EP4154859A1 - Medical apparatus for assisting patient to stand, control unit and control method therefor - Google Patents

Abstract

Medical apparatus (1) comprising an upper portion (2) and a lower portion (3), the upper portion (2) comprising a reception area for the upper limbs of the patient (21, 22), and the lower portion (3) comprising a zone for immobilizing part of the patient's lower limbs (31). The upper portion (2) is movable between a low position (EO), located towards the rear of the device and a high position (E3), located towards the front of the device and higher than the low position ( EO). The apparatus (1) comprises a control unit (4) and an actuating member (5), the control unit being configured to control the actuating member (5) to produce a movement of the upper portion (2) with respect to the lower portion (3) along a predetermined trajectory comprising a horizontal translation (T1) of the upper portion towards the front of the device followed by a displacement of the upper portion to the high position (E3).

Description

Technical area

The present disclosure relates to the field of medical devices for helping a patient to straighten up, i.e. to go from a seated position to a standing or intermediate position.

Prior art

Different devices such as standers, transfer bars or patient lifts can be used to help a person to move from a sitting position to a standing position, to be transferred from a bed to a chair or wheelchair and vice versa by going through the standing position or through an intermediate position. Furthermore, people can also be moved, when they are in a standing position or in an intermediate position thanks to these devices, for the toilet for example.

When the patient only needs a little help, a transfer handlebar can be used to help him up or to move from one sitting position to another. The patient's feet are then placed on a footrest and the patient presses his shins against a support zone provided for this purpose. He can then cling to a part in the shape of a handlebar and pull himself up with the strength of his arms. A qualified person, for example nursing staff, then helps the patient to pull himself up and straighten up by pushing on his pelvis, for example. In doing so, the nursing staff is exposed to the risk of musculoskeletal disorders, especially when this type of operation is repeated.

When the patient needs more help, electric standers and patient lifts are used. The entire effort is then supported by the device and the nursing staff is not involved. Electric standers can be used, for example, to enable patients to carry out various tasks while standing or to be transferred from one seated position to another. It should be noted that the standing position makes it possible to improve the intestinal function, to better solicit the respiratory and cardiovascular functions and has orthopedic benefits in particular. in stressing the joints, etc. Patient lifts are instead used to move patients between their bed and a chair. In both cases, the patients are harnessed to the device and lifted by it.

The use of these two types of apparatus has drawbacks. On the one hand, the patients being totally passive, this situation can be badly experienced by the patients who can refuse the use of the device and manifest an opposition to the care or an oppositional tone for example. On the other hand, when patients have a certain muscle tone and a certain motricity, their residual abilities are not called upon, which can lead to a deterioration in motor abilities, psychomotor maladjustment and bedriddenness when lying down. it's about old people.

It will also be noted that when using an electric stander, the patient, when placed in a so-called "standing" position, is in a retropulsion position, which does not favor the muscles used by a healthy patient to stand up and therefore does not promote the maintenance and restoration of its muscular and balance capacities.

There is therefore a need for a medical device to help a patient to straighten up, i.e. to move from a seated position to a standing or intermediate position while making the best use of his muscular capacities so as to facilitate his recovery while limiting the risks. musculoskeletal disorders of nursing staff helping him to recover.

Exposed

An object of the present disclosure is to remedy at least some of the above drawbacks.

In particular, an object of the present disclosure is to propose a medical device configured to help a patient to get up in a standing position or at least in an intermediate position between the seated position and the standing position while making it possible to better solicit his capacities. residual motor skills. In doing so, another object is to promote the restoration of the motor capacities of the patient or at the very least to limit the degradation of his residual motor capacities.

Another object of the present disclosure is to promote the acceptance of an apparatus for assisting the straightening of the patient between two seated positions or between a seated position and a standing or intermediate position.

Another object of the present disclosure is to limit the effort made by healthcare personnel in order to prevent associated musculoskeletal disorders.

There is proposed a medical device for helping a patient to stand up, said device comprising an upper portion and a lower portion, the upper portion comprising a zone for receiving the patient's upper limbs, and the lower portion comprising an immobilization zone part of the lower limbs of the patient, the patient being placed when using the device at the rear of said device. The upper portion is movable between a low position, located towards the rear of the device and in which the reception area can accommodate the upper limbs of the patient when said patient is in a starting seated position, and a high position, located towards the front of the appliance and higher than the low position. The apparatus comprises a control unit and an actuating member controlled by the control unit, the control unit being configured to control the actuating member to produce a movement of the upper portion with respect to the portion lower according to a predetermined trajectory, said trajectory comprising first of all, the upper portion being initially in the low position, a horizontal translation of the upper portion towards the front of the device to an intermediate position, followed by a displacement from the upper portion of the intermediate position to the high position.

