GB2459379A - Limb mobiliser and exerciser - Google Patents

Abstract

A limb loading and movement device (201) has opposed limb contact and displacement elements (203), with an intervening transfer drive (211), drive actuator (204) with input control (202).

Description

Limb Mobiliser and Exerciser Designated LARA' (an acronym for Leg Adductor Relaxation Assistor) A personal muscle or muscle group exerciser -in particular a limb and attendant muscle group loader and stretcher -is configured in a prime variant format for use by patients with restricted mobility, such as those suffering from chronic debilitating and progressively crippling diseases with muscle or nerve wasting or impairment symptoms, such as MS (Multiple Sclerosis), Cystic Fibrosis (CF), CF (Cerebral Palsy), Stroke, Alzheimers, Dementia or Trauma causing spinal cord dysfunction but has wider applicability for a relatively healthy fit subject, even extreme fitness or training regimes such as martial arts.

Displacement and Load In that regard both displacement or movement range and load applied over the movement range are relevant considerations, as to some extent in certain circumstances is the rate of load movement or work rate. That is both static and dynamic usage factors arise. For a chronic muscle weakness or disability a modest unilateral movement or loading may suffice, whereas for extreme training regimes a repeated cycle may be appropriate. Even for the otherwise fit, local muscle strain injury can admit to the more sympathetic movement and loading regime appropriate to those with a disability or disease.

Resistance Resistance to movement can arise passively though body muscle or joint articulation stiffness in chronic disability or physical handicap, in which case no supplementary device internal spring bias is necessary. For the fit body a bias loading might be incorporated, such as with a return spring, and/or reliance placed upon using the body muscles intentionally and proactively to resist device displacement.

Prior Art

Whilst diverse muscle exerciser formats are known for fitness development of the able-bodied, they are not all suitable, such as in force, movement range or disposition, for the disabled, nor do they readily admit of dual alternative or convertible mode use without risk of self-inflicted strain injury or tissue damage.

Dedicated Devices suitable for the physically disabled or handicapped require careful configuration traditionally more readily achievable when dedicated to a particular condition.

Multi-role A flexible multi-role device adaptable to a range of disabilities and also suitable as a fitness aid could enjoy wide appeal and so help justify larger production volumes with attendant lower cost. It could also find a role in countering natural progressive ageing conditions such as restricted mobility and arthritis.

Chronic Ailments In chronic ailments, such as with MS sufferers, muscle action impairment could attend a deterioration in protective nerve sheath -i.e. muscle action command signals perverted -whereupon lack of muscle use could lead to wasting. In CF sufferers the damage to brain or nerve tissue arises at birth, but with not dissimilar debilitating effect in muscle control.

Problems of stiff locked-up' or frozen' muscles or painful or seized joints which impede limb movement, such as leg spreading, are addressed by applying appropriate controlled counter-force. Typically, this is undertaken in professionally qualified or supervised physiotherapy treatment. That is, either a subject patient is treated by a professional or self-treats under supervision. Unfortunately, this ties-up' both patient and scarce, expensively-trained, staff resources in time-consuming and expensive clinic sessions. These are inflexible to schedule and do not necessarily meet individual patient needs. This also applies in recuperative therapy or treatment of sports and exercise injuries such as muscle or tendon strain.

Self-Actuated A self-actuated or operable personal exerciser, which once a user was trained did not need ongoing professional setting, operation or attendance, would thus be an advantage both for use outside a clinic and to reduce the supervisory and intervention times of a skilled professional. It is also a morale booster for a patient to undertake their own treatment regime with less frequent monitoring or supervision. That said, a facility for quick inspection or monitoring of device usage and effecting adjustment Term mo logy Muscle types A muscle group commonly known as aductor' is generally indicative of any muscle that pulls inward towards the mid-line of the body -the leg muscles being a prime example; impairment or failure of which is common in MS sufferers; whereas abductor refers to the opposite action -i.e. pulling apart from body midl-line, such as arm raising.

Even for the able-bodied, muscles can become stiff or cramped for which condition modest activity can help ease or remedy. Having an aid device can also be a stimulus or incentive in itself to exercise. A muscle group is generally better used to help preserve muscle tissue mass, than left idle to progressively waste away.

Quick Release and Muscle Spasm A desirable device feature would be a quick-release facility, for ease of rapid re- deployment and for use upon experiencing involuntary and uncontrolled muscle-spasms, readily accessible and operable instantly to disable an applied counter load.

A patient subject can generally quickly sense or recognise in advance the early onset of such spasms, whereas even an experienced physiotherapist can only react when the symptoms become manifest.

Statement(s) of Invention

A muscle loading and displacement device comprising a carrier frame, a plurality of body contact and displacement jaws mounted for relative movement upon the frame, a jaw displacement drive, and a drive actuator.

The device can be configured for personal use, that is self-supported by the patient, with displacement and load applied between opposed jaws for (counter-)balanced operation between limbs.

A single-handed command or operation of a drive actuator would be an advantage, leaving a hand free for initial guidance and support.

A user-operable or self-actuated limb and attendant muscle group loading device, configured as a mobiliser, exerciser, spreader or stretcher, operable to apply a controlled (incremental) progressive forced movement, such as an expanding, divergent or spreading displacement force, in opposition to a static locked of frozen muscle group, such as adductors.

Elongate Bar A compact device frame could be configured as an elongate bar or beam with a hollow shell or housing enclosing an internal drive with depending opposed jaws and surmounted by a drive actuator.

The bar could feature an internal cable drive transmission connected to movable opposed depending jaws with an intervening drive actuator.

An actuator could be configured as a manual ratchet winder. This could have single or twin handles for single or double-handed operation. An alternative would be a motorised or power-assisted drive actuator.

Scissor Action In a more distributed open lattice frame format, one construction has a scissor-action lozenge frame as an adjustable prop, jacking or spreader, operable to expand or contract in span, in a prescribed direction or orientation, upon operation of an input, such as an manual trigger lever, mounted upon a hand grip, with an incremental ratchet index action.

Diamond Lozenge Thus, say, four arms or links are interconnected in two pairs as a closed loop, by successive pivot joints at their outer ends, to form adjustable profile lozenged rectangle or diamond shape frame form; of which two opposite corners are brought together -as an input control, using a screw or ratchet drive action, so the intervening other two opposite corners are moved apart, this being used as an adjustable output spacing.

