EP3058927B1 - Wheel chair with vibration unit - Google Patents

Wheel chair with vibration unit Download PDF

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Publication number
EP3058927B1
EP3058927B1 EP16000113.7A EP16000113A EP3058927B1 EP 3058927 B1 EP3058927 B1 EP 3058927B1 EP 16000113 A EP16000113 A EP 16000113A EP 3058927 B1 EP3058927 B1 EP 3058927B1
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EP
European Patent Office
Prior art keywords
vibration unit
vibration
oscillations
wheelchair
wheelchair according
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EP16000113.7A
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German (de)
French (fr)
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EP3058927A1 (en
Inventor
Winfried Hoffmann
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Reha & Medi Hoffmann GmbH
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Reha & Medi Hoffmann GmbH
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Priority to PL16000113T priority Critical patent/PL3058927T3/en
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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
    • A61H23/00—Percussion or vibration massage, e.g. using supersonic vibration; Suction-vibration massage; Massage with moving diaphragms
    • A61H23/02—Percussion or vibration massage, e.g. using supersonic vibration; Suction-vibration massage; Massage with moving diaphragms with electric or magnetic drive
    • A61H23/0254—Percussion or vibration massage, e.g. using supersonic vibration; Suction-vibration massage; Massage with moving diaphragms with electric or magnetic drive with rotary motor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/10—Parts, details or accessories
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G5/00—Chairs or personal conveyances specially adapted for patients or disabled persons, e.g. wheelchairs
    • A61G5/10—Parts, details or accessories
    • A61G5/12—Rests specially adapted therefor, e.g. for the head or the feet
    • A61G5/128—Rests specially adapted therefor, e.g. for the head or the feet for feet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61H23/00—Percussion or vibration massage, e.g. using supersonic vibration; Suction-vibration massage; Massage with moving diaphragms
    • 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
    • A61H2201/01—Constructive details
    • A61H2201/0119—Support for the device
    • A61H2201/0138—Support for the device incorporated in furniture
    • A61H2201/0149—Seat or chair

