EP2535032B1 - Geeignete Vorrichtung für die Rehabilitationstherapie von Patienten mit einem Hirnschaden - Google Patents

Geeignete Vorrichtung für die Rehabilitationstherapie von Patienten mit einem Hirnschaden Download PDF

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Publication number
EP2535032B1
EP2535032B1 EP20110382194 EP11382194A EP2535032B1 EP 2535032 B1 EP2535032 B1 EP 2535032B1 EP 20110382194 EP20110382194 EP 20110382194 EP 11382194 A EP11382194 A EP 11382194A EP 2535032 B1 EP2535032 B1 EP 2535032B1
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Prior art keywords
arm
patient
vertical
section
support
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Not-in-force
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EP20110382194
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English (en)
French (fr)
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EP2535032A1 (de
Inventor
Manuel Menchon Bofill
Elena Sanchez Duran
José María Sabater Navarro
Nicolás Garcia Aracil
Carlos Perez Vidal
José María Azorin Poveda
Eduardo Fernandez Jover
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Alboaires SA
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Alboaires SA
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Priority to EP20110382194 priority Critical patent/EP2535032B1/de
Publication of EP2535032A1 publication Critical patent/EP2535032A1/de
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
    • A61H1/02—Stretching or bending or torsioning apparatus for exercising
    • A61H1/0274—Stretching or bending or torsioning apparatus for exercising for the upper limbs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5058—Sensors or detectors
    • A61H2201/5064—Position sensors

