FR3081704A1 - PRESSURE APPLICATION GARMENT - Google Patents

Abstract

This garment (1), which is intended for applying pressure on the body of a subject, comprises three active parts (3, 4, 5) which are an active abdominal part (3) intended to surround the abdomen of the subject and two lower active parts (4, 5) each intended to surround a lower member of the subject, each of the active parts (3, 4, 5) comprising at least one pocket (31, 41, 51) filled with sand with a fluid so as to obtain a positive pressure applied by the active part to the corresponding part of the subject's body. The garment (1) comprises, for each active part (3, 4, 5), at least one interface pressure sensor (2) intended to measure a pressure at the interface between the active part (3, 4, 5 ) and the corresponding part of the subject's body.

Description

PRESSURE APPLICATION GARMENT

The invention relates to a garment for applying pressure on the body of a subject, intended to apply pressure on the one hand on the subject's abdomen, and on the other hand on the subject's lower limbs. In particular, the invention relates to a garment for applying pressure to the body of a subject according to the principle of Low Positive Pressure on the Lower Limbs and on the Abdomen (FPP-MIA, or in English LBPP for Lower Body Positive Pressure), to allow a revascularization of the brain by the mobilization of the blood contained in the lower part of the subject's body. The invention also relates to a method of fitting such a garment for applying pressure to a subject.

The principle of Low Positive Pressure on the Lower Limbs and on the Abdomen (FPP-MIA) involves the application of constant low pressures, in particular between 10 and 40 mmHg, on the one hand on the abdomen of a subject, and on the other hand on the lower limbs of the subject, the pressure applied to the abdomen being strictly less than the pressure applied to the lower limbs. This concept was developed initially to ensure an adequate volume distribution in the supra and infraaortic zones, in particular for the flight of micro-gravitation. FPPMIA has been documented to move blood from the bottom to the top of the body, thereby increasing central cardiopulmonary blood volume.

W02008104861A1 describes the use of FPP-MIA for the treatment of individuals with a vascular impairment in the upper part of the body, in particular a cerebrovascular impairment or an eye disorder. This document describes the application of FPP-MIA using anti-gravity pants (anti-G suit), such as those sold by the company LIFE SUPPORT PRODUCTS INC, Saint Louis, Missouri, United States. Such anti-gravity pants include three independent air chambers, allowing positive pressure to be applied respectively to the abdomen and the two lower limbs of a subject. The air chambers are each connected to a pneumatic end and inflated manually using a pump, a pressure gauge being provided at each air chamber to provide instantaneous pressure values.

Anti-gravity pants have a rigid structure, which makes their installation complicated for bedridden subjects or with paralysis of the limbs. In addition, anti-gravity pants are generally available in one size, which is not suitable for all body types. However, when the morphology of a subject is not in accordance with the size of the anti-gravity pants, there is a risk that the pressure values indicated by the manometers do not correspond to the pressures actually applied to the parts of the body of the topic. The result is a lack of reliability in applying pressure to the subject's body. The implementation of FPP-MIA with anti-gravity pants also requires manual monitoring and adjustment of the pressures over time, in order to guarantee that the pressures applied to the subject are indeed constant on each part of the body, which is laborious.

It is to these drawbacks that the invention intends to remedy more particularly by proposing a garment making it possible to apply, in an automatic, reliable and precise manner, homogeneous and constant pressures on parts of the body of a subject.

To this end, the subject of the invention is a garment for applying pressure to the body of a subject, comprising three active parts, which are an abdominal active part intended to surround the subject's abdomen and two lower active parts intended each to surround a lower limb of the subject, each of the active parts comprising at least one pocket which can be filled with a fluid so as to obtain a positive pressure applied by the active part to the corresponding part of the subject's body, characterized in that it comprises , for each active part, at least one interface pressure sensor intended to measure a surface pressure at the interface between the active part and the corresponding part of the subject's body.

The supply of interface pressure sensors for each of the three active parts makes it possible to monitor the pressure values actually applied to the subject's abdomen and lower limbs. In particular, in the case of FPP-MIA, the pressure applied to the abdomen advantageously has a value included in the range of 10 to mmHg, preferably of the order of 10 mmHg, and the pressure applied to each lower limb Advantageously has a value in the range of 20 to 40 mmHg, preferably of the order of 20 mmHg. Control using the interface pressure sensors also ensures that the pressures applied are constant on each part of the subject's body throughout the duration of a pressure application session, which is notably order of 90 minutes in the case of FPP-MIA.

Preferably, each active part of the garment has a single refillable pocket, so as to simplify the design of the garment. For each active part, the number and arrangement of the interface pressure sensors are adapted to provide pressure measurements representative of the pressure actually applied to the body part of the subject, in particular by avoiding positioning sensors on bone parts.

As an example in a particular embodiment:

- the active abdominal part of the garment comprises three interface pressure sensors, comprising a front central sensor intended to be positioned at the front in the center of the abdomen and two lateral sensors intended to be positioned on the sides of the abdomen ;

each lower active part of the garment comprises three to five interface pressure sensors, comprising one or two lower sensors intended to be positioned at the level of the calf, in particular a posterior lower sensor on the posterior face of the calf and possibly an internal lower sensor on the inner side of the calf, and two or three upper sensors intended to be positioned at the thigh, in particular a posterior upper sensor on the posterior side of the thigh, an internal upper sensor on the internal side of the thigh and possibly a antero-internal upper sensor on the antero-internal side of the thigh.

