EP2435008B1 - Device for therapeutically treating and/or training the lower extremities of a person - Google Patents

Description

The invention relates to a device for the therapeutic treatment or training of the lower extremities of a person having the features of the preamble of claim 1.

A device of this kind is for example off DE 10 2006 035 715 A1 known.

The therapy of high-grade weakness of the lower extremities, e.g. after a stroke is difficult and often unsuccessful. Conventional physiotherapy is laborious and usually aims to relieve spasticity-related muscle spasms and exercises to prepare for walking, sitting and standing, e.g. to strengthen the weight transfer to the affected leg. This procedure often results in the patient not repeatedly practicing the walking and thus the foot and leg movements underlying the walking.

Modern scientific concepts of rehabilitation favor a repeated, if possible active practice of walking as early as possible, or if not yet practicable, practicing at least some movement sequences of walking with the feet and legs. For stroke patients it was shown that the repeated active, isometric and isotonic dorsiflexion of the feet and legs with respect to the regression of the motor function of the entire lower extremities was superior to a conventional therapy. Even greater successes could be achieved if the patient repeatedly practiced walking himself. Passive movements of paralyzed limb sections receive, on the one hand, the mobility of the movement segment and the memory of the brain in the sequence of movements.

A double-sided practice of the healthy side and the weakened side of the lower extremities is superior to a one-sided practice of the weakened side. The co-movement of the non-weakened side exerts a promoting influence on the activation of the responsible for the use of the paralyzed limb brain structures in the parietal lobe.

For the treatment of the healthy and the weakened side of the lower extremities, mechanical and electromechanical devices are known in the art. This is exemplified DE 36 18 686 A1 . DE 85 28 083 U1 . DE 81 09 699 U1 and DE 195 29 764 A1 directed. These known therapy devices include cranks that are operated by the patient. These cranks only allow asynchronous tracking of the weakened side. Asynchronous tracking movements do not reflect the variety of real movements. The desired transfer of the learning effect in connection with movement sequences from the brain lobe of the healthy to the affected side is only possible to a limited extent. Variations of the movements are excluded due to the rigid mechanical connection of the construction elements.

In addition, robotic systems are known for therapeutic purposes that include control systems that measure patient forces during exercise. Different evaluations of the parameters for determining minimum natural movements or forces and complete comparisons with predefined programs are possible. Such robot systems are out DE 100 28 511 A1 and the aforementioned DE 10 2006 035 715 A1 known.

In the robot system according to DE 100 28 511 A1 the degree of freedom for lateral pivoting of the foot plates is not required per se and has also proved in exercises as disadvantageous. The lateral pivoting of the foot plates causes a complicated and expansive structure, which makes it difficult for the therapist to access the patient. The one from the closest DE 10 2006 035 715 A1 known robot-based running simulator has proven in terms of everyday practicality as an improvement. In addition, as with the system according to DE 100 28 511 A1 that makes access to the patient more difficult.

DE 20 2008 001 590 U1 discloses a human gait training device with five-link kinematics mounted on a linearly driven carriage. The kinematics are driven by a recirculating ball screw on the carriage.

The invention has for its object to provide a device for the therapeutic treatment and / or training of the lower extremities of a person can be simulated with the various stress situations that occur in everyday life. The device is intended to allow a good access of the therapist to the patient.

According to the invention, this object is achieved by the device according to claim 1.

The invention has the advantage that the mechanics of the movement devices is simple and compact. This facilitates the therapist's access to the patient. With the device according to the invention, a successful therapy on the one hand by the frequent repetition of exercise elements and on the other hand by the transmission of learning effects of the responsible for the healthy limb side of the brain on the responsible for the weakened limb brain side or the brain area can be achieved. In addition, the device according to the invention allows the leg and back muscles to be strengthened for the purpose of further improving the patient in recovery and for training healthy people. The The device according to the invention provides the prerequisite for enabling running training or running therapy in an everyday environment specified on a screen, wherein different everyday simulations, for example climbing stairs, stepping on a sidewalk or situations, can be simulated by the robust and simply constructed mechanism where the patient stumbles.

Preferred embodiments of the invention are specified in the subclaims.