Definitions

  • the present invention relates to a device or apparatus for aiding in the rehabilitation treatment of patients with brain damage.
  • the brain is capable of sending signals to the muscles to perform a particular movement and in turn to learn increasingly more complex movements through the manner in which the senses perceive the movement that has actually occurred.
  • This feedback phenomenon is a complex mechanism.
  • the brain emits a command to the muscle through the motor pathways and peripheral nerves to perform a certain movement. There are many muscles involved in this movement and in most cases such movements must be done by following a certain sequence and each of them is done by applying a different intensity.
  • the brain is capable of assessing corrections in the way of giving commands and thus making the movement with which the body responds similar to the target movement in the brain. These corrections are evaluated through the perception that the brain receives as to how the movement has actually been produced.
  • Therapeutic exercises are exercises in which the patient performs a movement requiring a certain degree of coordination and which require the help of another.
  • Robots and devices responsible for helping in this therapeutic task are known, such as that described in Spanish patent with publication number ES2338623 where the patient remains stretched out on a hospital-type bed and two independent robot arms act on the patient in order to help him perform the repetitive exercises.
  • a first robot arm moves down from the ceiling and reaches the patient's hand through several mechanical connections.
  • the patent describes the use of several redundant degrees of freedom so that one and the same final position of the robot arm holding the arm of the patient can be reached by means of different intermediate positions of the first robot arm.
  • the redundancy i.e., being able to adopt different intermediate positions of the mechanical connections for one and the same end position, allows the therapist to help the patient and move the first robot arm so that it does not get in the way of him working with the patient and to do this such that he continues to hold the hand of the patient in the suitable position and orientation.
  • the robot It is important for the robot to have a force that can be easily overcome by the patient.
  • the movement the robot follows is thereby a movement which serves as a guide and can be easily altered by the patient if he forces a different trajectory.
  • the reason for this feature is evident.
  • a patient with brain damage may have an inhibited perception of movement or feeling in one of his limbs. A forced movement could hurt the patient and he would not realize or even say that he is being hurt.
  • the movement of the arm of the patient cannot be guided just by means of a single support point on the hand or wrist of the patient but a second and also guided support point which is fixed at the elbow or in a region close to the elbow is necessary.
  • the most effective type of movement for therapy to work on the coordination of the hand and the arm of the patient consists of a trajectory of the arm starting from a position virtually extended along the length of his body and located on the same side.
  • the movement of the hand or wrist of the patient corresponds to a trajectory ending at or approaching the opposite shoulder.
  • This movement must be performed with extended elbow and also with a trajectory which approaches the one followed by the hand.
  • This second trajectory of the elbow must be guided by a second robot arm.
  • the second robot arm described in the aforementioned patent with publication number ES2338623 has several drawbacks.
  • the first drawback is that the second robot arm is linked to the hospital-type bed.
  • the hospital-type bed is part of the device intended for therapy.
  • this device is not suitable for a person who must remain in a wheelchair. Though it is not obligatory for this patient to remain in the chair, he will always have to get up and get on the hospital-type bed to receive therapy as he cannot receive therapy in the wheelchair itself.
  • a second drawback of this second arm is that it has a cartesian configuration where one of the shifts is longitudinal along the length of the hospital-type bed. This movement is achieved because the hospital-type bed has a guide on one side allowing the arm to be shifted in this direction.
  • This Cartesian movement is insufficient and in practice the results show that the described configuration does not allow reaching the entire range required by the possible movements of the elbow.
  • This same configuration also prevents applying therapy to the two arms. To switch therapy to the other arm it is necessary to remove the anchor and install it on the other side of the hospital-type bed taking into account that the second robot arm does not have to be symmetrical to thus maintain an operating mode on the patient that is symmetrical.
  • An object of this invention is to provide a single apparatus that overcomes all the aforementioned drawbacks.
  • the present invention particularly allows applying therapy both to patients laying on a hospital-type bed and to patients in a wheelchair.
  • the present invention further allows acting both on the right arm of the patient and on the left arm with one and the same second arm without having to duplicate devices or having to uninstall or reinstall a second arm.
  • the present invention as claimed comprises a suitable apparatus for the rehabilitation therapy of patients with brain damage comprising:
  • one arm is lifted above the patient and serves to hold and guide the distal end of the arm of the patient; and the second arm simultaneously and in coordination with the first holds and guides the arm of the patient, mainly in the area close to the elbow.
  • the working area intended for situating the patient can be occupied by a hospital-type bed which is close to the base.
