JP2003052769A - Arm ergotherapy system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an arm ergotherapy system based on automatic exercises constituting a bio-feedback loop by sight stimulation. SOLUTION: In order to recover lowering in a motor function caused by a paralysis by a brain blood vessel fault, the frequent repeated exercises of the paralyzed arms are performed by the automatic exercises of a patient, for the functional fault of a motor center or propagation path caused by the brain blood vessel fault, the paralysis is recovered by reconstituting that function, function recovery by such plastic appearance of the brain is supported and the bio-feedback loop is composed by the sight stimulation. Besides, kinetic data in the exercise therapy are saved for quantitatively emulating the motor function recovery.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an upper limb exercise therapy system by automatic movement that constitutes a biofeedback loop by visual stimulation.

[0002]

2. Description of the Related Art Conventionally, there are the following devices for the purpose of being used for exercise therapy. 1) For example, the sanding used in the field of rehabilitation is fitted with a slippery mover or a mover with an appropriate frictional resistance and is moved on the flat plate member by automatic movement to recover the upper limb motor function or There is something that expands the range of motion of the upper limb joints. 2) In addition, JP-A-2000-279462 (P2000-
279462A), JP 2000-279464 (P2).
000-279464A), JP-A-2000-28804.
6 (P2000-288046A), a device for performing upper arm exercise assistance and upper limb rehabilitation by so-called passive movement is developed, in which the upper limbs are grasped by a suspension type device to guide upper limb movements.

3) Also, as a function recovery training device for stroke hemiplegic lower limbs, scientific research fund subsidy (Fundamental Research (C) (2)) 1998-1999 research result report "Stroke Hemiplegic Lower Limb Development of functional recovery training support system and its application to facilitative exercise therapy "March 2000 There is a research by Kawami Hemi (Associate Professor, Faculty of Medicine, Kagoshima University). This allows the patient to sit on the lower limb function recovery training support device in a long sitting position, the waist is fixed to the chair, and the foot is fixed to the movable footrest.
The foot is automatically moved in a horizontal plane. The position of the foot is presented as a foot index via a computer on a display placed in front of the patient. The patient compares the foot index with the target foot trajectory presented on the display, and performs exercise training under the visual stimulus. 4) Further, in Japanese Patent Laid-Open No. 10-258100, it is possible to automatically perform various passive exercises, isometric exercises, isotonic exercises, and constant-velocity exercises performed on a lower limb as assistance exercises by a physical therapist or the like. We are developing a possible device.

In the prior art described above, in the case of the device of 1), it is possible to improve the recovery of the upper limb motor function to a patient.
Although it is an automatic exercise that recovers the exercise function, strengthens the exercise muscle, and expands the range of motion of the joint, the exercise itself is left to the patient, and the effect as exercise therapy is not great. Further, in the case of the device of 2), it is possible to perform exercise therapy for the upper limbs by passive exercise or exercise assistance, but it is not configured to perform exercise therapy utilizing biofeedback. In the case of the device of 3), it is intended for the lower limbs, and the recovery exercise of the lower limb movement control function can be performed by the automatic movement that constitutes the biofeedback loop by visual stimulation. However, this device is for the lower limbs, which requires relatively simple movements, and cannot be applied when the range of motion is large in three dimensions and the movement is complicated like the upper limbs. Further, in the case of the device of 4), emphasis is placed on the realization of various exercises such as passive exercises, isometric exercises performed by a physiotherapist or the like as assisting exercises, isotonic exercises and constant velocity exercises for the lower limbs. Only.

[0005]

Up to now, it is strongly believed that the functional disorder of the motor center and the transmission path caused by cerebrovascular disorder is due to the improvement of the lesion of the brain, and the recovery of the motor function due to the expression of plasticity of the brain is limited. It has been considered to have been. Regarding the functional recovery of the lower limbs on the hemiplegic side, it was reported that there was no difference in recovery depending on the content of exercise therapy. The present inventor has recently shown the possibility of exercise therapy that promotes expression of plasticity in the brain, and reasoned that further improvement in the quality and quantity of training in the paralyzed upper limbs can further promote recovery of motor function. . To achieve this, it is necessary to further increase the number of repetitions of the training exercise. Manual training by doctors and physiotherapists has a limit in further increasing the number of training exercises both physically and temporally. Therefore, the present inventor aims to provide an upper extremity exercise therapy system that enables effective exercise therapy in order to solve such problems in the field of rehabilitation.