• émission, à destination de l'organe d'actionnement, d'une commande de placement de la portion supérieure dans la position basse,
• émission, à destination de l'organe d'actionnement, d'une commande de translation horizontale de la portion supérieure vers l'avant de l'appareil jusqu'à une position intermédiaire,
• émission, à destination de l'organe d'actionnement, d'une commande de déplacement de la portion supérieure de la position intermédiaire jusqu'à la position haute.

According to another aspect, there is proposed a method for controlling a medical device to help a patient stand up, said medical device comprising an upper portion and a lower portion, comprising a zone for receiving the upper limbs of the patient, and the lower portion comprising a zone for immobilizing part of the patient's lower limbs, the patient being placed when using the device at the rear of said device, the upper portion being movable between a low position, located towards the rear of the device and in which the reception area can accommodate the upper limbs of the patient when said patient is in a starting seated position, and a high position, located towards the front of the device and more high than the low position, the apparatus further comprising an actuating member for producing a displacement of the upper portion relative to the lower portion, said control method comprising the steps following:

• transmission, to the actuating member, of a command to placement of the upper portion in the lower position,
• sending, to the actuating member, of a command for the horizontal translation of the upper portion forwards of the device to an intermediate position,
• transmission, to the actuating member, of a command to move the upper portion from the intermediate position to the upper position.

According to another aspect, there is provided a control unit comprising a memory and a processor, the memory comprising program code instructions which, when executed by the processor, configure said processor to implement the control method described above.

According to another aspect, a computer program is proposed comprising instructions for implementing all or part of a control method as defined herein when this program is executed by a processor. In another aspect, there is provided a non-transitory, computer-readable recording medium on which such a program is recorded.

The characteristics exposed in the following paragraphs can, optionally, be implemented. They can be implemented independently of each other or in combination with each other:

In one embodiment, the displacement from the intermediate position to the high position comprises first of all an oblique translation of the upper portion towards the front of the device and upwards, followed by a vertical translation of the upper portion upwards, to the high position. The horizontal translation followed by the oblique translation then the vertical translation of the upper portion of the device encourages the patient to reproduce with his body a movement close to his natural motor pattern during his recovery, which promotes recovery or maintenance of his motor capacities or at least to limit the deterioration of his residual capacities.

In one embodiment, the reception zone of the upper portion comprises a gripping zone and/or a support zone for the forearms.

In one embodiment, the control unit is configured to control the actuating member to maintain the orientation of the upper portion invariant during its movement along the predetermined trajectory.

In a particular embodiment, the apparatus further comprises a strap and a strap retractor, the strap being intended to be attached to a harness intended to be fixed on the patient, the strap retractor being controlled by the unit control. Thus, when the residual capacities of the patient are insufficient, the latter can be helped by the harness which helps to tow him during his straightening movement in the standing position.

In one embodiment, the control unit controls the strap retractor together with the actuating member so as to reduce the length of the strap over at least part of the predetermined trajectory.

In one embodiment, the device is configured to determine a level of patient participation, and the control unit is configured to adjust the control of the actuator according to the determined level of participation; whereby the control of the actuating member is adapted according to the physical condition of the patient.

In one embodiment, the actuating member comprises at least one electric actuator controlled in position and in speed by the control unit, the control unit is configured to determine a level of patient participation as a function of a power supply current to the electric actuator, and the control unit is configured to adjust the speed of the electric actuator according to the determined participation level; whereby the time taken by the actuators to reach their set position is adapted according to the level of patient participation. Thus, the stress exerted by the device is adapted to the residual capacities of the patient by avoiding slowing down a patient in good physical condition or stressing a patient in less good condition too quickly.

In one embodiment, the device further comprises means for moving the device and at least one sensor adapted to detect that pressure is exerted by a user on an upper frame of the device, and in which the the control unit is configured to control the moving means as a function of signals received from the at least one sensor; whereby the device can detect when the nursing staff wishes to move the patient on the device and actuate motorized moving means. This facilitates the tearing of the device at the start of movement from one place to another, which limits the force to be applied by the nursing staff to initiate the movement of the device. This limits the musculoskeletal disorders caused by moving the device. Advantageously, the device can also detect, thanks to its sensors, the desired direction of movement and orient the means of movement according to the direction of movement detected. Finally, thanks to the sensors, the nursing staff can easily orient the movement of the device by acting on an easily accessible upper frame of the device.