  • This hospital-type bed does not have to be part of the apparatus and it is where the patient is situated, for example, laying down. In this case the head will be oriented towards the base.
  • the patient is in a wheelchair.
  • the back of the wheelchair is close to the base and the apparatus according to the invention acts on the patient by passing the first arm (of the apparatus) above the patient and the second arm (of the apparatus) on either side.
  • the invention is characterized in that this second arm has a rotating support such that the end of this rotating support can be arranged on either side of the area intended for situating the patient to allow access by means of the second arm to either side of the patient.
  • This special configuration of the second arm allows being able to access the patient on either side with a single arm and more easily guiding the arm of the patient. Additionally, it also allows the patient to be situated on a hospital-type bed or on a chair because the hospital-type bed does not have to be part of the base and therefore of the apparatus.
  • Figure 1 shows an embodiment of the invention acting on a patient (P) according to what is shown in the diagram of Figure 4 .
  • the patient (P) is being subjected to therapy consisting of the repetitive practice of an arm movement in which the trajectory of two relevant points is highlighted:
  • Both trajectories (M 1 , M 2 ) must be coordinated either by a therapist or by making use of an apparatus such as the one of the invention by means of two mechanical arms collaborating in the movement. It is said that they "collaborate” because they exert a gentle force making the arm of the patient tend to follow the correct trajectory but it does not impose the trajectory in a forced manner and without any deviation so as to prevent damage to any joint, tendon or muscle of the patient (P).
  • the hospital-type bed is a support for the patient (P) that does not belong to the base (1.1) of the apparatus (1) on which the two main arms, the first arm (1.2) and the second arm (1.3), are fixed.
  • the hospital-type bed can thereby be removed to bring in another patient who receives therapy, for example, in a wheelchair.
  • the first arm (1.2) is intended for guiding the arm of the patient (P) by the distal end (P 1 ).
  • the distal end (P 1 ) can be the hand because the patient grips a support (S), or the wrist because the patient is incapable of holding an object and the first arm (1.2) is linked through some type of grip, for example a Velcro strap.
  • the second arm (1.3) is intended for guiding the elbow (P 2 ) in a manner coordinated with the distal end (P 1 ).
  • FIG. 4 shows two end positions of the rotating support (1.3.1) of the second arm (1.3) according to the embodiment.
  • this rotating support (1.3.1) is an L-shaped tubular body emerging from the lower part of the base (1.1) raising up vertically and then extending horizontally. Due to the rotation according to a vertical shaft, this second horizontal section is located on either side of the patient.
  • the two end positions have been identified as X 1 and X 2 .
  • both arms (1.2, 1.3)
  • the elements making up said arms are described below.
  • the first arm (1.2) is made up of several sections kinematically connected from the base (1.1) to a support (S) intended for fixing the distal end (P 1 ) of the patient (P).
  • the kinematics of this first arm (1.2) is characterized by the degrees of freedom in each connection and those chosen for this embodiment can be seen in greater detail in Figure 2 .
  • the first section is a first rigid section (1.2.1) which is lifted above the area intended for situating the patient (P). Any point for working the distal end (P 1 ) of the arm of the patient (P) can be covered on this lifted position without interfering with the therapist's job and without hitting the patient (P).
  • a second projecting section (1.2.2) emerges from this first rigid section (1.2.1). According to this embodiment, this second projecting section (1.2.2) moves in a horizontal plane because it is linked to the rigid section (1.2.1) through a first vertical shaft (1.2.1.1).
  • Figure 2 shows an actuator (A 3 ) which, like the remaining actuators (A 1 , A 2 , A 4 , A 5 ), acts like an artificial muscle.
  • a second vertical section (1.2.3) emerges from the end of this first projecting section (1.2.2).
  • This vertical section (1.2.3) is also linked with the projecting section (1.2.2) through a rotating articulation with a second rotation shaft (1.2.2.1) arranged vertically.
  • the second vertical section (1.2.3) thereby switches the orientation of its lower end.
  • the articulated parallelogram (1.2.4) comprises 4 bars parallel to one another in sets of two.
  • a first vertical bar is the lower portion of the second vertical section (1.2.3). In this lower portion there are two rotating attachment points from which two oblique parallel bars emerge.
  • the second vertical section (1.2.3) is rotated, the two oblique bars are oriented towards the base, hence the upper part of the oblique bars is covering part of the projecting section (1.2.2).
  • the attachment between the support (S) and the third vertical section (1.2.5) is by means of a rotating attachment allowing any orientation of the support (S).
  • this third vertical section (1.2.5) can be located at any height.
  • a horizontal shaft (oblique according to the perspective in the drawing) emerging from the actuator (A 5 ) located in this articulation is shown in the lower part of the second vertical section (1.2.3).
  • Figure 2 is oriented, to the right of the actuator (A 5 ), the side opposite to where the articulated parallelogram (1.2.4) is located, there is a counterweight (1.2.4.1) integral with one of the oblique bars of the articulated parallelogram (1.2.4) which allows compensating for the weight of said parallelogram (1.2.4).