An object of the present invention is that the recovery of motor function due to central movement disorder is due to the reconfiguration and reprogramming of neural circuits in the central nervous system, and therefore, a biofeedback loop that enables exercise therapy to promote it is provided. An object of the present invention is to provide an exercise therapy system with built-in automatic exercise. The present invention also provides a means for storing and analyzing hand motion data, which can provide information for quantitatively grasping a patient's motor function recovery process and its evaluation.

[0007]

The inventor of the present invention has made extensive studies in order to solve the above problems, and as a result, has completed the invention described below. That is, the present invention, in order to recover the motor functional decline due to paralysis due to cerebrovascular disorder, to perform frequent and repetitive movements of the paralyzed limb due to automatic movement of the patient, and also to the motor center caused by cerebrovascular disorder. The dysfunction of the transmission path realizes that the function is reconfigured in some way and the paralysis is recovered, the functional recovery by such plastic expression of the brain is promoted, and the biofeedback loop by visual stimulation is configured. . In addition, the exercise data in the training therapy should be saved to quantitatively evaluate the recovery of motor function.

The key points in constructing the upper limb exercise therapy system of the present invention are 1) realization of automatic upper limb movement, 2) configuration of biofeedback loop and its active utilization, and 3) recording and analysis of motion data. is there. Regarding the above 1), the trajectory of the hand to be exercised by the patient is set within an arbitrarily inclined plane to realize the three-dimensional automatic movement of the upper limb. Regarding the 2) configuration of the biofeedback loop, the target motion trajectory of the hand to be exercised by the patient is presented on the display, and the position of the hand exercised by the patient is presented on the same display as the hand index. By these, they are actively given to the patient as visual stimuli to realize automatic movement, and a biofeedback loop as shown in FIG. 1 is configured. This promotes brain reprogramming in the premotor, motor and other areas. In addition, regarding 3) the recording and analysis of the movement data, it is possible to record the movement data obtained by measuring the position of the hand portion on which the patient has exercised using a computer and analyze the recorded movement data of the hand portion. The evaluation value of is calculated.

The upper limb exercise therapy system of the present invention is an upper limb exercise therapy for grasping the hand of the trainee's upper limb to realize the trajectory of the hand in a plane and measuring the position of the hand in the plane. In the system, first train means for recording standard motion trajectory data including the position and speed of the hand part to be exercised by the trainee, and the possible motion range of the hand part of the trainee are measured to obtain the hand part. A hand motion range measuring means for calculating a motion range characteristic value; and a target motion trajectory generation means for converting the standard motion trajectory data based on the hand motion range characteristic value to generate a target motion trajectory unique to the trainee. , Target movement trajectory presenting means for presenting the desired movement trajectory on the display, hand index presenting means for presenting the position of the hand of the trainee as a hand index, and hand motion data of the trainee A second storage means for recording and this recorded hand And a motion analysis means for analyzing the operational data.

In the upper limb movement therapy system of the present invention, the hand range of motion measuring means is a point where the upper limb of the trainee is extended forward in a state where the hand of the trainee lies in the plane. The hand point movable range characteristic value may be calculated by measuring the positions of the turned point and the point bent to the body side. The standard trajectory of the standard motion trajectory data in the upper limb exercise therapy system of the present invention is one vertical line, one right diagonal line, one left diagonal line, and eight vertical lines.
It may have a pattern of 8 characters, 8 diagonals to the right, 8 diagonals to the left, and an S-shaped / straight line combination.

The standard motion trajectory data in the upper limb movement therapy system of the present invention may include, as parameters, the characteristic value of the range of motion of the hand and a motion cycle in which the hand moves around the orbit. The target motion trajectory presenting means in the upper limb exercise therapy system of the present invention may present a target trajectory indicating the position of the hand and a target index indicating the position of the hand moving at a target speed. The hand part index presenting means in the upper limb exercise therapy system of the present invention may have the functions of the same presentation, line symmetry presentation, and point symmetry presentation with respect to the position and movement direction of the hand part. The movement analysis means in the upper limb movement therapy system of the present invention is characterized in that the movement length of the hand portion, the movement cycle, the time integration of the orbital error which is the distance between the hand portion index and the target trajectory, the distance between the hand portion index and the target index. The time integration of the index error, the area of the trajectory error, the number of times the hand is lost, and the spectral density of the trajectory error may be calculated.

