him - including health staff - to enable him or her to perform daily tasks.

Currently, any rehabilitation or posture correction requires the use of specialized equipment and Encom ^¬ brant to place the body segments in a statistically optimum position. In case of divergence, the equipment replace the segments in position or signal to a third person the need to intervene to correct the position. This is particularly costly in both human terms and means. In addition, the necessary equipment and personnel are most often found only in large cities, most often in hospitals. This creates constraints that are often unmanageable for a person who is integrated into the world of work and only requires a posture correction to avoid injuries due to a bad position. Such a person frequently gives up the correction because of the constraints. A person who reaches the end of post-traumatic rehabilitation may face diffi culties ^¬ similar. These material constraints are accentuated by the lack of equipment and staff of hospitals that may have difficulty integrating into their structures those who are not or no longer the care that constitutes their activity.

For example, a rehab allows a person with a spinal condition to learn to move or perform actions of daily living without falling. However, these reeducations relate only to the control of balance and do not take into account any injuries caused by the acquired position which is optimized only to avoid a fall. In practice, whatever the targeted activity or the circumstances, the posture correction procedures and the rehabilitation devices are limited either to allow the acquisition of a stable posture in which an activity can be performed without risk of falling, either learning to use an injured limb or equipped with a prosthesis. However, none of these devices take into account lesions that might appear on other parts of the body because of the equilibrium posture adopted equilibrium posture which is often recommended to avoid falls. For example, after placement of a prosthesis of a lower limb, the patient learns to gradually put his weight on the prosthesis until he has found a stable gait. However, instinctively, once the period of rehabilitation has been completed, the wearer of a prosthesis will tend unconsciously or consciously to limit the use of the equipped side and will carry more weight and effort on the side not equipped with prosthesis, provoking eventually irreversible lesions of the healthy limb. This additional traumatic effort will however be undetectable by the medical entourage, particularly because of the absence of a fall. Summary of the invention

The present invention aims to provide a device for reeducation and correction of a posture to prevent the appearance of lesions. More particularly, the present invention aims to provide a device for reeducation and correction of postural symmetry in dynamic or static situations.

The present invention aims to provide such a device that is simple, and can be used by a single person outside any framework and any installation.

The present invention also aims to provide such a device that adapts to the physical characteristics and sensorimotor capabilities and needs of the person.

The present invention also aims at providing such a device that can be used both in a static position and in a dynamic position.

To achieve these and other objects, the present invention provides a method for re-educating or correcting postural symmetry of a person in static or dynamic situations, including the steps of monitoring at least one parameter of at least one segment corporeal; detecting whether the parameter and / or a combination of parameters exceeds a threshold value by a lower or higher value; and warn the person by means of a signal of lingual electrostimulation of the exceeding of the threshold value.

According to one embodiment of the present invention, the coding of the lingual electrostimulation signal is performed according to the location of the overflow area.

According to one embodiment of the present invention, the coding of the lingual electrostimulation signal is performed according to the extent of the overshoot.

According to one embodiment of the present invention, the coding of the lingual electrostimulation signal is performed according to instructions for moving at least one body segment to compensate for the overshoot.

According to one embodiment of the present invention, the method further comprises, after the detection of an overshoot, the triggering of at least one actuator capable of causing compensation of the overshoot.

According to one embodiment of the present invention, the actuator is an electromuscular actuator or a sensory stimulator clean e.g. to apply a touch, tendon or muscle vibration.

The present invention also provides a device for reeducation or correction of postural symmetry in static or dynamic situations of a person, comprising at least one sensor placed on at least one body segment of the person; and a processing unit capable of detecting whether the parameter supplied by the one or more sensors and / or a combination of parameters exceeds at least a given threshold and capable of sending a signal representative of the overshoot to at least one actuator. According to one embodiment of the present invention, an actuator is a lingual electrostimulation device.