The medical device proposed makes it possible to help people to straighten up, either with a view to occupying the standing position or an intermediate position temporarily, or intermediately between two different seated positions, for example such as the devices known under the name transfer handlebars or electric standers. Advantageously, the displacement of the upper portion of the device intended to accommodate the forearms and/or the hands of the patient makes it possible to tow the patient upwards while soliciting his muscles. In addition, the trajectory of movement forwards then upwards favors the reproduction of the natural motor pattern with antepulsion during verticalization. The patient thus solicits the same muscles as those he uses naturally to get up. This encourages the restoration or maintenance of his motor skills and prevents the deterioration of his motor skills. We also avoid the psychomotor maladjustment caused by the non-reproduction of natural movements. Moreover, the movement being more natural and the use of the device less degrading, the device is better accepted. In addition, the patient being solicited, he can regain confidence in himself and in his abilities.

Brief description of the drawings

• La figure 1 montre un appareil médical en perspective selon un mode de réalisation ;
• La figure 2 montre l'appareil médical de la figure 1 selon une autre vue en perspective ;
• Les figures 3A, 3B, 3C et 3D montrent le patient utilisant l'appareil médical de la figure 1 à différents instants ;
• La figure 4 montre la trajectoire suivie par une portion supérieure de l'appareil selon un mode de réalisation.

Other characteristics, details and advantages will appear on reading the detailed description below, and on analyzing the appended drawings, in which:

• There figure 1 shows a medical device in perspective according to one embodiment;
• There figure 2 shows the medical device of the figure 1 according to another perspective view;
• THE Figures 3A, 3B , 3C and 3D show the patient using the medical device of the figure 1 at different times;
• There figure 4 shows the trajectory followed by an upper portion of the apparatus according to one embodiment.

Description of embodiments

The drawings and the description below contain, for the most part, certain elements. They may therefore not only serve to better understand this disclosure, but also contribute to its definition, where applicable.

Reference is now made to figure 1 And 2 which show two perspective views of a medical device 1 according to one embodiment. The medical device presented here can be used to allow the patient to adopt a standing position temporarily or to carry out a transfer between two different seated positions by passing through the standing position, such as stand-ups or transfer handlebars.

The medical device 1 comprises an upper portion 2 and a lower portion 3. The upper portion 2 comprises a reception area intended to accommodate the upper limbs of the patient such as the forearms and/or the hands of the patient, for example in to guide the patient when moving from a seated to a standing position. The reception area of the upper portion 2 can comprise for example, as shown in the figure 1 , at least one gripping zone 21 intended to be gripped by the patient and a support zone for the forearms 22. The reception zone of the upper portion 2 can comprise for example as illustrated in the figure 1 an internal gripping zone 21a and an external gripping zone 21b, intended to be gripped by both hands of the patient. The patient can thus choose the gripping area that suits him best. The forearm support zone 22 can be formed by a tablet on which the patient can place his two forearms. Optionally, the upper portion 2 can also comprise two angled arms forming a guardrail 23 adapted to frame the patient's torso when the latter grips a grip zone 21 and places his forearms on the support zone 22 Of course, other configurations of the upper portion 2 are possible. For example, the reception zone of the upper portion 2 can take the form of a V-shaped racing bicycle handlebar comprising two angled arms shaped to form, on an upper part, a gripping zone and on a lower part the guardrail, the lower part being optionally able to form two zones forearm support. It will be noted that in certain variants, the reception zone of the upper portion 2 may only comprise a support zone for the forearms, in which case the forearms are preferably fixed by straps on the zone 'support. Such a variant embodiment is particularly advantageous when the patient does not have enough strength or is unable to grip the gripping zone, for example in the event of paralysis of the hands. In another variant, one could also consider a reception zone of the upper portion 2 comprising only handles when the patient has sufficient strength and does not need to support his forearms to be guided in his movement by the device.

The lower portion 3 comprises an immobilization zone intended to accommodate and immobilize the lower limbs of the patient such as the shins for example and optionally the feet of the patient for example. As shown on the figure 1 , the immobilization zone of the lower portion 3 can comprise for example a support zone for the shins 31, said support zone 31 being intended to form an abutment for the patient's shins. By convention, the patient to be helped to stand up is considered to be located towards the rear of the medical device 1 (the direction towards the front of the medical device 1 corresponds to the direction along the X axis represented on THE figures 3A-3D ). The support zone for the shins is therefore located, with respect to the shins of the patient which are towards the rear of the medical device 1, towards the front of the medical device 1. The zone for immobilizing the portion lower 3 can also optionally comprise, as more particularly visible on the figure 1 , a footrest 32. The footrest 32 may optionally include a stopper 33 configured to block the back of the patient's feet. Additionally, optionally, footrest 32 may also include an anti-slip surface. The immobilization zone of the lower portion 3 can also comprise, as an alternative to the use of the rear stop, a device for holding the feet on the footrest 32 such as a strap for example. In addition, the foot support device may also include front and rear stops. Alternatively, the lower portion 3 can be configured to hold other parts of the lower limbs such as the knees or another part of the legs, for example in the event of amputation or paralysis. It should also be noted that the patient's lower limbs may also include parts artificial devices such as prostheses. Furthermore, the device 1 may also include, in some cases, a frame 7, the lower portion 2 being mounted fixed relative to the frame 7.