Definitions

  • the invention relates to an elevator with vibration unit, which is arranged in particular in or on the foot part of the elevator.
  • Tilting tables are known from the prior art which transmit vibrations to the patient via the feet in the area of the foot. These vibrations are often generated by a tilting movement of the foot section. These tilting tables have only two patient positions, namely lying and standing; sitting is not possible.
  • the primary goal of these generated vibrations, which have a frequency of 5 to 27 Hz, is muscle building, that is, an improvement in the muscular status of the leg and trunk muscles.
  • the vibration runs counter to demanding kinematics, as is required for a device with free position adjustment between lying, sitting and standing position (resonance vibrations). For this reason, the Galileo Delta tilting table is made of wood.
  • vibration plates In the fitness area, a wide variety of vibration plates are also used, which work in the range from 10 to 50 Hz and whose overall height is greater than 10 cm. These vibration plates or vibration trainers are mainly used to improve muscle tissue and tone.
  • the known vibration plates which are designed for operation on a horizontal surface, differ in particular in the way in which they move. There are so-called vertical systems with a rigid vibration surface, whereby the vibration surface moves vertically.
  • a vibration plate in this regard which only moves horizontally, is not known for such applications.
  • vibration plates are designed as stand-alone devices and cannot be integrated into other devices.
  • the central component of all therapeutic approaches is mobilization out of bed through the steps: sitting in bed, sitting on the edge of the bed, sitting in the chair and subsequent verticalization.
  • the earliest possible verticalization combines the advantages of prophylaxis against pneumonia, thrombosis, contracture, stimulation of the circulatory system and last but not least the psychological moment from another perspective.
  • Such an elevator is suitable, for example, for severely affected patients without postural control.
  • the object of the invention is to provide a medical elevator with at least one To provide vibration unit, wherein the vibration unit is to be integrated in the hospital elevator in such a way that its optimized dimensions do not have to be modified.
  • the medical elevator should make it possible to transmit to the patient only horizontal vibrations or vibrations that run parallel to the respective body surface of the patient.
  • the elevator should also be suitable for severely affected patients without postural control.
  • the vibrations should also reduce the tone in spastic patients (strength-releasing) without unnecessarily stressing the joints or the skeleton.
  • the vibration unit generates horizontal vibrations or vibrations running parallel to the respective body surface of the patient in the range from 1 to 100 Hz and the vibration unit is or are arranged in the area of the footrest, the seat and / or the backrest of the medical elevator.
  • the horizontal vibration plane or vibrations running parallel to the respective body surface of the patient avoid the stresses on the joints and the skeleton which are known to be highly stressful in the case of vibration vectors directed in a different way.
  • the elevator which is suitable for severely affected patients without postural control, is able to vertically verticalize the patient, whereby intelligent kinematics prevents excessive pressure on the breech region of the pressure-sensitive patients.
  • the patient's feet stand in particular on the vibration unit integrated in the area of the footrest or a footrest into which a vibration unit is integrated.
  • the patient experiences an increased tension in the muscles, especially the gluteal and thigh muscles, which are also activated when getting up naturally to secure and help the body stand up.
  • a vibration unit opens up therapeutic options, for example to support vegetative functions. These therapeutic options are particularly important for paraplegic patients or patients who are constantly dependent on a wheelchair.
  • the integrated vibration unit which can be a vibrating plate, it is possible for the first time that the patient's feet vibrate while sitting, getting up and standing.
  • the vibration is not limited to the soles of the feet, but acts as a so-called "whole-body vibration".
  • the vibration for example with a frequency of 25 - 100 Hz, has the effect of intensifying the goals of pneumonia and thrombosis prophylaxis, which are inherent in the verticalization.
  • the invention also provides non-therapeutic use of the medical elevator. Therapeutic uses are not covered by the claims.
  • the tonic vibration reflex leads to a contraction of the muscles in a frequency band of 30 - 100 Hz
  • the vibration stimulus additionally stimulates the length organs of the muscles, the so-called spindles, and the Golgi organs of the tendons, their information via Ia- and II- Fibers are directed to the spinal cord and there activate mono- and polysynaptic reflexes with subsequent muscle contraction. Even after the vibration has ended, the muscle can generate a greater force. Lower vibration frequencies, ie below 30 Hz, lead to the opposite effect.
  • the so-called pacinic bodies located in the subcutaneous tissue feel the vibration stimulus, they are differential receptors which, due to the constantly changing speed of the vibration stimulus and the associated acceleration of skin shifting, do not saturate and fire constantly.
  • the stimulus is conducted via the peripheral nervous system along the spinal cord, brain stem and the relay station thalamus into the sensory cortex.
  • the sensory and motor cortex are closely linked, which is why sensory irritation is playing an increasingly important role in motor rehabilitation.
  • the tonic vibration reflex strengthens the muscles, once again it should be emphasized that the facilitating effect applies to frequencies from 30 - 100 Hz.
  • the vibration provides additional stimulation of the gluteal, thigh and calf muscles during the assisted getting up process.
  • the neurological correlate of wakefulness is the so-called formatio reticularis of the brain stem, whereas consciousness, as perception of itself and interaction with the environment, is linked to the intactness of both large hemispheres.
  • the vibration promotes alertness and awareness in severely affected patients.
  • the cause is the non-saturated afferent flow through the various relay stations into the CNS.
  • the thalamus is the gateway to consciousness.
  • vibration stimulates the activity of the osteoblasts, the bone-forming cells, and thus prevents osteoporosis.
  • vibration as a non-saturating sensory stimulus has a number of positive effects, in particular on sensorimotor functions (strengthening, tonus reduction, improvement of motor control), awareness and support for prophylaxis of pneumonia, thrombosis and oteoporosis.
  • the vibration is therefore an ideal complement to the early verticalization of the severely affected patient.
  • the combination of the medical elevator which in particular has a footrest, a seat and a backrest, with at least one vibration unit, extends the functionality of medical elevators, which are used in particular for initial and early mobilization.
  • the vibrations with a value of 25-100 Hz, particularly preferably 30-50 Hz, 30-100 or 40-100 Hz. This enables the respective frequency of the oscillation to be adapted in a simple manner to the individual needs of the respective patient, for example in the context of initial and early mobilization, and the respective state of health.
  • the recommended frequencies for reducing spasticity and promoting motor control are, for example, 40-100 Hz and those for prophylaxis for pneumonia are around 30 Hz.
  • Fig. 1 shows a vibration unit 1 in a perspective view.
  • This vibration unit 1 is suitable for being integrated into a medical elevator 7, there in the area of the footrest 8, the seat 9 and / or the backrest 10.
  • the vibration unit 1 has an upper part 2 and a lower part 3, which are connected to one another by four elastically deformable connecting elements 4, which consist, for example, of a rubber-like material, the upper part 2 and the lower part 3 not touching one another directly.
  • the upper part 2 and the lower part 3 do not touch in the case where the patient's feet or another part of the body is or are arranged on the upper part 2 and thus exert pressure on the upper part 2 and thus on the balls 5.
  • the upper part 2 and the lower part 3 form - in the closed state - a plate-shaped housing 6, which can be designed in such a way that at least no splash water can penetrate into the interior of the housing 6 or at least is strongly prevented.
  • the overall height of the housing 6 in the closed state is between 3 and 4 cm, in Fig. 1 shown housing 6 3, 5 cm.
  • a ball 5 may be arranged in the lower part 3.
  • the ball 5 preferably consists of a solid material which has little or no elastic deformability.
  • the balls 5, in Figure 1 four balls 5 can be seen, touching - in the closed state of the housing 6 - thus simultaneously the upper part 2 and the lower part 3.
  • a vibration module 11 is arranged on the upper part 2 and is firmly connected to the upper part 2, so that vibrations can be transmitted.
  • the vibration module 11, which has, for example, at least one conventional electric drive, which drives a rotatable body with an imbalance, causes the vibrations. If the vibration unit 1 is switched on, it generates vibrations which are directed parallel to the longitudinal axes of the upper part 2 and the lower part 3 and which are therefore vibrations running parallel to the respective body surface of the patient sitting in the elevator. If the vibration unit 1 is arranged horizontally, it generates a horizontal vibration. In the case of a vibration unit 1 with an unbalance (In Fig. 1 not shown), in particular, a rotating vibration is generated.
  • the upper part 3 is deflected and the vibrations are transmitted, for example, to the feet of the seated patient.
  • the respective frequency with which the upper part 3 vibrates is determined in the usual way, in particular by the dimensioning and arrangement of an unbalance, the selection of the electric drive and / or by the selected speed.
  • the vibration unit 1 can be gradually or continuously in the usual manner are switched by conventional electrical control units, so that, as desired, in particular the vibration unit 1 optionally generates vibrations with a value in the range from 1 to 100 Hz, 30-50 Hz, 30-100 or 40-100 Hz.
  • the time duration of the generation of the vibrations can be determined and limited, for example to ten minutes.
  • Fig. 2 shows an embodiment of a medical elevator 7 with at least one vibration unit 1 in a schematic perspective view.
  • the mobile medical elevator 7 has at least one footrest 8, a seat 9 and a backrest 10. Otherwise, the medical elevator 7 can fulfill known functionalities and have the necessary components, assemblies and control programs in accordance with its respective level of equipment.
  • the medical elevator 7 is suitable for initial and early mobilization, in particular in early neurological rehabilitation, which enable gradual and continuous verticalization from a sitting position. From lying down to sitting to standing, a continuous sequence of movements can take place without the patient himself having to exert energy to change his position. This is done by a known infinitely variable change in position of the medical elevator (in Fig. 2 not shown). Such an elevator 7 is suitable, for example, for severely affected patients without postural control.
  • the medical elevator 7 enables at least three patient positions, namely a sitting, lying or standing position. The patient sits, lies or stands in or on the hospital elevator, regularly touching the foot section with his feet.
  • the vibration unit 1, for example one according to Fig. 1 Can be arranged in the area of the footrest 8, the seat 9 and / or the backrest 10 of the elevator 7. In the embodiment according to Fig. 2 the vibration unit 1 is arranged in the area of the footrest 8 and integrated in the footrest 8.