The foregoing link arrangement is relevant to counter the seizure or inward pull action of adductor muscle groups. Conversely, an opposite or reverse action could be contrived to counter the seizure or outward pull of abductor muscle groups.

Carrier Tray An open frame format could pose an entrapment hazard to counter which the frame could be contained within a carrier tray or shield. This lends itself to a lap tray in the case of a leg spreader device configuration.

Whatever the frame format, a dynamic variant could address limp' or flaccid muscle conditions, by imparting or imposing a (say, cyclical) repeated alternating or reversed movement. This to help stimulate blood supply to the subject muscles and tissue cell maintenance.

Practical constructional and operational considerations include * travel (ultimate outward extension) limit; * load (upper) limit; * (overall maximum) range of travel; * start point; * end point; * linearity! proportionality (or non-linearity / disproportionality) of action; * robustness and weight for longevity and ease of handling; * economy of manufacture to promote adoption; * generic format for wide application; * adaptability to bespoke, say, power-assisted variants; A slim-line profile compact device format comprises an elongate enclosed housing an internal drive transmission, such as a cable drive, a pair of opposed depending jaws coupled to the drive for movement apart or together under the command of an actuator control.

One configuration comprises a shallow depth bar or plate of waisted-end or stretched diamond plan-form with opposed depending jaw plates.

The jaws may be hinged to allow collapse fold against the lower body of the device.

If the device is working against the resistance of impaired, frozen or locked muscle groups, the applied (manual) force can be supplemented using some internal mechanical (dis)advantage in the drive or transfer mechanism, or to regulate or limit against excessive force, say by an over-ride or disable trip function.

A differential input vs output connection can be adopted, such as a relatively long input travel / short output delivery throw lever mounting arrangement may suffice for this. An example distributed or open frame core mechanism is one such as commonly fitted as incremental manual plunger dive to cartridge (mastic) contents displacement and discharge guns for mastic sealant. A long input travel or throw' through a hand squeeze trigger grip action advances a short travel floating swing link or index tab incrementally along a displacement shaft, where it is locked upon trigger displacement release ready for the next travel increment. This provides a mechanical advantage or elevated output force to overcome plunger movement resistance by cartridge viscosity. Similar considerations apply to self-application of muscle and limb loading for mobility.

The input displacement increments may be even, equalised, consistent or variable with input stroke, for greater control of corresponding output stroke. A one-way ratchet drive effect inhibits the reaction from the output displacement stroke from being fed back to the input (lever or trigger). Alternative input devices or operating modes to a reciprocating ratchet lever could include, say, a rotary handle, again with a ratchet drive and quick-release facility. Power assistance, such as electric motor or fluid pressure drive might also be incorporated, albeit with increased complexity and expense.

Over-Ride An over-ride or drive decouple mechanism could inhibit the application of excessive output force and/or displacement. Thus some predetermined resistance could be tolerated, but beyond that excessive load disabled before application.

Particular Construction In a particular open frame construction, a trigger body or carriage is fast with or secured to, by say, brazing or welding, to a carrier tube or sleeve within which is slidably located a drive shaft connected at one outward end to a pair of hinged links.

A corresponding opposed pair of hinged links is pivotally secured to corresponding opposite sides of a bridge piece mounted on the outward end of the carrier tube. The link pairs at opposite ends are conjoined or intercoupled circa mid-way of the overall device span by pivotal connection to limb capture cups at opposite sides.

Buffer Cushion A resilient drive coupling or buffer element could be incorporated in the input or output drive to cushion the abrupt or shock loading impact of sudden operation. Mechanical spring and/or fluid cell could be interposed in the drive transfer or drive line between actuator and displacement jaw. Contact pressure should be limited to prevent tissue morbidity and sores.

Limp Limb' Syndrome The converse of locked' or frozen' limbs or rather associated limb muscle groups would be dysfunctional or inoperative passive limp' limbs or muscle groups and a variant of the device could be contrived which simply moved limbs, say for circulatory benefit, against minimal offered resistance. Thus, a continual, say reciprocatory movement cycle could be helpful, so the device could use, say, a rotary input handle for corresponding continuous input. An alternative would be a linear reciprocatory pump action input with a re-circulatory output path.

Action Contact Area The point or rather area of contact of applied force, action or intervention to or with a recipient' patient under treatment is profiled, disposed and orientated for both optimised comfort and/or beneficial effect. Thus a scalloped and waisted cup or yoke can locally embrace or wrap part of a limb such as a leg and help self-locate or stabilise the applied counter' force. Restraint ties such as straps or bands could be used, provided consistent with patient freedom of action.

Typically, in practice opposed splay' or spread forces are applied and which helps (counter) balance the forces at work -with the input applied from a location in between opposed outputs. In one arrangement, the plane of the input force is orthogonal to the plane of the output forces.

Once opposed user limbs are captured by the extremities of output arms of the device some stability is achieved for the input action which may be single or double handed, possibly with some facility for re-orientation, such as rotation about an input travel axis contained in the output movement or spreader displacement plane.

(Input / Output) Load (Force) vs Travel Depending upon the condition symptoms under treatment, load and/or travel or primary input and/or output represent predominant considerations. Thus, say, an incremental manual input limit equivalent to an average hand or finger pull range of up to circa 6-8 inches (metric equivalent 15cm -20) could be allied to an average hand grip of 10-15 lbs (or rather Ibf), with a corresponding output travel reflecting -not merely a mechanical advantage per input stroke, but a cumulative movement of 10-inches is feasible. Metric equivalents would be 25 -38 cm and 44 -67 Newtons of Kgf. Thus load need not necessarily be at the expense of travel, as travel can be progressive or incremental.

Loading As a non-limiting indication, loads of several pounds or tens of pounds, (up to circa 50-150 lbs -effectively lifting an average person's weight single handed) and reflecting those which can be deployed by an average fit person, can be relied upon as input and/or transferred or applied as output.

