EP2916794A1 - Orthèse motorisée pour cheville et genou - Google Patents

Orthèse motorisée pour cheville et genou

Info

Publication number
EP2916794A1
EP2916794A1 EP13820927.5A EP13820927A EP2916794A1 EP 2916794 A1 EP2916794 A1 EP 2916794A1 EP 13820927 A EP13820927 A EP 13820927A EP 2916794 A1 EP2916794 A1 EP 2916794A1
Authority
EP
European Patent Office
Prior art keywords
orthosis
articular
ankle
elastic
knee
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP13820927.5A
Other languages
German (de)
English (en)
Inventor
Paolo Cappa
Fabrizio PATANÉ
Stefano Rossi
Enrico Castelli
Maurizio PETRARCA
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Ospedale Pediatrico Bambino Gesu Irccs
Universita degli Studi di Roma La Sapienza
Original Assignee
Ospedale Pediatrico Bambino Gesu Irccs
Universita degli Studi di Roma La Sapienza
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Ospedale Pediatrico Bambino Gesu Irccs, Universita degli Studi di Roma La Sapienza filed Critical Ospedale Pediatrico Bambino Gesu Irccs
Publication of EP2916794A1 publication Critical patent/EP2916794A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • A61H1/0237—Stretching or bending or torsioning apparatus for exercising for the lower limbs
    • A61H1/024—Knee
    • 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
    • A61H1/0237—Stretching or bending or torsioning apparatus for exercising for the lower limbs
    • A61H1/0266—Foot
    • 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
    • A61H3/00—Appliances for aiding patients or disabled persons to walk about
    • 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
    • A61H2201/16—Physical interface with patient
    • A61H2201/1602—Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
    • A61H2201/165—Wearable interfaces
    • 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
    • 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
    • A61H2201/5079—Velocity sensors
    • 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
    • A61H2201/5084—Acceleration sensors