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

Description

Die Erfindung betrifft einen Krankenfahrstuhl mit Vibrationseinheit, welche insbesondere im oder am Fußteil des Krankenfahrstuhls angeordnet ist.The invention relates to an elevator with vibration unit, which is arranged in particular in or on the foot part of the elevator.

Aus dem Stand der Technik sind Kipptische bekannt, welche im Fußbereich Schwingungen über die Füße auf den Patienten übertragen.
Diese Schwingungen werden dabei oft durch eine Kippbewegung des Fußteiles erzeugt. Diese Kipptische besitzen nur zwei Patientenpositionen, nämlich liegend und stehend; sitzend ist nicht möglich.
Primäres Ziel dieser erzeugten Schwingungen, welche eine Frequenz von 5 bis27 Hz besitzen, ist der Muskelaufbau, also eine Verbesserung des muskulären Statuses der Bein- und Rumpfmuskulatur.Tilting tables are known from the prior art which transmit vibrations to the patient via the feet in the area of the foot.
These vibrations are often generated by a tilting movement of the foot section. These tilting tables have only two patient positions, namely lying and standing; sitting is not possible.
The primary goal of these generated vibrations, which have a frequency of 5 to 27 Hz, is muscle building, that is, an improvement in the muscular status of the leg and trunk muscles.

Die Vibration läuft einer anspruchsvollen Kinematik, wie sie bei einem Gerät mit freier Positionsverstellung zwischen Liege-, Sitz- und Stehposition erforderlich ist, zuwider (Resonanzschwingungen). Wohl aus diesem Grund ist der Galileo Delta Kipptisch aus Holz gebaut.The vibration runs counter to demanding kinematics, as is required for a device with free position adjustment between lying, sitting and standing position (resonance vibrations). For this reason, the Galileo Delta tilting table is made of wood.

Im Fitness-Bereich werden außerdem unterschiedlichste Vibrationsplatten eingesetzt, welche im Bereich von 10 bis 50 Hz arbeiten und deren Bauhöhe größer als 10 cm ist. Diese Vibrationsplatten oder Vibrationstrainer werden überwiegend zur Verbesserung des Muskelgewebes und des Muskeltonus eingesetzt.
Die bekannten Vibrationsplatten, welche für einen Betrieb auf einer waagerechten Oberfläche konzipiert sind, unterscheiden sich insbesondere in der Art und Weise ihrer Bewegung.
Es gibt sogenannte vertikale Systeme mit einer starren Vibrationsfläche, wobei sich die Vibrationsfläche dabei in der Vertikalen bewegt.In the fitness area, a wide variety of vibration plates are also used, which work in the range from 10 to 50 Hz and whose overall height is greater than 10 cm. These vibration plates or vibration trainers are mainly used to improve muscle tissue and tone.
The known vibration plates, which are designed for operation on a horizontal surface, differ in particular in the way in which they move.
There are so-called vertical systems with a rigid vibration surface, whereby the vibration surface moves vertically.

Außerdem sind sogenannte 3D-Systeme am Markt, bei welchen sich die Vibrationsplatte zusätzlich horizontal bewegt.There are also so-called 3D systems on the market, in which the vibration plate also moves horizontally.

Eine diesbezügliche Vibrationsplatte, welche sich ausschließlich horizontal bewegt, ist für solche Anwendungen nicht bekannt.A vibration plate in this regard, which only moves horizontally, is not known for such applications.

Diese Vibrationsplatten sind als alleinstehende Geräte konzipiert und nicht in andere Geräte integrierbar.These vibration plates are designed as stand-alone devices and cannot be integrated into other devices.

Zentraler Bestandteil aller therapeutischen Ansätze ist die Mobilisation raus aus dem Bett über die Schritte: Sitzen im Bett, Sitzen an der Bettkante, Sitzen im Stuhl und anschließende Vertikalisation. Die frühestmögliche Vertikalisation vereint u.a. die Vorteile der Pneumonie-, Thrombose-, Kontrakturprophylaxe, der Anregung des Kreislaufs und nicht zuletzt das psychologische Moment der anderen Perspektive.The central component of all therapeutic approaches is mobilization out of bed through the steps: sitting in bed, sitting on the edge of the bed, sitting in the chair and subsequent verticalization. The earliest possible verticalization combines the advantages of prophylaxis against pneumonia, thrombosis, contracture, stimulation of the circulatory system and last but not least the psychological moment from another perspective.

Es sind Krankenfahrstühle zur Erst- und Frühmobilisation, insbesondere in der neurologischen Frührehabilitation, bekannt, welche eine allmähliche und kontinuierliche Vertikalisation aus einer Sitzposition heraus ermöglichen. Vom Liegen, über das Sitzen bis zum Stand kann ein kontinuierlicher Bewegungsablauf erfolgen, ohne dass der Patient selbst Energie aufbringen muss, um seine Position zu verändern.Medical elevators for initial and early mobilization, in particular in early neurological rehabilitation, are known which enable gradual and continuous verticalization from a sitting position. From lying down to sitting to standing, a continuous sequence of movements can take place without the patient himself having to exert energy to change his position.

Dies erfolgt durch eine stufenlos veränderliche Positionsänderung des Krankenfahrstuhls.This is done by an infinitely variable change in the position of the elevator.

Ein solcher Krankenfahrstuhl ist beispielsweise für schwer betroffene Patienten ohne posturalen Kontrolle geeignet.Such an elevator is suitable, for example, for severely affected patients without postural control.

Die Firma Reha & Medi Hoffmann GmbH bietet beispielsweise einen solchen Krankenfahrstuhl unter Bezeichnung "Mobilizer® Medior" seit Jahren an.For example, the company Reha & Medi Hoffmann GmbH has been offering such an elevator for many years under the name "Mobilizer® Medior".