Range & Increments of Travel As another non-limiting indication, cumulative or incremental input travel of several inches, can be relied upon, with output travel of the same, greater or less order. From a fully collapsed, say collapse-folded, condition for ease of transport and storage to a maximum extended deployment might be, say, 18-24 inches. For a multiple sequential stroke incremental input each increment might be a fraction, say nominally 1/2 inch for a lever stroke of some 2.5 -3.5 inches.

General Purpose vs Dedicated To recapitulate and preface discussion of device elaboration, the invention can be expressed as a mechanical displacement loading device for use as a personal muscle exerciser of general purpose or dedicated configuration.

The original emphasis was upon a simple manually-driven hand-held construction for use by and/or upon patients with progressively acute debilitating muscle impairment or muscle-wasting conditions or diseases such as Multiple Sclerosis (MS), Cystic Fibrosis (CF), Muscular Dystrophy, etc. Under those conditions muscles can lock-up, freeze or seize and an objective is therapeutic symptom easing or amelioration to counter muscle lack of response to command, inactivity leading to atrophy and ultimately calcification through disuse rather than to effect a cure. Ancillary benefits to connective tissue and bone can arise with muscle exercise. In one frame format a symmetrical double-sided lozenge action open lattice arm frame is used to contrive a controlled (lateral) spreading effect between opposed profiled bearer jaws in contact with the users legs, and in particular lower thighs or knees. An incremental push-displacement action over some part or all of a travel range is conveyed to the limbs by a manual trigger drive actuator enabling single-handed operation. A quick-release latch is operable by a finger to disengage the drive and instantly cancel the applied load at any position in the travel range. This without hazardous snap-back or shock.

The device can be configured to meet prescribed medical appliance standards and rules; to which end evaluation trials under professional supervision can readily be conducted, particularly with the measurement and travel control, measurement and plotting facilities described later. After a course of supervised training and instruction, users can be awarded a certificate of competence for solo use. Their performance under training can be recorded as a training record for future inspection. Similarly for re-fresher or advanced training. A corresponding discipline of familiarisation and certificate of supervisory competence can be contrived for professional trainers and instructors. For research purposes, clinical trials could evaluate user performance over time in turn to assess the progression of an underlying disease. Thus muscle weakening and/or reduced range could be determined. Such safeguards are helpful for general sports recreation and leisure and with implementation of extreme sports training and development regimes.

Muscle Impairment In physiology, limbs are movable by counterbalanced loading between opposed or counterpoised muscle groups. Thus limb discipline is achieved by a delicate interaction. Muscles have a natural tendency to contract or shorten. Muscle or muscle group impairment (such as lack of responsiveness or freezing) operative on or to one side of a limb can lead to limb displacement to or in favour or under the primary command or dictates of a residual active group. Muscle defects of excessive stiffness, tautness or rigidity are sometimes referred to as toning or over-toning.

Although muscle stretch' loading (against a tendency to contract or freeze) is one exemplary prime objective, in principle this can be achieved by either pushing or pulling. In the lead embodiments described later a user's legs are pushed apart by an expansion force applied from between the legs. An alternative would be to pull the legs apart by say opposed straps, again from an expansion mechanism. In either case the flesh is locally compressed, to ease which a buffer or spreader cushion can be interposed in a contact pad. Generally, it is not envisaged that flesh would be pulled as this might tear tissue and would be painful and unproductive in effecting underlying limb movement. That said, a modest local or distributed squeeze grip (such as with a tension strap or band) to move a limb wholesale might be tolerable.

Should a particular condition arise under which the legs were set frozen' apart, this might be countered by either pushing or pulling the legs back together. To address that, a reversible or even reciprocating (ie to-and-f ro') mechanism could be contrived by adaptation of a single loading' action device.

An intermediate variation under which general pattern of loading, followed by relaxation or unloading or even temporary reversal is achieved might be employed as a more muscle-friendly' displacement regime. Thus a (pulled', extended, deployed or simply fatigued) muscle could be given an opportunity to relax, recover' or re-energise' in an interval between loading sessions. For convenience, the term muscle' used herein includes sheathed muscle fibre and connective tendon or ligament tissue, which may contract (shorten) or extend as a musculo-tendinous unit. A loaded movement device regime can be conducted without tissue damage such as tearing or without exacerbating existing damage but rather consistent with remedial healing.

Muscle Spasm Muscle spasm can reflect an autonomous or uncommanded local condition, such as arising from a local biochemical imbalance (such as cramp) and/or attendant local nerve triggering, or reflect a remote-originating brain, brain stem or nerve channel command, either unprompted or in an attempt to address a perceived local condition, such as shivering. Another possibility is a brain or nerve pathway aberration and consequent chaotic signal to muscles. In the elderly progressive brain diseases such as alzheimers or consequent dementia could result in involuntary limb tremor or shaking. Whatever the underlying cause, limb and therefore muscle displacement loading can be safely tried to engender an ultimately patient-specific beneficial therapeutic effect. In that regard, the device can serve as a constructive practical cognitive learning or training tool as a focus of mental attention and physical effort, with a discernible visible outcome.

Compact and Streamlined Format From more rudimentary formats refinement in mechanism configuration, utility, ergonomics and action are now proposed. Thus a more compact enclosed format of streamlined' profile with minimal exposed moving parts or inadvertent garment or finger-trap risk is desirable. In one resolved design a flat shallow elongate slab, bar or plate form tapers from a fatter central drive hub to waisted opposite ends and completely encloses a cable drive to a pair of depending slender jaw plates, which themselves might be surmounted by slip-on/off soft gloves.

Setting Adjustment The device is suitable for either supervised or unsupervised use, but a setting adjustment for use only by a qualified person could be incorporated for operational factors, such as spasm disable, force and or displacement limit as discussed later. A continuous or infinitely variable mechanism could prescribe a force and/or displacement range. An indexed incremental mechanism could move between pre-set levels, either prescribed in absolute load or movement terms or in graded increments tailored to a subject patient.

Drive Elaboration Drive elaboration options include a facility to change the drive transmission (gearing') mechanical advantage and/or velocity ratio or leverage and thus the force and/or movement generated as an output for a given input displacement or force, such as through an operating lever or ratchet winder. Linear, non-linear or complex combination input vs output relationship could be contrived. Single action, repeated cycle action or reversible reciprocatory modes could be achieved. For the disabled, a unilateral forced move and hold' would be feasible. A parking detent or hold could preserve a given displacement.