According to the present disclosure, the upper portion 2 is movable relative to the lower portion 3 between a low position E0, located towards the rear of the device 1 and a high position E3, located towards the front of the device 1 By “high” and “low” it is simply meant that the high position E3 is situated higher with respect to the ground than the low position E0. When the upper portion 2 is in the low position E0, said upper portion 2 is substantially vertical to the tibia support zone 31 and the patient in the seated position can grip the gripping zone 21 and/or place his forearms on the support zone 22, the reception zone thus accommodating the upper limbs of the patient ( Figure 3A ). When the upper portion 2 is in the high position E3, the patient is in a standing position ( 3d figure ).

When mobilizing the patient between the seated position and the standing position as seen on the figures 3A to 3D , his shins are in abutment against the support zone for the shins 31 so that the patient's feet and shins are immobilized, the thighs, the torso and the pelvis being able to move to allow the patient to straighten up. It will be noted that the movement of the upper portion 2 of the device from the low position E0 to the high position E3 helps the patient to stand up by gripping the gripping zone and leaning on his forearms, the patient appealing to his residual motor skills, particularly in the pelvis and thighs, to straighten up.

Advantageously, the upper portion 2 moves relative to the lower portion 3 according to a predetermined trajectory which favors the reproduction of the motor pattern naturally used by a person in good health. In particular, the trajectory comprises a horizontal translation of the upper portion forwards of the device from the low position E0 to an intermediate position E1 then a displacement of the upper portion 2 from the intermediate position E1 to the high position E3. It will be noted that the movement of the upper portion 2 along the predetermined trajectory causes, for the patient leaning on and/or clinging to the upper portion 2, the movement of the patient's bust forward, which promotes the use of 'a movement of antepulsion for straighten up, which promotes the restoration of his muscular and balancing capacities or at least limits the deterioration of his residual capacities. It is recalled that with the devices of the prior art, the muscles making it possible to reproduce the natural straightening movement are not solicited.

There figure 4 illustrates a trajectory according to a particular embodiment and comprises, as previously described, a horizontal translation T1 of the upper portion towards the front of the device from a low position E0 to a first intermediate position E1. In the embodiment described here, this translation is followed by an oblique translation T2 of the upper portion towards the front of the device and upwards until reaching a second intermediate position E2. This translation is followed by a vertical translation T3, in the direction y, of the upper portion upwards until reaching the high position E3. It will be noted that the horizontal translation T1 is oriented along an axis x corresponding to a horizontal axis with respect to the ground, that the vertical translation T3 is oriented along an axis y corresponding to a vertical axis with respect to the ground and that the oblique translation T2 comprises a component along the x axis and a component along the y axis. The low position E0 can vary and be adjusted according to the initial seat height of the patient, to allow the patient in a seated position to grip the grip zone 21. The high position E3 as well as the first and second intermediate positions E1 , E2 may vary depending on the patient's morphology.

There Figure 3A represents the initial position of the patient E0 when seated. The shins rest against the support zone 31 and, in the embodiment described here, the feet are placed on the footrest 32 and the back of the feet is in contact with the stop 33. The hands grip a grip zone 21, here the external handles, and the forearms rest on the support zone 22. Then, when the upper portion 2 of the device moves forwards, according to the horizontal translation T1 according to the x axis, as shown in the Figure 3B , the patient tilts forward and begins to lift the buttocks from the seat. The upper portion 2 of the device then moves as illustrated in the Fig. 3C simultaneously forwards and upwards, according to the oblique translation T2, so that the patient straightens up with the upper body tilted forwards and leaning on his legs, the lower part of which is immobilized. Then the portion upper part 2 of the device moves upwards according to the vertical translation T3 according to the y axis as illustrated by the 3d figure , to reach the high position E3.

In order to adapt to the morphology of the patient, it is possible, for example, to define three user profiles depending on whether the patient is small, medium-sized or tall using a user interface. It is therefore possible to define three types of trajectories in which the positions E1, E2, E3 vary according to the profile of the user used. The positions E1 and E2 can be defined along the x axis as a function of the total horizontal travel of the upper portion, for example, and vary as a function of the profile considered, for example as a function of a reference size. The slope of the oblique translation T2 and the total horizontal stroke can be fixed or vary according to the profile used. The high position E3 can be defined according to a reference height specific to each profile. Finally, the trajectory can also take into account a different initial seat height to determine the height along the y axis of the low position E0.