In der Offenlegungsschrift US3 854 474 A wird ein Krankenfahrstuhl mit den Merkmalen der Präambel von Anspruch 1 beschrieben.In the published application US3 854 474 A describes a medical elevator with the features of the preamble of claim 1.

Es besteht seit längerem ein Bedarf, weitere Funktionalitäten in Krankenfahrstühle zu integrieren, welche insbesondere eine Erst- und Frühmobilisation weiter wirksam unterstützen.There has been a need for a long time to integrate further functionalities in medical elevators, which in particular further effectively support initial and early mobilization.

Aufgabe der Erfindung ist es, einen Krankenfahrstuhl mit zumindest einer Vibrationseinheit bereit zu stellen, wobei die Vibrationseinheit im Krankenfahrstuhl der Art integriert werden soll, dass dieser bezüglich seiner optimierten Dimensionen nicht modifiziert werden muss. Außerdem soll mit dem Krankenfahrstuhl ermöglicht sein, möglichst ausschließlich horizontale bzw. zur jeweiligen Körperoberfläche des Patienten parallelverlaufende Schwingungen auf den Patienten zu übertragen.
Der Krankenfahrstuhl soll außerdem für schwer betroffene Patienten ohne posturalen Kontrolle geeignet sein.
Die Schwingungen sollen auch tonusmindernd bei Spastikern (kraftlösend) sein, ohne dabei die Gelenke bzw. das Skelett unnötig zu belasten.The object of the invention is to provide a medical elevator with at least one To provide vibration unit, wherein the vibration unit is to be integrated in the hospital elevator in such a way that its optimized dimensions do not have to be modified. In addition, the medical elevator should make it possible to transmit to the patient only horizontal vibrations or vibrations that run parallel to the respective body surface of the patient.
The elevator should also be suitable for severely affected patients without postural control.
The vibrations should also reduce the tone in spastic patients (strength-releasing) without unnecessarily stressing the joints or the skeleton.

Die Aufgabe der Erfindung wird durch einen Krankenfahrstuhl mit Vibrationseinheit mit den Merkmalen gemäß Anspruch 1 gelöst.The object of the invention is achieved by an elevator with vibration unit with the features according to claim 1.

Erfindungswesentlich ist, dass die Vibrationseinheit horizontale Schwingungen oder zur jeweiligen Körperoberfläche des Patienten parallelverlaufende Schwingungen im Bereich von 1 bis 100 Hz erzeugt und die Vibrationseinheit im Bereich der Fußstütze, des Sitzes und/oder der Rückenlehne des Krankenfahrstuhls angeordnet ist oder sind. Durch die horizontale Schwingungsebene oder zur jeweiligen Körperoberfläche des Patienten parallelverlaufende Schwingungen werden die Belastungen auf die Gelenke und das Skelett vermieden, die bei anders gerichteten Schwingungsvektoren als stark belastend bekannt sind.It is essential to the invention that the vibration unit generates horizontal vibrations or vibrations running parallel to the respective body surface of the patient in the range from 1 to 100 Hz and the vibration unit is or are arranged in the area of the footrest, the seat and / or the backrest of the medical elevator. The horizontal vibration plane or vibrations running parallel to the respective body surface of the patient avoid the stresses on the joints and the skeleton which are known to be highly stressful in the case of vibration vectors directed in a different way.

Mit dem erfindungsgemäßen Krankenfahrstuhl steht erstmals eine effektive Therapieoption zwecks allmählicher Vertikalisation in der neurologischen Frührehabilitation zur Verfügung. Der für schwer betroffene Patienten ohne posturale Kontrolle geeignete Krankenfahrstuhl ist in der Lage, den Patienten stufenlos zu vertikalsieren, wobei eine intelligente Kinematik eine übermäßige Druckbelastung der Steißregion der Dekubitus-gefährdeten Patienten vermeidet. Die Füße der Patienten stehen insbesondere auf der im Bereich der Fußstütze integrierten Vibrationseinheit oder einer Fußstütze, in welche eine Vibrationseinheit integriert ist.With the medical elevator according to the invention, an effective therapy option is available for the first time for the purpose of gradual verticalization in early neurological rehabilitation. The elevator, which is suitable for severely affected patients without postural control, is able to vertically verticalize the patient, whereby intelligent kinematics prevents excessive pressure on the breech region of the pressure-sensitive patients. The patient's feet stand in particular on the vibration unit integrated in the area of the footrest or a footrest into which a vibration unit is integrated.

Neben den Vorteilen der Vertikalisation erfährt der Patienten während des Aufstehens eine vermehrte Anspannung der Muskulatur, insbesondere der Gluteal- und Oberschenkelmuskulatur, welche auch beim natürlichen Aufstehen aktiviert werden, um den Körper zu sichern und aufstehen zu helfen.In addition to the advantages of verticalization, the patient experiences an increased tension in the muscles, especially the gluteal and thigh muscles, which are also activated when getting up naturally to secure and help the body stand up.

Zusätzlich eröffnet die Ausstattung eines Krankenfahrstuhles mit Vibrationseinheit therapeutische Möglichkeiten beispielsweise zur Unterstützung der vegetativen Funktionen. Diese therapeutischen Möglichkeiten sind insbesondere für querschnittsgelähmte Patienten oder Patienten die ständig auf einen Rollstuhl angewiesen sind bedeutsam.In addition, equipping an ambulance with a vibration unit opens up therapeutic options, for example to support vegetative functions. These therapeutic options are particularly important for paraplegic patients or patients who are constantly dependent on a wheelchair.

Mit der integrierten Vibrationseinheit, welche eine Vibrationsplatte sein kann, ist erstmals ermöglicht, dass die Füße des Patienten während des Sitzens, des Aufstehens und des Stehens zusätzlich vibrieren. Die Vibration beschränkt sich nicht nur auf die Fußsohlen, sondern wirkt als sog. "whole-body vibration".With the integrated vibration unit, which can be a vibrating plate, it is possible for the first time that the patient's feet vibrate while sitting, getting up and standing. The vibration is not limited to the soles of the feet, but acts as a so-called "whole-body vibration".

