EP3050550B1 - Device for the training and treatment and/or support for the lower extremities of the body of a human being - Google Patents
Device for the training and treatment and/or support for the lower extremities of the body of a human being Download PDFInfo
- Publication number
- EP3050550B1 EP3050550B1 EP15000260.8A EP15000260A EP3050550B1 EP 3050550 B1 EP3050550 B1 EP 3050550B1 EP 15000260 A EP15000260 A EP 15000260A EP 3050550 B1 EP3050550 B1 EP 3050550B1
- Authority
- EP
- European Patent Office
- Prior art keywords
- pivot arm
- movement
- holding means
- rotary drive
- carriage
- 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.)
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Links
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- 210000003141 lower extremity Anatomy 0.000 title description 14
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Images
Classifications
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- A—HUMAN NECESSITIES
- A63—SPORTS; GAMES; AMUSEMENTS
- A63B—APPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
- A63B21/00—Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices
- A63B21/02—Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices using resilient force-resisters
- A63B21/023—Wound springs
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- 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
- A61H1/0255—Both knee and hip of a patient, e.g. in supine or sitting position, the feet being moved together in a plane substantially parallel to the body-symmetrical plane
- A61H1/0262—Walking movement; Appliances for aiding disabled persons to walk
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- A63B21/00178—Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices for active exercising, the apparatus being also usable for passive exercising
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- A63B21/00181—Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices comprising additional means assisting the user to overcome part of the resisting force, i.e. assisted-active exercising
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- A63B21/4034—Handles, pedals, bars or platforms for operation by feet
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- A63B22/00—Exercising apparatus specially adapted for conditioning the cardio-vascular system, for training agility or co-ordination of movements
- A63B22/0048—Exercising apparatus specially adapted for conditioning the cardio-vascular system, for training agility or co-ordination of movements with cantilevered support elements pivoting about an axis
- A63B22/0056—Exercising apparatus specially adapted for conditioning the cardio-vascular system, for training agility or co-ordination of movements with cantilevered support elements pivoting about an axis the pivoting movement being in a vertical plane, e.g. steppers with a horizontal axis
- A63B22/0058—Exercising apparatus specially adapted for conditioning the cardio-vascular system, for training agility or co-ordination of movements with cantilevered support elements pivoting about an axis the pivoting movement being in a vertical plane, e.g. steppers with a horizontal axis the vertical plane being the frontal body-plane
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- A63B22/00—Exercising apparatus specially adapted for conditioning the cardio-vascular system, for training agility or co-ordination of movements
- A63B22/20—Exercising apparatus specially adapted for conditioning the cardio-vascular system, for training agility or co-ordination of movements using rollers, wheels, castors or the like, e.g. gliding means, to be moved over the floor or other surface, e.g. guide tracks, during exercising
- A63B22/201—Exercising apparatus specially adapted for conditioning the cardio-vascular system, for training agility or co-ordination of movements using rollers, wheels, castors or the like, e.g. gliding means, to be moved over the floor or other surface, e.g. guide tracks, during exercising for moving a support element in reciprocating translation, i.e. for sliding back and forth on a guide track
- A63B22/203—Exercising apparatus specially adapted for conditioning the cardio-vascular system, for training agility or co-ordination of movements using rollers, wheels, castors or the like, e.g. gliding means, to be moved over the floor or other surface, e.g. guide tracks, during exercising for moving a support element in reciprocating translation, i.e. for sliding back and forth on a guide track in a horizontal plane
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- A63B69/00—Training appliances or apparatus for special sports
- A63B69/0028—Training appliances or apparatus for special sports for running, jogging or speed-walking
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- 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
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- A61H2201/1207—Driving means with electric or magnetic drive
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- A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
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- A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
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- A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
- A61H2201/12—Driving means
- A61H2201/1238—Driving means with hydraulic or pneumatic drive
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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
- A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
- A61H2201/14—Special force transmission means, i.e. between the driving means and the interface with the user
- A61H2201/1481—Special movement conversion means
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- A—HUMAN NECESSITIES
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- 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
- A61H2201/164—Feet or leg, e.g. pedal
- A61H2201/1642—Holding means therefor
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- A—HUMAN NECESSITIES
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- 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
- A61H2201/1652—Harness
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- 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
- A61H2201/1657—Movement of interface, i.e. force application means
- A61H2201/1664—Movement of interface, i.e. force application means linear
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- 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
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- A61H2201/1676—Pivoting
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- 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
- A61H2203/00—Additional characteristics concerning the patient
- A61H2203/04—Position of the patient
- A61H2203/0406—Standing on the feet
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- A—HUMAN NECESSITIES
- A63—SPORTS; GAMES; AMUSEMENTS
- A63B—APPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
- A63B2213/00—Exercising combined with therapy
Definitions
- the invention relates to a device for the therapeutic treatment or training of the lower extremities of a human.
- Devices for therapeutic treatment or training of the lower extremities of a person are for example out DE 10 2006 035 715 A1 .
- a double-sided practice of the healthy side and the weakened side of the lower extremities is superior to a one-sided practice of the weakened side.
- the co-movement of Non-weakened side exerts a promoting influence on the activation of the responsible for the use of the paralyzed limb brain structures in the parietal lobe.
- robotic systems are known for therapeutic purposes that include control systems that measure patient forces during exercise. Different evaluations of the parameters for determining minimum natural movements or forces and complete comparisons with predefined programs are possible. Such robot systems are out DE 100 28 511 A1 as well as the initially mentioned DE 10 2006 035 715 A1 . DE 20 2008 001 590 U1 and DE 10 2009 022 560 A1 known.
- the invention has for its object to provide a device for the therapeutic treatment and / or training of the lower extremities of a person can be simulated with the various stress situations that occur in everyday life.
- the device is intended to allow a good access of the therapist to the patient.
- the invention has the advantage that the mechanics of the movement devices is simple and compact.
- the reduced height of the mechanism facilitates the therapist's access to the patient.
- a successful therapy on the one hand by the frequent repetition of exercise elements and on the other hand by the transmission of learning effects of the responsible for the healthy limb side of the brain on the responsible for the weakened limb brain side or the brain area responsible can be achieved.
- a single movement within the entire gait cycle can be specifically isolated and repeatedly practiced by the patient.
- the device of the present invention allows the leg and back muscles to be strengthened to further improve the patient being well advanced and to train healthy people.
- the device according to the invention provides the prerequisite for enabling running training or running therapy either in a given everyday environment or evaluating the therapy performance in real time, whereby different everyday simulations, for example climbing stairs, entering, are made possible by the robust and simply constructed mechanism of a sidewalk or situations in which the patient stumbles.
- the linear drive may include a power transmission element that couples the first carriage to the fixed frame.
- the linear drive may comprise a driven chain, which is mounted on the carriage on the one hand and on the frame on the other hand, whereby the horizontal movement of the carriage is achieved in a simple manner.
- the carriage travels along two or more guide rails.
- the carriage can be made wider, which leads to the fact that the mechanics gain in stability, as the burden is better distributed by the patient on the movement mechanics.
- the stationary frame includes height-adjustable feet in the region of the guide rails of the carriages.
- the first rotary drive may include a power transmission element that couples the pivot arm to the carriage.
- the height adjustment of the pivot arm is variable by actuation of the force transmission element.
- the coupling of the swivel arm with the carriage by a force transmission element has the advantage that the height adjustment of the swivel arm takes place directly via the first rotary drive.
- the height movement of the swivel arm by a system in particular a force storage device, supported, which can store energy and can feed back to the mechanics if necessary.
- a system in particular a force storage device, supported, which can store energy and can feed back to the mechanics if necessary.
- An energy storage device is for example a spring element, in particular a tension or compression spring, which acts via a guide on a lever arm, which is firmly connected to the Schenkarm.
- the mechanism can be designed so that the height movement of the pivot arm is supported in its mechanical unfavorable position by the energy of the bias of the spring element.
- the first rotary actuator for the height adjustment may be spaced from the pivot arm and coupled thereto by a power transmission means.
- the first rotary drive can be arranged at a position favorable for the movement or for the center of gravity.
- the power transmission can be applied by the first rotary drive, for example, by a gear belt system on the carriage also spaced from the pivot arm on the swing arm itself.