According to one embodiment of the present invention, an actuator is an actuator capable of causing a postural reaction, such as an electromuscular actuator or a sensory stimulator. Brief description of the drawings

These and other objects, features, and advantages of the present invention will be set forth in detail in the following non-limiting description of particular embodiments in connection with Figures 1A, 1B and 1C which illustrate a person in moving course. detailed description

In general, the inventors have shown that all the lesions not directly related to an existing pathology or in the absence of pathology come from poor positioning of the body segments which break the natural postural symmetry.

Indeed, when the human body is in a stable equilibrium posture, it naturally presents a certain postural symmetry. For example, the upper limbs are balanced relative to each other so as to maintain the center of gravity of the body in a position of equilibrium.

After a trauma, or during the performance of a professional or sporting activity, this balance by symmetry is broken. The body finds a position of stable equilibrium, but at the expense of some of its segments which are then injured.

The devices and methods of rehabilitation developed so far are aimed solely at restoring, reacquisition of an equilibrium posture without taking into account the degree of symmetry or rather asymmetry of the acquired posture.

According to the present invention, different sensors are placed on a person. The sensors will be chosen from pressure sensors, inclinometers, goniometers, gyroscopes and magnetometers. A processing unit wirelessly receives the data from the sensors and processes them to determine the relative positions of different body segments and their eventual displacement.

In particular, pressure sensors are placed at the level of the soles of the feet to determine whether the nobody is static or dynamic and in what position. Indeed, if a person is still standing, the pressure exerted on the soles of the feet corresponds to the weight of the individual. If a person is sitting still, the pressure on the soles of the feet is much less than that of his weight, a part of the body being carried by the seat. If a person walks, the pressure changes substantially evenly from a minimum to a maximum, with each foot rising in turn. The static or dynamic general situation, standing or sitting, of the person is determined. Sensors allow deter ^¬ undermine various other data on the person's activity. Other sensors that can be used are pressure sensors placed at the level of a stump of an amputee. As illustrated in FIGS. 1A, 1B and 1C, especially during walking, a person is naturally brought naturally imperceptible to lean the bust aside (FIG. 1A), forward (FIG. 1B) and back (FIG. IC). The degree, duration and rate of inclination of the bust in each of these directions depend essentially on the speed of movement, or even its acceleration, but also the weight and age of the person. Such inclinations of the bust are necessary to maintain postural symmetry. After accidental trauma or when using a prosthesis, an individual will unconsciously reduce, accentuate or remove some of such inclinations. These changes are compensated unconsciously or following a reeducation by changes in the positions of other body segments to prevent a fall. This will not affect the balance, the stability of the individual, but causes an imbalance of the postural symmetry. This imbalance of postural symmetry results in an overload on certain body segments, an overload that causes injury over time. According to one embodiment of the present invention, kinematic sensors are provided for determining the position, speed and acceleration of the bust. When the combination of these parameters and their repetition reaches a certain threshold specific to the physical characteristics of the person, a lesion is likely to occur. The processing unit of the device according to one embodiment of the invention compares the data collected by the sensors or a combination of these data with programmable pre-established thresholds. For example, for a scoliotic person or an elderly person with low back pain, the treatment unit compares the angle of the bust with the vertical as well as with the lower limbs, compares the angular velocity with predefined zones of oscillation, and determines the risk of injury based on this information.

According to one embodiment of the present invention, when a risk of injury appears, the treatment unit sends a message either to staff supervising the rehabilitation or, preferably, to the person through any device visual, audible or tactile warning made available to the person. Communications between the processing unit and the warning device preferably takes place via a wireless system.

For example, a warning device is a Tongue Display Unit (TDU), which usually includes at least one artificial palate that can be placed in the oral cavity and has a matrix of electrodes that can come into contact with each other. at least with the upper surface of the tongue. The signal then has a coding specific to activate predefined areas of the electrode matrix. The coding makes it possible to indicate to the person either the existence of a risk of injury and possibly the segment or segments at the origin of this risk and, where appropriate, the degree of the risk of injury, ie an action to be taken in order to remove the risk of injury. The coding mode is chosen according to physical characteristics and sensorimotor capabilities and needs of the affected person, and his ability to analyze the situation.

