FR2715821A1 - Function re-education aid, esp. for the spine - Google Patents

Abstract

The air consists of a curvature sensor (11) with an output value related to its degree of curvature, an acquisition and processing unit (13) for the sensor output values, connected electrically to the sensor, and a data transfer and processor. The acquisition/processing unit is self-contained and portable, with a separate feed, control and storage systems for the sensor output values, and a feedback system. The sensor comprises a detector mounted on a supple and flat support and an electromagnetic wave emitter and receiver, and a supple and hollow wave guide tube of silicone. The acquisition/processing unit (13) contains a micro-controller (33) for the sensor output values, a memory (34) to store the values in code form, a control circuit (35) and a warning signal emitter (36).

Description

AID FOR FUNCTIONAL REHABILITATION,
ESPECIALLY OF THE RACHIS.

The present invention relates to a device for assisting with functional rehabilitation, in particular of the spine, comprising a curvature sensor delivering an output variable depending on its curvature, this sensor being placed on an area to be re-educated of a patient, a device for conditioning and acquisition of said output quantities connected to the curvature sensor by an electrical connection, a data transfer device and a data processing device
Among the objectives frequently sought during spinal rehabilitation, one aims in particular
- improving control of the spine's curvatures,
- correction of the degree of curvature of one or more
spinal segments (particularly in infant orthopedics).

The therapist then frequently encounters difficulties in the patient's awareness of the differential mobilities of the spinal segments and of the influence of the movements of the limbs on the spinal statics. The precise materialization of corrective exercise instructions often remains very uncertain in the absence of rigorous criteria of objectification, the therapist's eye being often the only means of measurement. Finally, the evaluation of the spinal control of a patient is very subjective for the same reasons while the treatments are spread over several months, even several years. In addition, since rehabilitation can only be done under the supervision of a therapist, it cannot be carried out freely at home with all the guarantees of correct execution. Consequently, it would be interesting to have a feedback device capable of objectively confirming therapy over the entire duration of the treatment. In addition, the value of feedback in functional rehabilitation has been demonstrated in particular by BASMAJAN
ZV (Facts vs miths in EMG Biofeedback. Biofeedback and Self
Regulation, 1976, 1, 369-371), S. GREENBERG (Kinesthetic Biofeedback A treatment Modality for Elbow Range of Motion in
Hemiplegia. The American Journal of Occupational Therapy - November 1980, volume 34, No. 11) and OP WOOLDRIDGE (Biofeedback
Background and applications to physical rehabilitation, Bulletin of
Prosthetics Research - Spring 1976) in the sense that it allows the refinement of a differentiated therapy.

A number of electronic goniometers have been developed for specific applications involving various parts of the body, including the wrist, knee and ankle, hand or elbow. These goniometers use different sensors such as potentiometers, strain gauges, Hall effect sensors or optical fibers. The main difficulty for angle measurements lies in the interpretation of the measurement results according to the morphology of the part of the body concerned. Indeed, the existence of several centers of flexion in the joints makes that the curvature generated is not uniform and makes the interpretation of the measurements difficult. In addition, almost all these goniometers require a heavy conditioner, which is not portable and therefore limited to clinical use. The devices designed to be portable are intended for simple feedback and are not provided with a measurement acquisition system.

The present invention proposes to overcome these drawbacks by providing a portable device allowing feedback and recording of events related to the patient's position and the individualized position limits set by the therapist, as well as storage and statistical analysis of these events.

This object is achieved by a device as defined in the preamble and characterized in that the packaging and acquisition device is an autonomous and portable device, and in that it comprises at least autonomous supply means, means for monitoring and continuously storing the values of the output quantity of the sensor, feedback means activated as a function of said values and means of communication with the data processing device.

According to a preferred embodiment, the curvature sensor comprises detection means mounted on a flat flexible support, said means comprising at least one emitter of electromagnetic waves, a receiver of said waves and a waveguide arranged to guide said waves from transmitter to receiver.