Definitions

  • the present invention relates to an ankle and/or knee orthosis, of motorized type.
  • this orthosis is intended for the rehabilitation of gait by acting on the ankle and/or knee articular joints of children with disorders that affect motive function, the standing posture and the transition from sitting to standing position and vice versa.
  • ankle and knee orthosis of passive type are available, i.e. orthosis without an engine that enables the dynamic interaction between patient and active orthosis.
  • the active dynamic interaction is required by the characteristics of the human gait.
  • a typical description of the gait begins with the placement of the heel on the ground to which follows a rotation of the ankle that brings the sole of the foot in contact with the ground. This stage is followed by a progression of the tibia with front passive closure of the ankle angle and subsequently observing the lifting of the heel by sealing effect of the triceps that determines an opening of the ankle angle until the big toe is detached from the ground, as consequence of the angle variation of the axis of the leg relative to the ground.
  • the knee bends mostly caused to the above mentioned forces that act as flexors on it by virtue of the change of the kinematic configuration of the lower limbs with respect to the direction of the reaction force with the ground. Knee bending is favored by the oscillation of the leg in the gravitational field and slightly accelerated by a small pulse of the extensors in the first step of oscillation which follows, in the final step of extension, of a co-contraction activity of agonists, antagonists groups that anticipates the receipt of the load in the subsequent positioning on the ground.
  • Such remodeling in the age of growth is influenced by the use and therefore the effectiveness of an orthosis is linked to the ability to prevent with greater or lesser efficiency the pathology from non-use. This occurs in a manner directly proportional to the versatility of the dynamic interaction of the orthosis with the patient that uses the orthosis.
  • Exoskeletons Motorized devices generally known as “exoskeletons” are also known, that can be grouped into three main categories, namely:
  • exoskeletons agents on both the upper and lower limbs for the enhancement of motor functions in healthy adult subjects (e.g. the system HAL-5 of Cyberdyne, Japan).
  • the exoskeletons of paragraph (a) are for adult patients with spinal cord injuries who have lost their mobility.
  • the exoskeletons are devices that generate the gait function for substitutive scopes and do not have useful functionality in the solicitation of mobility learning processes.
  • the substitutive aspect of the function can induce a process of improper learning and control of the dynamics of movement, namely a potential functional deterioration.
  • the exoskeletons referred to in points (b) and (c) are used for the so-called "empowering" of healthy adults and as such are suitable only to amplify the strength of a movement generated independently from the subject. Their use in pathological conditions only determines the 'fixation' of the movement strategy of the subject, or a potential increase in the inertia of the subject with respect to new learning.
  • Further known orthotic devices are bulky and not generally completely wearable. For example, such devices can only operate in conjunction with external systems, in particular to a walker or to a support device for supporting the operator and/or the energy sources used.
  • a scope of the present invention is therefore to provide an orthosis for use in pediatric rehabilitation that allows to realize the mechanical interactions mentioned above useful to the rehabilitation and/or assistance of mobility function, of the erect posture and of postural changes between the two functions.
  • the orthosis is specifically designed for use in mobility and functional rehabilitation involving the use of the ankle and/or knee joints of the pediatric subjects, both in orthopedic and neurological field.
  • the orthosis also lends to a modular effectively implementation, as will be better appreciated from the detailed description given below.
  • the orthosis can also be understood both as a temporary aid (rehabilitation of the function) or permanent aid (assistance to the function).
  • the orthosis When used to re-educate the function the orthosis generates forces that are transmitted to the patient by means of interposition of an elastic element, in function of the task, so as to ensure the conditions of motor learning as defined by the most recent scientific hypotheses. In general terms, these forces are applied in a synergistic manner such as to facilitate the movement or to amplify the error to induce corrective activities.
  • the action of the orthosis will consequently be addressed primarily to control the absorption of impact with the ground, to the guarantee of weight support, to the assistance on the energy required for progression and to ensuring adequate release of foot from the ground during an oscillation, as well as to prevent major deviations of the movement, ensuring greater safety, speed of execution and effectiveness.
  • these main activities are phase-dependent and controllable, as such, by means of the measurement of angles of the orthosis joint, of the forces exchanged and through the coupling of the motor of the orthosis to the lower limb of the subject guaranteed by an interposed passive elastic joint.
  • This feature can be used both to correct or assist the gait, but also in the maintenance of the upright posture and in the assistance of postural passages like that from sitting to standing and vice versa, where muscle weakness, pain or muscle control can prevent the wrong correct functionality.
  • FIG. 1 shows a side view of a preferred embodiment of the orthosis of the present invention, in the represented example an orthosis that affects both knee and ankle that is shown in a configuration worn by a subject in the pediatric age;
  • Figure 2 shows a front view of the orthosis of Figure 1 ;
  • FIG. 3 shows the support structure of the orthosis;
  • FIG. 4 shows a section of the articular unit 1 ;
  • Figure 5 refers to the ankle portion of the orthosis of Figure 1 , showing in detail a rear view.
  • an orthosis according to a preferred embodiment of the present invention is generally denoted by 100.
  • the orthosis 100 is apt to be worn on at one or each of the lower limbs of a subject in pediatric age and comprises a first articular unit of knee, overall denoted with 1 , and a second articular unit of ankle, the latter overall denoted by 2.
  • These two articular units 1 and 2 are functionally related and also, in the present example, structurally related to one another.
  • the orthosis 100 comprises a support structure 3, which represent precisely the bearing structure of the articular units 1 and 2.
  • the knee articular unit 1 comprises a first articular member or motor group 1 1 , apt to be fixed, in use, to the thigh of the subject, and a second articular member 31 , belonging to the support structure 3, apt to be fixed to the leg of the subject and connected to the first articular member 1 1 so as to be angularly movable with respect to it.
  • the elements 1 1 and 31 are connected together by a moving system 13, which in this example consists of belt 131 and pulleys 132, 133.
  • the ankle articular unit 2 comprises a first articular member or motor group 21 , apt to be fixed, in use, to the leg of the subject, and a articular member 32 , belonging to the support structure 3, apt to be fixed to the foot of the subject.
  • the elements 21 and 32 are connected together by a drive system 23 consists of, always in the present example, a belt 231 and pulleys 232, 233. Between each pair of articular members 1 1 -13 and 21 -23, is interposed an elastic element, respectively 12 for the knee unit 1 and 22 for the ankle unit 2.
  • Each elastic element 12 and 22 is constituted by a torsion spring, preferably a helical spring.
  • the support structure 3 also comprises two valves 33 and 34, connected by adjustable belts to the thigh and the leg of the subject.
  • the valves 33 and 34 are realized ad hoc according to the circumferential dimensions of the lower limb.
  • the motor groups 1 1 and 21 are connected to valves 33 and 34, through crossbars 35 and 36. In the present example is provided a second crossbar connected to the valve 34 to ensure the highest anchorage.