Die Vibration, beispielsweise mit einer Frequenz von 25 - 100 Hz, bewirkt, die der Vertikalisation immanenten Ziele der Pneumonie und Thromoseprophylaxe zu verstärken, daneben sind signifikante positive Effekte auf die Motorik, die Sensorik, den Muskeltonus, die Wachheit, das Bewusstsein und den Knochenstoffwechsel vorhandenThe vibration, for example with a frequency of 25 - 100 Hz, has the effect of intensifying the goals of pneumonia and thrombosis prophylaxis, which are inherent in the verticalization. In addition, there are significant positive effects on the motor system, sensor technology, muscle tone, alertness, awareness and bone metabolism available

Die Erfindung stellt auch eine nicht-therapeutische Verwendung des Krankenfahrstuhls bereit. Therapeutische Verwendungen sind nicht von des Ansprüchen umfasst.The invention also provides non-therapeutic use of the medical elevator. Therapeutic uses are not covered by the claims.

Die grundlegenden Effekte der Vibration sind insbesondere:The basic effects of vibration are in particular:

Motorik:Motor skills:

Der tonische Vibrationsreflex führt in einem Frequenzband von 30 - 100 Hz zu einer Kontraktion der Muskulatur, der Vibrationsreiz regt die Längenorgane der Muskeln zusätzlich an, die sog. Spindeln, und die Golgi-Organe der Sehnen an, deren Information via Ia- und II-Fasern an das Rückenmark geleitet werden und dort mono- und polysynaptische Reflexe mit nachfolgender Muskelkontraktion aktivieren. Auch nach Ende der Vibration kann der Muskel eine größere Kraft generieren. Geringere Vibrationsfrequenzen, d. h. unter 30 Hz, führen zum gegenteiligen Effekt.The tonic vibration reflex leads to a contraction of the muscles in a frequency band of 30 - 100 Hz, the vibration stimulus additionally stimulates the length organs of the muscles, the so-called spindles, and the Golgi organs of the tendons, their information via Ia- and II- Fibers are directed to the spinal cord and there activate mono- and polysynaptic reflexes with subsequent muscle contraction. Even after the vibration has ended, the muscle can generate a greater force. Lower vibration frequencies, ie below 30 Hz, lead to the opposite effect.

Sensorik:Sensor technology:

Den Vibrationsreiz verspüren die in der Unterhaut angesiedelten sog. Pacinischen Körperchen, sie sind Differentialrezeptoren, die auf Grund der sich ständig ändernden Geschwindigkeit des Vibrationsreizes und der damit verbundenen Beschleunigung der Hautverschiebung nicht saturieren und konstant feuern. Über das periphere Nervensystem wird der Reiz entlang des Rückenmarks, Hirnstamm und der Relaisstation Thalamus in den sensorischen Kortex geleitet. Der sensorische und motorische Kortex sind eng miteinander verbunden, weswegen der sensorischen Reizung eine immer größere Rolle auch in der motorischen Rehabilitation zukommt.The so-called pacinic bodies located in the subcutaneous tissue feel the vibration stimulus, they are differential receptors which, due to the constantly changing speed of the vibration stimulus and the associated acceleration of skin shifting, do not saturate and fire constantly. The stimulus is conducted via the peripheral nervous system along the spinal cord, brain stem and the relay station thalamus into the sensory cortex. The sensory and motor cortex are closely linked, which is why sensory irritation is playing an increasingly important role in motor rehabilitation.

Um die Vibration bewusst wahrzunehmen ist eine Umschaltung auf sensorische Assoziationsareale erforderlich, die den Reiz mit zuvor gemachten Erfahrungen abgleichen.In order to consciously perceive the vibration, it is necessary to switch to sensory association areas that compare the stimulus with previous experiences.

Aus den Effekten der Vibration auf das sensomotorische System leiten sich die folgenden intendierten Effekte ab:The following intended effects are derived from the effects of vibration on the sensorimotor system:

Kräftigung der Muskulatur:Strengthening the muscles:

Der tonische Vibrationsreflex kräftigt die Muskulatur, noch einmal sei betont, dass der fazilitatorische Effekt für Frequenzen von 30 - 100 Hz gilt. Insbesondere ist durch die Vibration eine zusätzliche Anregung der Gluteal-, Oberschenkel- und Wadenmuskulatur während des assistierten Aufstehvorgangs gegeben.The tonic vibration reflex strengthens the muscles, once again it should be emphasized that the facilitating effect applies to frequencies from 30 - 100 Hz. In particular, the vibration provides additional stimulation of the gluteal, thigh and calf muscles during the assisted getting up process.

Minderung der Spastik:Reduction of spasticity:

Läsionen des ZNS führen zu einer sog. Spastik, die in Extremfällen sich als Beuge-Strecktonus aller vier Extremitäten manifestieren kann. Eine Vibration im Frequenzband von 40 - 100 Hz mindert den Muskeltonus signifikant.Lesions of the CNS lead to a so-called spasticity, which in extreme cases can manifest itself as a flexion-stretching tone of all four extremities. A vibration in the frequency band of 40 - 100 Hz significantly reduces muscle tone.

Verbesserte motorische Kontrolle:Improved motor control:

Bei Patienten nach Schlaganfall bzw. ICP-Kinder erfolgte eine verbesserte motorische Kontrolle der spastisch gelähmten Extremitäten, diese können dann besser eingesetzt werden. Vermehrte sensorische Reizung induziert plastische Umbauvorgänge im motorischen Kortex.In patients after stroke or ICP children, there was improved motor control of the spastic paralyzed extremities, which can then be used better will. Increased sensory irritation induces plastic remodeling in the motor cortex.