Preferably, the transmitter comprises a light-emitting diode having an emission spectrum advantageously defined with respect to the receiver.

The receiver preferably comprises a phototransistor debiting on a resistive network, and the sensitivity of which is adapted to the emission spectrum of the transmitter.

According to a preferred embodiment, the waveguide generates losses of transmission of electromagnetic waves depending on its curvature. I1 is advantageously formed of a flexible hollow tube and smooth comprising silicone.

 The transmitter, the receiver and the resistive network are advantageously mounted on a printed circuit engraved on the flexible support.

According to an advantageous embodiment, the flexible support carrying the printed circuit, the transmitter, the receiver, the resistive network and the waveguide are molded in a flexible body.

According to the preferred embodiment, the waveguide is concave with respect to the plane of the support.

According to a preferred embodiment, the control and storage means of the conditioning and acquisition device comprise at least one microcontroller arranged to control the values of the output quantity of the sensor with respect to limit values fixed by the therapist, and a memory arranged to memorize a coding of said values.

Preferably, the feedback means of the conditioning and acquisition device comprise at least one control circuit controlled by the microcontroller, and a warning device arranged to deliver a sound feedback signal dependent on the output of the curvature sensor and the limit values set by the therapist.

The conditioning and acquisition device advantageously comprises a switch arranged to control the feedback means.

According to an advantageous embodiment, the communication means of the conditioning and acquisition device comprise a communication interface arranged to transmit the data stored in the memory to the data processing device via the transfer device.

The transfer device advantageously includes means for recharging the packaging and acquisition device.

According to a preferred embodiment, the data processing device is a microcomputer managed by specific software and arranged to manage patient files, initialize the operating parameters of the conditioning and acquisition device for a given patient, reread the data from this device and analyze this data.

The present invention and its advantages will appear better in the following description of an exemplary embodiment and with reference to the accompanying drawings, in which - Figure 1 is an overview of the device according to the invention; - Figure 2a is a top view of the curvature sensor of Figure 1; - Figure 2b is a side view of the curvature sensor of Figure 2a; and - Figure 3 is a block diagram of the packaging and acquisition device of Figure 1.

With reference to the figures, the device 10 comprises a curvature sensor 11 placed on an area to be rehabilitated 1 of a patient, for example an area of the spine, a conditioning and acquisition device 13 connected to the curvature sensor by a connection electrical 12, a data transfer device 14 and a data processing device 15.

The curvature sensor 11, shown in detail in FIGS. 2a and 2b, comprises a transmitter 16, a receiver 17 and a waveguide 18, mounted on a flexible support 19, for example 2001 lm thick. All of these components are molded in a flexible body 20, made for example of medical silicone. The emitter 16 is formed by a light emitting diode 21 emitting electromagnetic waves. It is disposed near one end of the waveguide 18 and is aligned with this end along an axis 16 '. It is controlled in pulsed mode of 5 ms per second in order to reduce the energy consumption of the circuit. According to a concrete embodiment, the transmitter can consist of a SEP 8705-003 diode whose emission has a maximum wavelength of, Ap = 880 nm.

The receiver 17 is placed near the other end of the waveguide 18, and is aligned with this end along an axis 17 '. It is formed by a phototransistor 22 which provides a current proportional to the amount of light it receives. The output of this receiver is connected to a resistive network 23 comprising at least one variable resistance 24. This resistive network converts the current of the phototransistor into a voltage proportional to the light flux which it receives.