  • the crossbars 35 and 36 are lockable in a plurality of mutual positions by means of connections to respective uprights 37 and 38.
  • the upright 37 is constituted by an upper strut 371 , bound to the crossbar 35, and a lower strut 372 , bound to the crossbar 36, connected each other by a universal joint 373, the axis of which is coaxial with the axis of the knee.
  • the upright 38 is constituted by an upper strut 381 and by a lower strut 382 connected by a universal joint 383, the axis of which is coaxial with the axis of flexion-extension of the ankle.
  • the presence of a plurality of seats of screws between the uprights and crossbars above mentioned serves to ensure an adaptability of the device to the anthropometry of the specific subject.
  • Alternative embodiments may provide retaining means on the leg other than this described here. Furthermore, there is provided a yoke retaining means 6, suitable to engage the bottom of a shoe worn on by the subject, for the detention of the second ankle articular member 32 to the foot of the subject. Even in this case, different kind of retaining means may be provided.
  • the orthosis 100 is completely self-contained and includes so-called "onboard" motor means associated with each articular unit 1 and 2.
  • the first articular unit 1 comprises a knee motor group 1 1 , connected via the elastic element 12 to the movement group 13, fixed to member 31 .
  • the second articular unit 2 comprises the already mentioned ankle motor group 21 , connected via the elastic element 22 to the movement group 23, fixed to member 32.
  • the specific arrangement of the components of each articular unit 1 and 2 will now be illustrated in greater detail. As an example, we will refer to the knee articular unit 1 . A similar description applies to the ankle articular unit 2.
  • the motor group 1 1 is composed of a motor 1 1 1 to which a further motor 1 12 can be associated in case of need.
  • the motors 1 1 1 1 and 1 12 are electric battery powered and transmit the torque via gear wheels 1 13 and 1 14 to a shaft 1 15 which present the housing of the first end of the torsion spring 12.
  • the second end of the torsion spring 12 is constrained to the pulley 132 belonging to the movement group 13.
  • the angular difference between the shaft 1 15 and the pulley 132 is measured by an encoder 14 housed in a seat made in the pulley 132.
  • the connection between the encoder 14 and shaft 1 15 is secured by a rubber tube 1 16.
  • the axial position of the elements 1 15, 132 and 14 is guaranteed by the presence of a frame 15 which also allows the connection of the articular unit 1 to the crossbar 35.
  • Alternative embodiments may provide alternative means to the encoder sensors or transducers above mentioned.
  • the motor 1 1 1 1 is activated so that the shaft 1 15 performs a rotation by a predetermined angle, rotation that is induced also on the first arm of the spring 12. In this way, the motor 1 1 1 produces an elastic loading condition of the spring 12.
  • the spring 12 will transmit a rotational movement to the pulley 132 via an elastic moment.
  • This elastic action typically equal to the product of the elastic constant of the spring 12 with the angular displacement induced between the elements 1 15 and 132, assists the displacement of the leg compared to the thigh of the subject, so assists a motive act of the subject wearing the orthosis .
  • the orthosis 100 may also include a belt or backpack shoulder module for positioning batteries or equivalent energetic means.
  • means sensors 4 and 5 apt to detect kinematic quantities such as rotation, speed and acceleration, are provided.
  • such means 4 and 5 at least include an accelerometer and a gyroscope.
  • Means 4 and 5 are apt to detect the movements of the subject that wearing the orthosis 100 .
  • FIG. 5 shows in greater detail the ankle articular unit 2, as already said, a description similar to that mentioned above for the knee unit, being valid for the ankle articular unit. Therefore, for example, two motors 21 1 , 212, two gear wheels 213, 214, torsion spring 22 and the movement group 23 are visible.
  • the orthosis 100 is advantageously inserted into a system for the rehabilitation of pediatric subjects that also includes a control unit apt to control the motor groups 1 1 and 21 associated to the orthosis in function of the measurements of the above mentioned sensor means 4 and 5 or other parameters, preferably in a manner adaptive with specific rehabilitation needs and/or above mentioned assistance.
  • the orthosis according to the invention may therefore interfere in a maximally effective manner with the moving attempts of the subject who wears it.
  • the value of the supporting action to such motive attempt can be calibrated - by an operator or automatically - depending on the specific therapeutic needs, in particular depending on the kind of correction to be obtained and/or the learning process that wants to trigger, and/or the entity of the values recorded by the sensor or transducers means, in particular in the present example the amplitude of the measured angle or the kinematics of the knee and ankle moving joints.
  • the orthosis may apply articular torque able to assist and optimize the function, increasing the autonomy of the patient.
  • the motorized joints have the additional characteristic to act with a motive action not directly on the segment body to rotate (tibia for the knee joint and foot for the ankle joint ), but by moving the equilibrium point of the elastic element mounted between the motor and the same segment body.
  • This provides the advantage of decoupling the motor from the subject, ensuring a high safety factor in case of malfunction of the orthosis or part of it.
  • this solution allows to apply to the joint a virtual force control, by acting with a position control directly on the displacement of the equilibrium point of the elastic element, allowing the use of an instrumentation much more simple and already partially included within the motor itself.
  • orthosis is completely modular and can be assembled in a specific way depending on the needs and anthropometric dimensions of users.
  • the orthosis can be easily used by the patient during both the functional rehabilitation and, at a later stage, during normal daily activities.
  • the orthosis is in fact completely wearable by the patient , especially with no hardware or cables external to the device that would limit the movement of the patient, making it impossible to use in the free walk.
  • the orthosis according to the invention allows re-educating the functional use of the lower limb by acting on the ankle and knee joints.
  • the orthosis according to the invention has the characteristic of being able to act simultaneously on both joints or on one joint only. Will be better appreciated at this point that the orthosis according to the invention, particularly in the embodiment described above, is apt to be used both in the neurological and orthopedic rehabilitation.
  • the orthosis can be used in all the lesions of the central nervous system that involve transient or permanent alterations of the mechanisms of motive control. Further, the orthosis is suitable for use in diseases that involve a temporary or permanent impairment of peripheral nerves. This is guaranteed by the fact that the orthosis can act as an 'expert' tutor in a mode dependent on the gait step by exerting adequate value torques to the subject and to the function to integrate, creating force fields apt to amplifying known mechanisms of motive learning. Furthermore, the orthosis allows a prolonged functional modification of the lower limb use which is able to interfere with the morphological development especially of soft tissues. In this sense it is possible to change the available peripheral resources used by the central nervous system to implement the strategies of motive control.
  • the orthosis also finds application in the orthopedic field, where it can be applied to rehabilitation after trauma or poly-trauma articular and to treatment of surgery results. Even in this field, the orthosis can be used in rehabilitative mode to restore correct movement patterns or in assistive mode where its interaction with the subject will be adapted to the progressive functional recovery. In more general terms , the orthosis is suitable to be used for rehabilitation or functional assistance in all those pathological conditions which result in a reduction of motive skills .