  • the first sections of the first arm (1.2) allow scanning the different points of the working plane, shown according to a plan projection in schematic Figure 4 , where the trajectory to be described by the distal end (P 1 ) of the patient (P) extends.
  • the last sections of the first arm (1.2) allow reaching any height on the same working plane, thereby generating the working range required for the correct application of the therapy.
  • a second arm (1.3) located on a rotating support (1.3.1) allowing this second arm (1.3) to reach the elbow (P 2 ) of the patient (P) either from his right or from his left side has been described in the description of the invention.
  • Figure 3 shows in detail the parts making up the second arm (1.3) according to one embodiment; nevertheless, Figure 4 shows several geometric aspects of relevance.
  • the patient (P) is laying on a hospital-type bed with the support (1.1) on his head. If instead of being in a hospital-type bed the patient were in a wheelchair then the support (1.1) of the apparatus (1) would be behind the patient (P).
  • the position of the shaft X 1 is the position in which the horizontal section of the rotating support (1.3.1) of the second arm (1.3) extends. This position is slightly oblique and allows locating the ball joint (1.3.2) at a point of the end of the rotating support (1.3.1) close to the places where the instant centers of rotation of the trajectory M 2 are located.
  • the attachment of the rotating support (1.3.1) has a quick fixing which unlocks or locks the angular position of said rotating support (1.3.1) at will.
  • the ball joint (1.3.2) allows the rotation in the form of an arc imposed by trajectory (M 2 ) of the elbow (P 2 ) where this arc is projected in space in plan view in the diagram of Figure 4 ; and also a rotation to allow the end of the extendable section (1.3.3) to reach any height required by the elbow (P 2 ).
  • the rotating arm (1.3.1) there is a support with a vertical actuator (A 2 ) allowing the orientation according to a first vertical shaft (E 1 ) of a vertical rotating support (1.3.2.1).
  • the vertical rotating support (1.3.2.1) has in its upper part two U-shaped arms at the upper ends of which there is rotatably anchored a support of the extendable section (1.3.2.2).
  • the rotatable attachment between the vertical rotating support (1.3.2.1) and the support of the extendable section (1.3.2.2) is according to a vertical shaft (E 2 ).
  • This second rotational movement would be free were it not for the presence of another horizontal actuator (A 1 ).
  • This other horizontal actuator (A 1 ) is also (like the aforementioned vertical actuator A 2 ) attached to the rotating support (1.3.1).
  • a rotating structure (G) in the shaft of the horizontal actuator (A 1 ) connected by means of a pivoting attachment (U) and it acts on the support (1.3.2.2) of the axially extendable section (1.3.3) at a point located above the vertical shaft (E 2 ) to allow lifting and lowering the axially extendable section (1.3.3).
  • the rotation of the horizontal actuator (A 1 ) causes the rotation of the rotating structure (G).
  • the rotation of the rotating structure (G) means that those points far from its rotation shaft experience a shift in a circular trajectory, particularly the pivoting attachment point (U).
  • both shafts (E 2 , E 3 ) are horizontal but different, hence the pivoting attachment (U) is a ball joint-type attachment to allow any relative orientation between the support (1.3.2.2) of the extendable section (1.3.3) and the rotating structure (G).
  • the lift force exerted by the horizontal actuator (A 1 ) will have a greater modulus value when the extendable arm (1.3.3) is extended in the direction perpendicular to the rotating support (1.3.1). If the extendable arm (1.3.3) is not located in a direction perpendicular to the rotating support (1.3.1), then the lift force will be less the farther away said direction is with respect to said perpendicular.
  • direction X 1 is not perpendicular to the longitudinal shaft of the hospital-type bed but it has a certain angle which approaches the natural trajectory of the elbow (P 2 ).
  • the rotating structure (G) is shown in this embodiment as an arm (G.3) reaching a counterweight (G.1).
  • the extension of the elements of the rotating structures is adjustable, as shown in the figure by means of a guide (G.2) and a setscrew (G.1.1).
  • the counterweight (G.1) acts in the preferred direction of action of the horizontal actuator (A 1 ) because it is located in the rotating structure (G) and exerts force in the same way as the horizontal actuator (A 1 ) does.
  • the extendable section (1.3.3) of the second arm (1.3) allows describing the curved trajectory (M 2 ) of the elbow (P 2 ) because the arc does not have to have all the instant centers of rotation where the ball joint (1.3.2) is located.
  • FIG. 3 shows fixing means (1.3.4) for fixing the end of the axially extendable section (1.3.3) to the elbow (P 2 ).
  • Figure 1 shows a display (2) which can be oriented so that the patient (P) can see it.
  • This display (2) can present images representing objects generated by means of virtual reality techniques and controlled by a processing unit.
  • the processing unit collects the signals from different sensors arranged in the articulations of the apparatus (1) and is capable of knowing at all times the position and orientation of the distal ends of the first arm (1.2) and second arm (1.3).
  • the feedback generated in the brain of the patient (P) by the image of a graphically displayed object moved by his arm enhances the brain's learning and therefore the therapy to be applied.
  • one embodiment incorporates a movement learning program comprising the movement to be applied to the patient repetitively which is defined (learned by the apparatus (1)) with a training phase in which the arms (1.2, 1.3) of the apparatus (1) are moved manually following the trajectory to be repeated.