The upper limb exercise therapy apparatus of the present invention comprises a hand part trajectory plane setting means for grasping the hand part of the upper limb of the trainee and realizing the trajectory of the hand part within a plane, and the position of the hand part within the plane. Hand part movement measuring means for measuring, the hand part index presenting means, the first storage means, the hand part movable range measuring means, the target motion trajectory generating means, the target motion trajectory presenting means, the second storage means, and It has the motion analysis means. The hand part orbital plane setting means in the upper limb exercise therapy apparatus of the present invention fixes the hand part of the trainee to the gripping part without constraining the degree of freedom of the joint part of the hand, and executes the movement in the plane in the orthogonal coordinate direction. The trainee's hand movement may be realized by a linear motion mechanism or a link mechanism that performs movement in the polar coordinate direction.

[0013]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described with reference to the drawings. FIG. 2 is a diagram showing the overall configuration of the upper limb exercise therapy system of the present invention. The hand portion 101 of the upper limb of the trainee who performs the therapeutic training is gripped by the grip portion 203 of the device. The gripping part of the device can move without resistance in the orbit setting plate 201 that is arbitrarily tilted to realize automatic movement, and the position within the plane is measured by the position measuring parts 205 and 207 and output as position information 305 and 307. To be done. The position information 305 and 307 of the hand of the trainee is fetched and processed by the arithmetic processing unit 403 of the computer 401,
The hand index 603 is presented on the display 601.

On the other hand, the target motion trajectory for the trainee to perform an upper limb motion is based on the data of the standard motion trajectory data storage unit 421 and the data measured by the hand motion range measuring unit 411.
It is generated by the target motion trajectory generation unit 413 as a target motion trajectory unique to the trainee. The generated target motion trajectory information is
It is processed by the arithmetic processing unit 403 and presented on the display 601 as a target trajectory 605 and a target index 607. The trainee has a hand index 603 presented on the display.
And the target trajectory 605 or the target index 607 are recognized and judged as the visual information 311, and the given task is performed. The hand motion data of the trainee is recorded in the hand motion data storage unit 423, and the motion analysis unit 415 performs analysis for motor function evaluation using this.

The hand range of motion measuring means extends the upper limbs forward as shown in FIG. 3 (a) in a state where the trainee receives the training while holding the hand part 101 with the holding part 203 of the apparatus. Based on the position information 305 and 307 of the three points of the point P1, the horizontal abduction point P2, and the body-side bent point P3, FIG.
The hand part movable range characteristic value is calculated by the procedure shown in (b).

The standard motion trajectory data is stored in the standard motion trajectory data storage unit 421. Of these, the standard trajectory is a vertical line (T1) and a diagonal right line (T) as shown in FIG.
2), one diagonal left (T3), eight diagonal right (T4), vertical 8
It has a pattern of a letter (T5), an oblique left eight letters (T6), and an S-letter / straight line combination (T7). However, these are for the upper right limb, and the one for the upper left limb is also prepared separately, and all are stored in a normalized form. The target index that moves at a specific speed with respect to each standard trajectory is normalized with respect to the motion cycle as a standard speed time series, and is stored in the standard motion data storage unit 421.

As shown in FIG. 5, the hand part movable range measuring part 41 is provided.
1. The trainee's peculiar hand movement range characteristic value measured by 1.
By using the standard trajectory and the standard velocity time series of the target index stored in the standard motion trajectory data storage unit 421, and the target motion cycle in which the hand makes a complete orbit in the training, the target trajectory unique to the trainee and the target index are calculated. The target velocity time series is generated by the target motion trajectory generation unit 413. The generated target motion trajectory unique to the trainee is displayed on the display 60 through the arithmetic processing unit 403.
Presented in 1.