By way of example, the total horizontal stroke can be comprised for example between 200 and 400 mm and vary according to the profiles. For example, the horizontal stroke can be set at 250 mm for a small patient, 300 mm for a medium-sized patient and at 350 mm for a tall patient. The total vertical stroke can be determined according to the reference height specific to each profile and, optionally, according to the seat height. Furthermore, position E1 can correspond to between 30 and 70% of the total horizontal travel and position E2 can correspond, along the x axis, to the rest of the maximum horizontal travel and along the y axis to between 25 and 50 % of total vertical travel.

It will be noted that the device can also be used, in a similar manner, to move from a standing position to a seated (or lying) position. The control unit 4 is then configured to control the actuation member 5 to produce a movement of the upper portion 2 relative to the lower portion 3 according to another predetermined trajectory between the high position E3 and the low position E0.

The trajectory used may correspond to the reverse of the trajectory used to put the person upright. Thus, the trajectory may include first of all, the upper portion being initially in the high position E3, a displacement of the upper portion from the high position E3 to an intermediate position E1, followed by an inverse horizontal translation of T1 from the upper portion towards the rear of the device to the low position E0. The movement from the high position to the intermediate position E1 may first of all comprise an inverse vertical translation of T3 from the upper portion downwards to the intermediate position E2 followed by an inverse oblique translation of T2 from the upper portion towards the back of the device and downwards.

To allow the movement of the upper portion 2 with respect to the lower portion 3, the apparatus 1 comprises a control unit 4 comprising a memory and a processor intended to control a movement actuation member 5 adapted to move the upper portion 2 between the low position and the high position according to the predetermined paths described above, these paths being determined by the control unit 4, for example according to the initial seat height and the user profile selected as described above. To do this, the control unit sends commands to the actuating member 5 and in particular a command to place the upper portion in the low position (E0). To this end, the memory comprises computer program instructions which, when executed by the processor, configure the latter to determine the commands sent to the actuating member 5.

In general, the actuating member 5 can include one or more actuators. They may for example be hydraulic, pneumatic or electric cylinders or even one or more electric motors associated with mechanisms such as gears or cams to convert the movement of the electric motor or motors into a movement of the upper portion. 2 according to the predetermined trajectory. In a preferred embodiment, the actuator member 5 comprises at least one electric actuator, such as an electric motor or an electric jack. In the embodiment described here, the actuator 5 comprises three electric cylinders 51, 52, 53. The cylinder 52 is intended to move the upper portion 2 in a direction of translation defined by the axis of the cylinder 52, the cylinder 52 being rotatably mounted on the frame 7 so that an actuation of the cylinder 51 makes it possible to orient the axis of the cylinder 52. Furthermore, the upper portion 2 is rotatably mounted on the cylinder 53, so that the cylinder 53 makes it possible to adjust the orientation of the upper portion 2 by relative to the frame 7. It is thus possible to adjust the orientation of the upper portion 2 during the translation movements T1, T2, T3 generated by rotation and translation using the cylinders 51 and 52. The cylinder 53 is preferably controlled so that the orientation of the upper portion 2 remains invariant when moving along the predetermined path. Thus, the guardrail can be maintained in an optimal position to surround the trunk of the patient throughout the movement of the upper portion. In addition, the position of the forearms remains substantially constant during movement, which makes it possible to avoid unnecessary strain on the muscles of the arms and shoulders and reduces the risk of contractures. It will be noted that the use of electric actuators is particularly advantageous because it makes it possible to obtain a smoother movement of the upper portion of the apparatus, the movement of the various actuators having better synchronization and being easily reconfigurable. In addition, the device thus obtained is more compact and easier to maintain and maintain than a device comprising hydraulic and/or pneumatic cylinders.

Optionally, the device 1 may further comprise a strap and a strap retractor 6 controlled by the control unit 4. For simplicity, only the strap retractor 6 is shown in the figures, and said retractor is by example attached to the upper portion 2 of the device 1. The strap is intended to be attached to a harness intended to be attached to the patient, for example on his pelvis or his torso. The harness may for example be in the form of a sacro-lumbar belt or in other forms known to those skilled in the art.

Advantageously, the strap winder 6 is controlled by the control unit 4 together with the actuating member 5 at least over part of the predetermined trajectory, so as to gradually reduce the length of the strap during the displacement of the upper portion 2 from the low position E0 to the high position E3, over at least part of said displacement from the low position E0 to the high position E3. Thus, the harness is gradually brought closer to the strap retractor 6 (and therefore to the upper portion 2) during the movement of the upper portion 2 from the low position E0 to the high position E3. The harness can thus exert, in addition to its function of stabilizing and securing the patient, a traction at the level of the pelvis or the torso of the patient during his mobilization favoring also the adoption of the natural motor pattern when his muscular forces are insufficient in particular. It is for example possible to control the retractor so as to tow the patient throughout the movement of the upper portion of the apparatus or only over a portion of its movement. The winder can for example be controlled with a constant speed of rotation around its axis or with different speeds depending on the position of the upper portion 2 of the device on the predetermined trajectory.