- the first drive pulley can be attached to the first rotary drive.
- the second drive pulley may be attached to the swing arm.
- the power transmission then takes place via the belt from the gear of the first rotary drive to the gear of the swivel arm and thereby on the swivel arm itself.
- the second rotary drive may comprise a power transmission element which couples the retaining means to the pivot arm.
- the rotation of the holding means is variable by actuation of the force transmission element.
- the coupling of the holding means with the swivel arm by means of a force transmission element has the advantage that the rotation of the holding means takes place directly via the rotary drive.
- the second rotational drive for the inclination change can be arranged spaced from the holding means and coupled thereto by a power transmission means.
- the second rotary drive can be arranged at a position which is favorable for the center of gravity.
- the power transmission from the second rotary drive for example, by a gear belt system spaced from the holding means are applied to the holding means itself.
- the first drive pulley can be attached to the second rotary drive.
- the second drive pulley may be attached to the support member.
- the power transmission is then via the belt from the gear of the second rotary drive to the gear of the holding element and thereby to the holding element itself.
- the retaining means may be movably mounted along the force transmitting member and adjusted via a locking mechanism. This adjustment of the holding means allows the holding means to be precisely adjusted to the crotch width.
- an adjusting device is arranged above the movement device, which is adapted to change the center of gravity of a person connected to the holding means people.
- This embodiment has the advantage that a control of the body center of gravity of a patient is possible by the adjusting device.
- the displacement of the center of gravity of the body occurring in the course of human locomotion, that is to say during locomotion can be simulated along the direction of locomotion, which takes place in the vertical and lateral direction.
- the control of the center of gravity allows the correct execution of the therapeutic movement, thus preventing postural damage caused by compensatory movements of the patient.
- Another advantage of controlling body center of gravity is that balance can be maintained in critical situations such as (simulated) tripping, slipping or under conditions where the proprioceptive component is disturbed. Repeated practice of these situations is necessary to minimize the risk of falls and falls for patients.
- the three-dimensional control of the center of gravity which is possible in this embodiment, and the option of influencing the proprioceptive component of the patients by means of perturbations, create the conditions for a safe, repeatable and targeted training.
- the perturbations of the proprioceptive component are performed by the retaining means, in particular the foot plates, which are connected to the feet of the patients. These can be moved to any position along the three degrees of freedom.
- vibrations can be realized by the holding means.
- Fig. 1 there is shown an apparatus which may be used for the therapeutic treatment and / or training of the lower extremities of a human during any movement of human locomotion in everyday situations or specific training conditions.
- the device is particularly well suited for training the lower extremities of neurological patients and has two driven, controllable movement units 11a, 11b.
- the two movement units 11a, 11b are each connected to a fixed frame 12.
- the moving units 11a, 11b have holding means 13a, 13b, for example foot plates with bindings, in which the feet of the patients are held.
- the movement devices 11a, 11b and thus the holding means 13a, 13b can be moved independently of one another along calculated movement sequences. Asynchronous or synchronous movements are possible.
- the device comprises a frame 34, on which the patient is connected to the adjusting device for changing the body center of gravity, and that with the stationary frame 12 is firmly connected.
- the frame 34 comprises two arms 35a, 35b which extend in a vertical direction from bottom to top, wherein the arms 35a, 35b are connected to the stationary frame 12 approximately at the height of the moving means 11a, 11b.
- a horizontally arranged connecting element 36 which connects the arms 35a, 35b.
- Arranged on the arms 35a, 35b approximately at the level of the forearms of the respective patient and vertically adjustable two side rails 37a, 37b are movably mounted.
- the side rails 37a, 37b serve as handles for patients who can cling to the side rails 37a, 37b.
- the movement devices 11a, 11b each have a pivot arm 14, which is pivotable in different elevations.
- the pivot arm 14 is articulated pivotably on a single carriage 15, which is guided by a linear guide 16.
- the linear guide 16 is fixedly connected to the fixed frame 12 and forms a rail in which the carriage 15 is slidably disposed. How out Fig. 1 . Fig. 2 and Fig. 4 can be seen, the pivot arm 14 is movably connected at one end to the carriage 15 via the first rotary drive 17.
- the pivot arm 14 is rotatably connected in each case with one of the holding means 13a, 13b.
- the connection point between the holding means 13a, 13b and the pivot arm 14 is located at the other, second longitudinal end of the pivot arm 14th
- the pivot arms 14a, 14b extend in the longitudinal direction of the respective linear guide 16.
- the pivot arms 14a, 14b are each movable on a circular path which runs along the longitudinal direction of the respective linear guide 16.
- the pivot arms 14a, 14b are each rotatably connected to the carriage 15 via the first rotary drive 17.
- the position of the pivot point of the respective pivot arm can be arranged arbitrarily.
- the pivot arms 14a, 14b can each be supported by a force storage system 20, which is attached at one end to the carriage 15 and at the other end with the pivot arm and is able to store energy and due to the movement mechanics.
- a force storage system comprises, for example, a tension or compression spring 21, which acts on the pivot arm 14 and the carriage 15 along a guide element 22 which is movably mounted on the pivot arm 14 and the carriage 15.
- a tension or compression spring 21 which acts on the pivot arm 14 and the carriage 15 along a guide element 22 which is movably mounted on the pivot arm 14 and the carriage 15.
- Other embodiments are possible.
- the force storage device 20 is formed in the form of a compression spring 21 which is biased in the most unfavorable position of the swing arm.
- the compression spring 21 is biased when the respective pivot arm 14a, 14b is disposed in the horizontal lower position. If the pivot arm 14a, 14b pivoted by the first rotary drive 17 upwards, this movement is supported by the compression spring 21, which relaxes it.
- the spring or generally the energy storage device 20 is fastened on the one hand to the carriage 15, specifically to an L-shaped holding arm 22a.
- a first leg of the support arm 22a extends in the longitudinal direction of the linear guide 16.
- the shorter second leg of the support arm 22a extends perpendicular thereto and is connected to a first end of the force storage device 20, specifically the spring 21.
- the second end of the spring 21 is connected to one end of the swing arm 14a, 14b.
- the connection between the pivot arm 14a, 14b and the spring 21 is designed so that the spring exerts a torque on the pivot arm 14a, 14b.
- the spring with a (not shown) lever on the pivot arm 14a, 14b fixedly connected.
- the spring 21 is guided by a guide rod 22.
- the guide rod 22 is located in the spring 21.
- the guide rod 22 is on the one hand on the support arm 22a and on the other hand attached to the pivot arm 14a, 14b.
- the guide rod 22 is telescopic. Other leadership options are possible.
- a tension spring can be used instead of the compression spring 21, a tension spring can be used. This is then to be arranged accordingly on the opposite side and to connect to the carriage or the swivel arm.
- pivot point on the pivot arm 14 is articulated in an area or at a location which is arranged between the connection of the respective pivot arm 14a, 14b with the carriage 15 and the connection of the pivot arm 15 with the holding means 13a, 13b.
- the carriage 15 has a linear drive 18 which is provided for changing the longitudinal position or horizontal position of the respective holding means 13a, 13b.
- the first linear drive 18 comprises a first power transmission means 23a, which connects the carriage 15 with the stationary frame 12 for power transmission.
- the first power transmission means 23a may comprise a driven toothed belt 24 which is connected on the one hand to the movable carriage 15 and on the other hand to the stationary frame 12.
- an electric motor is provided in each case.
- the linear drive 18 can also be realized by other means, for example by a driven chain, by a rack or by hydraulic or pneumatic cylinders.
- the first rotary drive 17 is associated with the carriage 15 and couples it with the pivot arm 14.
- a second force transmission element 23b is provided, which acts on the one hand on the first carriage 15 and on the other hand on the pivot arm 14.
- the second power transmission element has the function to take the pivot arm 14 with a movement of the carriage 15.
- the second force transmission element 23b acts as a push and pull element.
- a force from the pivot arm 14 are transmitted to the carriage 15 and vice versa, when the second power transmission element 23b is actuated. In this case, the angle between carriage 15 and pivot arm 14, and thus the altitude of the respective pivot arm 14a, 14b is changed.