The size, and more particularly the measurement surface, of each interface pressure sensor can be different from one sensor to another, in particular depending on their location. Thus, by way of example, for the abdominal active part, the anterior central sensor can be chosen with a measurement surface greater than the measurement surface of the lateral sensors.

According to one aspect of the invention, for each refillable pocket, the fluid receiving volume is delimited by a flexible layer impermeable to said fluid, in particular based on textile and / or plastic. Preferably, the material of the waterproof layer has elasticity properties, which can be obtained for example by incorporating elastane in the material of the layer or, in the case of a layer comprising a woven fabric, thanks to the textile weave. Advantageously, the material of the waterproof layer is selected to be washable on its external face, that is to say the face directed towards the outside of the pocket.

In one embodiment, the filling fluid for each pocket is air, the flexible layer delimiting the volume of each pocket then being airtight in a given pressure range, compatible with the air pressures to be imposed in the pocket to exert the required positive pressure on the subject's body. Such an airtight layer may in particular be a plastic layer, self-supporting or deposited on a support. In particular, the airtight layer may comprise the superposition of a textile layer, woven or nonwoven, in particular based on nylon, polypropylene, polyester, polyamide, cotton, and a coating layer, in particular in based on polyurethane, silicone, polyvinyl chloride (PVC) or another plastic material. Preferably, the surface mass of the textile layer is between 150 and 250 g / m ² . An example of a material which can be used to form the airtight layer in the context of the invention comprises a knitted nylon layer coated on one side with a polyurethane coating layer. Thanks to the airtightness of the flexible layer forming each of the pockets, it is not necessary to provide an air chamber, the pocket itself playing the role of air chamber. This results in a flexible structure of each refillable pocket, which improves the wearing comfort of the garment and facilitates its placement on a subject, including a bedridden or paralyzed subject.

Advantageously, each active part is a flexible part which can pass between a deployed configuration, allowing it to be placed around the corresponding part of the subject's body, and an adjusted configuration around the corresponding part of the subject's body. In the adjusted configuration, the active part is tubular in shape and its wall facing inwards is capable of applying positive pressure to the part of the subject's body.

According to one embodiment, each active part is a part based on textile and / or plastic material comprising first and second superimposed portions impermeable to said fluid, which define between them the volume for receiving fluid from each refillable bag. In the adjusted configuration of the active part on the corresponding part of the subject's body, the first portion is directed inward, while the second portion is directed outward. The first and second portions are advantageously linked together by a peripheral seam sealed to said fluid, or any other means of peripheral connection sealed to said fluid.

According to an advantageous characteristic, each interface pressure sensor is integral with the inner wall of the active part, that is to say the wall which is intended to be directed towards the corresponding part of the subject's body. In particular, the interface pressure sensor can be housed in a compartment provided for this purpose on the inner wall of the active part. Alternatively, the interface pressure sensor can be secured to the inner wall of the active part by any other suitable means, in particular by sewing, gluing, etc.

According to one aspect of the invention, the garment comprises a control unit comprising:

- a reception module configured to receive the interface pressure measurements from the interface pressure sensor (s) from each active part,

- a control module configured to control, from interface pressure measurements received by the reception module for each active part, at least one device for injecting fluid into the fillable pocket (s) of the active part, in order to maintain a predefined interface pressure value for this active part.

In particular, in the case of FPP-MIA, the predefined interface pressure setpoint for the active abdominal part is in the range of 10 to 20 mmHg and is strictly lower than the predefined interface pressure setpoint for each part. active lower, which is in the range of 20 to 40 mmHg. The control unit allows automatic control of the interface pressure and a slaving of the injection of fluid into the pockets of each active part according to the interface pressure measurements and the interface pressure setpoint, which guarantees the application of constant pressure throughout a session, without manual intervention.

Advantageously, each fillable pocket of the garment has at least one filling tip configured to be connected to a fluid injection device. For each refillable pocket, the garment is also provided with at least one sensor for filling the pocket with said fluid, such as a pressure gauge. In particular, for each refillable bag, this filling pressure sensor can be installed in a connecting pipe between a filling tip of the bag and the corresponding fluid injection device. Advantageously, the garment includes automatic servo means between the filling pressure sensor (s) and the interface pressure sensor (s) of each active part. In particular, the filling pressure sensor (s) of each active part can be linked to the control unit, so that an automatic control can be implemented between the filling pressure sensors and the pressure sensors interface of each active part to have a constant and controlled pressure applied to each part of the subject's body throughout the duration of a pressure application session. In the case of FPP-MIA, the principle is the mobilization of blood from the lower part of the body, which must be constant, controlled and self-regulated, to compensate for the losses while not being too strong to avoid the effects. deleterious. Such constant and controlled blood mobilization requires the application of constant, controlled and self-regulating pressure on each part of the subject's body for the duration of a session.

In the context of the invention, the device for injecting fluid into the fillable pocket or pockets of each active part of the garment can be a pump, or else a system for supplying compressed air such as those available in hospitals. In an advantageous embodiment, the device for injecting fluid into the fillable pocket (s) of each active part of the garment is a portable device, which allows

Γ use of clothing when transporting a subject. In one embodiment, the device for injecting fluid into the fillable pocket (s) of each active part of the garment is a portable pump integrated into the garment.

