EP2836184A1 - Wheelchair dynamic seating system suitable for dystonic disease - Google Patents

Wheelchair dynamic seating system suitable for dystonic disease

Info

Publication number
EP2836184A1
EP2836184A1 EP13775228.3A EP13775228A EP2836184A1 EP 2836184 A1 EP2836184 A1 EP 2836184A1 EP 13775228 A EP13775228 A EP 13775228A EP 2836184 A1 EP2836184 A1 EP 2836184A1
Authority
EP
European Patent Office
Prior art keywords
extension
order
articulation
rotation
spasms
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.)
Granted
Application number
EP13775228.3A
Other languages
German (de)
French (fr)
Other versions
EP2836184B1 (en
EP2836184A4 (en
Inventor
Andrea MAMMI
Salvatore Mura
Marco Paganini MORI
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Alu Rehab As
Original Assignee
Alu Rehab As
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Publication date
Application filed by Alu Rehab As filed Critical Alu Rehab As
Publication of EP2836184A1 publication Critical patent/EP2836184A1/en
Publication of EP2836184A4 publication Critical patent/EP2836184A4/en
Application granted granted Critical
Publication of EP2836184B1 publication Critical patent/EP2836184B1/en
Active legal-status Critical Current
Anticipated expiration legal-status Critical

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/10—Parts, details or accessories
    • A61G5/1056—Arrangements for adjusting the seat
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/10—Parts, details or accessories
    • A61G5/12—Rests specially adapted therefor, e.g. for the head or the feet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/10—Parts, details or accessories
    • A61G5/12—Rests specially adapted therefor, e.g. for the head or the feet
    • A61G5/121—Rests specially adapted therefor, e.g. for the head or the feet for head or neck
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/10—Parts, details or accessories
    • A61G5/12—Rests specially adapted therefor, e.g. for the head or the feet
    • A61G5/122—Rests specially adapted therefor, e.g. for the head or the feet for the back
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/10—Parts, details or accessories
    • A61G5/12—Rests specially adapted therefor, e.g. for the head or the feet
    • A61G5/125—Rests specially adapted therefor, e.g. for the head or the feet for arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/10—Parts, details or accessories
    • A61G5/12—Rests specially adapted therefor, e.g. for the head or the feet
    • A61G5/127—Rests specially adapted therefor, e.g. for the head or the feet for lower legs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/10—Parts, details or accessories
    • A61G5/12—Rests specially adapted therefor, e.g. for the head or the feet
    • A61G5/128—Rests specially adapted therefor, e.g. for the head or the feet for feet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/04—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs motor-driven