- the linear drive 18 forms a main drive, which moves the carriage 15 together with the first rotary drive 17 relative to the stationary frame 12.
- the first rotary drive 17, in particular the second force transmission element 23b acts as a driver, which transmits the driving force of the linear drive 18 to the pivot arm 14.
- the first rotary drive 17 acts as a height drive for the vertical movement of the pivot arm 14, as described above.
- the second power transmission means 23b for example in the form of a transmission, is rotatably connected to the carriage 15 and provides for the entrainment and height adjustment of the pivot arm 14th
- the first rotary drive 17 is fixed to the carriage 15 and coupled to the power transmission means 23b.
- Other power transmission elements such as a rack or hydraulic / pneumatic actuators are possible.
- the force transmission element 23b has a dual function and acts both as a driver and for the height adjustment of the pivot arm 14th
- the carriage 15 In the case of the movement device 11a arranged on the right in the forward direction, the carriage 15 is located, with the pivoting arm 14a projecting in the forward direction toward the frame 12.
- An orientation of the pivot arms 14a, 14b to the frame 12 is possible in any direction.
- other orientations of the pivot arm for example, the frame vertically downwardly projecting covered.
- a second rotary drive 19 is provided, which cooperates with the respective rotatably arranged holding means 13a, 13b.
- the rotary drive 19 is arranged in the region of the front end of the pivot arms 14a, 14b.
- the connection of the rotary drive 19 with the respective holding means 13a, 13b is effected by a third force transmission element 23c, for example in the form of a transmission.
- Other power transmission elements such as a rack or hydraulic / pneumatic actuators are possible.
- the force transmission element 23c acts both as a driver and for the tilt adjustment of the holding elements 13th
- the rotary drive 19 can also be arranged in the region of the rear end of the pivot arms 14a, 14b.
- the connection of the rotary drive 19 with the respective holding means 13a, 13b takes place in this case by the third force transmission element 23c via a belt, which on the one hand on a drive pulley on the pivot arm 14 and on the other on a driven pulley, which is connected to the holding means 13a, 13b, is arranged.
- the inclination of the holding means 13 a, 13 b is adjusted and adapted to the respective position of the pivot arm 14.
- all possible tilt positions are variably adjustable, which are required for the simulation of training and everyday situations.
- the movement of the holding means 13a, 13b takes place in a work plane extending in the sagittal direction, wherein a work space has proved to be expedient, the forward movement in the range of 0-800 mm, in particular at 650 mm, the height movement in the range of 0-400 mm, in particular at 250 mm and the pivoting movement of the holding means 13a, 13b in a range of - allows 80 ° to + 30 °.
- the pivoting movement of the holding means 13a, 13b takes place about a horizontally extending axis.
- the horizontal axis is moved by the operation of the linear drive 18 in the horizontal and the first rotary drive 17 in the vertical direction.
- the holding means 13a, 13b can be positioned along the horizontal axis 25 via a guide 26 and a shutter 27 so that the distance between the holding means 13a, 13b corresponds to the physiological step width of the patients. This ensures that the patients correctly load the joints during the exercise and the training effect is maximized, since no evasive movements or adaptation on the part of the patient are necessary during the execution of the movement sequence predetermined by the invention.
- a closure device is in Fig. 5 shown, wherein the horizontally extending axis 25 is given by a rack on which the guide 26, by operating the shutter 27 in the form of a screw, is firmly misunderstood and thereby a displacement along the horizontal axis 25 is no longer possible.
- the lower limb holding means 13a, 13b can be simulated with the patient standing and secured on it, both by programmed defaults of the control and by the patient in the case of compliant footplates. It can be varied between the programmed movement and the guided by the patient movement.
- a holding means 13a can be controlled by the patient and the other holding means 13b by programmed specifications.
- an adjusting device 28 is provided, which is arranged next to the movement devices 11a, 11b.
- the adjusting device 28 is located above the linear guides 16, so that the movement devices 11a, 11b, in particular the holding means 13a, 13b can be moved under the adjusting device 31.
- the adjusting device 28 is adapted to control the center of gravity of the body or to change the center of gravity of a person connected to the holding means 13a, 13b.
- the adjusting device 28 allows both a change in the body center of gravity in the vertical and in the transverse direction.
- the adjusting device 28 comprises a vertical drive 29 which cooperates with a belt 30.
- the strap 30 is connected to a patient carrying strap (not shown).
- the vertical drive allows a change in the length of the vertical portion of the belt 30 so that the center of gravity of the patient is variable in the vertical direction.
- the working space of the mechanism or of the adjusting device 31 for the change in focus is based on a zero position +/- 10 cm. Other areas are possible.
- An example of the embodiment of the adjusting device 28 is shown in FIG Fig. 1 .
- a deflation of the patient or an extension of the belt 33 is also possible.
- a transverse drive 32 which has a rotary drive connected to a disk 33.
- a rope is attached (not shown), the ends of which extend to the patient.
- the rope is deflected by an unillustrated roller system and engages at both ends, for example by carabiners, on lateral loops of the patient's belt.
- a possible working space for the center of gravity displacement enabled by the transverse drive 32 is, for example, based on a zero position, +/- 15 cm. Other areas are possible.
- the control of the center of gravity in the forward or backward direction is effected by the relative movement of the holding means 13a, 13b or the foot plates relative to the suspension point of the adjusting device 28.
- the position of the carriage 15 can be freely controlled on the linear guide 16. In this case, the suspension point of the patient in a direction parallel to the linear guide 16 is fixed, so that a corresponding displacement of the center of gravity is possible.
- the possible by the carriage length working space is based on a zero position +/- 10 cm. Other areas are possible.
- the device allows a highly variable and flexible therapy or training of the lower extremities, wherein the device is simple and compact and thus provides good access to the patient.
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Description
Die Erfindung bezieht sich auf eine Vorrichtung zur therapeutischen Behandlung oder zum Training der unteren Extremitäten eines Menschen.The invention relates to a device for the therapeutic treatment or training of the lower extremities of a human.
Vorrichtungen zur therapeutischen Behandlung oder zum Training der unteren Extremitäten eines Menschen sind beispielsweise aus
Die Therapie einer hochgradigen Schwäche der unteren Extremitäten z.B. nach einem Schlaganfall, ist schwierig und häufig nicht erfolgreich. Die konventionelle Physiotherapie ist aufwändig und zielt meistens darauf ab, durch Spastik bedingte Verkrampfungen der Muskeln zu lösen und Übungen zur Vorbereitung des Gehens in Sitz und Stand zu üben, um z.B. die Gewichtsübernahme auf das betroffene Bein zu stärken. Dieses Vorgehen führt häufig dazu, dass der Patient das Gehen und damit die dem Gehen zu Grunde liegenden Fuß- und Beinbewegungen nicht wiederholt übt.The therapy of high-grade weakness of the lower extremities, e.g. after a stroke is difficult and often unsuccessful. Conventional physiotherapy is laborious and usually aims to relieve spasticity-related muscle spasms and exercise to prepare for walking in the seat and posture, e.g. to strengthen the weight transfer to the affected leg. This procedure often results in the patient not repeatedly practicing the walking and thus the foot and leg movements underlying the walking.
Moderne wissenschaftliche Konzepte der Rehabilitation favorisieren ein wiederholtes, wenn möglich aktives Üben des Gehens so früh wie möglich, oder falls noch nicht möglich, das Üben zumindest einzelner Bewegungsfolgen des Gehens mit den Füßen und Beinen. Für Schlaganfallpatienten konnte gezeigt werden, dass die wiederholte aktive, isometrische und isotone Dorsalextension der Füße und Beine hinsichtlich der Rückbildung der motorischen Funktion der gesamten unteren Extremitäten einer konventionellen Therapie überlegen war. Noch größere Erfolge konnten erzielt werden, wenn der Patient das Gehen selbst wiederholt übte. Passive Bewegungen gelähmter Extremitätenabschnitte erhalten zum einen die Beweglichkeit des Bewegungssegments und die Erinnerung des Gehirns an die Bewegungsfolge.Modern scientific concepts of rehabilitation favor a repeated, if possible active practice of walking as early as possible, or if not yet practicable, practicing at least some movement sequences of walking with the feet and legs. For stroke patients it was shown that the repeated active, isometric and isotonic dorsiflexion of the feet and legs with respect to the regression of the motor function of the entire lower extremities was superior to a conventional therapy. Even greater successes could be achieved if the patient repeatedly practiced walking himself. Passive movements of paralyzed limb sections receive, on the one hand, the mobility of the movement segment and the memory of the brain in the sequence of movements.