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

Claims (12)

  1. Geeignete Vorrichtung (1) für die Unterstützung einer oberen Extremität auf einer Seite bei der Rehabilitationstherapie von Patienten mit einem Hirnschaden, umfassend:
    - eine Basis (1.1), auf welcher sich ein erster Arm (1.2) befindet, der vorgesehen ist, um das distale Ende (P1) des Arms des Patienten (P) zu halten und führen,
    - einen zweiten Arm (1.3) auf derselben Basis (1.1), um den Arm (P2) des Patienten (P) zu halten und führen,
    - wobei die Basis (1.1) einen Bereich aufweist, der vorgesehen ist, um den Patient (P) zu stellen, wobei dieser zweite Arm (1.3) eine drehbare Unterstützung (1.3.1) aufweist, so dass das Ende dieser drehbaren Unterstützung (1.3.1) auf jeder Seite des Bereichs, der vorgesehen ist, um den Patient (P) zu stellen, angeordnet werden kann, um den Zugang durch den zweiten Arm (1.3) auf jede Seite des Patienten (P) zu ermöglichen, dadurch gekennzeichnet, dass
    der zweite Arm (1.3) ein Kugelgelenk (1.3.2) aufweist, welches zwei unabhängige Winkeldrehungen (E1, E2) kombiniert und sich ein axial verlängerbarer Abschnitt (1.3.3) von diesem Kugelgelenk (1.3.2) erstreckt, bis zu Befestigungsmittel (1.3.4) für die Befestigung an dem Ellbogen des Patienten (P).
  2. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, dass eine erste Drehachse der beiden unabhängigen Winkeldrehungen (E1, E2), die das Kugelgelenk (1.3.2) aufweist, vertikal (E1) und die zweite Drehachse horizontal (E2) ist.
  3. Vorrichtung nach Anspruch 2, dadurch gekennzeichnet, dass das Kugelgelenk zwei Teile umfasst:
    - eine vertikale drehbare Unterstützung (1.3.2.1) gemäß der vertikalen Achse (E1);
    - eine Unterstützung (1.3.2.2) des axial verlängerbaren Abschnitts (1.3.3), wobei diese Unterstützung (1.3.2.2) auf der vertikalen drehbaren Unterstützung (1.3.2.1) gemäß der horizontalen Achse (E2) drehbar befestigt ist.
  4. Vorrichtung nach Anspruch 3, dadurch gekennzeichnet, dass das Kugelgelenk (1.3.2) Folgendes umfasst:
    - einen vertikalen Antrieb (A2), welcher auf der drehbaren Unterstützung (1.3.1) des zweiten Arms (1.3) befestigt ist und auf die vertikale drehbare Unterstützung (1.3.2.1) des Kugelgelenks (1.3.2) wirkt,
    - einen horizontalen Antrieb (A1), welcher auf der drehbaren Unterstützung (1.3.1) des zweiten Arms (1.3) befestigt ist und auf die Unterstützung (1.3.2.2) des axial verlängerbaren Abschnitts (1.3.3), an einem Punkt, der sich über der horizontalen Achse (E2) befindet, wirkt, durch eine drehbare Struktur (G), die mit einem schwenkbaren Anschluss (U) verbunden ist, um das Heben und Senken des axial verlängerbaren Abschnitts (1.3.3) zu ermöglichen.
  5. Vorrichtung nach Anspruch 4, dadurch gekennzeichnet, dass die drehbare Struktur (G) ein Gegengewicht (G.1) aufweist.
  6. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, dass die drehbare Unterstützung (1.3.1) L-förmig ist, mit einem ersten vertikalen und einem zweiten horizontalen Abschnitt, wobei das Ende dieses horizontalen Abschnitts dazu vorgesehen ist, auf jeder Seite des Patienten (P) gestellt zu werden.