In one embodiment, the second linear drive comprises a power transmission element that couples the two carriages. The distance between the two carriages is variable by actuation of the force transmission element. The coupling of the two carriages by means of a force transmission element has the advantage that one of the two carriages, in particular the second carriages, is taken along by the other carriage, in particular the first carriage. The forward movement or the horizontal movement of the movement device and thus of the holding element is achieved jointly by the first linear drive.

The second linear drive causes the relative movement between the two carriages. The power transmission element has the double function, on the one hand take the second carriage by the movement of the first carriage and thus acts as a mechanical connection between the two carriages. On the other hand, the force transmission element brings the force required for the relative movement of the two carriages. For this purpose, the power transmission element has its own drive. This embodiment has the advantage that the drives and associated slides can be made comparatively small, so that fast movement changes or rapid accelerations and decelerations can be realized.

The second linear drive may comprise a rotary spindle, which is rotatably mounted on the one hand on the first carriage and on the other hand on the second carriage. The spindle drive of the rotary spindle can be attached to the second or the first carriage. This simplifies the construction of the device.

The first linear drive may include a power transmission element that couples the first carriage to the fixed frame. The first linear drive may comprise a driven chain, which is attached to the first carriage on the one hand and the frame on the other hand, whereby the horizontal movement of the first and thus also of the second carriage is achieved in a simple manner.

The rotational drive for the inclination change can be arranged spaced from the holding means and coupled thereto by a power transmission means. As a result, the rotary drive can be arranged at a position which is favorable for the center of gravity. The rotary drive may expediently comprise a belt, which is arranged on a drive pulley on the boom and on a driven pulley on the holding element.

The arrangements of the respective drives described above, taken separately and in combination with one another, allow a simple construction of the respective movement device, which has a small footprint.

Preferably, a longitudinal end of the boom is hinged to the first carriage. The connecting element can act on the boom between the articulation point on the first carriage and the holding element. As a result, in each case a favorable torque transmission is achieved by the respective drives on the boom and thus on the holding means.

In a preferred embodiment of the invention, an adjusting device is arranged above the movement device, which is adapted to change the center of gravity of a person connected to the holding means people. This embodiment has the advantage that a control of the body center of gravity of a patient is possible by the adjusting device. Thus, on the one hand, the displacement of the center of gravity of the body occurring in the course of human locomotion, that is to say during locomotion, can be simulated along the direction of locomotion, which takes place in the vertical and lateral direction. On the other hand, the control of the center of gravity allows the correct execution of the therapeutic movement, thus preventing postural damage caused by compensatory movements of the patient. Another advantage of controlling the body's center of gravity is that the balance in critical situations, as in (simulated) tripping, slipping or under conditions where the proprioceptive component is disturbed. Repeated practice of these situations is necessary to minimize the risk of falls and falls for patients. The three-dimensional control of the center of gravity, which is possible in this embodiment, and the option of influencing the proprioceptive component of the patients by means of perturbations, create the conditions for a safe, repeatable and targeted training. The perturbations of the proprioceptive component are performed by the retaining means, in particular the foot plates, which are connected to the feet of the patients. These can be moved to any position along the three degrees of freedom. In addition, vibrations can be realized by the holding means.

Fig 1

eine perspektivische Ansicht einer Vorrichtung nach einem erfindungsgemäßen Ausführungsbeispiel;

Fig. 2

eine Seitenansicht der Vorrichtung gemäß Fig. 1;

Fig. 3

eine Seitenansicht der Bewegungseinheiten der Vorrichtung gemäß Fig. 1;

Fig. 4

eine Draufsicht auf die Vorrichtung gemäß Fig. 1.

The invention will be explained in more detail below with reference to exemplary embodiments with reference to the attached schematic drawings. In these show:

Fig. 1

a perspective view of a device according to an embodiment of the invention;

Fig. 2

a side view of the device according to Fig. 1 ;

Fig. 3

a side view of the moving units of the device according to Fig. 1 ;

Fig. 4

a plan view of the device according to Fig. 1 ,

In Fig. 1 a device is shown that can be used for the therapeutic treatment and / or training of the lower extremities of a human. The device is particularly suitable for training the lower extremities of neurological patients and has two driven controllable movement devices 10a, 10b. The two movement devices 10a, 10b are each connected to a stationary frame 11. The movement devices 10a, 10b have adhesive means 12a, 12b, for example Foot plates with bindings in which the feet of the patients or exercisers are held. The movement devices 10a, 10b and thus the holding means 12a, 12b can be moved independently of each other along passage trajectories. Asynchronous or synchronous movements are possible.