General-Purpose Muscle Conditioning Variants of the device also have a role in a wider general-purpose muscle-conditioning or toning regime, such as alternating cycles of isotonic muscle loading under constant (tension) force over a displacement range or alternative isometric regimes of muscle against muscle with minimal displacement. Muscle flex, muscle condition or tone and blood circulatory supply can thus be promoted.

Sports, Recreation and Leisure Aside from health and leisure activities, target muscle or muscle group development routines through static (loaded) holds' with attendant blood circulatory and oxygenation promotion can be tailored for specific sports, martial arts or yoga (or like physical and mental disciplines).

Calibration By appropriate device deployment, promotion of muscle strength at specific joint angles or over a joint articulation range can be achieved. With device deployment between jointed limbs the device extension span reflects the joint articulation, so device calibration could take account of a graded span and load applied over the span.

Measurement and Test Mode The device also admits of a measurement and test mode recording the force levels and range of joint and limb movement achieved by a user. Such measurement spread over time provide a history of exercise progress and change in patient condition. For research purposes, an indirect inference of tissue condition from performance can be compared with a laboratory histology scrutiny of invasive tissue sample specimens.

Performance Map Periodic measurement sampling over a spread of action can be use to create a personal performance change map for professional evaluation. In this way any improvement through exercise can be countered by deterioration through more acute condition severity.

Motivation For group therapy an element of motivation or incentivisation through competition can be introduced through display of comparative performance.

Audio-Visual Indicator The device itself could feature an action or performance indicator, say of force vs travel (and so work done') to promote user interest and involvement with progress and outcome. A visual analogue scale and pointer or digital alphanumeric readout would suffice. Alternatively, a LED indicator and warning light cluster could provide a colour-coded pattern of behaviour. Similarly, an audio sounder such as a repeated or cyclical pulse tone of variable frequency could be generated to reflect load tracking. A harmonious tone sequence could evoke appropriate operation, such as a continuous smooth loading stroke and conversely a discordant noise signal a fault or error condition, such as a jerky progress with loading and displacement lapses or reversals.

Constant Force The instant force necessary to be applied reflects the resistance encountered, but for a routinely stiff' (through disuse, degenerative wasting or atrophy) muscle requiring principally stretching or extension a constant force drive or transmission mechanism could be contrived to provide an even or constant force over a (contact jaw) displacement range. That in turn would reflect a constant work rate or user exertion which would be more comfortable and impose less heart strain.

Concordat A user (comparative) guidance chart or concordat could give the appropriate force loads and tracking ranges for diverse limb exercises, such as between forearms or between arms and legs, upper torso or trunk to floor, etc. Neutral Setting The device neutral or start setting could be adjustable, with a temporary slack or disengaged intercouple between actuator and movable body contact jaws. This would also be useful for the device in different orientations and between different limbs etc. It could also be allied to the end of range, so pre-set operative spans could be called up to avoid user over-exertion or strain. The device can thus transform from a passive to a pro-active role.

Manual or Automated Quick-Release An optional quick-release facility could be operative to disable the device upon muscle spasm, jerking or judder whether actual, forewarned, predicted or anticipated.

Generally such spasms are unpredictable although a user may have a premonition which a physiotherapist would not. An indicative or characteristic brain-wave pattern upon or prefacing if not predictive of a future signal generating a muscle spasm could be recognised and/or interpreted constructively. This to obviate patient discomfort or even injury upon (internal) spasm against an (external) appliance load. The device could require user manual re-set or an automated re-set after a set interval after spasm cessation could be contrived. A damper to obviate otherwise automated cycling alternately between set and re-set could be included. The intention would be to give the user comfort and reassurance in the device behaviour and characteristics.

Sensor Activation of Quick-Release Sensors attached to patient skin tissue local to target muscle can be configured to detect electrical signals associated with spasm onset. Feedback from sensors to the device can automatically activate quick-release upon detection of spasm onset.

In particular disease subsets, e.g. motor neurone disease or spinal cord dysfunction these electrical signals would not be otherwise detected as the sensory signals are not transmitted to the brain. Local motor nerve signals begin before sensory nerve signals so early detection of motor nerve signals will reduce spasm onset and allow early trigger of the quick-release.

Remote Activation of Quick-Release An remote trigger of quick-release can be achieved by coupling to, recognition and interpretation of prefacing local chaotic conditions or remote brain signals to muscle groups. A head band, skull cap, local limb strap or body band with embedded sensor probes or pick-ups could be used to remotely detect or directly (intrusively) to pick-up signals for relay by hard wire or local encoded low-power short range radio link on approved frequency bands to a receiver coupled to a quick-release actuator on the device or appliance.

In a group exercise training class session a supervisor could be equipped with a transmitter enabled with a master code authority to disable all the participant devices.

This either as a safety over-ride measure or to encourage repeated (re-)cycling of the device for both manual and target limb exercise movement.

Trembler Drive Disabler A mechanical trembler drive disabler, slip or cut-out could be contrived as a substitute or supplement to such an electronic (counter) measure upon muscle spasm. Thus, say, a spring-loaded drive transfer ball in a spider coupling in the drive path could be displaced to allow temporary drive slip upon accelerative loading attendant muscle spasm, rather like the converse of a seat belt inertial reel drive lock-up mechanism. A rotary tumbler adjustment could be fitted to set the disruptive spasm disturbance or shock level at which the drive over-ride intervention is initiated (see Figures 24A-B).

Force Limiter An overload cut-out or force limiter option can be fitted to either or both the input or output sides of the device. This would be operative to curtail the (limb spread) forces applied to the user. A pre-set adjustment could be tailored to the user. Thus, say, adult settings could be higher than juvenile settings subject to the user condition.

Travel Limiter A corresponding limiter option can be fitted to curtail the ultimate travel limit of the device. A measurement counter could track the session and absolute movement and intervene to disable the drive beyond that limit. This could be tailored to the user, taking account of age or condition. A user-specific target plot or map could be compared with actual performance to assess user weakness in force application or range of movement. Thus force capability might tail-oil at extremities of movement.