According to an advantageous embodiment, each interface pressure sensor is a pneumatic sensor connected in leaktight manner to a measurement module, in particular by means of a flexible tube. The use of such a pneumatic sensor has the advantage of limiting the electronics to be loaded directly on the active parts of the garment. In particular, the pneumatic sensor can be a sensor as described in WO2009072011A1, comprising a cushion having a shell of flexible polymer, for example silicone, which is capable of receiving in its internal volume a predetermined volume of injected air corresponding to a known positive pressure. The measurement module includes a pressure gauge and an air injection piston which are in fluid communication with each other and with the pneumatic sensor. The measurement module of each sensor is configured to transmit the interface pressure measurements to the receiving module of the control unit. This data transmission can be carried out by any means, in particular by wired connection means or wireless means such as Bluetooth or WiEi. Advantageously, the measurement module of each pressure sensor is integrated in a housing of the control unit.

As a variant, each interface pressure sensor can be an electronic sensor, in particular a sensor which measures a force applied to a surface at the interface between the active part and the corresponding part of the subject's body, from which a pressure interface is calculated. Each electronic sensor is configured to transmit the interface pressure values to the receiving module of the control unit. This data transmission is preferably carried out by wireless connection means such as Bluetooth or WiEi.

According to one aspect of the invention, each active part comprises means for adjusting the active part around the corresponding part of the subject's body, in order to best conform to the shape of the corresponding part of the subject's body and to obtain the most efficient and homogeneous pressure application possible.

In one embodiment, the adjustment means comprise elements for closing the active part, allowing an adjustment of the circumference of the active part around the corresponding part of the subject's body, preferably suitably over the entire length. of the active tubular part. According to a particular embodiment, the closure elements comprise at least one pair of gripping strips, comprising a first strip provided with hooks and a second strip provided with loops, which extend along the length of the active part. Alternatively or in combination, the closure elements may comprise a plurality of tightening strap and clip systems distributed over the length of the active part.

In one embodiment, the adjustment means comprise raised patterns of the active part capable of applying the active part against the corresponding part of the subject's body when filling the or each fillable pocket of the active part. The relief patterns can in particular be seams for sculpting the flexible layer based on textile and / or plastic material forming the pocket or pockets of the active part, which impose a shaping of the active part in the filled state. to best fit the shape of the corresponding part of the subject's body.

According to one characteristic, the lower active parts of the garment are linked to the abdominal active part, so as to facilitate the positioning of the garment on the subject's body. According to one aspect of the invention, each lower active part comprises, at its end opposite to the abdominal active part, a plurality of segments capable of being folded over one another to adapt the length of the active part less than the length of the subject's corresponding lower limb. Likewise, the abdominal active part may comprise, at one end, a plurality of segments capable of being folded over one another to adapt the length of the active abdominal part to the length of the subject's abdomen. Preferably, for each active part, in the folded state of the segments on top of each other, the portion of the refillable bag corresponding to the folded segments is not filled with fluid. In order to further improve the adaptability of the garment to the morphology of each subject, the presence of foldable or roll-up segments can be combined with the provision of different sizes of the garment, for example S, M, L, XL.

According to one aspect of the invention, at least one of the lower active parts of the garment comprises an internal tightening element which, when the lower active part is in place around the lower limb of the subject, is able to surround the thigh of the subject and to apply a tightening thereof. The internal tightening element can thus play the role of a tourniquet making it possible to apply a venous occlusion at the level of the thigh of the subject. Preferably, the internal clamping element is a cuff intended to be inflated to a standardized pressure (50 mmHg). The application of a venous occlusion at the level of the subject's thigh using the internal clamping element is advantageously combined with a measurement of the variations in volume of the lower limb resulting from this occlusion and its lifting, in order to d '' assess the volume of mobilizable blood (or venous bed).

In the event that the estimate of the volume of mobilizable blood is zero or less than a predefined value, an injection of liquid into the venous network, in particular 500 mL of physiological saline, can be implemented before the application session of pressure using the garment according to the invention.

Different plethysmography techniques can be used to measure the variations in volume of the lower limb, in particular air plethysmography by measuring for example the variations in air pressure in the lower active part of the garment forming an air-filled sleeve around the limb subject. More precisely, the implementation principle is as follows: the internal tightening element surrounding the subject's thigh is inflated so as to apply a venous occlusion at the level of the subject's thigh; the lower limb of the subject then distends due to blockage of the venous return; the thigh tourniquet is then loosened, and the subject's lower limb regains its initial volume because the venous return resumes its normal course. The variation in volume of the lower limb provides an estimate of the volume of fluid that can be mobilized, including the lymph and venous blood. Advantageously, the garment according to the invention makes it possible not only to apply the venous occlusion thanks to the internal clamping element of the lower active part, but also to measure, by air plethysmography, the difference between the volume of the lower limb at rest and the volume of the lower limb a few minutes after the application of the venous occlusion, directly using the lower active part of the garment which forms a sleeve around the lower limb of the subject and measuring the volume of air in this sleeve before and after the application of the venous occlusion.