The device comprises a frame 28, on which the patient is suspended for weight relief, and which is fixedly connected to the frame 11. The frame 28 comprises two arms 28a, 28b which extend forwards in the sagittal direction, the arms 28a, 28b extending approximately to and reaching over the height of the movement means 10a, 10b. Provided at the front end of the arms 28a, 28b are vertically arranged connecting elements 29a, 29b, which connect the arms 28a, 28b to side rails 30a, 30b. The side rails 30a, 30b are arranged approximately at the level of the lower arms of the respective patient and vertically adjustable. The side rails 30a, 30b serve as handles for patients who can cling to the side rails 30a, 30b.

The movement devices 10a, 10b each have a boom 13, which is pivotable in different elevations. The boom 13 is articulated pivotably on a first carriage 14, which is guided in a linear guide 15. The linear guide 15 is fixedly connected to the stationary frame 11 and forms a rail in which the carriage 14 is slidably disposed. As in Fig. 3 to recognize the boom 13 is articulated at a first longitudinal end 13a on the first carriage 14. For this purpose, a first pivot bearing 13b is provided, which connects the boom 13 with the first carriage 14 pivotally. The first pivot bearing 13b may be disposed at a different location on the boom 13, for example, spaced from the longitudinal end 13a.

The boom 13 is rotatably connected in each case with one of the holding means 12a, 12b. The connection point between the holding means 12a, 12b and the arm 13 is located at the other, second longitudinal end 13c of the arm 13 and has a second pivot bearing 13e spaced from the first pivot bearing 13b.

The boom 13 forms a pivot arm which extends in the longitudinal direction of the respective linear guide 15.

In the direction of the first carriage 14, ie in the direction of forward movement of the patient in use, a second carriage 16 is arranged, which is guided in the linear guide 15 slidably. The second carriage 16 is relatively movable to the first carriage 14, so that the distance between the two carriages 14, 16 is variable. As in Fig. 3 to recognize, the second carriage 16 is pivotally connected by a connecting element 17 with the boom 13. The connecting element 17 may, for example, comprise a connecting rod or two connecting rods arranged in parallel next to one another. Other connecting elements 17 are possible. The connecting element 17 engages on the one hand on a bearing block 16a of the second carriage 16 and on the other hand on the boom 13 between the articulation point 27 on the first carriage 14 and the holding element 12a, 12b. The connecting element 17 is connected by two pivot bearings 17a, 17b to the second carriage 16 and the boom 13. The pivot bearing 17b in the boom 13 is arranged approximately centrally between the articulation point 13d on the first carriage 14 and the holding element 12a, 12b. Another arrangement of the pivot bearing 17b on the boom 13, in particular an eccentric arrangement, is possible.

In general, the connecting element 17 is articulated on the arm 13 in an area or at a location which is arranged between the connection of the arm 13 to the first carriage 14 and the connection of the arm 13 to the retaining means 12a, 12b.

The connecting element 17 and the boom 13 together with the first and second carriages 14, 16 form a kind of scissors mechanism. By the relative movement of the two carriages 14, 16 to each other, the angle between the boom 13 and the connecting element 17 is changed. As in Fig. 3 shown by the two arms 13, 16 by a reduction in the angle, ie by reducing the distance between the two carriages 14, 16 of the boom 13 moves upward, wherein the holding means 12a, 12b a circular path around the pivot point 13d of the boom 13 on first carriage 14 or generally about a horizontal axis which extends transversely to the direction of gear describes. Thereby, the height position of the second longitudinal end 13c of the cantilever 13 and thus of the holding means 12a, 12b connected to the second longitudinal end 13c is changed.

Due to the articulation of the boom 13 on the first carriage 14 this is taken along with the second carriage 16 by a movement of the first carriage 14, whereby the horizontal movement of the entire movement device 10a, 10b is achieved.

The first carriage 14 may also be referred to as a main carriage and the second carriage 16 as a relative carriage.