Advantageously, the device can also be configured to adapt the displacement of the upper portion of the device according to the physical condition of the patient. In particular, the apparatus is configured to determine a patient's level of participation and to adjust the control of the actuation member 5 as a function of the patient's level of participation.

When the actuator 5 comprises at least one electric actuator such as an electric actuator as is the case here, it is possible to measure a supply current of at least one electric actuator to deduce the level of participation of the patient and adjust the control of the actuator according to the level of patient participation. Indeed, the more the patient participates, the less the electric actuator will consume energy.

In the present case, the electric actuators being controlled in position, it is possible to adjust the speed or rather the time that the actuators take to reach their set position. Thus, a patient in better physical condition will not be limited in his natural movement by a faster movement of the upper portion of the device. For patients requiring a high degree of assistance, a slower motion will be beneficial.

Advantageously, to determine the patient's level of participation, the control unit 4 measures an indicator of the electrical consumption Cmes of the electrical actuator when the actuator member is controlled to move over at least part of the predetermined trajectory between the low position E0 and the high position E3, the patient being on the device 1 and straightening up with the help of the device 1.

Furthermore, the control unit 4 determines an indicator of the reference electricity consumption Cref for the patient, this indicator of the reference electricity consumption Cref being determined according to a weight indicator and possibly a height indicator of the patient. This indicator of the reference electrical consumption is representative of the consumption that the electric actuator would have if a reference patient with the same weight indicator and possibly the same height indicator is on the device and is totally passive during the displacement of the upper portion.

An indicator of the electrical consumption of the electrical actuator is also determined when the actuating member moves empty Cvacuum over at least part of the predetermined path between the low position E0 and the high position E3, the patient does not being therefore not on device 1. The level of participation PartPat can then be determined as follows: ${\mathit{Go}}_{\mathit{Pat}}=\frac{\left({\mathrm{VS}}_{\mathit{ref}}-{\mathrm{VS}}_{\mathit{my}}\right)}{\left({\mathrm{VS}}_{\mathit{ref}}-{\mathrm{VS}}_{\mathit{empty}}\right)}$

Thus, the patient's level of participation is determined in relation to the empty consumption of the electric actuator when it is subjected to the same instruction. Furthermore, the variation in electrical consumption induced by the patient also depends on his weight and possibly on his height. Thus, the level of participation is also determined in relation to a reference determined according to the weight and possibly the height of the patient. The weight and height of the patient can be assessed roughly by an indicator: fat, thin, normal and small size, average size and large size for example or more finely by taking into account the weight and the actual height of the patient. .

Thus, all things considered, the more the patient participates, the more the measured electrical consumption will decrease and the less the patient participates, the more the measured electrical consumption will approach the reference electrical consumption for a person of similar weight and possibly of similar height.

Then, using the determined participation level, a speed correction coefficient Coeff _corr of the electric actuator is deduced and the control of the electric actuator is adjusted according to the speed correction coefficient.

The electric actuator speed correction coefficient can be calculated as follows:] $${\mathit{coefficient}}_{\mathit{correct}}=1+\left({\mathit{Go}}_{\mathit{pat}}\ast R\_\mathit{gain}\_\mathit{name}\_\mathit{max}-1\right)$$

R_gain_nom_max being a proportionality coefficient taking into account the maximum speed that can be reached by the electric actuator relative to the nominal control speed of the electric actuator in the absence of patient participation. Thus, the higher the level of participation of the patient Part _Pat , the more the speed correction coefficient Coeff _corr increases.

When the electric actuator is controlled by a PWM (Pulse Width Modulation) signal, the duty cycle defines the speed used to reach the setpoint position. Thus, by multiplying the duty cycle of the PWM setpoint signal by the speed correction coefficient Coeff _corr , the speed of the electric actuator is adjusted according to the level of participation determined. Thus, the higher the level of participation of the patient Part _Pat , the more the speed correction coefficient Coeff _corr increases and the more the speed of the actuator to reach the setpoint position increases.

The various indicators of electrical consumption mentioned above may correspond to electrical currents measured at the terminals of the electrical actuator ( C _mes ), determined according to a weight indicator and possibly an indicator of the patient's height ( C _ref, ), or even correspond to the electric current at the terminals of the electric actuator in the absence of a patient on the device ( C _empty ).

Back to the picture 2 , the device 1 may further comprise means for moving the device. The patient can thus be moved, for example, from his bed to the bathroom to wash himself or be easily transferred from a seated position to another seated position. For example, the frame 7 can be mounted on several wheels 71 in order to allow movement of the device.