The hand index presenting means has the three functions of the same presentation, line symmetry presentation and point symmetry presentation with respect to the position and movement direction of the hand. Examples of the line symmetry presentation and the point symmetry presentation regarding the vertical eight-character target trajectory are shown in FIGS. 6A and 6B, respectively. Point A in FIG. 6 is the device of the hand, and point B is the position of the hand index presented on the display.

The motion analysis means uses the hand motion data recorded in the hand motion data storage unit to calculate the target trajectory length (L
0), motion realization orbital length (L1), motion cycle (T), orbital length ratio (L1 / L0), orbital velocity (L1 / T), time integration of orbital error, time integration of index error, orbital error Area, trajectory error time integration motion period ratio (orbit error time integration
/ T), index error time integration movement period ratio (time integration of index error / T), orbit error area orbit length ratio (area of orbit error /
L0), the number of hesitations, and the evaluation values of the spectral density of the orbital error are calculated, and the results are used to assist in the evaluation of the effect of upper limb exercise training. The trajectory error is an absolute value of the distance between the hand index and the target trajectory, and the index error is an absolute value of the distance between the hand index and the target index. The number of times of hesitation is the number of times the movement direction of the hand index clearly continues to move in a direction that does not return to the trajectory.

[0020]

[Examples] The invented upper limb exercise therapy system was installed in the Kirishima Rehabilitation Center of Kagoshima University Hospital for clinical application. Two types of tasks were set as training tasks. That is, it is 1 trajectory following task (TF task) and 2 index following task (MF task) for the target trajectories of the seven types of motion patterns shown in FIG. The trajectory tracking task involves moving the hand index along the target trajectory, and the patient was required to move "smoothly, quickly and accurately." In the index tracking task, it was required to move the hand index over the target index and move it along the target trajectory.

As the inspection task, in addition to the above-mentioned index following task, the following tasks were prepared in order to inspect the hand control ability including the cognitive and judgment processes. That is, the 3 mirror image trajectory tracking task (MedTF task). The hand index is displayed in a line symmetrical position with respect to the position of the hand. In order for the patient to perform this task, the process of converting visual information into left and right arm movements in the opposite direction is necessary.
It is for examining such a high level information processing capability.

Example 1 An example of a clinical test will be described. The training is a trajectory-following task (TF
The task) is performed 50 to 100 times a day almost every day while observing the patient's condition. 1 to evaluate the training results
The examination was performed every week on a trajectory following task and an index following task (MF task) having the same motion pattern. For example, patient M
(Age: 51 years old, diagnosis: traumatic brain injury, paralyzed side: right)
7 and 8 show the motion trajectories and trajectory errors in the TF task examination, and FIGS. 9 and 10 show the trajectory and index errors in the MF task examination of the same patient. 7 and 9 are inspection data before the start of training, and FIGS. 8 and 10 are inspection data on the day two weeks after the start of training. 7 and 8 motion trajectories,
Comparing the motion trajectories of FIG. 9 and FIG. 10, respectively, it can be seen that the hand portion follows the target trajectory more smoothly and accurately than before by the two weeks of training. Further, as is clear from these figures, the orbital error and the index error are remarkably improved by the training. In addition, the vertical axis of the trajectory error graph and the index error graph represents the error (cm), and the horizontal axis represents the time obtained by normalizing the motion cycle. The thin line in the graph shows the measured value of the orbital error or the index error superimposed on each cycle. Further, the middle part of the three thick solid lines is the average value, and the upper and lower parts thereof are the standard deviations. From the above, it was revealed that this patient was able to perform fine movement control of the upper limbs on the paralyzed side as a result of training for 2 weeks.

Next, an example of a mirror image vertical eight-character track following task will be shown. The motion trajectories of the vertical 8-figure TF task and the mirror-image vertical 8-figure TF task of a healthy person are shown in FIGS. 11 (a) and 11 (b), respectively. 12 (a) and 12 (b) show the motion trajectories. The mirror image vertical 8 character TF task is a difficult task even for healthy people.
Also in FIG. 11, the motion trajectory (b) of the mirror image vertical 8-character TF task is
The orbital error is considerably increased compared to the motion orbit (a) of the vertical 8-character TF task.