Förderung der Wachheit und des Bewusstseins:Promoting alertness and awareness:

Das neurologische Korrelat der Wachheit ist die sog. Formatio reticularis des Hirnstamms, wohingegen das Bewusstsein als Wahrnehmung seiner Selbst und Interaktion mit der Umwelt an die Intaktheit beider Großhemisphären gebunden ist. Die Vibration fördert die Wachheit und das Bewusstsein schwer betroffener Patienten. Ursächlich ist der nicht saturierende afferente Flow über die verschiedenen Relaisstationen in das ZNS. Der Thalamus ist dabei das Tor zum Bewusstsein.The neurological correlate of wakefulness is the so-called formatio reticularis of the brain stem, whereas consciousness, as perception of itself and interaction with the environment, is linked to the intactness of both large hemispheres. The vibration promotes alertness and awareness in severely affected patients. The cause is the non-saturated afferent flow through the various relay stations into the CNS. The thalamus is the gateway to consciousness.

Osteoporoseprophylaxe:Osteoporosis prophylaxis:

Die Vibration regt die Tätigkeit der Osteoblasten, der knochenbildenden Zellen, an und beugt damit einer Osteoporose vor. Mehrere Untersuchungen konnten diesen Effekt bestätigen, wobei Frequenzen im Bereich von 30 - 50 Hz relevant sind Zusammenfassend sind mit der Vibration als nicht saturierendem sensorischen Reiz eine Vielzahl an positiven Effekten verbunden, namentlich auf die Sensomotorik (Kräftigung, Tonusminderung, Verbesserung der motorischen Kontrolle), das Bewusstsein und zur Unterstützung der Pneumonie-, Thrombose- und Otseoporoseprophylaxe. Die Vibration ist somit eine ideale Ergänzung der frühen Vertikalisation des schwer betroffenen Patienten. Die Kombination des Krankenfahrstuhls, welcher insbesondere eine Fußstütze, einen Sitz und eine Rückenlehne besitzt, mit zumindest einer Vibrationseinheit, erweitert die Funktionalität von Krankenfahrstühlen, welche insbesondere der Erst- und Frühmobilisation dienen.The vibration stimulates the activity of the osteoblasts, the bone-forming cells, and thus prevents osteoporosis. Several studies were able to confirm this effect, with frequencies in the range of 30 - 50 Hz being relevant. In summary, vibration as a non-saturating sensory stimulus has a number of positive effects, in particular on sensorimotor functions (strengthening, tonus reduction, improvement of motor control), awareness and support for prophylaxis of pneumonia, thrombosis and oteoporosis. The vibration is therefore an ideal complement to the early verticalization of the severely affected patient. The combination of the medical elevator, which in particular has a footrest, a seat and a backrest, with at least one vibration unit, extends the functionality of medical elevators, which are used in particular for initial and early mobilization.

Die abhängigen Ansprüche 2 bis 7 enthalten vorteilhafte Ausgestaltungen der Erfindung ohne diese damit zu begrenzen.The dependent claims 2 to 7 contain advantageous embodiments of the invention without thereby limiting it.

Bevorzugt ist, dass die Schwingungen mit einem Wert von 25 - 100 Hz, besonders bevorzugt 30 - 50 Hz, 30 - 100 oder 40 - 1 00 Hz, erzeugt werden.
Damit ist ermöglicht, dass die jeweilige Frequenz der Schwingung auf die individuellen Bedürfnisse des jeweiligen Patienten, beispielsweise im Rahmen der Erst- und Frühmobilisation, und des jeweiligen Gesundheitszustand in einfacher Art und Weise abstimmbar sind.It is preferred that the vibrations with a value of 25-100 Hz, particularly preferably 30-50 Hz, 30-100 or 40-100 Hz.
This enables the respective frequency of the oscillation to be adapted in a simple manner to the individual needs of the respective patient, for example in the context of initial and early mobilization, and the respective state of health.

Die empfohlenen Frequenzen für die Minderung der Spastik und der Förderung der motorischen Kontrolle liegen beispielsweise bei 40 - 100 Hz und für die für die Pnewnonieprophylaxe bei ca. 30 Hz.The recommended frequencies for reducing spasticity and promoting motor control are, for example, 40-100 Hz and those for prophylaxis for pneumonia are around 30 Hz.

Weitere Merkmale, Eigenschaften und Vorteile der vorliegenden Erfindung ergeben sich aus der nachfolgenden Beschreibung von Ausführungsbeispielen unter Bezugnahme auf die Figur 1 bis 2.Further features, properties and advantages of the present invention result from the following description of exemplary embodiments with reference to FIG Figure 1 to 2 .

Es zeigen:

Fig. 1
ein Ausführungsbeispiel einer Vibrationseinheit 1 in einer perspektivischen Ansicht, wobei das Gehäuse 6 geöffnet ist, und
Fig. 2
eine Ausführungsform eines Krankenfahrstuhls 7 mit zumindest einer Vibrationseinheit 1 in einer schematischen perspektivischen Ansicht.
Show it:
Fig. 1
an embodiment of a vibration unit 1 in a perspective view, the housing 6 is open, and
Fig. 2
an embodiment of a medical elevator 7 with at least one vibration unit 1 in a schematic perspective view.

Fig. 1 zeigt eine Vibrationseinheit 1 in einer perspektivischen Ansicht. Diese Vibrationseinheit 1 ist geeignet, in einen Krankenfahrstuhl 7, dort im Bereich der Fußstütze 8, des Sitzes 9 und/oder der Rückenlehne 10 integriert zu sein. Fig. 1 shows a vibration unit 1 in a perspective view. This vibration unit 1 is suitable for being integrated into a medical elevator 7, there in the area of the footrest 8, the seat 9 and / or the backrest 10.

Die Vibrationseinheit 1 besitzt ein Oberteil 2 und ein Unterteil 3, welche durch vier elastisch verformbare Verbindungselemente 4, welche beispielsweise aus einem gummiartigen Material bestehen, miteinander verbunden sind, wobei sich das Oberteil 2 und das Unterteil 3 nicht direkt berühren. Das Oberteil 2 und das Unterteil 3 berühren sich auch nicht in dem Fall, wo die Füße oder ein anderer Körperteil des Patienten auf dem Oberteil 2 angeordnet ist oder sind und damit einen Druck auf das Oberteil 2 und damit auf die Kugeln 5 ausüben.The vibration unit 1 has an upper part 2 and a lower part 3, which are connected to one another by four elastically deformable connecting elements 4, which consist, for example, of a rubber-like material, the upper part 2 and the lower part 3 not touching one another directly. The upper part 2 and the lower part 3 do not touch in the case where the patient's feet or another part of the body is or are arranged on the upper part 2 and thus exert pressure on the upper part 2 and thus on the balls 5.