Definitions

  • the present device is intended to ameliorate the strains caused by spasms and dystonias (especially those related to extension) in diseased subjects in particular when they are seated onto dynamic seating systems, such as push or motorized wheelchairs.
  • the present invention relates to a device designed as a dynamic seating system for disabled people or subjects suffering from dystonias, primarily those related to extension. Spasms and contractions from which these patients suffer tend to be particularly fatiguing for the subjects and seriously put the durability of their wheelchairs to the test.
  • the present device is a wheelchair, the supports of which are completely articulated by means of springs and dampeners, so that all the strains do not rest on the patient nor on the wheelchair .
  • a dynamic seating system is that allowing for and supporting a controlled, balanced movement while providing stability to the individual who uses the device.
  • a dynamic seating system is a seating system reacting to the forces exerted by the user and somehow allows the extension of the hip joint and/or the adjustment of the backrest.
  • Dynamic seating systems are explicitly designed to resist to and follow the sudden, vigorous and strong movements of the user.
  • the object of the present invention is an adjustable modular wheelchair, with points of contact with the patient being all dampened.
  • this wheelchair as compared to a fixed wheelchair, is provided with the following degrees of freedom:
  • a suitably sized wheelchair based on the anthropometric sizes of the patient (as are generally commercially available) brings the rotation joints of the wheelchair close to those of the patient, significantly improving the efficacy of the system.
  • a further adjustment used by the device object of the present invention is that related to the positioning of the containment belts so that no pressure is exerted on the abdomen, but only on the iliac crests (district where no pain is caused to the patient) .
  • leaf springs are used for the flexion and extension of the footrest (i.e., the flexion and extension of the ankle) hinged upon the support tube of the footrest itself; also, the footrest may be pushed in the direction of the tibia (longitudinal axis of the leg) : gas springs are used (compression spring and gas dampener integrated in a single cylinder) which are calibrated to control and support the extension along the tibial axis; it is worth noting how it is necessary to use a small mechanism to convert the extension of the mechanical structure to a spring compression, since compression springs may have a greater resistance and it is very difficult to find extension springs capable of bearing loads which are typical of dystonic spasms.
  • the leg may extend freely by rotating around an articulation positioned at the knee level; the return is slightly dampened by the extension tube included.
  • the seat pan is hinged on the front horizontal tube which connects the two half frames of the wheelchair. In turn the seat pan is made integral with the patient by means of belts adjustable in position along the sides of the seat pan itself. Rubber elements dampen the contact between half frames and seat pan.
  • the backrest may rotate about an axis coinciding with the transverse axis of the pelvis. It is capable of tilting while remaining supported by a gas (compression) spring. Finally, the headrest, which is secured to the backrest, may be pushed backwards. In this movement, it is always supported by a gas (compression) spring.
  • a walking assistance device which transforms from a chair to a rollator is described in US Patent No. 6,619,681 (Charlie Gutierrez, Delano Association for the developmentally disabled, Delano, 2003) ; it provides for the assisting device being articulated.
  • a device for personal mobility having a partially dynamic seat pan is described in US Patent 2005/00229866 (Wayne Hanson et al . , Bozeman, MT, 2005).
  • InterCo GmbH manufactures wheelchairs with a dynamic seating system called Aktivline.
  • Pro Medicare has developed a wheelchair with a dynamic seating system called Adacta Klim.
  • the seating systems built so far provide, in order to function, the simultaneous involvement of seat pan and backrest (in some cases also the footrests), which are tightly bound to each other and thus limit the movement of a district to a movement which is induced by another district; thereby, the extension schemes are not followed, involving the single districts in a non- constrained manner.
  • the present patent as compared to existing solutions, addresses the problem in its entirety, without limiting to a few musculoskeletal districts.
  • This type of approach is completely innovative, in fact it allows any type of strains to be discharged and not delocalized to other districts.
  • the advantages of this dynamic seating systems are apparent:
  • the present patent seeks to address the problem by summarizing the various solutions, introducing new ones (e.g. the rotation of the footrest corresponding to the rotation of the ankle) , and using all the components synergistically (all the articulations of the seating system work together simultaneously, each supporting the strain of the musculoskeletal district of interest) , and optimizing all the components based on the requirements of the user (for the correct functioning of the device it is worth attempting to have the anatomic rotation axes coinciding with those of the articulated seat pan) .
  • the present patent in order to obtain the maximum efficacy of the dynamic wheelchair, not only does it use a wheelchair which can be adjusted based on the anthropomorphic sizes of the user, but also shifts the axes of the knee and hip joints (main districts where spasms are located) so that better results are obtained.
  • a further advantage is the modular nature of the assisting device: the wheelchair object of the present invention does not establish that all the segments are dynamic, but it is possible to implement only those that are strictly necessary to obviate the discomforts related to a specific disease. For example, those who suffer from head trauma are likely to require the dynamic footrest only and not the other segments or, if they show rigidity of the trunk, the dampened backrest will be required, but not the dynamic seat pan (but rather the positioning device of the pelvic belt) .
  • Figure 1 shows the device in its complete configuration, in the two configurations of rest and extension .
  • Figure 2 shows the detail of the headrest dampening .
  • Figure 3 shows the dampening movement of the backrest.
  • Figure 4 shows the adjustment of the tilting plane of the seat pan.
  • Figure 5 shows the possibility to rotate the seat pan plane in order to follow a situation of spasticity.
  • Figure 6 reports the possibility to extend the legs around the knee joint.
  • Figure 7 shows the possibility to drive the footrest away from the knee and the dampening system thereof .
  • Figure 8 shows the rotation of the footrest and the return spring thereof.
  • Figure 1 shows the proposed device in its complete possibility to articulate. There are to be found the dampening system 1 of the headrest, the rotation 2 of the backrest, the rotation 3 of the seating plane, the rotation 4 of the cushion with respect to the seating plane, the rotation 5 of extension of the knee, the extension 6 of the footrest, and the rotation 7 of the footrest itself.
  • Figure 2 shows the detail of the dampening system 1 of the headrest, in its configuration at rest (top) and in its compressed configuration (bottom) .
  • rod 9 also slides into the guide 10 integrally fixed to rod 11 and, through the latter, to the frame.
  • Gas springs 12 follow the pushing movement and then restore the rest position. They are secured to the supports 13 integral with the guide 10 (and thus with the frame) and with the sliding rod 9.
  • FIG 3 shows the rotation mechanism 2 of backrest 14.
  • the backrest 14 by being subjected to the pushing movements of the back, rotates about the hinge integral with the frame.
  • Backrest 14 is integral with the lever 16 which, by rotating, then compresses the gas spring 17, the other end of which is secured to the frame. Thereby, the spring 17 still follows the movement and, once the pushing movement from the back is ended, returns the backrest 14 to its rest position.
  • Figure 4 shows the rotation mechanism 3 of the seating plane 18.
  • the seating plane 18 may rotate about the hinge 19 integral with the frame, once the relevant unlock lever 20 is actuated. Such a rotation is dampened by the gas spring 21.
  • Figure 5 shows the rotation 5 of the cushion plane 22 about the tube of the seating plane 23.
  • the cushion plane 22 is caused to rotate by the user' s pelvis which is secured by means of containment belts which engage the sliding supports 24 which are movable along guides 25.
  • the rotation occurs by virtue of hinges 26 and the return is dampened by rubber dampeners 27.
  • Figure 6 shows the rotation 5 of the leg rest system 28 about hinge 29 by means of an articulated parallelogram-shaped system.
  • Figure 7 shows the extension 6 of the footrest 30.
  • tube 31 slides into tube 32, which acts as a frame.
  • Tube 31 when sliding, also brings down tube 33 which is connected to the gas spring 3 .
  • the other end of the gas spring 34 is connected to the tube 31.
  • the gas spring 34 returns the footrest 30 to its rest position.
  • Figure 8 shows the rotation 7 of the footrest 30 under the pushing movement of the feet and ankle of the user.
  • the footrest 30 rotates about the tube 35 by virtue of the hinge 36 and, once the pushing movement of the user ends, the laminated ( or leaf) spring 37 returns it to its rest position.
  • the system may be equally implemented with two half footrests, even entirely independent when the tube 35 is divided into two independent halves: this would allow for asymmetrical pushing movements of the two lower limbs (different extensions around the knee axis, different pushing movements with a tendency to push the footrest away, different rotations of the ankle and foot) .