Furthermore, at least one of the wheels 71 can be driving so that the movement of the device is assisted, in particular at the start of the movement in order to limit the force exerted by the nursing staff to set the device in motion. This limits the musculoskeletal disorders induced on the nursing staff when the device is moved. The drive wheel is then controlled by the control unit 4. In the example described here, the device 1 comprises four wheels 71 arranged at the four corners of the frame 7 and a drive wheel 71a located under the frame 7 between the four wheels 71. Of course, other configurations are possible and the device can for example comprise two wheels or four driving wheels 71. The driving wheel comprises an electric stepper motor and a corresponding control unit.

In the embodiment described here, the frame 7 further comprises a lower frame 72 on which is mounted an upper frame 73. The upper frame 73 is mounted so as to be able to be moved relative to the lower frame 72 when sufficient pressure is exercised. The upper frame 73 can for example be mounted on studs made of elastic material such as natural rubber or elastomer. Advantageously, the upper frame 73 can be used by the nursing staff to direct the movement of the device and to exert pressure in order to tow the device. To this end, it will be noted that the upper frame 73 is able to be moved independently of the upper portion 2 of the device 1.

The device further comprises at least one sensor 74 suitable for detecting that a pressure is exerted by a user on an upper frame 73 of the device and the control unit 4 is configured to control the displacement means as a function of signals received from the at least one sensor 74. Advantageously, the at least one sensor 74 is located at the junction between the upper frame 73 and the lower frame 72.

The control unit 4 can for example be configured to trigger means for moving the device from the signals received from the at least one sensor when the control unit 4 determines that the pressure exerted on the upper frame 73 is greater than a reference value. The control unit 4 then issues at least one command intended for the displacement means and more particularly the controller of the drive wheel(s) comprising a rolling command in order to trigger an assisted displacement of the device. Thus, the actuation of the displacement means is only triggered when a force applied by the caregiver is greater than the reference force. Advantageously, this reference force is chosen to correspond to the value beyond which it is considered that musculoskeletal disorders may occur. According to the standards currently in force, it can be a force of between 6 and 8 kg.

Furthermore, as a variant or in addition, the control unit 4 can be configured to determine a desired direction of movement of the device from the signals received from the at least one sensor. The device then comprises a plurality of sensors, the signals emitted by these can be used to determine a desired direction of movement and the control unit 4 then sends a command to the controller of the drive wheel(s) comprising a steering control of the drive wheel(s).

The sensors 74 are then distributed at different places between the upper frame 73 and the lower frame 72 as visible on the figure 2 . These may be simple sensors, for example a “push button” type sensor, emitting a signal when a predefined portion of the upper frame 73 is above a predefined portion of the lower frame 72. Such sensors thus make it possible to determine whether a portion of the upper frame has moved in a determined direction following pressure applied to the upper frame 73. These may also be pressure sensors capable of measuring the pressure exerted on the sensor by the senior manager 73 and therefore by the nursing staff. Depending on the type of sensor used, the orientation of the drive wheel(s) is determined more or less precisely, the best accuracy being obtained with pressure sensors.

Optionally, the device 1 may comprise means for immobilizing the device, intended to be activated in particular when the upper portion 2 of the device moves between the low position and the high position and vice versa. These immobilization means can be formed by a brake 8 placed for example at the front of the device 1. The brake can therefore be easily engaged by the nursing staff when the latter is in front of the device. As a variant or in addition, the immobilization means may correspond to a blocking of the drive wheel(s) and be activated by the control unit 4, in particular by sending a command to block the corresponding drive wheel(s).

It will also be noted that the apparatus presented here allows a verticalization or a transfer of a patient from one place to another not having sufficient residual capacities, the patient being able if necessary to be towed into the position adapted to the phase of the movement in progress using the harness and the retractor controlled by the control unit in conjunction with the movement of the upper portion of the device. In addition, the device is able to adapt the help straightening according to the patient's real abilities by measuring his level of participation in the straightening movement. The assistance provided by the device also makes it possible to reduce the musculoskeletal disorders of the nursing staff since the latter no longer has to provide effort to help the patient to stand up or to set the device in motion when moving the patient. here from one place to another.

Thus, any person with sufficient residual capacities in terms in particular of tonus of the upper and lower limbs and of the trunk and of sufficient articular amplitude allowing recovery, capable of leaning on at least one foot and of gripping the gripping area , to hold a seated balance and to stabilize in a standing position with support can use the device.

It should be noted that the medical device presented here is designed to allow the patient to straighten up and adopt a natural and vertical standing position, by promoting the movement of antepulsion forwards when passing from the seated position to the standing position. upright and vice versa. The feet, knees, hips and shoulders are then substantially aligned in a vertical direction. In variant embodiments, depending on the type of use envisaged, the medical device can also be used to promote the adoption of a position comprised between the seated position and the standing position. The high position of the present invention is then lower than for the standing position but the forward translation, starting from the low position, followed by a movement towards the high position always makes it possible to promote the movement of antepulsion and therefore the reproduction of natural movements to straighten up, which promotes the use of the patient's residual capacities.