It should be noted that the risk of injury mentioned above can be quantified as a near or distant risk. Thus, a surgeon or a high-level athlete may choose to maintain the posture at risk by considering that the duration of maintenance of this posture will be low enough for a lesion to not appear. According to one embodiment, the device and in particular the treatment unit can take into account the recent history of postures taken by the wearer to indicate an increasing risk of injury. Thus, a surgeon performing a particularly long intervention may neglect long-term risk warnings but will be warned that he is approaching a stage at which if he does not change his posture one of his body segments will be harmed.

According to another embodiment of the present invention, whether the information on the risk of injury is transmitted to the user or not, when an injury is possible, the processing unit triggers the start of clean actuators. to cancel the risk of injury.

Such actuators are for example electromuscular actuators or sensory stimulators that cause contraction stimulation or vibration of a tendon, a tactile receptor or a muscle. This stimulation is felt unconsciously by the person as a real movement of his own body and leads him to reflexively reverse movement. The actuator thus causes a displacement to compensate for the risk of injury.

According to one embodiment of the invention, the processing unit chooses to activate an actuator or to warn the user according to the overshoot observed. Thus, if the exceeding of a threshold value is sufficiently low for a reflex movement to be sufficient to compensate for it, the unit of processing will be limited to activate at least one actuator so as to cause such compensation. If the exceeding of thresholds or is too large, the CPU notify the utili ^¬ sateur using the TDU device of one of the ways described above.

It should be noted that the thresholds vary significantly from one individual to another. Thus, for a person with low back pain or scoliosis, it will be normal to have a large inclination of the bust relative to the vertical axis and relative to the lower limbs.

The device according to the present invention then makes it possible to monitor the inclinations of the trunk-head assembly with respect to the vertical axis, on the one hand, and with respect to the lower limbs, on the other hand. Depending on the extent of lumbalgia or scoliotic pathology, thresholds are set so that the inclination of the bust remains within a range that is compatible with the pathology and with the absence of lesions in the lower limbs.

A method and device for preventing lesions as described above can be used in various cases. In particular, they can be used in the context of a reeducation or during a convalescence. They can also be used to keep elderly people or people with spatial perception impairments at home. Such a method and such a device have many advantages. In particular, they free the person from close or regular supervision, increasing his autonomy. Correspondingly, they free up staff and equipment for tracking others.

The device is particularly discreet thanks to the use of a non-visible warning device system using a wireless communication protocol between the different elements. This improves the integration of people into working life. For example, after a trauma of a joint such as the knee or the ankle, it should be limited flexion. The possible bending angle is then gradually increased during rehabilitation. This is achieved today by relatively restrictive systems of immobilization, controlled flexion and under the control of third parties. It is now possible according to the present invention to provide the person under rehabilitation of existing sensors in détermi ^¬ ner the inclination of the segments lying on either side of the joint and to report to it by means of a device warning if it exits the allowed bending zone. It is also possible to use the warning device to indicate to a person being rehabilitated that he or she stops bending too early and must continue to reach a threshold value. During rehabilitation, the threshold value is gradually changed to increase the flexion range of the joint over time.

Another application lies in the rehabilitation after an intervention in traumatology, orthopedics, or rheumatology, and after the installation of a prosthesis, including lower limbs. Indeed, after the installation of a prosthesis, the angle of inclination of the rest of the body relative to the prosthesis and the weight that can support the paired member are limited. These limits become less binding over time. A classic problem then encountered is that a person fitted meets the re-education thresholds during sessions, but no longer outside. Such failure to respect resides in App ^¬ cation of overweight and / or bending of the prosthetic limb in the early stages of the apparatus. Another defect of respect is on the contrary an under use of the paired member. In the latter case, the non-paired limb is subjected to excessive stresses that can lead to lesions. According to the present invention, it is possible by means of appropriate sensors, a treatment unit and a warning device to assist the person fitted to respect the re-education thresholds outside of specific sessions.