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Otolaryngology (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)
  • Percussion Or Vibration Massage (AREA)

Abstract

The present device is intended to ameliorate the strains caused by spasms and dystonias (especially those related to extension) in diseased subjects in particular when they are seated onto dynamic seating systems, such as push or motorized wheelchairs. Disease affecting the central nervous system (head- brain traumas, children brain paralysis, evolutionary disease of the central nervous system, etc.) generally have serious consequences especially affecting the musculoskeletal system. Some of these prevent voluntary control of the muscles of the trunk and lower limbs, and the diseased subjects suffer from acute muscle contractions. The device allows for controlled disarticulation, by means of calibrated springs and dampeners, of all the wheelchair components on which the strains and tensions of the user are discharged. In particular, an object of the present invention is the articulation of the footrest (extension and rotation), the articulation of the footrest itself (for the extension of the leg at the knee level), the rotation of the seat pan and backrest, and the articulation of the headrest. It is worth noting that the novelty of the device lies in the synergy among these articulations. Although these articulations have already been partially implemented in other wheelchairs, only in this device they are implemented all together to The present device is intended to ameliorate the strains caused by spasms and dystonias (especially those related to extension) in diseased subjects in particular when they are seated onto dynamic seating systems, such as push or motorized wheelchairs. Disease affecting the central nervous system (head- brain traumas, children brain paralysis, evolutionary disease of the central nervous system, etc.) generally have serious consequences especially affecting the musculoskeletal system. Some of these prevent voluntary control of the muscles of the trunk and lower limbs, and the diseased subjects suffer from acute muscle contractions. The device allows for controlled disarticulation, by means of calibrated springs and dampeners, of all the wheelchair components on which the strains and tensions of the user are discharged. In particular, an object of the present invention is the articulation of the footrest (extension and rotation), the articulation of the footrest itself (for the extension of the leg at the knee level), the rotation of the seat pan and backrest, and the articulation of the headrest. It is worth noting that the novelty of the device lies in the synergy among these articulations. Although these articulations have already been partially implemented in other wheelchairs, only in this device they are implemented all together to The present device is intended to ameliorate the strains caused by spasms and dystonias (especially those related to extension) in diseased subjects in particular when they are seated onto dynamic seating systems, such as push or motorized wheelchairs. Disease affecting the central nervous system (head- brain traumas, children brain paralysis, evolutionary disease of the central nervous system, etc.) generally have serious consequences especially affecting the musculoskeletal system. Some of these prevent voluntary control of the muscles of the trunk and lower limbs, and the diseased subjects suffer from acute muscle contractions. The device allows for controlled disarticulation, by means of calibrated springs and dampeners, of all the wheelchair components on which the strains and tensions of the user are discharged. In particular, an object of the present invention is the articulation of the footrest (extension and rotation), the articulation of the footrest itself (for the extension of the leg at the knee level), the rotation of the seat pan and backrest, and the articulation of the headrest. It is worth noting that the novelty of the device lies in the synergy among these articulations. Although these articulations have already been partially implemented in other wheelchairs, only in this device they are implemented all together to eliminate any point of strain of the patient onto the wheelchair. Furthermore, the particular implementation set forth makes the modular system adaptable to different dynamic seating systems and adjustable both following the anthropometric sizes of the patients and the intensity of their spasms.