Such travel and force limiters and/or plotters could be combined in single safety over-ride or monitoring module. User tracking and audit functions could be stored locally for later download or relayed to a central point. Similarly, unique coded setting or adjustment commands could be relayed from a central control to an individual device. Fuse

Limiters could function rather like an overload or short-circuit electrical fuse or (re-settable) overload relay or trip-switch to guard against permanent circuit', in this case muscle, damage. A drive transmission latch could serve as a fuse' re-set.

Combination Paired or other multiple conjoined devices could be used co-operatively together in mutual alignment or relative offset say to extend or (re-)orientate travel range. To this end quick-release mounting and/or connector fittings could be employed.

Solo vs Joint Co-operative Whilst the device is intended primarily for solo use, with an individual user sensing the applied body loads, a co-operative joint participative or mutual use of individual or multiple devices might be contemplated between the limbs or other body parts of different parties. Thus, say, the device might be operative between the respective fore arms of users positioned side-by-side.

Embodiments There now follows a description of some particular embodiments of the invention, by way of example only, with reference to the accompanying diagrammatic and schematic drawings, in which a diversity of configurations and formats are explored: Figures lAthrough 9B reflect a group of embodiments with an exposed, eg scissor-arm mechanical configuration (albeit with an option of cover tray enclosure or encapsulation); whereas a later group of embodiments reflect more compact or enclosed configurations, including a simple bar format. Of this group Figures 1A and 1 B show 3D views of an (incremental-drive) limb displacement loader or mobiliser, in particular a leg spreader, device; More specifically Figure lAshows a limb spreader device in a largely collapsed or retracted condition, generally at the end of one limit of its travel, with opposed limb capture cups on opposite sides more closely juxtaposed; Figure lB shows the device of Figure lAin an extended or splayed condition, with opposed limb contact or capture cups spread apart; Figures 2Aand 2B show the device of Figures lAand lB disposed between a subject patient limbs (in this case legs) for treatment; with skeletal body frame loosely depicted in chained lines; More specifically Figure 2Ashows the retracted device of Figure lApositioned between the upper legs or upper thighs of a subject or patient to be treated; a pistol grip handle and operating trigger lever are upwardly-presented for ease of access by the subject reaching forward with the arm(s); Figure 2B shows a subsequent deployment stage to Figure 2A with the device extended by repeated alternating squeeze and release trigger ratchet drive action to spread and separate incrementally the subject limbs and thus the legs overall; the user can immediately sense the force applied and adjust the displacement to a tolerable (dis)comfort level; Figures 3A and 3B show a variant device of Figures 1A and 1 B with swivel handle provision to allow re-orientation such as reversal of grip, as might be useful for a therapist situated in front of the patient subject; More specifically Figure 3A shows the device with frame lozenge collapsed and contact arms retracted, ready for deployment; Figure 3B shows handle swivel re-orientation upon a turntable mount; Figures 4A and 4B show a more fully compact collapsible device frame variant, with provision for over-fold of operating handle and temporary disconnection and re-connection of drive link arms; More specifically Figure 4Ashows initial disconnection of link arms 11 and inward fold over the corresponding link on that side at the opposite end; Figure 4B shows release and over-fold of the trigger 14 and pistol grip handle 13 about a pivot mount upon the carrier 15; this so as the handle and trigger lie closely alongside the link arms 11 Figures 5A through 5 G show variant limb contact and capture jaw configurations; More specifically Figure 5A shows a stepped angular profile open-sided cup profile, with a back bearer plate surmounted by contiguous opposed arms to help locate a user limb; Figure 5B shows a minimal shallow curvature back-plate with sprung coil opposed cup arms; Figure SC shows a variant of Figure SB with twin restraint cup arms; Figure SD shows a variant of Figure SD with twin opposed bearer pads; Figure SE shows a resilient deformable cushion bearer pad; Figure SF shows an breathable' perforated open-mesh cup pad; Figure 5G shows a stubby plain cylindrical bearer rod or bar; Figures 6A and 6B show an alternative upright re-orientation of the device, presenting the operating handle towards the subject, or if reversed through 180 degrees, to an operator (not shown); More specifically Figure 6A shows an upright orientated spreader device in position between the subject upper legs or thighs, ready for deployment (ie expansion or spreading) with a pistol grip handle and pivoted operating trigger orientated towards the trunk of a prospective subject user; Figure 6B shows the device of Figure 6A in use expanded with subject limbs spread apart; Figures 7A and &B show an elongate rack (bar or tube) and rotary pinion drive variant with a rack bar 60 interposed between opposed spreader arms 11, themselves pivotally interconnected at one end with limb contact and/or capture pads 12 at opposite outboard ends; with a ratchet drive lever 25, operable by reciprocal to-and-fro action, to rotate a drive pinion 62 within the arm pivot coupling and upon engaging the rack bar 60 to draw that bar in one or other direction and in doing so to vary the disposition of the bar coupling bridge 54 to the opposite arms and in turn thus vary the arm articulation and relative spacing or separation of the arm outboard ends with limb contact bearer pads 12; More specifically Figure 7Ashows a collapsed or retracted condition with opposed spreader arms 11 closely juxtaposed; Figure 7B shows an extended or expanded condition of the spreader of Figure 7A, with opposed arms well separated and ratchet 20 drive bar driven upward through the arm pivot coupling 53; Figures 8A through 8D depict variant device configurations, using a so-called lazy tongs' serially-repeated crossed link scisssor frame assembly; More specifically Figures 8A1 and 8A2 show respectively extended and compact collapse-folded conditions of a fluid (eg pneumatic) charge actuator at a central position of an actuator bridging arm, in a lazy-tong scissor frame link array with opposite ends presenting prospective limb contact pads; Figure 8B shows a rotary drive alternative to the actuator of Figure 8A, with a continuously operable rotary crank handle 61 driving a pinion 62 engaging a rack toothed profile bridging bar 60 of a lazy-tong scissor frame linkage 63; Figure 8C1 (extended) and Figure 8C2 (collapsed) show reverse drive mode of the rotary actuator linkage of Figure 8B; Figure 8D shows a double-acting fluid (say hydraulic) actuator variant of Figure 8A; Figures 9A and 9B depict a variant of Figures 1 A and 1 B with a stacked pivot bearing pad assembly at opposite ends, rather than a bridge element; More specifically Figure 9A depicts a collapsed condition with opposite end pivots presenting a more compact profile; Figure 9B depicts an expanded condition of Figure 9A; Manual drive power is desirable for ease and economy of manufacture, deployment and use; but self-powered or power-assisted versions are indicated for completeness and might be useful for severe handicap conditions.