Das Oberteil 2 und das Unterteil 3 bilden - im geschlossenen Zustand - ein plattenförmiges Gehäuse 6, welches der Art gestaltet sein kann, dass zumindest kein Spritzwasser in den Innenraum des Gehäuses 6 eindringen kann oder ein solches zumindest stark verhindert ist.
Die Bauhöhe des Gehäuses 6 beträgt im geschlossenen Zustand zwischen 3 bis 4 cm, im in Fig. 1 dargestellten Gehäuse 6 3, 5 cm.
Im Unterteil 3 kann in jeweils einer elastischen Manschette, in Fig. 1 nicht dargestellt, jeweils eine Kugel 5 angeordnet sein.
Die Kugel 5 besteht bevorzugt aus einem Vollmaterial, welches nur eine geringe oder keine elastische Verformbarkeit besitzt. Die Kugeln 5, in Figur 1 sind vier Kugeln 5 ersichtlich, berühren - im geschlossenen Zustand des Gehäuses 6 - somit gleichzeitig das Oberteil 2 und das Unterteil 3.
Am Oberteil 2 ist ein Vibrationsmodul 11 angeordnet und mit dem Oberteil 2 fest verbunden, so dass Schwingungen übertragbar sind. Das Vibrationsmodul 11, welches beispielsweise zumindest einen üblichen Elektroantrieb besitzt, welcher einen rotierbaren Körper mit einer Unwucht antreibt, erzeugt ursächlich die Schwingungen. Wird die Vibrationseinheit 1 eingeschaltet, erzeugt diese eine zu den Längsachsen des Oberteils 2 und des Unterteils 3 parallel gerichtete Schwingungen, welche damit zur jeweiligen Körperoberfläche des im Krankenfahrstuhl sitzenden Patienten parallelverlaufende Schwingungen sind.
Ist die Vibrationseinheit 1 horizontal angeordnet, erzeugt diese somit eine horizontale Schwingung.
Bei einer Vibrationseinheit 1 mit einer Unwucht (In Fig. 1 nicht dargestellt) wird insbesondere eine rotierende Schwingung erzeugt. Dadurch wird das Oberteil 3 ausgelenkt und die Schwingungen beispielsweise auf die Füße des sitzenden Patienten übertragen.
Die jeweilige Frequenz, mit welcher das Oberteil 3 schwingt, wird in üblicher Art und Weise, insbesondere durch die Dimensionierung und Anordnung einer Unwucht, die Auswahl des Elektroantriebes und/oder durch die gewählte Drehzahl, bestimmt.
Die Vibrationseinheit 1 kann in üblicher Art und Weise stufenweise oder stufenlos durch übliche elektrische Steuereinheiten geschaltet werden, so dass, wie gewünscht, insbesondere die Vibrationseinheit 1 wahlweise Schwingungen mit einem Wert aus dem Bereich von 1 bis 100 Hz, 30 - 50 Hz, 30 - 100 oder 40 - 100 Hz erzeugt.
Außerdem kann in üblicher Art und Weise die zeitliche Dauer der Erzeugung der Schwingungen bestimmt und begrenzt werden, beispielsweise auf zehn Minuten.The upper part 2 and the lower part 3 form - in the closed state - a plate-shaped housing 6, which can be designed in such a way that at least no splash water can penetrate into the interior of the housing 6 or at least is strongly prevented.
The overall height of the housing 6 in the closed state is between 3 and 4 cm, in Fig. 1 shown housing 6 3, 5 cm.
In the lower part 3, in each case an elastic sleeve, in Fig. 1 not shown, a ball 5 may be arranged.
The ball 5 preferably consists of a solid material which has little or no elastic deformability. The balls 5, in Figure 1 four balls 5 can be seen, touching - in the closed state of the housing 6 - thus simultaneously the upper part 2 and the lower part 3.
A vibration module 11 is arranged on the upper part 2 and is firmly connected to the upper part 2, so that vibrations can be transmitted. The vibration module 11, which has, for example, at least one conventional electric drive, which drives a rotatable body with an imbalance, causes the vibrations. If the vibration unit 1 is switched on, it generates vibrations which are directed parallel to the longitudinal axes of the upper part 2 and the lower part 3 and which are therefore vibrations running parallel to the respective body surface of the patient sitting in the elevator.
If the vibration unit 1 is arranged horizontally, it generates a horizontal vibration.
In the case of a vibration unit 1 with an unbalance (In Fig. 1 not shown), in particular, a rotating vibration is generated. As a result, the upper part 3 is deflected and the vibrations are transmitted, for example, to the feet of the seated patient.
The respective frequency with which the upper part 3 vibrates is determined in the usual way, in particular by the dimensioning and arrangement of an unbalance, the selection of the electric drive and / or by the selected speed.
The vibration unit 1 can be gradually or continuously in the usual manner are switched by conventional electrical control units, so that, as desired, in particular the vibration unit 1 optionally generates vibrations with a value in the range from 1 to 100 Hz, 30-50 Hz, 30-100 or 40-100 Hz.
In addition, the time duration of the generation of the vibrations can be determined and limited, for example to ten minutes.