On the other hand, the movement trajectory (a) of the vertical 8-character TF task of the upper limb of the healthy side of the stroke patient of the subject (age: 59 years old, diagnosis: cerebral hemorrhage, paralysis side: left) of FIG. 12 is shown in FIG. The trajectory error is not so large as compared with the motion trajectory (a) of the vertical 8-figure TF task of a healthy person, and it seems that there is no obstacle at first glance. However, looking at the motion trajectory (b) of the mirror image vertical 8-figure TF task of the stroke patient in FIG. 12, the motion trajectory is extremely disordered and the trajectory error is extremely large. This result is very interesting because it shows that local brain injury in stroke patients impairs not only the paralyzed upper limbs but also the non-paralyzed upper limbs.

[Example 2] A case where the stroke patient has upper limb dysfunction on the paralyzed side will be described. Stroke is known to cause various impairments in motor function depending on the site of injury. The movement disorder is divided into spasticity, rigidity, relaxation, ataxia, tremor, and apraxia depending on the nature. These may be seen in combination clinically. As an evaluation method, the recovery process of spastic paralysis is divided into the degree of separation from joint exercise, that is, the variability of movement in 5 stages by the Brunnstrom Stage and 12 stages by the hemiplegic function test, and the muscle strength is divided into 6 stages by the manual muscle strength test. Has been evaluated. However, these cannot be said to be continuous quantitative evaluations, and the effects of misalignment, ataxia, rigidity, and tremor are not included in the evaluation. Although the simple upper limb function test (STEF) is a quantitative evaluation method, it is an evaluation of the functional ability of the upper limb on the paralyzed side from the shoulder to the fingers, not the voluntary movement of the upper limb itself.
The upper limb movement therapy system invented can quantitatively evaluate the skill of voluntary movement of the upper limbs regardless of the nature of the movement disorder.

Therefore, here, a study is added for the purpose of quantitatively evaluating the motor function of the hemiplegic upper limbs of stroke patients, particularly the voluntaryness in finely adjusting the flexion and extension of the shoulder and elbow to follow the target trajectory. . As shown in Table 1, the subjects were 10 stroke patients (age: 57.4 ± 11.9 years old) and 7 control healthy persons (age: 57.1 ± 7.5).
Years old). Stroke patients were diagnosed by cerebral hemorrhage (3), cerebral infarction (7), paralyzed side by right (5), left (5), disease duration was 33.
± 47 weeks (7 to 160 weeks). The degree of hemiplegia in the upper limbs is upper limb grade 5 or higher (grade: 8.2 ± 3.1) capable of performing a trajectory following task. In the case of clinically no neurological findings, a person who consented to the test after fully understanding the purpose and content of the test was used as a healthy control. It should be noted that the subject sits in front of the invented upper limb exercise therapy device and uses a belt from the upper limb shoulder to the contralateral waist to measure so that he or she does not move the body to adjust the movement of the hand index. Fixed to.

[0027]

[Table 1]

The inspection task includes a diagonal 8 character TF task and a diagonal 8 character M.
Two types of F task were used. The evaluation contents of each task are as follows: Orbit error area [cm * cm]
(The movable range of the hand is normalized to 50 [cm])
Orbit error time integration [cm * s] and index error time integration [cm * s] were used in the oblique 8-character MF task. Each evaluation value is an average value per one cycle.

A) A diagonal 8-figure TF task A diagonal 8-figure target trajectory inclined obliquely outward and forward from the center
Exactly tracing with the hand index, the subject was instructed to do "on the target line as accurately as possible and as quickly as possible". The movement from the center of the body to the diagonally outer front and the movement from the outer front to the center of the body are highly difficult movements in the case where the joint movement that remains in the recovery process of stroke hemiplegic upper limbs remains. Therefore, the movement pattern of this oblique 8-figure task means a movement pattern suitable for the evaluation of hemiplegic recovery process, and by repeating this movement pattern, separation of joint movements is promoted to enable various movements. . In other words, it has a meaning as a movement pattern for recovering paralysis.