As in the Figures 3 . 4 To recognize, the first carriage 14 has a first linear drive 18, which is provided for changing the longitudinal position or horizontal position of the respective holding means 12a, 12b. The first linear drive 18 comprises a first power transmission means 21a, which connects the first slide 14 to the fixed frame 11 for power transmission. The first power transmission means 21a may comprise a driven chain 24, which is connected on the one hand to the movable carriage 16 and on the other hand to the stationary frame 11. For driving the chain 24, an electric motor is provided in each case. The first linear drive 18 can also be realized by other means, for example by a rack or by hydraulic or pneumatic cylinders.

The second linear drive 19 is associated with the second carriage 16 and couples it to the first carriage 14. For this purpose, a second force transmission element 21b is provided which engages on the one hand on the first carriage 14 and on the other hand on the second carriage 16. The second power transmission element has the function to take the second carriage 16 with a movement of the first carriage 14. In this case, the second force transmission element 21b acts as a push and pull element. In addition, a force can be transmitted from the second carriage 16 to the first carriage 14 by the second power transmission element 21b and vice versa, when the second power transmission element 21b is actuated. In this case, the distance between the two slides 14, 16 and thus the altitude of the boom 13 is changed.

In general, the second linear drive 19 acts as a relative drive between the two slides 14, 16, wherein one of the two carriages 14, 16, in particular the first carriage 14 forms an abutment and the other carriage 14, 16, in particular the second carriage 16, based on the Abutment is relatively movable and that by actuating the second linear actuator 19. The first Linear drive 18 forms a main drive, which moves both carriages 14, 16 together with the second linear drive 19 relative to the stationary frame 11. The second linear drive 19, in particular the force transmission element 21b acts as a driver, which transmits the driving force of the first linear drive 18 to the second carriage. In addition, the second linear drive 18 acts as a relative drive for the relative movement between the two carriages 14, 16, as described above.

The second power transmission means 21b may comprise, for example, a rotary spindle 22 which is rotatably connected to the first and second carriages 14, 16 and provides for the advancement of the second carriage 16. In the embodiment according to Fig. 4 the spindle drive 23 is attached to the second carriage 16 and coupled to the rotary spindle 22. It is also possible that the spindle drive 23 is attached to the first carriage 14. Accordingly, the spindle nut of the spindle drive can optionally be arranged on the first or on the second carriage 14, 16. Other power transmission elements, such as a rack or hydraulic / pneumatic actuators are possible. In general, the force transmission element 21b has a dual function and acts both as a driver and for the change in distance between the two carriages 14, 16.

By actuating the second linear drive 19, the distance between the two slides 14, 16 is changed, as in Fig. 4 shown. When the movement device 10a is arranged on the right in the forward direction, the two carriages 14, 16 are located close to one another, the rotary spindle 22 protruding beyond the frame 11 at the rear. In this position, the boom 13 is arranged in the maximum height position. At maximum extended rotary spindle 22, as shown in the left-hand movement device 10b, the boom 13 is in the lowest altitude.

To adjust the inclination of the holding means 12a, 12b, a rotary drive 20 is provided, which cooperates with the respective rotatably arranged holding means 12a, 12b. The rotary drive 20 is arranged in the region of the articulation point 13d. The connection of the rotary drive 20 with the respective holding means 12a, 12b is effected by a third force transmission element 21c, for example in the form of a belt 25. The belt 25 is on the one hand on a drive pulley 26 on the boom 13 and on the other hand on a driven pulley 27, which is connected to the holding element 12a, 12b, arranged. Instead of the belt 25, other power transmission elements 21 c can be used, which convert a translational movement into a rotary movement, for example a toothed rack, which meshes with a pinion on the holding means 12 a, 12 b. By the rotary drive 20, the inclination of the holding means 12a, 12b adjusted and adapted to the respective position of the boom 13. Ultimately, all possible tilt positions are variably adjustable, which are required for the simulation of everyday situations.

The movement of the holding means 12a, 12b takes place in a work plane extending in the sagittal direction, wherein a working space has proved to be advantageous, the forward movement in the range of 400-600 mm, in particular 550 mm, the height movement in the range of 300-500 mm, in particular at 400 mm and the pivotal movement of the holding means 12a, 12b in a range of - allows 80 ° to + 30 °.