According to an advantageous characteristic, the garment comprises a protective textile, capable of being replaced each time the garment is used, which is removably secured to the inner wall of one or each active part of the garment, that is to say the wall of the active part which is directed inwards in adjusted configuration of the active part around the corresponding part of the subject's body. The protective fabric plays the role of a second skin, making it possible to avoid irritation of the subject's skin due to contact with the active part. The protective fabric also prevents contamination of the active part. Preferably, the protective fabric is placed on the inner wall of each active part while under tension, and is kept stretched by any suitable means such as gripping strips or the like. It is indeed important to avoid the presence of folds in the protective textile during a pressure application session, in particular LPP-MIA. Examples of textiles suitable for protective textiles are microfiber textiles having a basis weight of between 40 and 170 g / m ² .

The subject of the invention is also a method of fitting a garment as described above on a subject, this method comprising steps in which:

- Each active part of the garment is positioned in the deployed configuration at the level of the corresponding part of the subject's body;

- Each active part of the garment is passed from the deployed configuration to the adjusted configuration around the corresponding part of the subject's body;

- each filling pocket of the garment is filled with said fluid until, for each active part, a measurement of each interface pressure sensor of the active part is substantially equal to a predefined interface pressure value for this active part.

In the case of a subject for whom the fitting of the garment can be carried out only in the lying position of the subject, the method of fitting the garment as described above comprises steps in which:

- The garment is placed on a bed with each of the active parts in the deployed configuration;

- the subject is stretched on the back above the garment, by positioning each part of the subject's body on the corresponding active part of the garment;

- Each active part of the garment is passed from the deployed configuration to the adjusted configuration around the corresponding part of the subject's body;

- each filling pocket of the garment is filled with said fluid until, for each active part, a measurement of each interface pressure sensor of the active part is substantially equal to a predefined interface pressure value for this active part.

The characteristics and advantages of the invention will appear in the following description of several embodiments of a garment and of a method of fitting a garment according to the invention, given solely by way of example and made with reference to the accompanying drawings in which:

- Figure 1 is a front view of a garment according to a first embodiment of the invention;

- Figure 2 is a rear view of the garment of Figure 1;

- Figure 3 is a front view of the garment of Figure 1 with its active parts in the deployed configuration;

- Figure 4 is a section on a larger scale along the plane IV-IV of Figure 3;

- Figure 5 is a front view of the garment of Figure 1 placed on a subject and connected to air injection devices;

- Figure 6 is a view similar to Figure 1 for a garment according to a second embodiment of the invention;

- Figure 7 is a view similar to Figure 5 for a garment according to a third embodiment of the invention, the air injection devices having been omitted for better visibility; and

- Figure 8 is a rear view of the garment of Figure 7.

As shown in FIGS. 1 to 5, the garment 1 for applying pressure in the first embodiment comprises three active parts, namely an active abdominal part

3, intended to surround the abdomen A of a subject, and two lower active parts 4, 5, each intended to surround a leg, or lower limb Li, L2, of the subject. Each of the active parts 3, 4, 5 of the garment 1 is a flexible textile part made of airtight material. In particular, in this example, the airtight material of each active part 3, 4, 5 comprises a knitted nylon textile layer coated on one side with a polyurethane coating layer. In order to facilitate the placement of the garment 1 on the subject's body, the two lower active parts 4, 5 are linked to the abdominal active part 3 by junction elements 9, which are in particular elastic textile bands. Each active part 3, 4, 5 is deformable between a deployed configuration which is substantially flat, visible in FIG. 3, allowing it to be placed around the corresponding part of the subject's body, and a tubular configuration, visible in FIGS. 1, 2 or 5, in which it is able to surround the corresponding part of the subject's body and to be adjusted around it.

As illustrated for the active part 5 in the section of FIG. 4 (it being understood that the active parts 3 and 4 have sections similar to that of the active part 5), each active part 3, 4, 5 of the garment 1 comprises the superimposition of an interior textile portion 33, 43, 53, intended to be directed towards the body of the subject, and of an exterior textile portion 34, 44, 54, intended to be directed towards the exterior, which are both made of airtight material as described above. For each active part 3, 4, 5, the inner textile portions 33, 43, 53 and outer 34, 44, 54 made of airtight material are linked together by a peripheral seam 32, 42, 52, which is also airtight. Thus, for each active part 3, 4, 5 of the garment 1, an airtight pocket 31, 41, 51 is delimited between the interior textile portion 33, 43, 53 and the exterior textile portion 34, 44, 54, the interior volume V of the bag 31, 41, 51 being able to be filled with air.

In this example, each active part 3, 4, 5 comprises a single refillable pocket 31, 41, 51, which has the advantage of simplifying the design of the garment 1. However, as a variant, each active part 3,4, 5 may include a plurality of refillable pockets. Each refillable pocket 31, 41, 51 of the garment 1 is intended to be filled with air, so that in the adjusted configuration of the active part 3, 4, 5 on the corresponding part of the subject's body, the inner textile portion 33, 43, 53 applies positive pressure to it.

Each refillable pocket 31, 41, 51 of the garment 1 comprises a plurality of filling tips 36, 46, 56, distributed over the surface of the pocket in order to optimize its filling. As illustrated diagrammatically in FIG. 5, the filling tips 36, 46, 56 of the active parts 3, 4, 5 are adapted to be connected to air injection devices 63, 64, 65. Different types of devices d air injection can be used in the context of the invention. In particular, each air injection device 63, 64, 65 can be a portable pump integrated into the garment 1, or even a supply of compressed air to a hospital. Each refillable pocket 31, 41, 51 is equipped with at least one pressure gauge 60 for measuring the air filling pressure of the pocket. Preferably, to measure the filling pressure in different zones of each refillable bag 31, 41, 51, a pressure gauge 60 is installed in each connecting pipe between a filling nozzle 36, 46, 56 of the bag and the device air injection 63, 64, 65 corresponding.