Figures lAthrough 9B of the drawings are now discussed in more detail before reverting to the remaining Figures 1OA through 33B of the drawing sequence.

Referring to Figures lAthrough 9B a manually-operable limb mover, mobility aid or (re-) mobiliser, in this case configured as a leg spreader 10, comprises a scissor-action frame of opposed output' displacement or spreader link arms 11, with respective outboard profiled limb (embrace or capture) cup jaws 12, coupled to a transfer mechanism 17 running upon a traveller 19 running upon a transfer stem or shaft 18 with an input carrier 15 driven by a floating drive link plate 23.

Essentially, operation or actuation is by repeated pull (with spring-back up release) of a spring-loaded trigger lever 14 pivoted upon carrier 15 to displace the floating drive link plate 23 along transfer shaft 18. Upon release, the lever 14 returns to its original undisplaced condition relative to the carrier 15, but which has been moved incrementally along the transfer shaft 18 by the last cycle of input lever 14 movement.

A reduced movement travel can be achieved simply by pulling the lever 14 through a reduced input travel arc. The transfer shaft 18 slides with a drive tube or sleeve 24 to one inboard end of which the carrier 15 is made fast, say be brazing or welding, so the reaction to displacement of the drive link plate is to drive the shaft 18 inward or outward taking with it the opposite end with attached link arms 11.

The device or apparatus 10 is first positioned between the limbs to be spread and orientated so the output arms 11 will engage and eventually displace those limbs. The slim profile of the compact collapse-folded device, clustered closely around the transfer shaft, assists such insertion and positioning; a convenient tactic being to first dispose between opposed limbs to be spread, then rotate about the transfer shaft 18 to present arm ends towards them. The trigger slide carrier 15 is fully retracted and disposed towards the user's body and within convenient arms reach, to permit comfortable hand grip and trigger squeeze operation. With repeated operational cycles of the trigger 14, the carrier 15 moves incrementally and progressively along the transfer shaft 18 to draw the shaft 16 into the drive tube 24 and pull inward the outboard shaft end, and in doing so lozenges the overall link assembly.

As the carrier 15 moves along the transfer shaft 18, so the arms 11 are together driven by the corresponding intermediate transfer links 32 to move in unison progressively further apart., bringing the limb cups 12 initially into contact with the user limbs 40 and spreading those limbs 40 progressively further apart.

For a more experienced user, the device can be set at the outset with the output arms spread sufficiently to contact the limbs to be spread. A quick-release facility 50 on the carrier latch 51 allows the carrier 15 to be freely run along the transfer shaft 18 until the desired output spacing has been achieved, whereupon simply releasing the latch link re-engages it and the carrier 15 with the transfer shaft.

For self-use, a patient-operator can judge the amount and rate of output arm displacement and thus engaged' limb movement, along with tolerance' for the amount of load applied. If the patient's condition is such that the amount of load applied cannot be felt, sensed or gauged, a force-limiter or over-ride release may be incorporated into the mechanism, to inhibit application of excess force. Force limitation over-ride or bypass can be applied at any chosen output displacement.

Such a force limiter is also useful if treatment is being applied by a third party professional therapist, such as a physiotherapist.

In this particular construction, the transfer shaft 18 comprises dual co-axial inter-fitting elements of a fixed sleeve 21 carrying a bridge 22 at one outboard end and to which side swing links 23, 24 are pivotally secured.

The drawing sequence should be generally self-explanatory, with the device shown in various conditions and dispositions; but by way of general comment Figures 2A and 2B show initial and subsequent operation phases or use, of the spreader device in conditions of Figures 1A and 1B; along with the relative disposition and operation of the spreader device 11 between a user's limbs, in this case the upper legs or thighs. The amount of displacement is at the user and/or third party therapist operator's discretion.

Each limb capture cup 12 is carried by swivel spigot 27 with a common pivot 29 for conjoined outer links 31, 33, and 32, 34 on opposite sides of the transfer shaft 18.

Figures 3A and 3B show a swivel mounted operating handle 13 and associated pull trigger 14. A storage mounting hook option can also be fitted to one end.

Figures 4A and 4B show provision for collapse over-folding of a handle and trigger assembly 13, 14.

Figures 5A through 5G show variant forms of capture cuff. Positive location of a limb to inhibit inadvertent slippage out upon loading, along with a facility for ready dis-engagement upon unloading is desirable, so a minimalist cup format or even just a contact bearer pad lends itself to this.

Figures 6A and 6B show the spreader re-orientated relative to the earlier drawings, with the transfer shaft assembly orientated upright or vertical, rather than horizontal; again in initial collapsed and then in expanded conditions, with the user trunk and limbs (upper and lower legs) depicted in chain dotted lines; Figures 7A and 7B show a variant with a side handle and trigger assembly acting as a ratchet and pinion drive to a slide tube 24.

Figures 8Athrough 8D show so-called lazy-tong' spreader variants, with diverse means of actuation, from a piston-in-cylinder actuator of Figure 8A, a rotary handle actuator of Figures 8B and 8C to a motorised drive of Figure 8D.

Manual power is desirable for ease and economy of manufacture, deployment and use; but powered versions are indicated for completeness and might be useful for severe handicap conditions.

Reverting to the drawing sequence Figures 10A through 10D show a pneumatic! hydraulic concertina-fold spider mechanism.

A fluid, eg pneumatic or hydraulic, powered concertina fold scissor-action spreader arm assembly 101 deploys from a compact inter-folded nest (of Figure 10A) to a more straightened-out spayed arm configuration (of Figure lOB) using a common central drive spider actuator 102 with a plunger trigger 103. Depending jaws 104 are pivot-mounted at opposite sides of the assembly.

Figures hA through 11C show a passive containment bar with jaw actuator.