Ein beidseitiges Üben der gesunden Seite und der geschwächten Seite der unteren Extremitäten ist einem einseitigen Üben der geschwächten Seite überlegen. Die Mitbewegung der nicht geschwächten Seite übt dabei einen fördernden Einfluss auf die Aktivierung der für den Einsatz der gelähmten Extremität verantwortlichen Hirnstrukturen im Scheitellappen aus.A double-sided practice of the healthy side and the weakened side of the lower extremities is superior to a one-sided practice of the weakened side. The co-movement of Non-weakened side exerts a promoting influence on the activation of the responsible for the use of the paralyzed limb brain structures in the parietal lobe.
Zur Therapie der gesunden und der geschwächten Seite der unteren Extremitäten sind mechanische und elektromechanische Geräte im Stand der Technik bekannt. Hierzu wird beispielhaft auf
Darüber hinaus sind Robotersysteme zu Therapiezwecken bekannt, die Steuersysteme umfassen, welche die Kräfte des Patienten während der Übung messen. Dabei sind unterschiedliche Auswertungen der Parameter zum Ermitteln von Mindesteigenbewegungen oder Kräften und vollständige Vergleiche mit vorgegebenen Programmen möglich. Derartige Robotersysteme sind aus
Weitere Robotersysteme, welche zur therapeutischen Behandlung und/oder Unterstützung der unteren Extremitäten eines Menschen während des Gehens zum Einsatz kommen sind aus
Bei dem Robotersystem gemäß
Bei den Systemen gemäß
Ein anderes Trainingsgerät zur medizinischen Therapie und Rehabilitation von Körpermuskelpartien von Patienten ist bekannt von
Der Erfindung liegt die Aufgabe zugrunde, eine Vorrichtung zur therapeutischen Behandlung und/oder zum Training der unteren Extremitäten eines Menschen zu schaffen, mit der vielfältige Belastungssituationen simuliert werden können, die im Alltag auftreten. Die Vorrichtung soll einen guten Zugang des Therapeuten zum Patienten erlauben.The invention has for its object to provide a device for the therapeutic treatment and / or training of the lower extremities of a person can be simulated with the various stress situations that occur in everyday life. The device is intended to allow a good access of the therapist to the patient.
Erfindungsgemäß wird diese Aufgabe durch die Vorrichtung gemäß Anspruch 1 gelöst.According to the invention, this object is achieved by the device according to claim 1.
Die Erfindung hat den Vorteil, dass die Mechanik der Bewegungseinrichtungen einfach und kompakt aufgebaut ist. Durch die geringere Höhe der Mechanik wird der Zugang des Therapeuten zum Patienten erleichtert.The invention has the advantage that the mechanics of the movement devices is simple and compact. The reduced height of the mechanism facilitates the therapist's access to the patient.
Mit der erfindungsgemäßen Vorrichtung kann eine erfolgreiche Therapie einerseits durch das häufige Wiederholen von Übungselementen und andererseits durch die Übertragung von Lerneffekten der für die gesunde Extremität zuständigen Gehirnseite auf die für die geschwächte Extremität zuständige Gehirnseite bzw. das zuständige Gehirnareal erzielt werden. So kann beispielsweise gezielt ein einzelner Bewegungsablauf innerhalb des gesamten Gangzyklus isoliert und wiederholt vom Patienten geübt werden. Auch erlaubt die erfindungsgemäße Vorrichtung zur weiteren Verbesserung des in der Genesung fortgeschrittenen Patienten sowie zum Training gesunder Menschen die Kräftigung der Bein- und Rückenmuskulatur. Die erfindungsgemäße Vorrichtung bietet die Voraussetzung dafür, dass durch einem Bildschirm das Lauftraining bzw. die Lauftherapie entweder in einer vorgegebenen Alltagsumgebung oder eine Evaluierung der Therapieleistung in Echtzeit ermöglicht wird, wobei durch die robust und einfach aufgebaute Mechanik unterschiedliche Alltagssimulationen, beispielsweise das Treppensteigen, das Betreten eines Bürgersteigs oder Situationen simuliert werden können, bei denen der Patient stolpert.With the device according to the invention, a successful therapy on the one hand by the frequent repetition of exercise elements and on the other hand by the transmission of learning effects of the responsible for the healthy limb side of the brain on the responsible for the weakened limb brain side or the brain area responsible can be achieved. For example, a single movement within the entire gait cycle can be specifically isolated and repeatedly practiced by the patient. Also, the device of the present invention allows the leg and back muscles to be strengthened to further improve the patient being well advanced and to train healthy people. The device according to the invention provides the prerequisite for enabling running training or running therapy either in a given everyday environment or evaluating the therapy performance in real time, whereby different everyday simulations, for example climbing stairs, entering, are made possible by the robust and simply constructed mechanism of a sidewalk or situations in which the patient stumbles.
Bevorzugte Ausführungsformen der Erfindung sind jeweils in den Unteransprüchen angegeben.Preferred embodiments of the invention are specified in the subclaims.
Der Linearantrieb kann ein Kraftübertragungselement umfassen, das den ersten Schlitten mit dem ortsfesten Rahmen koppelt. Der Linearantrieb kann eine angetriebene Kette umfassen, die am Schlitten einerseits und am Rahmen andererseits befestigt ist, wodurch auf einfache Weise die Horizontalbewegung des Schlittens erreicht wird.The linear drive may include a power transmission element that couples the first carriage to the fixed frame. The linear drive may comprise a driven chain, which is mounted on the carriage on the one hand and on the frame on the other hand, whereby the horizontal movement of the carriage is achieved in a simple manner.
Bei einer bevorzugten Ausführungsform fährt der Schlitten entlang zwei oder mehreren Führungsschienen. Dadurch kann der Schlitten breiter gestaltet werden, was dazu führt, dass die Mechanik an Stabilität gewinnt, da die Belastungen durch den Patienten besser auf die Bewegungsmechanik verteilt werden.In a preferred embodiment, the carriage travels along two or more guide rails. As a result, the carriage can be made wider, which leads to the fact that the mechanics gain in stability, as the burden is better distributed by the patient on the movement mechanics.
Bei einer bevorzugten Ausführungsform beinhaltet der ortsfeste Rahmen im Bereich der Führungsschienen der Schlitten höhenverstellbare Füße. Dadurch können etwaige Unebenheiten im Fußboden ausgeglichen werden und die Erfindung kann auch auf unebenem Untergrund zum Einsatz kommen.In a preferred embodiment, the stationary frame includes height-adjustable feet in the region of the guide rails of the carriages. As a result, any unevenness in the floor can be compensated and the invention can also be used on uneven ground.
Der erste Drehantrieb kann ein Kraftübertragungselement umfassen, das den Schwenkarm mit dem Schlitten koppelt. Die Höhenverstellung des Schwenkarms ist durch Betätigung des Kraftübertragungselements veränderbar. Die Kopplung des Schwenkarms mit dem Schlitten durch ein Kraftübertragungselement hat den Vorteil, dass die Höhenverstellung des Schwenkarms direkt über den ersten Drehantrieb erfolgt.The first rotary drive may include a power transmission element that couples the pivot arm to the carriage. The height adjustment of the pivot arm is variable by actuation of the force transmission element. The coupling of the swivel arm with the carriage by a force transmission element has the advantage that the height adjustment of the swivel arm takes place directly via the first rotary drive.