B) Slanted 8-figure MF task This is a task that uses the same target trajectory as the above-mentioned slanted 8-character trajectory tracking task, but is a task that matches the hand index with the target index that rotates in 12 seconds per cycle, and adjusts the movement speed. The subject was instructed to "put the hand index on the target index at all times" in order to obtain
This is a task that requires fine adjustment of the movement direction and speed. In addition, in the example in which the movement speed was slow and it took 12 seconds or more for one cycle, the inspection of this problem was not performed. The stroke patients were examined on the affected upper limbs, and the normal subjects were examined on both upper limbs. The degree of paralysis of the upper limb on the paralyzed side is evaluated by the hemiplegic function test, which evaluates the degree of separation of hemiplegia from joint movement, and the ability to move small pins or paper pieces from the ball with fingers, in other words, the skill of the shoulders, elbows and fingers The simple upper limb function to evaluate was used.

The results of the inspection are as follows. 1) Orbital error and index error in the oblique 8-figure TF task and the oblique 8-figure MF task of the upper extremity side of stroke patients Table 2 shows the results of the notation for the comparison between normal stroke patients and stroke patients. The orbital error area in the oblique 8-figure TF task is 25.6 ± 7.0 [cm * cm] for stroke patients.
And significantly (p <0.005) larger than 2.42 ± 0.86 [cm * cm] of healthy subjects. The index error time integration is also 60.4 [cm * s] for stroke patients and 40.4 for healthy subjects.
Although not significant (p <0.07) compared to [cm * s], it tended to be large.

[0032]

[Table 2]

2) Relationship between Grade 8 Oblique Tracking Task Performance and Hemiplegic Upper Limb Function Table 3 shows the results related to the notation. Oblique 8 of the paralyzed upper limb
No significant correlation (r = -0.371) was found between the trajectory error area and hemiplegic grade in the letter MF task, but there was a significant negative correlation with the simplified upper limb function test (STEF). A correlation (r = -0.577, p <0.05) was found. That is, it is shown that the higher the athletic ability from the shoulder to the finger, the smaller the deviation from the target trajectory even in the oblique 8-figure MF task. Index error time integration and grade or S
No correlation was found with TEF.

[0034]

[Table 3]

From the above results, the following effects were recognized. As a result of performing the oblique 8-figure MF task on the paralyzed upper limb of the stroke patient, the stroke patients had significantly larger orbital error areas than those of the healthy subjects. However, in this result, no significant correlation was found between the trajectory error time integral and the paralysis grade, and as shown in FIG. 13, the trajectory error time integral and the negative upper limb function test (STEF) were negatively correlated. Admitted.
This means that the trajectory error time integral does not simply represent the degree of paralysis, but that it evaluates overall voluntaryness, that is, rigidity, apraxia, ataxia, etc. are added to the evaluation factors. Suggests. The STEF not only evaluates the functions of the upper limbs but also the functions of the fingers, and the invented upper limb motion therapy apparatus targets only the functions of the shoulders and elbows of the upper limbs, but similar results are obtained. On the other hand, there was no correlation between the index error time integral and the hemiplegic grade or the results of the simple upper limb function test (see FIG. 14). This is considered to be partly because the task of index tracking is performed with a limited number of highly voluntary subjects capable of rapid movement of the paralyzed limb.

As described above, it was possible to quantitatively evaluate voluntaryness by performing the oblique 8-figure trajectory following task that requires elaborate control in the paralyzed upper limb of a stroke patient. The trajectory following task by the invented motion therapy apparatus is a task of converting visual information in the upper limbs, which is not usually performed by moving a hand index projected outside the body along a target line, into a motion, The evaluation of motor control ability and motor learning ability using a device is highly useful as a method for clarifying previously unrecognized functional dysfunction on the paralyzed side, and is expected to be applied clinically in the future.

[Example 3] An example of the effect of the trajectory following training of the paralyzed upper limb in a stroke patient will be described. In order to improve the involuntaryness of the upper limbs on the paralyzed side in stroke patients, exercise pattern training that promotes the degree of separation from joint exercise is used first, but more advanced exercise control after separation from joint movement is achieved to some extent. In order to acquire, we tried to improve the paralysis by repeatedly moving the paralyzed upper limb according to the target trajectory. The subjects were eight stroke patients (age: 55.5 ±
11.8 years old, hemiplegic grade: 6-12). The subject was required to accurately trace the target trajectory in the oblique 8-figure TF task as training. Training is 50-100 a day
Trials, 500 trials in total, were repeated as one course during hospitalization. The orbit tracking ability evaluation was performed every 1 cool.
The orbital error area [cm * cm] per trial was used as an index of motion accuracy. The orbital error area of the upper limb on the paralyzed side is 25.2 ± 7.9 [cm * cm] to 16.2 when comparing before and after 500 trainings in the first course.
Remarkably decreased to ± 4.4 [cm * cm]. The trajectory tracking training of the paralyzed upper limbs gradually enabled fine movement control of the paralyzed upper limbs. One of the patients in the chronic phase was also aware of the impression that "it was easier to put on the futon".