The correction of postural symmetry to avoid lesions is not limited to a context of post-traumatic rehabilitation. The present invention also applies to preventing the appearance of lesions in a context of professional activities or relaxation outside any traumatic history. Indeed, the combination of sensors, a treatment unit and a warning device and any actuators can be used to optimize a posture related to a regular activity. Thus, it is possible to determine according to an activity and the characteristics of the user an optimal position in which the activity is performed without injury. For example, for fencers, it is possible to determine an ideal position of the different body segments with respect to each other, to provide the firer with sensors intended in particular to determine the angles between the different segments as well as with the weapon, comparing the data to optimal ranges, and transmitting postural symmetry correction information to the shooter via a warning device.

The present invention can also be used as a preventive measure in situations other than sports applications. Thus, musculoskeletal disorders related to a poor working position, for example when performing static tasks such as performing a musical work, typing text and / or data entry by means of a computer keyboard, are the cause of various syndromes and lesions including foot pain, swelling of the legs, varicose veins, generalized muscle fatigue, pain in the lower back, joint stiffness of the neck and / or shoulders. .. Likewise, the sitting position in which are practi ^¬ cated these activities can cause lesions of the spine. The postural symmetry correction according to the present invention can be used during training to to correct an incorrect position better than a human observer could and before lesions appear. In addition, the device according to the invention being made of non-bulky and non-stigmatizing elements, it can be used in a non-discriminatory and practical manner during the execution of an activity.

The present invention also applies to the control of the sitting position of a hemiplegic person. Indeed, a hemiplegic has significant sensory deficits on the injured side. Hemiplegia is accompanied by a decrease in the generation and maintenance of forces and an increase in muscle latency. Current rehabilitations allow a person to compensate for disabilities and learn to stand, move without falling and perform various activities including professional. However, until now we have seen the appearance of multiple lesions in hemiplegics. The device of the present invention makes it possible to avoid these lesions either by performing a reflex stimulation or by indicating at any time or in case of risks to the wearer that he must modify his posture.

In general, the method and the device according to the present invention can be used to correct the position of any seated person, particularly a disabled person to avoid the appearance of lesions. Of course, the present invention is susceptible of various variations and modifications which will be apparent to those skilled in the art. In particular, the number and nature of the sensors as well as any actuators are chosen according to the intended application. The sensors will be limited to the activity studied, and to the single segment (s) to be re-educated or whose position must be corrected.

Claims

1. A method of reeducation or correction of the postural symmetry of a person in static or dynamic situations, characterized in that it comprises the following steps: monitoring at least one parameter of at least one body segment; detecting whether the parameter and / or a combination of parameters exceeds a threshold value by a lower or higher value; and notifying the person by means of a signal electro ^¬ lingual stimulation exceeded the threshold value.

The method of claim 1, wherein the coding of the lingual electrostimulation signal is performed according to the location of the overflow area.

3. The method of claim 2, wherein the coding of the lingual electrostimulation signal is performed according to the magnitude of the overshoot.

The method of claim 1, wherein the coding of the lingual electrostimulation signal is performed according to instructions for moving at least one body segment to compensate for the overshoot.

5. Method according to claim 1, characterized in that it further comprises, after the detection of an overshoot, the triggering of at least one actuator capable of causing compensation of the overshoot.

The method of claim 5, wherein the actuator is an electromuscular actuator or sensory stimulators.

7. Device for the reeducation or correction of the postural symmetry of a person in static or dynamic situations, characterized in that it comprises: at least one sensor placed on at least one body segment of the person; and a processing unit capable of detecting whether the parameter supplied by the one or more sensors and / or a combination of parameters exceeds at least a given threshold and capable of sending a signal representative of the overshoot to at least one actuator.

8. Device according to claim 7, wherein an actuator is a lingual electrostimulation device.

9. Device according to claim 7, wherein an actuator is an actuator capable of causing a postural reaction, such as an electromuscular actuator or a sensory stimulator.