Bei einer bevorzugten Ausführungsform wird die Höhenbewegung des Schwenkarms durch ein System, insbesondere eine Kraftspeichereinrichtung, unterstützt, welches Energie speichern kann und bei Bedarf auf die Mechanik zurückspeisen kann. Dadurch können Antriebe und Kraftübertragungselemente, konkret der erste Drehantrieb, mit geringerem Platz- und Energieversorgungsbedarf eingebaut werden, wodurch die Mechanik an Kompaktheit gewinnt und der Einsatz in jedem Umfeld garantiert ist.In a preferred embodiment, the height movement of the swivel arm by a system, in particular a force storage device, supported, which can store energy and can feed back to the mechanics if necessary. This allows drives and Kraftübertragungselemente, specifically the first rotary actuator, are installed with less space and energy supply requirements, whereby the mechanics gain in compactness and the use is guaranteed in any environment.
Eine Kraftspeichereinrichtung ist beispielsweise ein Federelement, insbesondere eine Zug- oder Druckfeder, das über eine Führung auf einen Hebelarm einwirkt, welcher fest mit dem Schenkarm verbunden ist. Dadurch kann die Mechanik so ausgelegt werden, dass die Höhenbewegung des Schwenkarms in seiner mechanischen ungünstigsten Position durch die Energie der Vorspannung des Federelements unterstützt wird.An energy storage device is for example a spring element, in particular a tension or compression spring, which acts via a guide on a lever arm, which is firmly connected to the Schenkarm. Thereby, the mechanism can be designed so that the height movement of the pivot arm is supported in its mechanical unfavorable position by the energy of the bias of the spring element.
Der erste Drehantrieb für die Höhenverstellung kann beabstandet vom Schwenkarm angeordnet und mit diesem durch ein Kraftübertragungsmittel gekoppelt sein. Dadurch kann der erste Drehantrieb an einer für die Bewegung oder für den Schwerpunkt günstigen Position angeordnet sein. Die Kraftübertragung kann vom ersten Drehantrieb beispielsweise durch ein Zahnrad-Riemen System am Schlitten auch beabstandet vom Schwenkarm auf den Schwenkarm selbst aufgebracht werden. Die erste Antriebsscheibe kann dabei am ersten Drehantrieb angebracht sein. Die zweite Antriebsscheibe kann am Schwenkarm angebracht sein. Die Kraftübertragung erfolgt dann über den Riemen vom Zahnrad des ersten Drehantriebs auf das Zahnrad des Schwenkarms und dadurch auf den Schwenkarm selbst.The first rotary actuator for the height adjustment may be spaced from the pivot arm and coupled thereto by a power transmission means. As a result, the first rotary drive can be arranged at a position favorable for the movement or for the center of gravity. The power transmission can be applied by the first rotary drive, for example, by a gear belt system on the carriage also spaced from the pivot arm on the swing arm itself. The first drive pulley can be attached to the first rotary drive. The second drive pulley may be attached to the swing arm. The power transmission then takes place via the belt from the gear of the first rotary drive to the gear of the swivel arm and thereby on the swivel arm itself.
Der zweite Drehantrieb kann ein Kraftübertragungselement umfassen, das das Haltemittel mit dem Schwenkarm koppelt. Die Drehung des Haltemittels ist durch Betätigung des Kraftübertragungselements veränderbar. Die Kopplung des Haltemittels mit dem Schwenkarm durch ein Kraftübertragungselement hat den Vorteil, dass die Drehung des Haltemittels direkt über den Drehantrieb erfolgt.The second rotary drive may comprise a power transmission element which couples the retaining means to the pivot arm. The rotation of the holding means is variable by actuation of the force transmission element. The coupling of the holding means with the swivel arm by means of a force transmission element has the advantage that the rotation of the holding means takes place directly via the rotary drive.
Der zweite Drehantrieb für die Neigungsänderung kann beabstandet vom Haltemittel angeordnet und mit diesem durch ein Kraftübertragungsmittel gekoppelt sein. Dadurch kann der zweite Drehantrieb an einer für den Schwerpunkt günstigen Position angeordnet sein. Auch die Kraftübertragung vom zweiten Drehantrieb kann beispielsweise durch ein Zahnrad-Riemen System beabstandet vom Haltemittel auf das Haltemittel selbst aufgebracht werden. Die erste Antriebsscheibe kann dabei am zweiten Drehantrieb angebracht sein. Die zweite Antriebsscheibe kann am Halteelement angebracht sein. Die Kraftübertragung erfolgt dann über den Riemen vom Zahnrad des zweiten Drehantriebs auf das Zahnrad des Halteelements und dadurch auf das Halteelement selbst.The second rotational drive for the inclination change can be arranged spaced from the holding means and coupled thereto by a power transmission means. As a result, the second rotary drive can be arranged at a position which is favorable for the center of gravity. The power transmission from the second rotary drive, for example, by a gear belt system spaced from the holding means are applied to the holding means itself. The first drive pulley can be attached to the second rotary drive. The second drive pulley may be attached to the support member. The power transmission is then via the belt from the gear of the second rotary drive to the gear of the holding element and thereby to the holding element itself.
Bei einer bevorzugten Ausführungsform kann das Haltemittel entlang des Kraftübertragungselements beweglich angebracht werden und über einen Verschlussmechanismus eingestellt werden. Durch diese Einstellung des Haltemittels ermöglicht es, dass das Haltemittel präzise auf die Schrittbreite eingestellt werden kann.In a preferred embodiment, the retaining means may be movably mounted along the force transmitting member and adjusted via a locking mechanism. This adjustment of the holding means allows the holding means to be precisely adjusted to the crotch width.
Die vorstehend beschriebenen Anordnungen der jeweiligen Antriebe ermöglichen jeweils für sich genommen und in Kombination miteinander einen einfachen Aufbau der jeweiligen Bewegungseinrichtung, die einen geringen Platzbedarf hat.The arrangements of the respective drives described above, taken separately and in combination with one another, allow a simple construction of the respective movement device, which has a small footprint.
Bei einer bevorzugten Ausführungsform der Erfindung ist eine Verstelleinrichtung oberhalb der Bewegungseinrichtung angeordnet, die zur Änderung des Körperschwerpunktes eines mit den Haltemitteln verbundenen Menschen angepasst ist. Diese Ausführungsform hat den Vorteil, dass durch die Verstelleinrichtung eine Kontrolle des Körperschwerpunktes eines Patienten möglich ist. Damit kann einerseits die bei der menschlichen Lokomotion, also bei der Fortbewegung auftretende Verschiebung des Körperschwerpunkts entlang der Richtung der Fortbewegung simuliert werden, die in vertikaler und seitlicher Richtung erfolgt. Andererseits kann durch die Kontrolle des Schwerpunkts die korrekte Ausführung der therapeutischen Bewegung ermöglicht und somit Haltungsschäden, welche von kompensatorischen Bewegungen der Patienten verursacht werden, vorgebeugt werden. Ein weiterer Vorteil der Kontrolle des Körperschwerpunkts besteht darin, dass das Gleichgewicht in kritischen Situationen, wie beim (simulierten) Stolpern, Ausrutschen oder unter Bedingungen, bei denen die propriozeptive Komponente gestört ist, gehalten werden kann. Ein wiederholtes Üben dieser Situationen ist notwendig, um das Fall- und Sturzrisiko der Patienten zu minimieren. Die bei dieser Ausführungsform ermöglichte dreidimensionale Kontrolle des Schwerpunkts und die Option, durch Perturbationen die propriozeptive Komponente der Patienten zu beeinflussen, schafft die Voraussetzung für ein sicheres, wiederholbares und zielgerechtes Training. Die Perturbationen der propriozeptiven Komponente werden durch die Haltemittel, insbesondere die Fußplatten ausgeführt, die mit den Füßen der Patienten verbunden sind. Diese können in beliebige Position entlang der drei Freiheitsgrade gefahren werden. Zusätzlich können durch die Haltemittel Vibrationen realisiert werden.In a preferred embodiment of the invention, an adjusting device is arranged above the movement device, which is adapted to change the center of gravity of a person connected to the holding means people. This embodiment has the advantage that a control of the body center of gravity of a patient is possible by the adjusting device. Thus, on the one hand, the displacement of the center of gravity of the body occurring in the course of human locomotion, that is to say during locomotion, can be simulated along the direction of locomotion, which takes place in the vertical and lateral direction. On the other hand, the control of the center of gravity allows the correct execution of the therapeutic movement, thus preventing postural damage caused by compensatory movements of the patient. Another advantage of controlling body center of gravity is that balance can be maintained in critical situations such as (simulated) tripping, slipping or under conditions where the proprioceptive component is disturbed. Repeated practice of these situations is necessary to minimize the risk of falls and falls for patients. The three-dimensional control of the center of gravity, which is possible in this embodiment, and the option of influencing the proprioceptive component of the patients by means of perturbations, create the conditions for a safe, repeatable and targeted training. The perturbations of the proprioceptive component are performed by the retaining means, in particular the foot plates, which are connected to the feet of the patients. These can be moved to any position along the three degrees of freedom. In addition, vibrations can be realized by the holding means.