Claims (13)

Medical device (1) for helping a patient to stand up, said device comprising an upper portion (2) and a lower portion (3), the upper portion (2) comprising a zone for receiving the upper limbs of the patient (21, 22), and the lower portion (3) comprising a zone for immobilizing part of the lower limbs of the patient (31), the patient being placed when using the device at the rear of the said device, characterized in that : - the upper portion (2) is movable between a low position (E0), located towards the rear of the device and in which the reception area can accommodate the patient's upper limbs when said patient is in a seated position departure, and a high position (E3), located towards the front of the device and higher than the low position (E0), and - the apparatus (1) comprises a control unit (4) and an actuating member (5) controlled by the control unit (4), the control unit being configured to control the actuating member (5) to produce a displacement of the upper portion (2) with respect to the lower portion (3) according to a predetermined trajectory, said trajectory comprising first of all, the upper portion being initially in the low position (E0), a translation horizontal (T1) of the upper portion towards the front of the device to an intermediate position (E1), followed by a displacement of the upper portion from the intermediate position to the high position (E3). Device according to Claim 1, in which the displacement from the intermediate position to the high position comprises firstly an oblique translation (T2) of the upper portion towards the front of the device and upwards, followed by a vertical translation (T3) of the upper portion upwards, to the high position (E3). Device according to any one of the preceding claims, in which the reception zone of the upper portion (2) comprises a grip zone (21) and/or a support zone for the forearms (22). Apparatus according to any preceding claim, wherein the control unit (4) is configured to control the actuating member (5) to keep the orientation of the upper portion invariant during its movement along the predetermined trajectory. Apparatus according to any preceding claim, wherein the apparatus further comprises a strap and a strap retractor (6), the strap being intended to be attached to a harness intended to be attached to the patient, the retractor strap (6) being controlled by the control unit (4). Apparatus according to claim 5, wherein the control unit (4) controls the strap winder (6) together with the actuating member (5) so as to reduce the length of the strap over at least a of the predetermined trajectory. Apparatus according to any preceding claim, wherein: - the device is configured to determine a level of patient participation, - the control unit is configured to adjust the control of the actuation member according to the determined level of participation. Apparatus according to claim 7, wherein: - the actuating member (5) comprises at least one electric actuator (51, 52, 53) controlled in position and in speed by the control unit (4), - the control unit (4) is configured to determine a level of participation of the patient according to a supply current of the electric actuator, and - the control unit (4) is configured to adjust the speed of the electric actuator according to the level of participation determined. Apparatus according to any preceding claim, wherein the apparatus (1) further comprises means for moving (71a) the apparatus and at least one sensor (74) adapted to detect that pressure is exerted by a user on an upper frame (73) of the apparatus, and in which the control unit is configured to control the means of displacement according to signals received from the at least one sensor. Method for controlling a medical device (1) to help a patient stand up, said medical device comprising an upper portion (2) and a lower portion (3), comprising a reception area for the upper limbs of the patient (21 , 22), and the lower portion (3) comprising a zone for immobilizing part of the lower limbs of the patient (31), the patient being placed when using the device at the rear of said device, the upper portion (2) being movable between a low position (E0), located towards the rear of the device and in which the reception area can accommodate the upper limbs of the patient when said patient is in a starting seated position, and a high position (E3 ), located towards the front of the device and higher than the low position (E0), the device (1) further comprising an actuating member (5) for producing a movement of the upper portion (2) with respect to the lower portion (3), said control method comprising the following steps: - transmission, to the actuating member (5), of a command to place the upper portion in the lower position (E0), - transmission, to the actuating member (5), of a command for the horizontal translation of the upper portion forwards of the device to an intermediate position (E1), - transmission, to the actuating member (5), of a command to move the upper portion from the intermediate position (E1) to the high position (E3). Method for controlling a medical device (1) according to claim 10, in which the control for moving the upper portion (2) from the intermediate position (E1) to the high position (E3) comprises an oblique translation ( E2) of the upper portion towards the front of the device and upwards, followed by a vertical translation (E3) of the upper portion upwards, to the high position. A method of controlling a medical device (1) according to any one of claims 10 to 11, wherein the device further comprises a strap and a strap retractor (6), the strap being intended to be attached to a harness intended to be fixed on the patient, the strap winder (6) is controlled jointly with the actuating member (5) so as to reduce the length of the strap during the movement of the upper portion (2 ) from the low position (E0) to the high position (E3). A control unit (4) comprising a memory and a processor, the memory comprising program code instructions which, when executed by the processor, configure said processor to implement the control method according to any of claims 10 to 12.

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