The waveguide 18 is in the form of a hollow and smooth tube 25 of 100 or 150 mm in length, made for example of silicone, carried by wedges or support elements 26. It is made so as to transmit the light from the transmitter 16 to the receiver 17 while generating transmission losses proportional to its curvature. When the support 19 rests on a flat surface, the waveguide 18 has a concave curvature defined by an angle of curvature QC of a value substantially equal to 150. This angle of curvature corresponds to the angle formed between the tangents 18 ', 18 "at the ends of said guide, as illustrated in FIG. 2b. It also corresponds to the angle formed between the axis 16' of the transmitter 16 and the axis 17 'of the receiver 17. The curvature sensor 11 is arranged to have a working area of between -10 and about 200. When this sensor has a curvature of -10, the waveguide has an angle of curvature of 5. Thus, the transmitter and the receiver are practically aligned and the transmission losses are low. The useful output voltage of the receiver is therefore maximum. When the sensor 11 has a curvature of 200, the waveguide has a curvature of 350. The transmission losses in this guide waves are particularly important and the output voltage useful tie is minimal.

As the output voltage is independent of the direction of curvature of the waveguide 18, it is important, in order to be able to determine the direction of curvature of the sensor 11, that the waveguide can only work in one direction of curvature . This is ensured by giving this waveguide an angle of curvature such that the sum of the angle of curvature of the waveguide and that of the sensor always has the same sign regardless of the position of the sensor within the limits. from his working position. Thus, by giving the waveguide an angle of 150 and authorizing a working position of the sensor corresponding to angle values between -10 "and +200, the waveguide can take curvatures corresponding to angles between +50 and +350 These angles are always positive, there is a one-to-one correspondence between the output voltage of the receiver and the curvature of the sensor.

In order not to increase the rigidity of the flexible body 20 and to facilitate the connection of the sensor to the other parts of the device, the transmitter 16, the receiver 17 and the resistive network 23 are mounted on a printed circuit engraved on the flexible support 19, connected to the conditioning and acquisition device 13 by connection terminals 27.

This conditioning and acquisition device 13, illustrated diagrammatically in FIG. 3, is a portable device and made autonomous by means of a rechargeable power supply 30. This device comprises a low-pass filter 31 and an analog / digital converter 32 which transform the output quantity of the sensor into a coded value usable by a microcontroller 33.

This is responsible for managing a static RAM memory 34 arranged to store the coded values of the output quantity of the curvature sensor, a control circuit 35 of a warning device 36 and of an indicator light 37, a programmable clock 38 and an RS232 type interface 39 for transmitting information to the data processing device 15. The warning device 36 consists for example of a loudspeaker which emits a differentiated sound when the angle of sensor curvature exceeds limit values set by the therapist. This audible signal constitutes feedback for the patient, and is differentiated by a low tone and a high tone depending on the limit crossed. The feedback can be activated or deactivated at any time by means of a switch 40 which is connected to the microcontroller 33 by an interface 41 advantageously comprising a low-pass filter. When activated, the indicator light 37 flashes. The clock 38 marks temporally all the output quantities of the sensor acquired by the device 13.

The transfer device 14 is designed to connect the portable device 13 to the processing device 15. It further comprises recharging means arranged to recharge one or more devices 13 placed on connectors 42.

The processing device 15 consists of a microcomputer, for example of the PC-AT type, having means for storing, managing, displaying and statistical analysis of the data.

Specific software installed on the microcomputer offers three types of activities, each with different headings, namely:
a) Management of patient files
- View the list of files
- Load an existing file
- Create a new file
- Delete a record
- Print the list of files
b) Connection with the conditioning and acquisition device
- Parameter adjustment
- Test in active phase mode (working phase with retro
information enabled)
- Startup and logout
- Play a recording
c) Data analysis
- Global analysis of a recording
- Daily analysis
- Add / view comments
After creating or loading a patient file, follow the procedure below for autonomous use of the conditioning and acquisition device 13 1) Parameter adjustment: recording of certain information such as the position of the sensor in the area re-educated, the angular value corresponding to the spontaneous position of the patient, the limit values for forward and backward movements, the lag time in the working phase called the active phase, the analysis window outside the working phases called the passive phase.

2) Validation of the above parameters by a dynamic test that can also be used for learning. This test is carried out in active phase mode.