In order to control the pressure actually applied to the subject's abdomen A by the abdominal active part 3 and to the subject's lower limbs Li, L2 by the lower active parts 4, 5, the garment 1 comprises pressure sensors 2 of interface reported on the inner textile portion 33, 43, 53 of each active part 3,4, 5. Each sensor 2 is intended to measure a pressure at the interface between the active part 3, 4, 5 on which it is fixed and the corresponding part of the subject's body. Each sensor 2 can for example be sewn in a compartment provided for this purpose on the corresponding inner textile portion 33, 43, 53. As a variant, each sensor 2 can be secured to the corresponding inner textile portion 33, 43, 53 by any other suitable means, in particular by sewing, gluing, etc.

In an exemplary embodiment, each interface pressure sensor 2 can be a pneumatic sensor as described in W02009072011A1, comprising a flexible polymer cushion capable of receiving in its internal volume a predetermined volume of injected air corresponding to a positive pressure known, the bearing being tightly connected by means of a flexible tube (not shown) to a measurement module 72.

The measurement module 72 of each sensor 2 comprises in particular a pressure gauge and an air injection piston, which are in fluid communication with each other and with the pneumatic sensor 2. The use of such pneumatic sensors makes it possible to avoid the presence of electronic components on the active parts 3, 4, 5 of the garment 1, the electronics being offset in the measurement module 72 outside the textile parts. These pneumatic sensors also have the advantage of being compatible with the relatively low interface pressure levels sought in the case of EPPMIA, which are in particular in the range of 10 to 40 mmHg. Of course, as a variant, the garment 1 may include electronic interface pressure sensors, provided that the sensitivity of these electronic sensors is compatible with the desired interface pressure levels.

For each active part 3, 4, 5, the number and the arrangement of the interface pressure sensors 2 are adapted to provide pressure measurements representative of the pressure actually applied to the body part of the subject. By way of nonlimiting example, in this embodiment, the active abdominal part 3 of the garment 1 comprises three interface pressure sensors 2, namely a front central sensor 2 intended to be positioned at the front in the center of the subject's abdomen and two lateral sensors 2 intended to be positioned on the sides of the abdomen. Each lower active part 4, 5 of the garment 1 comprises five interface pressure sensors 2, namely a posterior lower sensor 2 intended to be positioned at the rear of the subject's calf, an internal lower sensor 2 intended to be positioned on the inner side of the calf, a posterior upper sensor 2 intended to be positioned on the posterior side of the thigh of the subject, an internal upper sensor 2 intended to be positioned on the internal side of the thigh, and an upper antero-internal sensor 2 intended to be positioned on the anterointerne side of the thigh.

The garment 1 comprises a control unit 7, illustrated in FIG. 5, which can be in the form of a box capable of being attached to the surface of a textile part of the garment 1, or on a piece of furniture such as a bed on which the pressure application session is carried out using the garment 1. In the case of pneumatic type interface pressure sensors 2, the measurement module 72 associated with each sensor garment interface pressure tire 1 is advantageously integrated in the housing of the control unit 7, which moreover comprises a reception module 70 configured to receive the interface pressure measurements from the measurement module 72 of each pneumatic interface pressure sensor. The link between each measurement module 72 and the reception module 70 can then be wired or wireless. In the case of interface pressure sensors 2 of electronic type, each electronic interface pressure sensor is configured to transmit the interface pressure measurements directly to the reception module 70 of the control unit 7, in particular by wireless connection means. The manometer (s) 60 for measuring the filling pressure of each refillable bag 31, 41, 51 are also linked to the control unit 7. Thus, an automatic control can be set up between the sensors 60 for filling pressure and the interface pressure sensors 2 of each active part 3, 4, 5.

The control unit 7 also includes a control module 71, which is configured to control the air injection device (s) 63, 64, 65 as a function of the interface pressure measurements received by the reception module 70 for each active part 3, 4, 5, so as to maintain a predefined interface pressure setpoint for this active part. The control unit 7 provides automatic control of the interface pressure, and a servo-control of the air injection into the pocket 31, 41, 51 of each active part 3, 4, 5 according to the pressure measurements sensor interface 2 and the preset interface pressure setpoint for each active part. It is thus possible to apply, in an automated manner, constant and controlled pressure to each part of the subject's body throughout a pressure application session using garment 1, without manual intervention.

In particular, according to an example, for the application of EPP-ΜΙΑ using the garment 1, the predefined interface pressure setpoint for the active abdominal part 3 is 10 mmHg, and the interface pressure setpoint predefined for each lower active part 4, 5 is 20 mmHg, the garment 1 being advantageously configured to maintain the preset interface pressure setpoint for each active part 3, 4, 5 for a period of the order of 90 minutes.

In order to best fit the shape of each part of the subject's body and to obtain the most effective and homogeneous pressure application possible on each part of the body, each active part 3, 4, 5 of the garment 1 comprises means for adjusting the active part 3,4, 5 around the corresponding part of the subject's body. In the example shown in FIGS. 1 to 5, these adjustment means comprise a pair of gripping strips on each active part 3, 4, 5, making it possible to close the active part in the adjusted configuration around the corresponding part A, Li , L2 of the subject's body.