  7. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, dass der erste Arm (1.2) einen ersten steifen Abschnitt (1.2.1) umfasst, welcher über dem Bereich gehoben wird, der vorgesehen ist, um den Patient (P) zu stellen, wobei aus diesem Abschnitt ein vorstehender Abschnitt (1.2.2) herausragt und ein zweiter vertikaler Abschnitt (1.2.3) seinerseits von diesem vorstehenden Abschnitt (1.2.2) herausragt, wobei alle gemäß vertikalen Drehachsen miteinander drehbar verbunden sind, und wobei der letzte vertikale Abschnitt (1.2.3) bis zu einer Unterstützung (S) durch eine Zwischenverbindung reicht, um das distale Ende des Patienten (P) zu halten, wobei sich diese letzte Unterstützung (S) durch die Zwischenverbindung vertikal verlagern kann.
  8. Vorrichtung nach Anspruch 7, dadurch gekennzeichnet, dass die Zwischenverbindung ein gelenkiges Parallelogramm (1.2.4) mit zueinander parallelen Stangen in zweier Gruppen umfasst, wobei zwei dieser vertikal sind, wobei zumindest ein Teil des zweiten vertikalen Abschnitts (1.2.3) eine dieser vertikalen Stangen ist.
  9. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, dass eine oder mehrere Bewegungen der Gelenke der Arme durch bevorzugt pneumatischen künstlichen Muskeln betätigt werden.
  10. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, dass die Gelenke Lagesensoren aufweisen.
  11. Vorrichtung nach Anspruch 10, dadurch gekennzeichnet, dass sie eine Verarbeitungseinheit umfasst, die geeignet ist, eine Bewegung für ihre spätere wiederholte Ausführung zu lernen.
  12. Vorrichtung nach den Ansprüchen 10 und 11, dadurch gekennzeichnet, dass sie graphische Anzeigemittel umfasst, welche durch die Verarbeitungssteuereinheit gesteuert werden, so dass sie ein System virtueller Realität bereitstellen, koordiniert mit den Bewegungen, die von den Lagesensoren ermittelt werden, um die Lernprozesse der Rehabilitationsbehandlung rückzuführen.
EP20110382194 2011-06-13 2011-06-13 Geeignete Vorrichtung für die Rehabilitationstherapie von Patienten mit einem Hirnschaden Not-in-force EP2535032B1 (de)

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EP20110382194 EP2535032B1 (de) 2011-06-13 2011-06-13 Geeignete Vorrichtung für die Rehabilitationstherapie von Patienten mit einem Hirnschaden

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EP2535032B1 true EP2535032B1 (de) 2015-04-22

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CN111166627B (zh) * 2020-03-05 2021-11-30 江苏医药职业学院 一种偏瘫患者痉挛恢复装置

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US20030115954A1 (en) * 2001-12-07 2003-06-26 Vladimir Zemlyakov Upper extremity exoskeleton structure and method
US20040243027A1 (en) * 2003-04-21 2004-12-02 Hook Steven D. Repetitive motion exercise therapy device and method of treatment using same
WO2005075155A2 (en) * 2004-02-05 2005-08-18 Motorika Inc. Fine motor control rehabilitation
US20060293617A1 (en) * 2004-02-05 2006-12-28 Reability Inc. Methods and apparatuses for rehabilitation and training
ES2338623B1 (es) 2008-08-05 2012-02-07 Universidad Miguel Hernandez Brazo robótico.

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