Description

WHEELCHAIR DYNAMIC SEATING SYSTEM SUITABLE FOR DYSTONIC DISEASE
DESCRIPTION
The present device is intended to ameliorate the strains caused by spasms and dystonias (especially those related to extension) in diseased subjects in particular when they are seated onto dynamic seating systems, such as push or motorized wheelchairs.
Diseases affecting the central nervous system (head-brain traumas, children brain paralysis, evolutionary diseases of the central nervous system, etc.) generally have serious consequences especially affecting the musculoskeletal system. Some of these prevent voluntary control of the muscles of the trunk and lower limbs, and the diseased subjects suffer from acute muscle contractions.
SCOPE OF THE INVENTION
The present invention relates to a device designed as a dynamic seating system for disabled people or subjects suffering from dystonias, primarily those related to extension. Spasms and contractions from which these patients suffer tend to be particularly fatiguing for the subjects and seriously put the durability of their wheelchairs to the test. The present device is a wheelchair, the supports of which are completely articulated by means of springs and dampeners, so that all the strains do not rest on the patient nor on the wheelchair .
SUMMARY OF PRIOR ART
Diseases affecting the central nervous system (head-brain traumas, children brain paralysis, evolutionary disease of the central nervous system, etc.) generally have serious consequences especially affecting the musculoskeletal system. Some of these prevent voluntary control of the muscles of the trunk and lower limbs, and the diseased subjects suffer from acute muscle contractions which often lead even to the dislocation of greater joints. The specificity and violence of movements make it hard to identify any support for these subjects and force them to remain exiled in a place where, when moving, they do not risk to bump against rigid elements. The medical devices available at present are not suitable for containing a subject which makes continuous uncontrolled movements. It is worth adding that in order to secure the patient to the device it is necessary to use braces, abduction wedge, etc. The immobility and rigidity of these systems, besides increasing the probability of joint dislocation, also causes an hyper-pressure in the pelvic area with detrimental consequences for the health of the patient .
The effect of stretched ischiocrural muscles is detected at the level of the pelvis (when presently commercially available seating systems are used) , which becomes retroverted with a consequent forward sliding movement thereof, extension of the trunk and posteriorization of the head. In certain cases this event causes opisthotonus (state of serious hypertension and spasticity where the head, neck and backbone of an individual shift into a completely bulged or bridge position) and/or dystonic seizures. Each dystonic seizure tends to distort the posture of the individual on the dynamic seating system and an external intervention is usually required to restore the correct position of the individual on the wheelchair.
In short time, the reiteration of pushing movements produces structural damages to the wheelchair (head rest, backrest and footrest which firstly support pushing movements) . In short to medium periods there appear even serious lesions of the musculoskeletal system and lesions of the skin (e.g. containment belts may cause excessive pressures with consequent skin redness and tearing) , loss of strength in the musculoskeletal system, and loss of joint mobility.
Although there are pharmacological therapies (such as use of the botulinum toxin and intrathecal infusion therapy with baclofen - ITB intrathecal baclofen therapy which includes implanting a programmable infusion system, which delivers the anti-spasm drug directly in the point of greater efficacy, or even the use of dopaminergic drugs), rehabilitation is the less invasive approach ensuring better results. It is mainly necessary to seek posture solutions which allow to maintain the seated position with stability, safety and comfort (also during spasms) , prevent damages to shoulder blades and to shoulder joints, identify posture elements that let certain districts free for voluntary activities (e.g. the possibility to turn the head to direct one's eyes) . The dynamic control of posture allows the user to make temporary posture shifts while continuing to be supported .
In their study, Cooper at al. show that a dynamic seating system may positively affect the reduction of spasticity and the increase of certain functional activities (Cooper D., Dilabio M., Broughton G., Brown D., "Dynamic seating components for the reduction of spastic activity and enhancement of function", 17th International Seating Symposium 2001). Crane at al . report the reduction in spasticity intensity and in contact pressures, a better posture stability, a better comfort, an improvement in functional aspects, the prevention of damages to the seating systems, and a better vocal and/or breathing ability (Crane B.A., Holm M.B. , Hobson D., Cooper R.A., Reed M.P., "A dynamic seating intervention for wheelchair seating discomfort", Am J Phys Med Rehabil. 2007 Dec; 86 ( 12 ) : 988-93 ) . There have also been highlighted the positive effects of the dynamic posture system in subjects with children brain paralysis when in the seated position and during daily activities (Michael H. and Sheri Simkins, "Effects of Dynamic Wheelchair Seating in Children with Cerebral Palsy", 24th ISS Vancouver 2008 Montana State University (USA) Epicenter Therapy Services, Bozeman, MT) .
A dynamic seating system is that allowing for and supporting a controlled, balanced movement while providing stability to the individual who uses the device. In the practice, a dynamic seating system is a seating system reacting to the forces exerted by the user and somehow allows the extension of the hip joint and/or the adjustment of the backrest. Dynamic seating systems are explicitly designed to resist to and follow the sudden, vigorous and strong movements of the user.
It has also been observed that a thoroughly designed dynamic seating system induces a decrease in the intensity and duration of the extension pushing movement at the trunk and head level, a lesser hyperextension of the head during spasms, a lesser involvement of lower limbs, a greater consistency of anatomic parts with the components of the posture system during and after the spasm (maintenance of correct posture) , a lesser consumption of physical energies by the patient, and an improvement in swallowing and consequent reduction of sialorrhea (Ferrari A. "In tema di postura e di controllo posturale", Giornale Italiano di Medicina Riabilitativa, 2003-1; 61-7) .