More specifically, in the example shown, each active part 3, 4, 5 comprises, over its entire length in the axial direction in tubular configuration, a first gripping strip 37, 47, 57 provided with hooks, which is located on a first longitudinal end of the active part, on the side the outer textile portion 34, 44, 54, and a second gripping strip 38, 48, 58 provided with loops, which is located on the second longitudinal end of the active part, this time on the side of the interior textile portion 33, 43, 53. The gripping strips 37, 38, 47, 48, 57, 58 allow an adjustment of the circumference of the active part 3, 4, 5 around the corresponding part A, Li , L2 of the subject's body appropriately over the entire length of the active part.

Each of the two lower active parts 4, 5 also comprises, opposite the active abdominal part 3, a roll-up portion 45, 55 designed to adapt the length of the lower active part 4, 5 to the length of the lower limbs Li, L2 of the subject and thus apply a positive pressure as targeted as possible on the lower limbs Li, L2. As can be clearly seen in FIGS. 1 and 5, each roll-up portion 45, 55 is formed by a plurality of segments S configured to be folded over one another. Preferably, in the folded state of the segments S on top of each other, the portion of the refillable bag 41, 51 corresponding to the folded segments S cannot be filled with air.

As can be seen in FIG. 3, the lower active part 4 of the garment 1, which is intended to cover the right leg or right lower limb Li of the subject, comprises an inner cuff 40 which, when the lower active part 4 is in place around the subject's right lower limb Li is able to surround the subject's right thigh and to apply a tightening thereof. The tightening cuff 40 can in particular be an inflatable cuff, comprising gripping bands to allow it to be held around the thigh of the subject and intended to be filled with air at a standardized pressure of the order of 50 mmHg. The tightening cuff 40 is provided to allow an evaluation of the volume of mobilizable blood (or venous bed) of the subject before the implementation of a pressure application session, in particular of LPP-MIA, using the garment. 1.

The procedure for evaluating the volume of mobilizable blood can advantageously comprise the application of a venous occlusion at the level of the subject's right thigh using the clamp cuff 40, and the measurement of the variations in volume of the right lower limb resulting of this occlusion and its lifting, in particular by air plethysmography, by measuring the variations in air pressure in the lower active part 4 forming a sleeve filled with air around the right lower limb Li of the subject.

In the case of LPP-MIA, the evaluation of the volume of mobilizable blood prior to a session of application of the differential pressures of LPP-MIA using garment 1 is important, because this volume determines the effectiveness of the treatment. of LPP-MIA on the subject. In particular, when the volume of mobilizable blood in the lower part of the subject is low, there is a risk that the transfer of blood to the upper part of the subject resulting from the application of LPP-MIA does not allow effective revascularization of the brain. In this case, it is advantageous to fill the subject's venous network with a liquid, in particular physiological saline, before applying the LPP-MIA using the garment 1, so as to increase the volume of mobilizable blood. . It is considered that, when the subject's volume of mobilizable blood, evaluated as described above, is zero or less than a predefined value, an injection of 500 ml of physiological saline into the subject's venous network can advantageously be implemented before a LPP-MIA session using clothing 1.

Preferably, as shown in FIG. 5, when it is put on a subject, the garment 1 comprises a protective textile 8 disposable between the body of the subject and each of the active parts 3, 4, 5. The textile of protection 8, which is for example a microfiber textile having a surface mass of between 40 and 170 g / m ² , plays the role of a second skin making it possible to avoid irritations of the subject's skin due to contact with the parts active 3, 4, 5. Advantageously, the protective fabric 8 is applied in a removable manner to the inner textile portion 33, 43, 53 of each active part 3, 4, 5, while being held taut by any appropriate means, for example using gripping strips, so as to avoid the presence of folds which may irritate the subject's skin. The protective fabric also makes it possible to avoid soiling of the active parts 3, 4, 5, so that garment 1 can be reused for different pressure application sessions, without hygiene problem insofar as the protective fabric 8 used during a session is removed at the end of the session and replaced by a new protective fabric 8 for a later session.

An example of a method of applying pressures according to the principle of Low Positive Pressure on the Lower Limbs and on the Abdomen (FPP-MIA), on the abdomen A and the lower limbs Li, L2 of a subject, on the Using the garment 1 described above comprises steps as described below.

First, we put the garment 1 on the subject, preferably in a deflated state of the garment, that is to say a state where each of the refillable pockets 31, 41, 51 of the garment is little or not filled with air.

For this, each active part 3, 4, 5 of the garment 1 is positioned in its deployed configuration, as shown in FIG. 3, and the protective fabric 8 is applied to the interior textile portion 33, 43, 53 of each active part 3, 4, 5. The active abdominal part 3 of the garment 1 is then placed at the level of the subject's abdomen A, and the two lower active parts 4, 5 are each placed at the level of a lower limb Li, L2 of the topic. Each active part 3, 4, 5 is then closed from its deployed configuration to a tubular configuration around the corresponding part of the subject's body, and adjusted around the corresponding part of the subject's body using gripping bands 37, 38 , 47, 48, 57, 58.