Die Erfindung wird nachfolgend mit weiteren Einzelheiten unter Bezug auf die beigefügten schematischen Zeichnungen anhand von Ausführungsbeispielen näher erläutert. In diesen zeigen:
-
Fig 1
eine perspektivische Ansicht einer Vorrichtung nach einem erfindungsgemäßen Ausführungsbeispiel; -
Fig. 2
eine Seitenansicht der Vorrichtung gemäßFig. 1 ; -
Fig. 3
eine Vorderansicht der Vorrichtung gemäßFig. 1 -
Fig. 4
eine Draufsicht der Vorrichtung gemäßFig. 1 -
Fig. 5
eine perspektivische Ansicht der Verschlussvorrichtung zur Positionierung der Haltemittel
-
Fig. 1
a perspective view of a device according to an embodiment of the invention; -
Fig. 2
a side view of the device according toFig. 1 ; -
Fig. 3
a front view of the device according toFig. 1 -
Fig. 4
a plan view of the device according toFig. 1 -
Fig. 5
a perspective view of the closure device for positioning the holding means
In
Die Vorrichtung umfasst ein Gestell 34, an dem der Patient zur Verstelleinrichtung zur Änderung des Körperschwerpunktes verbunden wird, und das mit dem ortsfesten Rahmen 12 fest verbunden ist. Das Gestell 34 umfasst zwei Arme 35a, 35b, die sich in vertikaler Richtung von unten nach oben erstrecken, wobei die Arme 35a, 35b in etwa auf der Höhe der Bewegungseinrichtungen 11a, 11b fest mit dem ortsfesten Rahmen 12 verbunden sind. Am oberen Ende der Arme 35a, 35b ist ein horizontal angeordnetes Verbindungselement 36 vorgesehen, welches die Arme 35a, 35b verbindet. Auf den Arme 35a, 35b können in etwa auf Höhe der Unterarme des jeweiligen Patienten angeordnet und vertikal verstellbar zwei Seitenholme 37a, 37b beweglich angebracht sein. Die Seitenholme 37a, 37b dienen als Griffe für Patienten, die sich an den Seitenholmen 37a, 37b festhalten können.The device comprises a
Die Bewegungseinrichtungen 11a, 11b weisen jeweils einen Schwenkarm 14 auf, der in verschiedene Höhenlagen schwenkbar ist. Der Schwenkarm 14 ist dazu an einem einzigen Schlitten 15 schwenkbeweglich angelenkt, der durch eine Linearführung 16 geführt ist. Die Linearführung 16 ist mit dem ortsfesten Rahmen 12 fest verbunden und bildet eine Schiene, in der der Schlitten 15 verschieblich angeordnet ist. Wie aus
Der Schwenkarm 14 ist jeweils mit einem der Haltemittel 13a, 13b drehbeweglich verbunden. Die Verbindungsstelle zwischen dem Haltemittel 13a, 13b und dem Schwenkarm 14 befindet sich am anderen, zweiten Längsende des Schwenkarms 14.The pivot arm 14 is rotatably connected in each case with one of the holding means 13a, 13b. The connection point between the holding means 13a, 13b and the pivot arm 14 is located at the other, second longitudinal end of the pivot arm 14th
Der Schwenkarme 14a, 14b erstrecken sich in Längsrichtung der jeweiligen Linearführung 16. Die Schwenkarme 14a, 14b sind jeweils auf einer Kreisbahn beweglich, die entlang der Längsrichtung der jeweiligen Linearführung 16 verläuft. Die Schwenkarme 14a, 14b sind jeweils über den ersten Drehantrieb 17 mit dem Schlitten 15 drehbeweglich verbunden. Die Position des Drehpunktes des jeweiligen Schwenkarms kann dabei beliebig angeordnet sein.The
Die Schwenkarme 14a, 14b können jeweils durch ein Kraftspeichersystem 20 unterstützt werden, welches an einem Ende am Schlitten 15 und am anderen Ende mit am Schwenkarm befestigt ist und in der Lage ist Energie zu speichern und auf die Bewegungsmechanik zurückzuführen. Ein solches System weist beispielsweise eine Zug-oder Druckfeder 21 auf, welche entlang eines Führungselements 22, welches auf dem Schwenkarm 14 und dem Schlitten 15 beweglich befestigt ist auf den Schwenkarm 14 und den Schlitten 15 einwirkt. Andere Ausführungsformen sind möglich.The
Bei der in den Figuren dargestellten Vorrichtung ist die Kraftspeichereinrichtung 20 in der Form einer Druckfeder 21 ausgebildet, die in der ungünstigsten Lage des Schwenkarms vorgespannt ist. Mit anderen Worten ist die Druckfeder 21 vorgespannt, wenn der jeweilige Schwenkarm 14a, 14b in der horizontalen unteren Position angeordnet ist. Wird der Schwenkarm 14a, 14b durch den ersten Drehantrieb 17 nach oben verschwenkt, so wird diese Bewegung durch die Druckfeder 21 unterstützt, die dabei entspannt.In the apparatus shown in the figures, the
Wie in den Figuren zu erkennen, ist die Feder bzw. allgemein die Kraftspeichereinrichtung 20 einerseits am Schlitten 15, konkret an einem L-förmigen Haltearm 22a befestigt. Dabei erstreckt sich ein erster Schenkel des Haltearms 22a in Längsrichtung der Linearführung 16. Der kürzere zweite Schenkel des Haltearms 22a erstreckt sich senkrecht dazu und ist mit einem ersten Ende der Kraftspeichereinrichtung 20, konkret der Feder 21 verbunden. Das zweite Ende der Feder 21 ist mit einem Ende des Schwenkarms 14a, 14b verbunden. Die Verbindung zwischen dem Schwenkarm 14a, 14b und der Feder 21 ist so gestaltet, dass die Feder ein Drehmoment auf den Schwenkarm 14a, 14b ausübt. Dazu ist die Feder mit einem (nicht dargestellten) Hebel am Schwenkarm 14a, 14b fest verbunden.As can be seen in the figures, the spring or generally the
Die Feder 21 ist durch eine Führungsstange 22 geführt. Die Führungsstange 22 befindet sich in der Feder 21. Die Führungsstange 22 ist einerseits am Haltearm 22a und andererseits am Schwenkarm 14a, 14b befestigt. Für den Längenausgleich ist die Führungsstange 22 teleskopierbar. Andere Führungsmöglichkeiten sind denkbar.The
Anstelle der Druckfeder 21 kann eine Zugfeder verwendet werden. Diese ist dann entsprechend auf der gegenüberliegenden Seite anzuordnen und mit dem Schlitten bzw. dem Schwenkarm zu verbinden.Instead of the
Allgemein ist der Drehpunkt am Schwenkarm 14 in einem Bereich bzw. an einer Stelle angelenkt, der bzw. die zwischen der Verbindung des jeweiligen Schwenkarms 14a, 14b mit dem Schlitten 15 und der Verbindung des Schwenkarms 15 mit dem Haltemittel 13a, 13b angeordnet ist.Generally, the pivot point on the pivot arm 14 is articulated in an area or at a location which is arranged between the connection of the
Durch die Drehbewegung des Schwenkarms 14 wird der Winkel zwischen dem Schwenkarm 14 und dem Schlitten 15 verändert. Wie in
Aufgrund der Anlenkung des Schwenkarms 14 am Schlitten 15 wird dieser durch eine Bewegung des Schlittens 12 mitgenommen, wodurch die Horizontalbewegung der gesamten Bewegungseinrichtung 11a, 11b erreicht wird.Due to the articulation of the pivot arm 14 on the
Wie aus den