3) The device 13 is autonomous after transfer of the aforementioned parameters by means of the transfer device 14. The date and time of the disconnection of the device 13 are also transmitted. From this instant, the device 13 can continuously record the work performed by the patient over several days.

At the end of a work assignment agreed with the therapist, the device 13 is reconnected to the transfer device 14. The content of the acquisition memory 34 is then transmitted to the microcomputer 15, which makes it possible to carry out statistical analyzes and present the data in graphical form for example.

The use of such a rehabilitation device can be done in different ways. One way having been experimented comprises the following stages: - Installation of the curvature sensor.

The sensor 11, with a useful length of 100 mm, is placed for example at the height of the 5th lumbar vertebra identified according to techniques known in masso-physiotherapy. It is placed vertically on the line of the spinous processes. To obtain effective support for this sensor, a hypoallergenic adherent spray is first applied to the skin, then the sensor is put in place and held by a hypoallergic film lined with an elastic bandage, both adhesive.

- Definition of the work environment.

By digging movements (anteversion of the pelvis) or erasing of the lumbar trough (retroversion of the pelvis), the response of the sensor 11 is checked using the microcomputer 15 in order to control its positioning. The device 13 then takes into account the spontaneous position of the patient. From this equilibrium position, the experimenter allows a range of 50 on either side of this spontaneous position.

A latency of 1 second is chosen. This time determines the period for recording the output quantity emitted by the sensor 11 and the sound feedback generated by the warning device 36.

The objective for the person is to correct their position based on this audible feedback.

- Experimentation under the guidance of the therapist.

The series of exercises intended for a better awareness of a lumbar segment of the patient and carried out after the definition of the environment, includes the following three sequences:
First sequence:
From the starting position (quadrupedic position with
vertical arms and thighs), we ask:
- anterior elevation of an arm for 6 seconds,
- 6 seconds of rest,
- anterior elevation of the other arm for 6 seconds,
- 6 seconds of rest.

This sequence is repeated once, then followed by a time of
12 second rest.

Second sequence:
From the same starting position, we ask:
- rear elevation of a lower limb for 6 seconds
(hip extension),
- 6 seconds of rest,
- rear elevation of the other lower limb for 6
seconds,
- 6 seconds of rest.

This sequence is repeated once, then followed by a time of
12 second rest.

Third sequence:
From the same starting position, we ask:
- cross elevation of upper limb and limb
lower counter-lateral for 6 seconds,
- 6 seconds of rest,
- cross elevation in the opposite diagonal for 6
seconds,
- 6 seconds of rest.

This sequence is repeated once, then followed by a time of
12 second rest.

This series of exercises is repeated three times with a rest time of three minutes.

At the end of the three series, the data contained in the memory 34 of the conditioning and acquisition device 13 are transferred to the data processing device 15 to be stored, analyzed and / or displayed.

The rehabilitation device according to the present invention is easily portable since the device 13 can be separated from the transfer device 14. A patient who wishes to practice rehabilitation at home takes the curvature sensor 11 and the device 13 connected to said sensor by the cable. link 12. It performs the prescribed exercises during work phases or active phases voluntarily triggered by switch 40. A work phase has for example a duration of 10 minutes. However, the patient can interrupt it at any time by pressing this switch. The feedback signal being generated by this device 13, the patient is warned by a differentiated sound each time the curvature sensor exceeds one of the two limit values. This device 13 can also work in a masked manner, in the passive phase, that is to say that it can record the overshoots of the limit values without feedback. After a certain number of days of use at home, when the device has reached its autonomy, the patient returns to the therapist who connects it to the transfer device 14 and thus transfers the information from memory 34 to the micro- computer 15. These data are stored on the individual patient file and can then be analyzed, commented on and / or viewed by the therapist.