A passive' (ie without internal drive), slender profile, (solid) bar 110 is surmounted by a single movable jaw 111 with integrated claw-actuator 112 with spring-return trigger lever 113 operable to traverse the bar for span adjustment in relation to a fixed opposed jar 114 at the other end of the bar.

Figures 12A through 12D show a scissor' frame spreader.

A scissor-action spreader arm assembly 120 with diametral drive rod 121 set vertical or upright for lozenge' expansion or contraction of opposed carrier arms 122 with outboard jaws 123; a parallelogram linkage 124 dictates and preserves a consistent jaw orientation; the assembly sits upon a splayed-leg floor stand 125, with a ratchet lever drive handle 126 at an opposite overlying side. This allows a seated user to fit the jaws between parted legs and access from one side for single-handed drive handle operation at waist level.

Figures 13A through 13C show a straight drive bar with a manual actuator.

A convenient format is a straight full-span elongate bar 130 of slender profile and either rectangular (as shown) or round cross-section with an enclosed internal (say cable) drive transmission 131 to a pair of opposed depending movable jaws 132 with profiled faces to bear upon limbs, such as legs, to be spread and with a mid-span rotary (continuous or ratchet) drive handle or winder 133 to vary the jaw spacing. This would allow single-handed adjustment and setting of jaw relative position by simultaneous closing or outward movement of both jaws.

Figures 14A through 14C) show a motorised straight drive bar.

A motorised version of the Figures 13A-C sequence features a compact side-saddle' mounted (electric) drive motor 134 substituting for a manual rotary winder handle; an umbilical power cord (not shown) connects to a power supply such as a battery pack or mains step down transformer. A stepper (rather than continuous power) motor would effect progressive cumulative incremental movement in prescribed small steps.

These could loosely equate to the movements of a manual ratchet drive, so be perceived as acceptable to the user. A travel and/or load sensor and limiter or cut-out could be fitted to avoid excessive jaw displacement or applied force. A programmable electronic interface could follow a predetermined regime either from a repertoire or library of rehearsed and proven stroke and load routines or a bespoke procedural path tailored to the user physiology and epidemiology.

Figures 15A through 15C show a bowed bar.

A curvilinear bowed bar 140, again of slender profile with internalised drive, set in a large radius curvature with offset radial push/pull drive rod 141 through a pair of splayed spreader arms 142 to opposed jaw travellers 143 entrained upon the bar.

The overall configuration has loose (long or cross) bow and arrow' connotations, but with an alternative push-pull (and possibly rotate to latch) action upon an upturned handle end of the drive rod. The overall jaw closure or outward movement path is more sympathetic to spreading or closure of user limbs (in particular legs) about a common spinal trunk. A latch detent and spring return bias (not shown) could be fitted at the bar/rod interface to hold the rod in a selected one of a series of incremental pre-set positions, with a quick-release facility. Whilst a fixed curvature radius is depicted variable curvature or flexible bars could be contemplated in later variants.

Figures 16A through 1 6C show a body trunk / torso carriage.

A body trunk or torso wrap carriage is configured as an adjustable throat strap or band 150 with an arcuate carrier sleeve 151 for outboard orbital jaw travellers 152 of adjustable splay, by respective drive arms 153 captive to a common mid-set ratchet drive lever 154 upon a radial slide bar 155 with an inboard end carried upon the trunk band; again allowing single-handed operation.

Figure 17 shows a straight bar with single-ended drive.

A straight full-span elongate slender profile hollow bar 160 with enclosed transfer drive and end ratchet drive actuator 161 with spring trigger levers to an internalised, say cable or spiral screw, transmission (not shown) for depending pivot jaws 162 upon respective travellers or carriages 163, with a quick-release push button option 164 to disengage the drive and allow free jaw movement.

Figures 18A through 18B show a split-fold bar.

A collapse fold, split-halves variant of such a straight bar could be contemplated with a mid-span pivot 170 adjacent a winder. This would allow the bar to fold in half the width of the full operational span for compact storage and carriage. The internal (say cable) drive tension would adjust to allow such collapse in-fold (Figure 18B). The over-fold could be asymmetric with a longer bar portion carrying the drive winder again as in Figure 18B. Hinged drop-down jaw flaps such as of Figure 27 would provide a still more compact format when retracted upwards. The winder handle could serve as a fold-over capture element or clasp for the overlying bar portions.

Figures 19A through 19B show a variable curvature bar.

A flex conduit bar 171 with internal drive for entrained jaws 172 could substitute in whole or in part (such as an interposed curved segment or sector) for a straight bar for a more sympathetic jaw tracking movement in relation to patient physiology. A bar structure in the form of a pipe bending spring might be contemplated. The flex or give might be used for compliant loading or be locked out by, say, an internal tension wire.

Figures 20A through 20D) show various alternative bar dispositions.

A bar 180 is configured to allow alternative disposition between different limbs or parts of the body, ie other than a primary role as a leg spreader, such as secondary roles between forearm and an individual leg on the same side of the body, between opposite forearms and between fore an upper arms. Multiple alternative roles ie a multi-role rather than a dedicated role allow a more cost-effective flexible device.

Other modes such as between torso and limbs could be contrived, if necessary with mounting adjustment such as straps or ties and alternative or extended jaw profiles.

Depending upon its presentation to the user, the bar can usefully serve as a personal brace and hand hold for ease of deployment.

A hollow bar section accommodates an internal drive mechanism and may be terminated in an end blanking piece. A rectangular, even square, cross-section is depicted, but a round or pipe conduit cross-section may be substituted, or even mixed sections, say to provide handlebar end grips. In that regard, a rotary twist lock might be incorporated to inhibit certain functionality, such as over-fold or jaw drive.

Figures 21A through 21B show a hard-wired automated remote quick-release per skull cap sensor.

A skull cap 190 with embedded sensors is used to pick up brain signals upon or forewarning of muscle spasms to trigger an actuator quick-release 191 through a hard wired umbilical cable link 192 or radio link.

Figures 22A through 22B show a wireless automated remote quick-release per a head band or cap sensor.

A head band 193 embedded sensor variant of Figures 21A through 21B with a wireless or radio link to an actuator quick release.

Alternatives (not shown) for either hard wired or radio link would include a local muscle sensor, such as to a wrist, palm or finger band Figures 23A and 23B show a spasm disturbance sensor fitted to a linear bar device.