Der erste Drehantrieb 17 ist dem Schlitten 15 zugeordnet und koppelt diesen mit dem Schwenkarm 14. Dazu ist ein zweites Kraftübertragungselement 23b vorgesehen, das einerseits am ersten Schlitten 15 und andererseits am Schwenkarm 14 angreift. Das zweite Kraftübertragungselement hat die Funktion, den Schwenkarm 14 bei einer Bewegung des Schlittens 15 mitzunehmen. Dabei wirkt das zweite Kraftübertragungselement 23b als Schub- und Zugelement. Zusätzlich kann durch das zweite Kraftübertragungselement 23b eine Kraft vom Schwenkarm 14 auf den Schlitten 15 übertragen werden bzw. umgekehrt, wenn das zweite Kraftübertragungselement 23b betätigt wird. Dabei wird der Winkel zwischen Schlitten 15 und Schwenkarm 14, und somit die Höhenlage des jeweiligen Schwenkarms 14a, 14b verändert.The first
Der Linearantrieb 18 bildet einen Hauptantrieb, der den Schlitten 15 zusammen mit dem ersten Drehantrieb 17 relativ zum ortsfesten Rahmen 12 bewegt. Der erste Drehantrieb 17, insbesondere das zweite Kraftübertragungselement 23b wirkt dabei als Mitnehmer, der die Antriebskraft des Linearantriebs 18 auf den Schwenkarm 14 überträgt. Zusätzlich wirkt der erste Drehantrieb 17 als Höhenantrieb für die Höhenbewegung des Schwenkarms 14, wie vorstehend beschrieben.The
Das zweite Kraftübertragungsmittel 23b, beispielsweise in der Form eines Getriebes, ist mit dem Schlitten 15 drehbar verbunden und sorgt für die Mitnahme und Höhenverstellung des Schwenkarms 14.The second power transmission means 23b, for example in the form of a transmission, is rotatably connected to the
Bei dem Ausführungsbeispiel gemäß
Bei der in Vorwärtsrichtung rechts angeordneten Bewegungseinrichtung 11a befindet sich der Schlitten 15, wobei der Schwenkarm 14a in Vorwärtsrichtung zum Rahmen 12 hinausragt. Eine Orientierung des Schwenkarme 14a, 14b zum Rahmen 12 ist in jeder Richtung möglich. Dadurch werden andere Orientierungen des Schwenkarms, beispielsweise zum Rahmen senkrecht nach unten ragend, abgedeckt.In the case of the
Zur Einstellung der Neigung der Haltemittel 13a, 13b ist ein zweiter Drehantrieb 19 vorgesehen, der mit dem jeweiligen drehbeweglich angeordneten Haltemittel 13a, 13b zusammenwirkt. Der Drehantrieb 19 ist im Bereich des vorderen Ende der Schwenkarme 14a, 14b angeordnet. Die Verbindung des Drehantriebs 19 mit dem jeweiligen Haltemittel 13a, 13b erfolgt durch ein drittes Kraftübertragungselement 23c, beispielsweise in der Form eines Getriebes. Andere Kraftübertragungselemente, beispielsweise eine Zahnstange oder hydraulische/pneumatische Betätigungselemente sind möglich. Das Kraftübertragungselement 23c wirkt sowohl als Mitnehmer als auch für die Neigungsverstellung der Halteelemente 13.To adjust the inclination of the holding means 13a, 13b, a second
Der Drehantrieb 19 kann auch im Bereich des hinteren Ende der Schwenkarme 14a, 14b angeordnet werden. Die Verbindung des Drehantriebs 19 mit dem jeweiligen Haltemittel 13a, 13b erfolgt in diesem Fall durch das dritte Kraftübertragungselement 23c über einen Riemen, welcher einerseits auf einer Antriebsscheibe am Schwenkarm 14 und andererseits auf einer Abtriebsscheibe, die mit dem Haltemittel 13a, 13b verbunden ist, angeordnet ist. Durch den Drehantrieb 19 wird die Neigung des Haltemittels 13a, 13b eingestellt und an die jeweilige Position des Schwenkarms 14 angepasst. Dabei sind letztendlich alle möglichen Neigungspositionen variabel einstellbar, die für die Simulation von Trainings- und Alltagssituationen erforderlich sind.The
Die Bewegung der Haltemittel 13a, 13b erfolgt in einer in sagittaler Richtung sich erstreckenden Arbeitsebene, wobei sich ein Arbeitsraum als zweckmäßig herausgestellt hat, der die Vorwärtsbewegung im Bereich von 0 - 800 mm, insbesondere bei 650 mm, die Höhenbewegung im Bereich von 0 - 400 mm, insbesondere bei 250 mm und die Schwenkbewegung des Haltemittels 13a, 13b in einem Bereich von - 80° bis + 30° ermöglicht.The movement of the holding means 13a, 13b takes place in a work plane extending in the sagittal direction, wherein a work space has proved to be expedient, the forward movement in the range of 0-800 mm, in particular at 650 mm, the height movement in the range of 0-400 mm, in particular at 250 mm and the pivoting movement of the holding means 13a, 13b in a range of - allows 80 ° to + 30 °.
Die Schwenkbewegung des Haltemittels 13a, 13b erfolgt um eine horizontal verlaufende Achse. Die horizontal verlaufende Achse wird durch die Betätigung des Linearantriebs 18 in horizontaler und des ersten Drehantriebs 17 in vertikaler Richtung verschoben.The pivoting movement of the holding means 13a, 13b takes place about a horizontally extending axis. The horizontal axis is moved by the operation of the
Die Haltemittel 13a, 13b können entlang der horizontal verlaufenden Achse 25 über eine Führung 26 und einen Verschluss 27 so positioniert werden, dass der Abstand zwischen den Haltemittel 13a, 13b der physiologischen Schrittbreite der Patienten entspricht. Dadurch wird sichergestellt, dass die Patienten während des Übens die Gelenke korrekt belasten und der Trainingseffekt wird maximiert, da während der Durchführung des von der Erfindung vorgegebenen Bewegungsablaufs keine Ausweichbewegungen oder Adaptation seitens des Patienten notwendig sind. Eine solche Verschlussvorrichtung ist in
Zur Simulation der Alltagssituationen der menschlichen Lokomotion können die Haltemittel 13a, 13b für die unteren Extremitäten mit dem auf diesen stehenden und befestigten Patienten sowohl durch programmierte Vorgaben der Steuerung als auch durch den Patienten bei nachgiebigen Fußplatten simuliert werden. Dabei kann zwischen der programmierten Bewegung und der durch den Patienten geführten Bewegung beliebig variiert werden. Alternativ kann ein Haltemittel 13a durch den Patienten und das andere Haltemittel 13b durch programmierte Vorgaben gesteuert werden.To simulate the everyday situations of human locomotion, the lower limb holding means 13a, 13b can be simulated with the patient standing and secured on it, both by programmed defaults of the control and by the patient in the case of compliant footplates. It can be varied between the programmed movement and the guided by the patient movement. alternative For example, a holding means 13a can be controlled by the patient and the other holding means 13b by programmed specifications.