Fig. 2 zeigt eine Ausführungsform eines Krankenfahrstuhls 7 mit zumindest einer Vibrationseinheit 1 in einer schematischen perspektivischen Ansicht.
Der fahrbare Krankenfahrstuhl 7 besitzt zumindest eine Fußstütze 8, einen Sitz 9 und eine Rückenlehne 10. Ansonsten kann der Krankenfahrstuhl 7 bekannte Funktionalitäten erfüllen und die diesbezüglich erforderlichen Bauteile, Baugruppen und Steuerprogramme entsprechend seinem jeweiligen Ausstattungsgrad besitzen. Fig. 2 shows an embodiment of a medical elevator 7 with at least one vibration unit 1 in a schematic perspective view.
The mobile medical elevator 7 has at least one footrest 8, a seat 9 and a backrest 10. Otherwise, the medical elevator 7 can fulfill known functionalities and have the necessary components, assemblies and control programs in accordance with its respective level of equipment.

Der Krankenfahrstuhl 7 ist zur Erst- und Frühmobilisation, insbesondere in der neurologischen Frührehabilitation, geeignet, welche eine allmähliche und kontinuierliche Vertikalisation aus einer Sitzposition heraus ermöglichen. Vom Liegen, über das Sitzen bis zum Stand kann ein kontinuierlicher Bewegungsablauf erfolgen, ohne dass der Patient selbst Energie aufbringen muss, um seine Position zu verändern. Dies erfolgt durch eine bekannte stufenlos veränderliche Positionsänderung des Krankenfahrstuhls(in Fig. 2 nicht dargestellt).
Ein solcher Krankenfahrstuhl 7 ist beispielsweise für schwer betroffene Patienten ohne posturalen Kontrolle geeignet.
Der Krankenfahrstuhl 7 ermöglicht zumindest drei Patientenpositionen, nämlich eine Sitz-, Liege- oder Standposition. Der Patient sitzt, liegt oder steht im oder auf dem Krankenfahrstuhl, wobei er mit den Füßen regelmäßig das Fußteil berührt.
Die Vibrationseinheit 1, beispielsweise eine gemäß Fig. 1, kann im Bereich der Fußstütze 8, des Sitzes 9 und/oder der Rückenlehne 10 des Krankenfahrstuhls 7 angeordnet sein. Im Ausführungsbeispiel gemäß Fig. 2 ist die Vibrationseinheit 1 im Bereich der Fußstütze 8 angeordnet und in der Fußstütze 8 integriert.The medical elevator 7 is suitable for initial and early mobilization, in particular in early neurological rehabilitation, which enable gradual and continuous verticalization from a sitting position. From lying down to sitting to standing, a continuous sequence of movements can take place without the patient himself having to exert energy to change his position. This is done by a known infinitely variable change in position of the medical elevator (in Fig. 2 not shown).
Such an elevator 7 is suitable, for example, for severely affected patients without postural control.
The medical elevator 7 enables at least three patient positions, namely a sitting, lying or standing position. The patient sits, lies or stands in or on the hospital elevator, regularly touching the foot section with his feet.
The vibration unit 1, for example one according to Fig. 1 , Can be arranged in the area of the footrest 8, the seat 9 and / or the backrest 10 of the elevator 7. In the embodiment according to Fig. 2 the vibration unit 1 is arranged in the area of the footrest 8 and integrated in the footrest 8.

Liste der BezugszeichenList of reference numbers

  • Vibrationseinheit 1Vibration unit 1
  • Oberteil 2Upper part 2
  • Unterteil 3Lower part 3
  • Verbindungselemente 4Fasteners 4
  • Kugel 5Ball 5
  • Gehäuse 6Housing 6
  • Krankenfahrstuhl 7Hospital elevator 7
  • Fußstütze 8Footrest 8
  • Sitz 9Seat 9
  • Rückenlehne 10Backrest 10
  • Vibrationsmodul 11Vibration module 11

Claims (8)

  1. Wheelchair with vibration unit, whereby the vibration unit (1) has an electrically driven rotating body, the vibration unit (1) is arranged in the area of the footrest (8) and/or the seat (9) of the wheelchair (7), and the wheelchair (7) can at least be adjusted to a sitting, lying, and standing position, whereby the vibration unit generates horizontal oscillations or oscillations parallel to the surface of the corresponding patient's body In the range of 1 to 100 Hz, characterized in that the vibration unit (1) has a deflectable upper section (2) and a lower section (3), which are connected to each other through elastically deformable connection elements (4), whereby the upper section (2) and the lower section (3) do not make direct contact, a vibration module (11) is arranged on the upper section (2), which is firmly connected to the upper section (2), whereby the vibration module (11) has at least one electric drive, balls (5) are arranged between the upper section (2) and lower section (3), whereby these balls (5) are in contact with the upper section (2) and lower section (3), and the vibration unit (1) can be switched by an electric control unit.
  2. Wheelchair according to Claim 1, characterized in that the oscillations are generated by an electrically driven rotating body.
  3. Wheelchair according to Claim 2, characterized in that the rotating body has an imbalance.
  4. Wheelchair according to Claim 2, characterized in that the electric drive is an unbalanced motor.
  5. Wheelchair according to Claim 1, characterized in that the vibration unit (1) can selectively generate oscillations at a frequency in the range of 1 to 100 Hz.
  6. Wheelchair according to Claim 1, characterized in that oscillations at a frequency of 25 - 100 Hz, or at an especially preferred frequency of 30 - 50 Hz, 30 - 100 Hz, or 40 - 100 Hz are generated.
  7. Wheelchair according to Claim 1, characterized in that the vibration unit (1) can selectively generate oscillations for a predefined period of time.
  8. Non-therapeutic use of a wheelchair according to at least one of claims 1 to 7 for applying horizontal oscillations or oscillations parallel to the surface of the corresponding patient's body in the range of 1 to 100 Hz.
EP16000113.7A 2015-02-17 2016-01-19 Wheel chair with vibration unit Active EP3058927B1 (en)

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DE102019000667A1 (en) 2019-01-31 2020-08-06 Reha & Medi Hoffmann Gmbh Mobilization wheelchair
DE202019002177U1 (en) 2019-05-20 2019-06-14 Reha & Medi Hoffmann Gmbh Data processing system for an electric motor driven ambulance or Mobilisationsrollstuhl

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IL132760A0 (en) * 1999-11-04 2001-03-19 Advanced Dialysis Methods Ltd Vibrator for treatment of constipation
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