The pivotal movement of the holding means 12a, 12b takes place about a horizontal axis. The horizontally extending axis is displaced by the actuation of the two linear drives 18, 19 in the horizontal and vertical directions.

To simulate the everyday situations of human locomotion, the lower extremity holding means 12a, 12b can be simulated with the patient standing on and fixed to it, both by programmed defaults of the control and by the patient on compliant foot plates. It can be varied between the programmed movement and the guided by the patient movement. Alternatively, a holding means 12a may be controlled by the patient and the other holding means 12b by programmed defaults.

In the embodiment according to Fig. 1 an adjusting device 31 is provided, which is arranged above the moving means 10a, 10b. The adjusting device 31 is located above the linear guides 15, so that the movement devices 10a, 10b, in particular the holding means 12a, 12b can be moved under the adjusting device 31. The adjusting device 31 is for controlling the center of gravity of the body or for changing the center of gravity of a person connected to the holding means 12a, 12b customized. The adjusting device 31 allows both a change in the body center of gravity in the vertical and in the transverse direction. For this purpose, the adjusting device 31 comprises a vertical drive 33 a, which cooperates with a belt 32. The strap 32 is connected to a patient carrier strap (not shown). The vertical drive allows a change in the length of the vertical portion of the belt 32, so that the center of gravity of the patient is variable in the vertical direction. The working space of the mechanism or of the adjusting device 31 for the change in focus is based on a zero position +/- 10 cm. Other areas are possible. An example of the embodiment of the adjusting device 31 is shown in FIG Fig. 1 and may include a rotary drive connected to a pivot mechanism 33c. The pivoting mechanism 33c shortens the patient's carrying belt via a pulley system, thus pulling the patient's center of gravity upward. A deflation of the patient or an extension of the belt 32 is also possible.

The swing mechanism 33c has a swing arm to which three rollers are attached. The rollers, in particular two end rollers and a central roller arranged between the two end rollers, serve to deflect the belt 32 and form an arrangement by means of which the body center of gravity of a patient can be changed. In each case one of the two end rollers is located at one end of the pivot arm. The central roller is arranged centrally in the pivot or pivot point of the swivel arm. The strap 32 extends from the patient lifter 35 via the first end roller under the central roller and from there via the second end roller through the pivoting mechanism out to the patient's belt. The vertical drive, in particular the rotary drive 33a causes a pivoting movement about the pivot point of the pivot mechanism, in particular of the pivot arm. As a result, the end rollers are raised or lowered at the end of the pivot arm and thereby lift or lower the belt 32nd

Other means for raising and lowering the belt 32 are possible.

The patient lift 35 serves to lift the patient into the treatment position or to lower the patient from the treatment position after completion of the treatment.

To control the transverse component of the center of gravity, a transversal drive 33b is provided which has a rotary drive connected to a pulley 34. On the disc 34, a rope is attached (not shown), the ends of which extend to the patient. The rope is deflected by an unillustrated roller system and engages at both ends, for example by carabiners, on lateral loops of the patient's belt. By rotation of the disc 34, the patient is drawn by shortening one of the two ends in the transverse direction. A possible working space for the center of gravity displacement enabled by the transverse drive 33b is, for example, +/- 5 cm in relation to a zero position. Other areas are possible.

The control of the center of gravity in the forward or backward direction is effected by the relative movement of the holding means 12a, 12b or the foot plates relative to the suspension point of the adjusting device 31. The position of the first carriage 14 (main slide) can be freely controlled on the linear guide 15. In this case, the suspension point of the patient is stationary in a direction parallel to the linear guide 15, so that a corresponding displacement of the center of gravity is possible. The workspace possible by the length of the slide is +/- 10cm relative to a zero position. Other areas are possible.

The device allows a highly variable and flexible therapy or training of the lower extremities, wherein the device is simple and compact and thus provides good access to the patient.