Bei dem Ausführungsbeispiel gemäß
Andere Einrichtungen zum Heben und Senken des Gurtes 30 sind möglich.Other means for lifting and lowering the
Zur Kontrolle der transversalen Komponente des Schwerpunkts ist ein Transversalantrieb 32 vorgesehen, der einen mit einer Scheibe 33 verbundenen Rotationsantrieb aufweist. An der Scheibe 33 ist ein Seil befestigt (nicht dargestellt), dessen Enden bis zum Patienten reichen. Das Seil wird über ein nicht dargestelltes Rollensystem umgelenkt und greift an beiden Enden, beispielsweise durch Karabiner, an seitlichen Ösen des Patientengurts an. Durch Rotation der Scheibe 33 wird der Patient durch die Verkürzung eines der beiden Seilenden in transversaler Richtung gezogen. Ein möglicher Arbeitsraum für die durch den Transversalantrieb 32 ermöglichte Schwerpunktverlagerung beträgt beispielsweise, bezogen auf eine Nullposition, +/- 15cm. Andere Bereiche sind möglich.To control the transverse component of the center of gravity, a
Die Kontrolle des Schwerpunkts in Vorwärts- bzw. Rückwärtsrichtung erfolgt durch die Relativbewegung der Haltemittel 13a, 13b bzw. der Fußplatten bezogen auf den Aufhängungspunkt der Verstelleinrichtung 28. Die Position des Schlittens 15 kann auf der Linearführung 16 frei angesteuert werden. Dabei ist der Aufhängungspunkt des Patienten in einer Richtung parallel zur Linearführung 16 ortsfest, so dass eine entsprechende Verlagerung des Schwerpunkts möglich ist. Der durch die Schlittenlänge mögliche Arbeitsraum beträgt bezogen auf eine Nullposition +/- 10 cm. Andere Bereiche sind möglich.The control of the center of gravity in the forward or backward direction is effected by the relative movement of the holding means 13a, 13b or the foot plates relative to the suspension point of the adjusting device 28. The position of the
Die Vorrichtung lässt eine äußerst variable und flexible Therapie bzw. ein Training der unteren Extremitäten zu, wobei die Vorrichtung einfach und kompakt aufgebaut ist und somit guten Zugang zum Patienten gewährt.The device allows a highly variable and flexible therapy or training of the lower extremities, wherein the device is simple and compact and thus provides good access to the patient.
- 11a, 11b11a, 11b
- Bewegungseinrichtungenmovers
- 1212
- Rahmenframe
- 13a, 13b13a, 13b
- Haltemittelholding means
- 14a, 14b14a, 14b
- Schwenkarmeswing arms
- 1515
- Bewegungsschlittentraveling carriage
- 1616
- Linearführunglinear guide
- 1717
- Erster DrehantriebFirst rotary drive
- 1818
- Linearantrieblinear actuator
- 1919
- Zweiter DrehantriebSecond rotary drive
- 2020
- KraftspeichereinrichtungPower storage device
- 2121
- Federfeather
- 2222
- Führungselementguide element
- 22a22a
- Haltearmholding arm
- 23a, 23,b, 23c23a, 23, b, 23c
- KraftübertragungselementePower transmission elements
- 2424
- Zahnriementoothed belt
- 2525
- Achseaxis
- 2626
- Führungguide
- 2727
- Verschlussshutter
- 2828
- Verstelleinrichtungadjustment
- 2929
- Vertikalantriebvertical drive
- 3030
- Gurtbelt
- 3131
- Rollensystemroller system
- 3232
- TransversalantriebTransversalantrieb
- 3333
- Scheibedisc
- 3434
- Gestellframe
- 35a, 35b35a, 35b
- Armepoor
- 3636
- Verbindungselementconnecting element
- 37a, 37b37a, 37b
- Seitenholmeside rails
Claims (12)
- An apparatus for training and therapeutic treatment and/or support of a human's extremities with driven controllable movement devices (11a, 11b), which are connected to a stationary frame (12) and have holding means (13a, 13b) for attachment to an extremity, these being movable independently of one another along predetermined movement patterns, wherein the movement devices (11a, 11b) each have a pivot arm (14a, 14b), which can be aligned in different height positions and is connected at one end to a movement carriage (15) that is movable along a linear guide (16) and at the other end to one of the holding means (13a, 13b), each being rotationally movable, wherein the movement carriage (15) is guided by the linear guide (16), and the linear guide is fixedly connected to the stationary frame, wherein a linear drive (18) is provided for changing the horizontal position of the respective holding means (13a, 13b), a first rotary drive (17) being provided for changing the height position of the respective holding means (13a, 13b) and a second rotary drive (19) being provided for changing the inclination of the respective holding means (13a, 13b), wherein the pivot arms (14a, 14b) are each movable on a circular path along the longitudinal direction of the respective linear guide (16), wherein the movement carriage (15) is movable together with the first rotary drive (17) relative to the stationary frame (12) by means of the linear drive (18), the first rotary drive (17) acting as an entraining element for the pivot arm (14a, 14b) which transfers the driving force of the linear drive (18) to the pivot arm (14a, 14b) and in addition the first rotary drive (17) acts as a drive for the height movement of the pivot arm (14a, 14b), characterized in that the second rotary drive (19) is attached to the pivot arm (14a, 14b) or to the holding means (13a, 13b), and couples the holding means (13a, 13b) and the pivot arm (14a, 14b).
- The apparatus according to claim 1, characterized in that the linear guide (16) has multiple guide rails along which the movement carriage (15) is disposed to be movable.
- The apparatus according to claim 1 or 2, characterized in that the first rotary drive (17) comprises a second force transfer element (23b), which is attached to the movement carriage (15) and connects it to the pivot arm (14a, 14b) in a rotationally movable manner, wherein the alignment of the pivot arm (14a, 14b) is adjustable by actuation of the second force transfer element (23b).
- The apparatus according to claim 1 or 2, characterized in that the first rotary drive (17) comprises a second force transfer element (23b), which is attached to the pivot arm (14a, 14b) and connects this to the movement carriage (15) in a rotationally movable manner, wherein the alignment of the pivot arm (14a, 14b) is adjustable by actuation of the force transfer element (21b).
- The apparatus according to any one of claims 1 to 4, characterized in that the pivot arm (14a, 14b) is connected to a force storage device (20) to support the first rotary drive (17).
- The apparatus according to claim 5, characterized in that the force storage device (20) has at least one spring (21), which is attached at one end to the movement carriage (15) and at the other end to the pivot arm (14a, 14b).
- The apparatus according to claim 6, characterized in that the spring (21) acts along a guide element (22), which is attached movably to the pivot arm (14a, 14b) at one end and to the movement carriage (15) at the other end.
- The apparatus according to any one of claims 1 to 7, characterized in that the linear drive (18) comprises a first force transfer element (23a) which couples the movement carriage (15) to the stationary frame (12).
- The apparatus according to any one of claims 1 to 8, characterized in that the linear drive (18) comprises a driven toothed belt (24), which is connected to the movement carriage (15).
- The apparatus according to any one of claims 1 to 9, characterized in that the second rotary drive (17) comprises a third force transfer element (23c), which couples the pivot arm (14a, 14b) to the holding means (13a, 13b).
- The apparatus according to at least one of claims 1 to 10, characterized in that the holding means (13a, 13b) is disposed to be movable along its own axis (25) via a guide (26), and the distance from the pivot arm (14a, 14b) is adjustable by means of a closure (27).
- The apparatus according to at least one of claims 1 to 11, characterized in that an adjusting device (31) is disposed above the movement device (10a, 10b), which is adjusted to change the center of gravity of the body of the person connected to the holding means (13a, 13b).
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP15000260.8A EP3050550B1 (en) | 2015-01-28 | 2015-01-28 | Device for the training and treatment and/or support for the lower extremities of the body of a human being |
ES15000260.8T ES2634696T3 (en) | 2015-01-28 | 2015-01-28 | Device for training and therapeutic treatment and / or assistance to the lower limbs of a person |
CA2918956A CA2918956A1 (en) | 2015-01-28 | 2016-01-25 | Device for controlling the training and the therapeutic treatment and/or for supporting the lower extremities of a human |
US15/005,418 US10080915B2 (en) | 2015-01-28 | 2016-01-25 | Device for controlling the training and the therapeutic treatment and/or for supporting the lower extremities of a human |
US16/139,883 US10596405B2 (en) | 2015-01-28 | 2018-09-24 | Device for controlling the training and the therapeutic treatment and/or for supporting the lower extremities of a human |
Applications Claiming Priority (1)
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EP15000260.8A EP3050550B1 (en) | 2015-01-28 | 2015-01-28 | Device for the training and treatment and/or support for the lower extremities of the body of a human being |
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EP3050550A1 EP3050550A1 (en) | 2016-08-03 |
EP3050550B1 true EP3050550B1 (en) | 2017-03-22 |
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EP15000260.8A Active EP3050550B1 (en) | 2015-01-28 | 2015-01-28 | Device for the training and treatment and/or support for the lower extremities of the body of a human being |
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EP (1) | EP3050550B1 (en) |
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CA2918956A1 (en) | 2016-07-28 |
EP3050550A1 (en) | 2016-08-03 |
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