For the upper limbs on the paralyzed side of a stroke patient, a method called sanding in which the paralyzed hand is fixed to a small plate and the table is slid vertically and horizontally is used as an occupational therapy. However, this can only be used for general voluntary and strength building purposes. The hemiplegic upper limb training device of the present invention is required to perform finer voluntary control while performing the same movement of the upper limb. In order to perform trajectory tracking training with the paralyzed upper limb, it is necessary to be able to add / extend and flex the shoulder joint and bend / extend the elbow joint to a certain extent. By repeating it, the voluntary nature of the shoulder joint and the elbow joint is improved.

According to the above results, the upper extremity exercise therapy system of the present invention can automate the training which is essential for promoting recovery of central palsy of achieving the target exercise, and can show the training effect to the patient as a trajectory map. Also, it became clear that it has many excellent points as training equipment, such as being able to quantitatively grasp the training process.

[0040]

Industrial Applicability As described above, the upper extremity exercise therapy system according to the present invention can automate the exercise of achieving the target exercise essential for the promotion of recovery of central palsy, present the exercise effect to the patient, and provide the biofeedback effect. It was revealed that the exercise therapy system has excellent points such as the ability to utilize the exercise and the quantitative grasp of the training process. In addition, it was possible to provide a means for storing and analyzing the hand movement data that can provide information for quantitatively grasping and evaluating the motor function recovery process of the patient.

[Brief description of drawings]

FIG. 1 is a diagram showing a configuration of a biofeedback loop by visual stimulation.

FIG. 2 is a diagram showing an example of an upper limb exercise therapy system of the present invention.

FIG. 3 is a diagram showing a flow of a hand part movable range measuring method and calculation of a hand part movable range characteristic value.

FIG. 4 is a diagram showing a standard flight route pattern stored in a standard operation trajectory data storage unit.

FIG. 5 is a diagram showing a flow of creating a target motion trajectory.

FIG. 6 shows, as an example, the position and movement direction (point B) of the hand index with respect to the position and movement direction (point A) of the hand portion with respect to the vertical 8-character target trajectory and the point symmetry with the presentation (FIG. (A)). It is a figure shown about presentation ((b) figure).

FIG. 7 is a diagram showing a motion trajectory and a trajectory error (before training) of a vertical 8-character TF task test of a patient M.

FIG. 8 is a diagram showing a motion trajectory and a trajectory error (two weeks after training) in a vertical 8-character TF task test of a patient M.

FIG. 9 is a diagram showing a motion trajectory and an index error (before training) in a vertical 8-character MF task test of a patient M.

FIG. 10 is a diagram showing a motion trajectory and an index error (after two weeks of training) in the vertical 8-character MF task test of the patient M.

FIG. 11 is a diagram showing motion trajectories of a normal 8-character vertical TF task (a) and a mirror image vertical 8-character TF task (b).

[Fig. 12] Vertical 8-figure TF task (a) of the upper limb of the stroke patient
FIG. 8 is a diagram showing a motion trajectory of a mirror image vertical 8-character TF task (b).

FIG. 13 is a diagram showing a correlation between a trajectory error time integration and a simple upper limb function test.

FIG. 14 is a diagram showing a correlation between an index error time integral and a simple upper limb function test.