The object of the present invention is an adjustable modular wheelchair, with points of contact with the patient being all dampened. In particular this wheelchair, as compared to a fixed wheelchair, is provided with the following degrees of freedom:
- extension of the footrest (extension along the tibial axis)
- rotation of the footrest (flexion and extension of the ankle)
- rotation of the leg rest (extension of the knee j oint )
- rotation of the seat pan (extension of the hip around the transverse axis of the pelvis)
- rotation of the backrest (extension of the back around the pelvis)
- shift of the headrest (extension of the neck) . These degrees of freedom, suitably hinged and adequately dampened, allow to support the patient while giving him/her an adequate freedom of movement, when the contractions and involuntary spasms force him/her to extend his/her entire body (or even only parts of it) causing pushing movements against the wheelchair components.
It is worth noting that a suitably sized wheelchair based on the anthropometric sizes of the patient (as are generally commercially available) brings the rotation joints of the wheelchair close to those of the patient, significantly improving the efficacy of the system. To this purpose, a further adjustment used by the device object of the present invention is that related to the positioning of the containment belts so that no pressure is exerted on the abdomen, but only on the iliac crests (district where no pain is caused to the patient) .
It is also worth noting that, although there exist dynamic seating systems, they only concern certain districts by following an operation principle different from that proposed in this application: they tend to cause the user to push against one of those components (which is kept blocked) in order to rotate those which have been left free. However, this support is a considerably greater burden both for the patient (who in any case finds a painful obstacle to spasms and contractions) and the wheelchair (which continues to have a point on which all the strains and impacts due to the contractions are primarily discharged) .
The implementations of the degrees of freedom used in order to optimize the operation of the wheelchair object of the present invention are briefly described below. For the footrest, leaf springs are used for the flexion and extension of the footrest (i.e., the flexion and extension of the ankle) hinged upon the support tube of the footrest itself; also, the footrest may be pushed in the direction of the tibia (longitudinal axis of the leg) : gas springs are used (compression spring and gas dampener integrated in a single cylinder) which are calibrated to control and support the extension along the tibial axis; it is worth noting how it is necessary to use a small mechanism to convert the extension of the mechanical structure to a spring compression, since compression springs may have a greater resistance and it is very difficult to find extension springs capable of bearing loads which are typical of dystonic spasms. The leg may extend freely by rotating around an articulation positioned at the knee level; the return is slightly dampened by the extension tube included. The seat pan is hinged on the front horizontal tube which connects the two half frames of the wheelchair. In turn the seat pan is made integral with the patient by means of belts adjustable in position along the sides of the seat pan itself. Rubber elements dampen the contact between half frames and seat pan. The backrest may rotate about an axis coinciding with the transverse axis of the pelvis. It is capable of tilting while remaining supported by a gas (compression) spring. Finally, the headrest, which is secured to the backrest, may be pushed backwards. In this movement, it is always supported by a gas (compression) spring.
A device with a dampened seat pan is described in US Patent No. 5,904,398 (Susan Farricielli, 1999).
A device with a dynamic seating system (limited to the seat pan as such) is described in US Patent No. 6,991,292 (Jon Michael Kasten, Adaptive Engineering Lab Inc, 2006) .
A device with tilting, dampened backrest is described in US Patent No. 2009/0195038 (Mark Carl Underwood, Dickinson Wright Pile, 2009) .
A walking assistance device which transforms from a chair to a rollator is described in US Patent No. 6,619,681 (Charlie Gutierrez, Delano Association for the developmentally disabled, Delano, 2003) ; it provides for the assisting device being articulated.
A device for personal mobility having a partially dynamic seat pan is described in US Patent 2005/00229866 (Wayne Hanson et al . , Bozeman, MT, 2005).
A device which provides a mobile seat pan to follow the movements of the user is described in US patent No. 6,488,332 (Michael Markwald, Interco GmbH, 2002).
InterCo GmbH manufactures wheelchairs with a dynamic seating system called Aktivline. Pro Medicare has developed a wheelchair with a dynamic seating system called Adacta Klim.
Miller's Adaptive Technologies
(http : //www .millersadaptive . com/ ) manufactures components for dynamic seating systems.
SUMMARY OF THE INVENTION
With respect to the first two patents, the device introduces considerable differences, since it lets all the push points free. The same applies to US patent 2009/0195038 (which limits the articulation of the backrest only) .
US Patent No. 6,619,681 described a widely articulated but not dampened chair which is not capable of supporting dystonic thrusts.
US Patent 2005/00229866 limits the articulation of the seat pan, as the previous ones.
The products from InterCo tend to cause the patients to lean their feet onto the fixed footrest, and in fact they do not discharge the involved strains completely, but only partially. The same applies to the device called Adacta Klim.
The components of Miller's Adaptive, which do not cover all the joints, do not form part of a unitary design and thus they only locally alleviate the thrusts.
The seating systems built so far provide, in order to function, the simultaneous involvement of seat pan and backrest (in some cases also the footrests), which are tightly bound to each other and thus limit the movement of a district to a movement which is induced by another district; thereby, the extension schemes are not followed, involving the single districts in a non- constrained manner. In the currently commercially available wheelchairs, a single district always involves and moves another district, thus preventing the user from pulling or pushing, in terms of quality and quantity of the strain, only the district which at that time is more significantly affected by the spasm; experience teaches that in the same user spasms which appear are never identical to the preceding and following ones, neither in terms of intensity nor duration or affected district; therefore, only a system completely releasing one district from the other may follow all the spasms in their variations, based on localization district, intensity and direction.