LIST OF REFERENCE NUMBERS

10a, 10b

movers

11

frame

12a, 12b

holding means

13

boom

13a

first longitudinal end

13b

first pivot bearing

13c

second longitudinal end

13d

articulation

13e

second pivot bearing

14

first sled

15

linear guide

16

second sled

16a

bearing block

17

connecting element

17a, 17b

pivot bearing

18

first linear drive

19

second linear drive

20

rotary drive

21a, 21b, 21c

Power transmission element

22

spindle

23

spindle drive

24

Chain

25

belt

26

sheave

27

driven pulley

28

frame

28a, 28b

poor

29a, 29b

fasteners

30a, 30b

side rails

31

adjustment

32

belt

33a

vertical drive

33b

Transversalantrieb

33c

swivel mechanism

34

adjusting disc

35

patient lifts

Claims (11)

1. Apparatus for the therapeutic treatment and/or training of the lower extremities of a human being, having driven controllable movement devices (10a, 10b) which are connected to a stationary frame (11) and which in each case have holding means (12a, 12b) for attachment of an extremity, which are movable independently of one another along gait trajectories, the movement devices (10a, 10b) each having an arm (13) pivotable into different height-wise positions, which arm (13), on the one hand, is in articulated connection with a first slider (14) of a linear guide (15) and, on the other hand, is rotatably connected to one of the holding means (12a, 12b), the linear guide (15) forming a rail in which the first slider (14) is displaceably arranged,
   characterised in that
   a second slider (16) of the linear guide (15) is movably arranged in front of the first slider (14) in the gait direction and relative to the first slider (14), which second slider (16) is displaceably guided in the linear guide (15) and is in articulated connection with the arm (13) by way of a connecting element (17), the first slider (14) having a first linear drive (18) for changing the length-wise position of the respective holding means (12a, 12b), the second slider (16) having a second linear drive (19) for changing the height-wise position of the respective holding means (12a, 12b), and the arm (13) having a rotary drive (20) for changing the inclination of the respective holding means (12a, 12b), the first linear drive (18) forming a main drive which moves both sliders (14, 16) together with the second linear drive (19) relative to the stationary frame (11), the second linear drive (19) acting as a catch which transmits the drive force of the first linear drive (18) to the second slider (16), and the second linear drive (19) in addition acting as a relative drive for the relative movement between the two sliders (14, 16) so that the spacing between the two sliders (14, 16) is modifiable.
2. Apparatus according to claim 1,
   characterised in that
   the second linear drive (19) comprises a force transmission element (21b) which couples together the two sliders (14, 16), and the spacing between the two sliders (14, 16) is modifiable by actuation of the force transmission element (21b).
3. Apparatus according to claim 1 or 2,
   characterised in that
   the second linear drive (19) comprises a rotary spindle (22) which is rotatably attached, on the one hand, to the first slider (14) and, on the other hand, to the second slider (16).
4. Apparatus according to claim 3,
   characterised in that
   a spindle drive (23) of the rotary spindle (22) is attached to the second or first slider (14, 16).
5. Apparatus according to one of claims 1 to 4,
   characterised in that
   the first linear drive (18) comprises a force transmission element (21a) which couples the first slider (14) to the stationary frame (11).
6. Apparatus according to at least one of claims 1 to 5,
   characterised in that
   the first linear drive (18) comprises a driven chain (24) which is attached, on the one hand, to the first slider (14) and, on the other hand, to the frame (11).
7. Apparatus according to at least one of claims 1 to 6,
   characterised in that
   the rotary drive (20) for changing the inclination is arranged spaced away from the holding means (12a, 12b) and is coupled to the latter by a force transmission means (21c).
8. Apparatus according to at least one of claims 1 to 7,
   characterised in that
   the rotary drive (20) comprises a belt (25) which is arranged on a drive wheel (26) on the arm (13) and on a drive wheel (27) on the holding element (12a, 12b).
9. Apparatus according to at least one of claims 1 to 8,
   characterised in that
   a longitudinal end (13a) of the arm (13) is in articulated connection with the first slider (14).
10. Apparatus according to at least one of claims 1 to 9,
    characterised in that
    the connecting element (17) acts on the arm (13) between the point of articulated connection (13d) with the first slider (14) and the holding element (12a, 12b).
11. Apparatus according to at least one of claims 1 to 10,
    characterised in that
    an adjustment device (31) is arranged above the movement device (10a, 10b), which is adapted to change the centre of gravity of the body of a human being who is connected to the holding means (12a, 12b).

Images