In the case of a bedridden subject or with limbs paralysis, the design of the garment 1 allows it to be put on the subject while the latter is in the lying position. In this case, the garment 1 is positioned on a bed, with each of its active parts 3, 4, 5 in the deployed configuration and provided with the protective fabric 8, then the subject is stretched out on his back above the garment 1 in positioning the subject's abdomen A at the level of the active abdominal part 3 and each of the lower limbs Li, L2 of the subject at the level of the corresponding lower active part 4, 5 of the garment. Each active part 3, 4, 5 is then closed from its deployed configuration to a tubular configuration around the corresponding part of the body of the elongated subject, and adjusted around the corresponding part of the body of the subject using gripping bands 37, 38, 47, 48, 57, 58, which have been provided at the front of the garment for this purpose.

We can then proceed, for the subject equipped with the garment 1, to measure the volume of mobilizable blood. To do this, a venous occlusion is applied at the level of the subject's right thigh root using the cuff 40, and the variations in volume of the right lower limb Li resulting from this occlusion and its lifting are measured by plethysmography. This can be, for example, air plethysmography, by measuring the variations in air pressure in the lower active part 4 forming a sleeve filled with air around the subject's right lower limb Li. Depending on the value of the volume of mobilizable blood thus evaluated, an injection of physiological saline can optionally be carried out in the subject's venous network, in order to increase the volume of mobilizable blood and improve the effect of FPP- MIA in case of hypovolemia venous bed.

Next, each pocket 31, 41, 51 is filled with the garment 1 using the air injection devices 63, 64, 65 connected to the filling tips 36, 46, 56, until obtaining for each active part 3, 4, 5 of a measurement of each interface pressure sensor 2 of the active part substantially equal to the predefined interface pressure setpoint for this active part. In particular, according to an advantageous example of application of FPP-MIA using the garment 1, the predefined interface pressure setpoint for the active abdominal part 3 is 10 mmHg, and the predefined interface pressure setpoint for each lower active part 4, 5 is 20 mmHg. The control unit 7 of the garment 1 can be configured to perform this filling of the pockets 31, 41, 51 of the garment automatically.

The application of a constant and homogeneous pressure of 10 mmHg on the abdomen A of the subject and 20 mmHg on each lower limb Li, L2 of the subject for a determined period, for example a period of 90 minutes, is then ensured automatically by the garment 1, thanks to the garment control unit 7 which is configured to selectively actuate the air injection devices 63, 64, 65 according to the interface pressure measurements of the sensors 2 so as to maintain , during the determined duration, an interface pressure value measured by each sensor 2 equal to the predefined interface pressure setpoint for the active part 3, 4, 5 on which this sensor 2 is fixed.

In the second embodiment shown in Figure 6, elements similar to those of the first embodiment bear identical references. The garment 1 of this second embodiment differs from that of the first embodiment in that the means for adjusting the active parts 3, 4, 5 on the body of a subject are formed by a plurality of closure systems to tightening straps 37 ', 47', 57 'and corresponding clips 38', 48 ', 58', in place of the gripping strips 37, 38, 47, 48, 57, 58. As shown in Figure 6, for each active part 3,4, 5, the closing systems with tightening straps 37 ', 47', 57 'and clips 38', 48 ', 58' are distributed over the entire length of the active part in the axial direction in configuration tubular, so as to allow an adjustment of the circumference of the active part 3, 4, 5 around the corresponding part A, Li, L2 of the subject's body suitably over the entire length of the active part.

In the third embodiment shown in Figures 7 and 8, elements similar to those of the first embodiment bear identical references. The garment 1 of this third embodiment differs from that of the first embodiment in that the means for adjusting the active parts 3, 4, 5 on the body of a subject are not limited to gripping bands 37, 38, 47, 48, 57, 58 of longitudinal closure. In this third embodiment, the adjustment means also comprise seams 39, 49, 59 for sculpting the textile of each active part 3, 4, 5. The seams 39, 49, 59 of each active part 3, 4, 5 are designed to impose a shaping of the active part which applies the active part against the corresponding part A, Li, L2 of the subject's body when filling the refillable bag 31, 41, 51 of the active part with 'air. Seams 39, 49, 59 of each active part

3, 4, 5 allow the active part to best match the shape of the corresponding part of the subject's body. In addition, as visible in FIG. 8, the garment 1 of this third embodiment includes the buttocks of the subject. The covering part of the subject's buttocks can be a fillable part, capable of being filled with air, in particular it can correspond to a fillable pocket, insofar as it may be useful to also apply constant and controlled pressure on the patient's buttocks to expel blood into this area. Alternatively, the subject's buttock covering portion may not be refillable.

As is apparent from the previous examples, a garment according to the invention, comprising interface pressure sensors on the inner wall of each of its active parts, makes it possible to automatically apply uniform and constant pressures to the abdomen and the lower limbs of a subject. In particular, the garment according to the invention is well suited for the application of pressures according to the principle of Low Positive Pressure on the Lower Limbs and on the Abdomen (FPP-MIA), bringing into play differential pressures applied to the 'abdomen and lower limbs of a subject. Thanks to the airtightness and the flexibility of the textile forming each of the active parts of the garment, each active part can play the role of an air chamber while retaining a flexible structure, which ensures a good wearing comfort of the garment and to facilitate its fitting on a subject, including a bedridden or paralyzed subject. The possibility of supplying the garment of the invention in different sizes, for example S, M, L, XL, and the presence of means for adjusting the garment on each part of the body, also make it possible to have adaptability of the garment to the morphology of each subject, which contributes to the effectiveness of the garment for treatments by application of pressures, in particular according to the principle of FPP-MIA.