In conclusion, the present patent, as compared to existing solutions, addresses the problem in its entirety, without limiting to a few musculoskeletal districts. This type of approach is completely innovative, in fact it allows any type of strains to be discharged and not delocalized to other districts. The advantages of this dynamic seating systems are apparent:
- increase of comfort of the user
- improvement of the pelvis stability
- increase of tolerance to the seated position
- reduction of muscle and joint pain and fatigue of the user
- wide limitation of skin injuries
- reduction od "bumps" caused by sudden spasms
considerable reduction of damages to the assisting device.
In effect, the use of dynamic seating systems is quite recent and therefore still needs to be defined. The present patent seeks to address the problem by summarizing the various solutions, introducing new ones (e.g. the rotation of the footrest corresponding to the rotation of the ankle) , and using all the components synergistically (all the articulations of the seating system work together simultaneously, each supporting the strain of the musculoskeletal district of interest) , and optimizing all the components based on the requirements of the user (for the correct functioning of the device it is worth attempting to have the anatomic rotation axes coinciding with those of the articulated seat pan) . With regard to this last aspect, the present patent, in order to obtain the maximum efficacy of the dynamic wheelchair, not only does it use a wheelchair which can be adjusted based on the anthropomorphic sizes of the user, but also shifts the axes of the knee and hip joints (main districts where spasms are located) so that better results are obtained.
Normal dynamic wheelchairs are mostly suitable for dystonic or spastic subjects only, while they are not suitable for subjects with head trauma as is that of the present invention. Furthermore, in the presently available systems, it is essential to secure the feet of the subject with belts; such a situation should be considered as not compatible with all types of disease (and, in any case, not comfortable) .
A further advantage is the modular nature of the assisting device: the wheelchair object of the present invention does not establish that all the segments are dynamic, but it is possible to implement only those that are strictly necessary to obviate the discomforts related to a specific disease. For example, those who suffer from head trauma are likely to require the dynamic footrest only and not the other segments or, if they show rigidity of the trunk, the dampened backrest will be required, but not the dynamic seat pan (but rather the positioning device of the pelvic belt) .
BRIEF DESCRIPTION OF THE DRAWINGS
The present invention will be better understood with reference to the following drawings which describe the various components of the device.
Figure 1 shows the device in its complete configuration, in the two configurations of rest and extension .
Figure 2 shows the detail of the headrest dampening .
Figure 3 shows the dampening movement of the backrest.
Figure 4 shows the adjustment of the tilting plane of the seat pan.
Figure 5 shows the possibility to rotate the seat pan plane in order to follow a situation of spasticity.
Figure 6 reports the possibility to extend the legs around the knee joint. Figure 7 shows the possibility to drive the footrest away from the knee and the dampening system thereof .
Finally, Figure 8 shows the rotation of the footrest and the return spring thereof.
DESCRIPTION OF PREFERRED EMBODIMENTS
Figure 1 shows the proposed device in its complete possibility to articulate. There are to be found the dampening system 1 of the headrest, the rotation 2 of the backrest, the rotation 3 of the seating plane, the rotation 4 of the cushion with respect to the seating plane, the rotation 5 of extension of the knee, the extension 6 of the footrest, and the rotation 7 of the footrest itself.
Figure 2 shows the detail of the dampening system 1 of the headrest, in its configuration at rest (top) and in its compressed configuration (bottom) . When the head pushes against the cushion 8, rod 9 also slides into the guide 10 integrally fixed to rod 11 and, through the latter, to the frame. Gas springs 12 follow the pushing movement and then restore the rest position. They are secured to the supports 13 integral with the guide 10 (and thus with the frame) and with the sliding rod 9.
Figure 3 shows the rotation mechanism 2 of backrest 14. The backrest 14, by being subjected to the pushing movements of the back, rotates about the hinge integral with the frame. Backrest 14 is integral with the lever 16 which, by rotating, then compresses the gas spring 17, the other end of which is secured to the frame. Thereby, the spring 17 still follows the movement and, once the pushing movement from the back is ended, returns the backrest 14 to its rest position.
Figure 4 shows the rotation mechanism 3 of the seating plane 18. The seating plane 18 may rotate about the hinge 19 integral with the frame, once the relevant unlock lever 20 is actuated. Such a rotation is dampened by the gas spring 21.
Figure 5 shows the rotation 5 of the cushion plane 22 about the tube of the seating plane 23. The cushion plane 22 is caused to rotate by the user' s pelvis which is secured by means of containment belts which engage the sliding supports 24 which are movable along guides 25. The rotation occurs by virtue of hinges 26 and the return is dampened by rubber dampeners 27.
Figure 6 shows the rotation 5 of the leg rest system 28 about hinge 29 by means of an articulated parallelogram-shaped system.
Figure 7 shows the extension 6 of the footrest 30. When the user's feet push against the footrest 30, tube 31 slides into tube 32, which acts as a frame.
Tube 31, when sliding, also brings down tube 33 which is connected to the gas spring 3 . The other end of the gas spring 34 is connected to the tube 31. When the pushing movement of the feet ends, the gas spring 34 returns the footrest 30 to its rest position.
Finally, Figure 8 shows the rotation 7 of the footrest 30 under the pushing movement of the feet and ankle of the user. The footrest 30 rotates about the tube 35 by virtue of the hinge 36 and, once the pushing movement of the user ends, the laminated ( or leaf) spring 37 returns it to its rest position.
The system may be equally implemented with two half footrests, even entirely independent when the tube 35 is divided into two independent halves: this would allow for asymmetrical pushing movements of the two lower limbs (different extensions around the knee axis, different pushing movements with a tendency to push the footrest away, different rotations of the ankle and foot) .