Figures 24A and 24B show load force setting adjustment for a linear bar device.

Figures 25A and 25B show a travel limiter for a linear bar device.

Figures 26A and 26B show a measurement and test mode of a linear device with an on-board indicator, taking account of both displacement and applied force; in the case of Figure 26A with a push outward spreader action and in the case of Figure 26B with a push inward action or push outward against resistance.

Figure 27 shows supervised group use of an individual device per participant.

Figures 28A through 28D show intercouple of pair devices with an axially aligned bridge piece to extend overall range.

Figures 29A and 29B show shared device use; in the case of Figure 29A between the upper legs of juxtaposed users with an extended device such as of Figures 28A through 28C; in the case of Figure 29B with a normal span (solo) device disposition between the upper arms of juxtaposed users.

A puller coupling variant of the straight bar device is shown in Figure 30 using depending loop bands or straps to pull rather than push upper legs apart.

An arm exerciser variant is depicted in Figure 31 operative between forearm or wrist and upper arm or shoulder to address intervening arm or adjacent wrist, arm and shoulder muscles.

A flat bar with drive disengagement upon reversal is depicted in Figures 32A through 32C.

Figures 33A and 33B depict an underside view of a flat bar or slab format of Figures 32A-C with a continuous travel guide slot, channel, groove or pathway 211 in the underside. Key component features include 201 casing 202 double handed drive lever 203 jaws 204 ratchet drive 205 jaw traveller connection 206 cable 2o7pulleywheel 208 drive wheel 209 drive pawl 210 quick release lever 211 travel slot 2l2brakepawl This represents a development of the bar of Figures 13A through 13B is a waisted shallow depth plate or slab format for a shallow depth hollow casing 201 with fully enclosed cable 206 and cable drive wheel 208 to opposed depending hinged jaw plates 203 mounted upon jaw travellers with drive connections 205 with a return loop around end pulley posts 207. Drive is initiated and commanded through an upper side double-handled winder 202 with a ratchet capstan drive 204 to cable runs to opposite plate ends. The cable 206 can be tied or held friction captive with respective jaw traveller drive pin upstands 205.

An overload back-up of drive slippage could be contrived by sliding wire surface to drive pin contact interface. An ultimate fail-safe of cable failure arises upon excessive winder force application.

A quick drive release facility features a brake mechanism with a spring loaded drive pawl or lever 209 and associated drive ratchet wheel 208 that under clockwise rotation moves and holds the jaws 203 in position, not allowing them to return together in a closed direction.

Upon, anti-clockwise rotation of the handle 202 the drive pawl 209 is disconnected from the ratchet wheel 204, whereupon a release lever 210 engages with a brake pawl 212, allowing the ratchet wheel 204 to spin freely and the jaws 203 to move unrestrained by the cable drive 206 and to return to closed condition under external force or feedback, such as arising from muscle spasm and attendant limb tremor.

Again, the overall device span is convenient for bridging between a user's knees for (upper) leg spreading exercise. Jaw travel range could be limited by a slotted throat plate on the underside, but in principle could extend over the entire span between internal cable end return posts. Out-turned carrier plates for each jaw carry cable drive or capture posts. A central winder shaft with a drive cog is engageable with coupling pivot pawls to an annular drive collar with cable end capture or entrapment fixtures. A split clamshell housing of robust base plate surmounted by a lighter weight cover could be employed, using metal and or plastics materials for this and the drive components.

A (say electric) motorised drive version (not shown), say with appropriate step down reduction gearing, would allow more elaborate drive controls and position monitoring through motor electrical connection and programmable electronic controller. For use in periodic bursts a rechargeable battery or battery pack could be carried by the user or even fitted within the device housing. A re-charging facility by generation under user displacement might also be contrived for longer battery life. An alternative self-contained power source might be contrived by a pressurised fluid (say, pneumatic or hydraulic) reservoir selectively coupled to a fluid actuator. A partially-evacuated barometric variant might use the pressure differential in relation to prevailing atmospheric pressure to expand or contract a bellows actuator.

Generally, drive disengagement or disabling upon muscle spasm can be achieved by user reaction, such ad through a ratchet or one-way drive, implemented by suspending or slight reversal of a drive winder, or by some pro-active automated io intervention such as triggered from a local or remote muscle or nerve electrical sensor or input vs output comparator.

Component List leg spreader device 11 spreader link arms 12 limb capture cup 13 operator handle 14 trigger lever input carrier 16 shaft 17 transfer mechanism 18 transfer shaft 19 traveller ratchet 21 fixed sleeve 22 bridge 23 floating drive link plate 24 drive tube I sleeve ratchet drive transfer 31 transfer links 32 transfer links 33 transfer links 34 transfer links user limbs quick release 51 carrier latch 53 pivot coupling 54 bar coupling bridge rack bar 61 rotary crank handle 62 pinion 63lazytonglinkage 101 concertina fold scissor-action spreader arm assembly 102 central drive spider actuator 103 plunger trigger 104 Depending jaws 110 slender profile, (solid) bar 111 movable jaw 112 claw-actuator 113 spring-return trigger lever 114 fixed jar 120 spreader arm assembly 121 diametral drive rod 122 opposed carrier arms 123 outboard jaws 124 parallelogram linkage 125 floor stand 126 ratchet lever drive handle elongate bar 131 drive transmission 132 movable jaws 133 winder 134 drive motor bowed bar 141 drive rod 142 spreader arms 143 jaw travellers 150 adjustable throat strap 151 carrier sleeve 152 orbital jaw travellers 153 drive arms 154 ratchet drive lever 155 radial slide bar profile bar 161 ratchet drive actuator 162 pivot jaws 163 traveller 164 quick-release push button pivot 171 flex conduit bar 172 entrained jaws bar 190 skullcap 191 quick-release 192 cable link 193 head band 194 radio link 195 spasm sensor 196 (lockable) force setting 197 travel limiter 198 onboard computer 199 safety over-ride 200 computer I display 201 casing 202 double handed drive lever 203 Jaws 204 ratchet drive 205 jaw traveller connection 206 cable 207 pulley wheel 208 drive wheel 209 drive pawl 210 quick release lever 211 travel slot 212 brake pawl