[Explanation of symbols]

101 Hand of upper limb 201 Orbit setting plate 203 Hand grip 205, 207 Position measuring unit 305, 307 Position information 311 Visual stimulation information 401 computer 403 arithmetic processing unit 411 Hand range of motion measurement section 413 Target motion trajectory generation unit 415 Motion Analysis Department 421 Standard motion trajectory data storage unit 423 Hand movement data storage 601 display 603 Hand index displayed on the display Target trajectory presented on the 605 display Target indicators presented on the 607 display

   ─────────────────────────────────────────────────── ─── Continued front page    (72) Inventor Kazumi Kawahira             3917-598 Takachiho, Makien Town, Aira District, Kagoshima Prefecture (72) Inventor Atsuo Maruyama             12-3 Tagamidai, Kagoshima City, Kagoshima Prefecture (72) Inventor Yasuhiro Sueyoshi             14-10-31, Meiwa 4-chome, Kagoshima City, Kagoshima Prefecture (72) Inventor Yuei             2-2-502 Motomachi, Higashi-gun, Kagoshima City, Kagoshima Prefecture (72) Inventor Seiji Eto             3617-324 Takachiho, Makien Town, Aira District, Kagoshima Prefecture (72) Inventor Takashi Yoshino             Kagoshima Prefecture Kagoshima City Karato Minato 3-chome 31-1-31

Claims (9)

[Claims] 1. An upper limb exercise therapy system for grasping a hand of an upper limb of a trainee to realize a trajectory of the hand in a plane and measuring a position of the hand in the plane. First storage means for recording standard motion trajectory data consisting of the position and velocity of the hand to be exercised by the person, and the possible range of movement of the hand of the trainee is measured to calculate the hand movement range characteristic value. Hand motion range measuring means, target motion trajectory generating means for converting the standard motion trajectory data based on the hand motion range characteristic value to generate a target motion trajectory unique to the trainee, and displaying the target motion trajectory A target motion trajectory presenting means, a hand part index presenting means for presenting the position of the hand of the trainee as a hand part index, and a second storage means for recording hand part motion data of the trainee. , A motion analysis hand that analyzes this recorded hand movement data An upper extremity exercise therapy system having steps. 2. The hand part range of motion measuring means, with the hand part of the trainee present in the plane, at the point where the upper limb of the trainee is extended forward, at the point of horizontal abduction and on the body side. The upper limb exercise therapy system according to claim 1, wherein the position of the bent point is measured to calculate the characteristic value of the range of motion of the hand. 3. The standard trajectory of the standard motion trajectory data is:
Vertical 1 letter, diagonal right 1 letter, diagonal left 1 letter, vertical 8 letters, diagonal right 8
The upper extremity exercise therapy system according to claim 1 or 2, which has a pattern of a letter, a left diagonal eight, and an S / straight line combination. 4. The upper limb motion therapy according to claim 1, wherein the standard motion trajectory data includes, as parameters, a characteristic value of the range of motion of the hand and a motion cycle in which the hand moves around the orbit. system. 5. The target motion trajectory presenting means presents a target trajectory indicating the position of the hand portion and a target index indicating the position of the hand portion moving at a target velocity, according to any one of claims 1 to 4. Upper limb exercise therapy system. 6. The hand part index presenting means has the functions of the same presentation, line symmetry presentation, and point symmetry presentation with respect to the position and movement direction of the hand part. Upper limb exercise therapy system. 7. The motion analysis means includes the orbital length of the hand part, the motion cycle, the time integration of the orbital error which is the distance between the hand part index and the target track, and the index which is the distance between the hand part index and the target index. Time integration of error, area of trajectory error, number of lost hands,
7. The upper limb exercise therapy system according to claim 1, wherein the spectral density of the trajectory error is calculated. 8. A hand orbital plane setting means for gripping the hand of the trainee's upper limb to realize a trajectory of the hand within a plane, and a hand movement measuring means for measuring the position of the hand within the plane. An upper limb having the hand part index presenting means, the first storing means, the hand moving range measuring means, the desired motion trajectory generating means, the desired motion trajectory presenting means, the second storage means, and the motion analyzing means. Exercise therapy device. 9. A linear motion mechanism in which the hand portion raceway surface setting means fixes the hand portion of the trainee to the gripping portion without constraining the degree of freedom of the joint portion of the hand and carries out the movement in the orthogonal coordinate direction within the plane. 9. The upper limb exercise therapy device according to claim 8, wherein the trainee implements a hand movement by a link mechanism that performs a movement in a polar coordinate direction.