The invention is not limited to the examples described and shown. In particular, in the previous examples, each active part 3, 4, 5 of the garment comprises a single refillable pocket 31, 41, 51. As a variant, the active parts of a garment according to the invention may each comprise any number of refillable pockets. Preferably, each refillable pocket of each active part is then provided with at least one interface pressure sensor. Furthermore, the number and arrangement of the interface pressure sensors on each active part of a garment according to the invention may be different from those described in the previous examples. The interface pressure sensors used can also be of different sizes, adapted according to their location, and of different types, in particular pneumatic sensors, electronic sensors, combinations of pneumatic and electronic sensors, etc.

Finally, the garment according to the invention has been described above for the application of pressures corresponding to the principle of Low Positive Pressure on the Lower Limbs and on the Abdomen (FPP-MIA). Alternatively, it can be used for the automated application of all types of pressure on the abdomen and / or lower limbs of a subject, for example pressures varying over time, which can then be controlled automatically by the garment control unit.

Claims (13)

1. Garment (1) for applying pressure to the body of a subject, comprising three active parts (3, 4, 5), which are an active abdominal part (3) intended to surround the abdomen (A) of the subject and two lower active parts (4, 5) each intended to surround a lower member (Li, L2) of the subject, each of the active parts (3, 4, 5) comprising at least one fillable pocket (31, 41, 51) with a fluid so as to obtain a positive pressure applied by the active part to the corresponding part of the subject's body, characterized in that it comprises, for each active part (3, 4, 5), at least one pressure sensor interface (2) for measuring a pressure at the interface between the active part (3, 4, 5) and the corresponding part of the subject's body. 2. Garment according to claim 1, characterized in that, for each refillable pocket (31, 41, 51), the volume (V) for receiving fluid is delimited by a flexible layer (32-34, 42-44, 52 -54) impervious to said fluid, in particular based on textile and / or plastic. 3. Garment according to any one of claims 1 or 2, characterized in that each active part (3, 4, 5) is a part based on textile and / or plastic comprising two superimposed portions (33, 34, 43, 44, 53, 54) leaktight to said fluid, which define between them the volume (V) for receiving fluid from each refillable bag (31, 41, 51). 4. Garment according to any one of the preceding claims, characterized in that each interface pressure sensor (2) is integral with the wall (33, 43, 53) of the active part (3, 4, 5) which is intended to be directed towards the body part of the subject. 5. Garment according to any one of the preceding claims, characterized in that it comprises a control unit (7) comprising a reception module (70) configured to receive the interface pressure measurements from the pressure sensor (s) interface (2) of each active part (3, 4, 5), and a control module (71) configured to control, from interface pressure measurements received by the reception module for each active part, at least one device for injecting fluid (63, 64, 65) into the fillable pocket (s) (31, 41, 51) of the active part, in order to maintain a predefined interface pressure value for this active part. 6. Garment according to any one of the preceding claims, characterized in that it comprises, for each refillable bag (31, 41, 51), at least one filling pressure sensor (60) of the bag in fluid, and automatic control means between the filling pressure sensor (s) (60) and the interface pressure sensor (s) (2) of each active part (3, 4, 5). 7. Garment according to any one of the preceding claims, characterized in that each interface pressure sensor (2) is a pneumatic sensor connected in leaktight manner, in particular by means of a flexible tube, to a measurement module ( 72). 8. Garment according to any one of the preceding claims, characterized in that each active part (3, 4, 5) comprises adjustment means (37, 38, 39, 47, 48, 49, 57, 58, 59 ) of the active part around the corresponding part of the subject's body. 9. Garment according to claim 8, characterized in that the adjustment means comprise closing elements (37 ('), 38 ('), 47 ('), 48 ('), 57 ('), 58 ( ')) of the active part (3, 4, 5), allowing an adjustment of the circumference of the active part around the corresponding part of the subject's body. 10. Garment according to any one of claims 8 or 9, characterized in that the adjustment means comprise relief patterns (39, 49, 59) of the active part (3, 4, 5) capable of applying the active part against the corresponding part of the subject's body when filling the or each refillable pocket (31, 41, 51) of the active part. 11. Garment according to any one of the preceding claims, characterized in that at least one of the lower active parts (4) comprises an internal clamping element (40) which, when the active part (4) is in place around the lower limb (Li) of the subject, is able to surround the thigh of the subject and to apply a tightening thereof. 12. Garment according to any one of the preceding claims, characterized in that it comprises a protective textile (8), capable of being replaced each time the garment is used, which is removably secured to the wall (33, 43, 53) of one or each active part (3,4, 5) intended to be directed towards the part of the subject's body. 13. A method of fitting a garment according to any one of the preceding claims on a subject, characterized in that it comprises steps in which: - Each active part (3, 4, 5) of the garment is positioned in the deployed configuration at the level of the corresponding part (A, Li, L2) of the subject's body; - Passing each active part (3, 4, 5) of the garment from the deployed configuration to a configuration adjusted around the corresponding part (A, Li, L2) of the subject's body; - we proceed to fill each fillable pocket (31, 41, 51) of the garment with said fluid until obtaining, for each active part (3, 4, 5), a measurement of each interface pressure sensor (2 ) of the active part substantially equal to a predefined interface pressure value for this active part.