The rehabilitation device according to the present invention allows a control of the correct position of the spine by the patient himself by means of the sound feedback signal, as well as an objective control on the part of the therapist, since the data are quantitative and not qualitative. In addition, as this data can be stored and viewed, subject to full compliance with the application protocol, the patient can be treated by different therapists. This also allows reliable long-term treatment since the progress of rehabilitation can be clearly visualized without calling on the therapist's memory. Finally, this device being portable, it allows the patient to continue rehabilitation at home, without the need to have recourse to the skills of an experienced therapist to assess the quality and compliance with the prescribed gymnastic exercise protocol.

The present invention is not limited to the embodiment described, but extends to any modification obvious to a person skilled in the art. Its application can be extended, particularly in the areas of functional rehabilitation, ergonomics, adaptation and postural control in professional situations and in daily life.

Claims (16)

Claims 1. A device for assisting with functional rehabilitation, in particular of the spine, comprising a curvature sensor delivering an output variable depending on its curvature, this sensor being placed on an area to be rehabilitated by a patient, a conditioning device and a acquisition of said output quantities connected to the curvature sensor by an electrical connection, a data transfer device and a data processing device, characterized in that the conditioning and acquisition device (13) is an autonomous device and portable, and in that it comprises at least autonomous power supply means, means of control and continuous storage of the values of the output quantity of the sensor (11), feedback means activated as a function said values and means of communication with the data processing device (15). 2. Device according to claim 1, characterized in that the curvature sensor (11) comprises detection means mounted on a flat flexible support (19), said means comprising at least one emitter (16) of electromagnetic waves, one receiver (17) of said waves and a waveguide (18) arranged to guide said waves from the transmitter (16) to the receiver (17). 3. Device according to claim 2, characterized in that the transmitter (16) comprises a light-emitting diode (21) having an emission spectrum advantageously defined with respect to the receiver (17). 4. Device according to claim 3, characterized in that the receiver (17) comprises a phototransistor (22) debiting on a resistive network (23), and whose sensitivity is adapted to the emission spectrum of the transmitter (16) . 5. Device according to claim 2, characterized in that the waveguide (18) generates losses of transmission of electromagnetic waves depending on its curvature. 6. Device according to claim 2, characterized in that the waveguide (18) is concave relative to the plane of the support (19). 7. Device according to claim 2, characterized in that the waveguide (18) is formed of a flexible hollow tube and smooth (25). 8. Device according to claim 7, characterized in that the hollow and smooth flexible tube (25) comprises silicone. 9. Device according to claim 4, characterized in that the transmitter (16), the receiver (17) and the resistive network (23) are mounted on a printed circuit engraved on the flexible support (19). 10. Device according to claim 9, characterized in that the flexible support (19) carrying the printed circuit, the transmitter (16), the receiver (17), the resistive network (23) and the waveguide (18 ) are molded in a flexible body (20). 11. Device according to claim 1, characterized in that the control and storage means of the conditioning and acquisition device (13) comprise at least one micro-controller (33) arranged to control the values of the output quantity of the sensor (11) with respect to limit values set by the therapist, and a memory (34) arranged to store a coding of said values. 12. Device according to claim 11, characterized in that the feedback means of the conditioning and acquisition device (13) comprise at least one control circuit (35) controlled by the micro-controller (33), and a warning device (36) arranged to deliver an audio feedback signal dependent on the output quantity of the curvature sensor (11) and on the limit values set by the therapist. 13. Device according to claim 12, characterized in that the conditioning and acquisition device (13) comprises a switch (40) arranged to deactivate the feedback means (35, 36). 14. Device according to claim 1, characterized in that the communication means of the conditioning and acquisition device (13) comprise a communication interface (39) arranged to transmit the data stored in the memory (34) to the device data processing (15) via the transfer device (14). 15. Device according to claim 14, characterized in that the transfer device (14) comprises means for recharging the packaging and acquisition device (13). 16. Device according to claim 1, characterized in that the data processing device (15) is a microcomputer managed by specific software and arranged to manage patient files, initialize the operating parameters of the packaging device and acquisition (13) for a given patient, re-read the data from this device (13) and analyze this data.