Landscapes

  • 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)
  • Orthopedics, Nursing, And Contraception (AREA)
  • Thermotherapy And Cooling Therapy Devices (AREA)
  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)

Abstract

L'invention concerne une orthèse (100) pour cheville et genou, motorisée et de type modulaire, qui comprend une unité articulaire (1) de genou et une unité articulaire (2) de cheville. Chacune de ces unités articulaires (1, 2) est formée par deux éléments (11, 13 ; 21, 23), mobiles au plan angulaire l'un par rapport à l'autre, entre lesquels est interposé un ressort de torsion (12, 22) ou un élément élastique équivalent. L'agencement global est tel que, en utilisation, cet élément élastique est sollicité dans un état de charge élastique par un moteur correspondant ou une paire de moteurs correspondante (111, 112 ; 211, 212) de l'orthèse, associés avec un des deux éléments mobiles au plan angulaire, de manière à exercer une action élastique correspondante sur l'autre élément articulaire, l'action élastique venant assister un acte moteur du patient.
EP13820927.5A 2012-11-07 2013-10-30 Orthèse motorisée pour cheville et genou Withdrawn EP2916794A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT000539A ITRM20120539A1 (it) 2012-11-07 2012-11-07 Ortesi motorizzata di caviglia e ginocchio.
PCT/IB2013/059775 WO2014072883A1 (fr) 2012-11-07 2013-10-30 Orthèse motorisée pour cheville et genou

Publications (1)

Publication Number Publication Date
EP2916794A1 true EP2916794A1 (fr) 2015-09-16

Family

ID=47428892

Family Applications (1)

Application Number Title Priority Date Filing Date
EP13820927.5A Withdrawn EP2916794A1 (fr) 2012-11-07 2013-10-30 Orthèse motorisée pour cheville et genou

Country Status (3)

Country Link
EP (1) EP2916794A1 (fr)
IT (1) ITRM20120539A1 (fr)
WO (1) WO2014072883A1 (fr)

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP6662020B2 (ja) * 2015-03-10 2020-03-11 株式会社ジェイテクト 揺動関節装置、歩行アシスト装置、搬送装置及びマニピュレータ
CN109859597A (zh) * 2019-03-07 2019-06-07 哈工大机器人（合肥）国际创新研究院 一种康复模拟人位姿采集系统及方法
CN110370253A (zh) * 2019-08-23 2019-10-25 西安魔晶五维家居有限公司 一种穿戴型腿部关节助力机构
CN111920652B (zh) * 2020-07-22 2021-06-18 燕山大学 可自适应调节脚踝承载力的辅助行走器

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5020790A (en) * 1990-10-23 1991-06-04 Board Of Supervisors Of Louisiana State University And Agricultural And Mechanical College Powered gait orthosis
US7549969B2 (en) * 2003-09-11 2009-06-23 The Cleveland Clinic Foundation Apparatus for assisting body movement
US20070123997A1 (en) * 2005-03-31 2007-05-31 Massachusetts Institute Of Technology Exoskeletons for running and walking
US8500823B2 (en) * 2005-03-31 2013-08-06 Massachusetts Institute Of Technology Powered artificial knee with agonist-antagonist actuation
WO2012100250A1 (fr) * 2011-01-21 2012-07-26 Iwalk, Inc. Orthèse d'articulation électrique s'adaptant au terrain

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
None *
See also references of WO2014072883A1 *

Also Published As

Publication number Publication date
ITRM20120539A1 (it) 2014-05-08
WO2014072883A1 (fr) 2014-05-15

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