Claims

1. An articulated wheelchair endowed with dynamic hardware solutions in order to increase sitting tolerance, decrease discomfort and pressure on the user and to prevent damage to the chair during user's muscular spasms. It is made of:
a. a modular frame, suitable for different anthropometric sizes that can be endowed with:
b. a footrest which can rotate in order to allow the flexion and the extension of the ankle (leaf springs move the footrest back in the initial position)
c. a leg rest
i. which can rotate in order to allow the flexion and the extension of the leg around the knee joint
ii. endowed with a gas spring in order to allow the user to push the feet downwards
d. a seat pan which can rotate in order to allow extension of the thigh around the knee
e. a backrest which can rotate (at the hip level) in order to allow the extension of the user' s back endowed with a gas spring moving the backrest in the initial position
f. a headrest endowed with gas springs in order to support the head during a neck extension and bring the head back in the initial position when the spasm ends. g. an adjustable seat belt moving along the seat pan in order to comfortably tie the user' s bottom to the seat pan itself.
2. The invention of the preceding claim but propelled by motor (s) and endowed with a command device (as in the electric wheelchairs) in order to increase the user' s independence or endowed with a command device for the assistant so that the assistant can use the device with greater ease.
3. The invention of the preceding claims with further dynamic solutions such as:
a. a rotating head rest in order to support the head shaking
b. rotating armrests in order to support spasms and rotation of the arms and the trunk
c. a seat pan which can rotate along the sagittal axis in order to support spasms and rotation of the trunk
d. rotating leg rests in order to support spasms and internal or external rotation of the legs
4. The invention of the preceding claims in which the gas spring can be replaced by other dynamic solution such as viscoelastic materials or magneto-rheological or electro-rheological fluids.
5. The invention of the preceding claims with two footrests, one the left foot and one for the right foot in order to support asymmetrical spasms.
EP13775228.3A 2012-04-12 2013-04-11 Wheelchair dynamic seating system suitable for dystonic disease Active EP2836184B1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT000042A ITPI20120042A1 (en) 2012-04-12 2012-04-12 DYNAMIC ASSISTANCE TO DISTONIE MOBILITY
PCT/IB2013/000784 WO2013153446A1 (en) 2012-04-12 2013-04-11 Wheelchair dynamic seating system suitable for dystonic disease

Publications (3)

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EP2836184A1 true EP2836184A1 (en) 2015-02-18
EP2836184A4 EP2836184A4 (en) 2015-10-07
EP2836184B1 EP2836184B1 (en) 2017-06-14

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EP (1) EP2836184B1 (en)
DK (1) DK2836184T3 (en)
IT (1) ITPI20120042A1 (en)
WO (1) WO2013153446A1 (en)

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DE102019216940A1 (en) * 2019-11-04 2021-05-06 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Neck support
CN114795132B (en) * 2022-06-28 2022-10-28 广州中医药大学第一附属医院 Auxiliary diagnosis system for temporal lobe epilepsy cognitive disorder

Family Cites Families (13)

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Publication number Priority date Publication date Assignee Title
NL9001040A (en) * 1990-05-01 1991-12-02 Linido Bv DISABLED CHAIR.
US6276704B1 (en) * 1997-09-23 2001-08-21 Charles J. Suiter Adjustable wheelchair having a tilting and reclining seat
DE29718696U1 (en) 1997-10-21 1998-02-26 Interco Ges Fuer Die Planung U Movable seating arrangement
US5904398A (en) 1997-10-23 1999-05-18 Farricielli; Susan Ergonomically designed seat assembly for a portable wheelchair
AU6685200A (en) * 1999-12-15 2001-06-25 Rehatechnik Moller Gmbh Dynamic seat shell
DE10108311A1 (en) * 2001-02-21 2002-08-29 Interco Ges Fuer Die Planung U Seat shell with adjustable support elements
US6619681B2 (en) 2001-05-16 2003-09-16 Delano Association For The Developmentally Disabled Dynamic seating and walking wheelchair
CA2465842A1 (en) * 2001-12-14 2003-06-26 The Helping Hand Company (Ledbury) Limited Improvements relating to torso support structures
US20050229866A1 (en) 2004-04-14 2005-10-20 Simpson Jeffrey M Collapsible pet housing
US6991292B2 (en) 2004-05-27 2006-01-31 Adaptive Engineering Lab, Inc. Dynamic seat support for a wheelchair
GB2448688A (en) 2007-04-23 2008-10-29 Jcm Seating Solutions Ltd A segmented seat back assembly
IT1400287B1 (en) * 2010-05-25 2013-05-24 Vassilli Srl DYNAMIC HEADREST.
IT1400137B1 (en) * 2010-05-25 2013-05-17 Vassilli Srl HANDLING OF A TILTING OR ARTICULATED BACKREST COMBINED WITH A SITTING.

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Publication number Publication date
DK2836184T3 (en) 2017-09-25
EP2836184B1 (en) 2017-06-14
WO2013153446A1 (en) 2013-10-17
ITPI20120042A1 (en) 2013-10-13
EP2836184A4 (en) 2015-10-07

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