JP2003079683A - Kinesitherapy apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an apparatus and system for performing kinesitherapy for the purpose of restoring, keeping and strengthening kinetic function by automatic motion constituting a bio-feedback loop by the stimulation of visual sensation. SOLUTION: The kinesitherapy apparatus is constituted so as to perform automatic motion applying properly changing load resistance to the upper limbs or lower limbs of a patient in order to restore the lowering of kinetic function due to the paralysis of the upper and lower limbs caused by a cerebrovascular disease, to allow a patient himself to perform frequent repetitive motion due to the paralyzed limbs, to enable kinesitherapy for accelerating the reconstitution of the centrostaltic function or the function of a transfer route because the paralysis is restored by treating the disorder of the centrostaltic function or the functional disorder of the transmission route brought about by the cerebovascular disease in some form, to accelerate the functional restoration due to the development of the plasticity of a brain and to constitute the bio-feedback loop by the stimulation of visual sensation. Further, operation data in kinesitherapy are stored to quantitatively evaluate the restoration of kinetic function.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an apparatus and system for performing exercise therapy for the purpose of recovering, maintaining and strengthening motor function by automatic exercise 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) JP-A-2000-279462 (P2000-27)
9462A), JP 2000-279464 (P200).
0-279464A), JP-A-2000-288046.
(P2000-288046A), a device for assisting upper limb movement or rehabilitating upper limbs by so-called passive movement is developed, in which the upper limbs are grasped by a suspension type device to guide upper limb movements. 2) Exercise therapy device TEM (JP-A-10-25810)
0) is a rehabilitation device for performing lower extremity exercise training aimed at recovery of gait function in stroke patients.
It is possible to automatically control various passive exercises for the lower limbs, isometric exercises, isotonic exercises, and constant velocity exercises performed by a physical therapist or the like as assistance exercises.

3) In the sanding of the upper limb motion therapy device used in the field of rehabilitation, a slippery mover or a mover with appropriate frictional resistance is attached to the hand to move it on the flat plate member by automatic movement, It recovers upper limb motor function and expands the upper limb joint range of motion.
Japanese Unexamined Patent Publication No. 7-308352 has developed a device that can always maintain a constant load required to move a moving element. 4) As a sitting training machine (PW-3, manufactured by Hitachi, Ltd.), a 2-belt walking training machine has been commercialized with the aim of preventing the bedridden of the elderly. This allows simple reciprocating movements of the lower limbs while sitting in a wheelchair. 5) An ergometer (strength ergo system, manufactured by Mitsubishi Electric Engineering Co., Ltd.) having muscle strength measurement and exercise posture adjustment functions has been developed. 6) As a joint exercise device, Cybex used for the purpose of automatic exercise and muscle strengthening, and CPM (Continuous Passive) for the purpose of passive movement and prevention of contracture
Motion). 7) As a rehabilitation device for paralyzed lower limbs,
Although there is Japanese Patent Laid-Open No. 11-70148, it is a device for alleviating contracture disorder due to paralysis of the lower limbs. 8) Further, as a lower limb joint exercise device, Japanese Patent Laid-Open No. 6-22
There is a device 5912, which is a device for performing setting and bending and stretching exercises while keeping the lower limb horizontal or elevated and without applying excessive force to the knees or the affected area. 9) As a walking training machine, a walking training machine (PW-10, manufactured by Hitachi, Ltd.) in which a treadmill is improved by using impedance control has been developed.

10) 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 function recovery Development of a training support system and its application to facilitative exercise therapy "March 2000 There is a pioneering study by the research principal, Heiwami Kawa (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, the foot is fixed to the movable footrest, and the foot is automatically exercised in the horizontal plane without any passive movement. It moves without resistance. 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 presented on the display with the foot target trajectory, and exercise training is performed under the visual stimulus.

In the prior art described above, in the case of the device of 1), it is possible to perform exercise therapy for the upper limbs by passive exercise or exercise assistance, but the configuration is such that exercise therapy utilizing biofeedback can be performed. Not not. Also, in the case of the device of 2), emphasis is placed on the realization of various exercises such as passive exercises, isometric exercises, isotonic exercises, and constant velocity exercises performed by a physical therapist or the like as assistance exercises for the lower limbs. There is. Therefore, although it is possible to perform exercise therapy for the lower limbs by passive exercise or exercise assistance with this device, it is not configured to perform exercise therapy by automatic exercise utilizing biofeedback.

[0006] In the sanding of 3), the recovery of the motor function is performed for the patient whose recovery of the motor function of the upper limbs is considerably advanced.
Although the exercise is performed automatically by strengthening the exercise muscles and expanding the range of motion of the joint, the exercise itself is left to the patient, and the effect as exercise therapy is not great. On the other hand, in Japanese Unexamined Patent Publication No. 7-308352, the load required to move the mover can always be kept at a constant value for exercise therapy, but the effect is limited because the load is constant. Moreover, the effect of exercise therapy cannot be evaluated by this device. In 4), a person can easily reciprocate the lower limbs while sitting in a wheelchair, but the training effect cannot be evaluated, and there is no effect more than maintaining the motor function of the trainee.
In addition, the device of 5) can perform muscle strength training and muscle strength measurement of the lower limbs under various exercise postures according to the state of the trainee from the semi-recumbent position to the recumbent position. It is not a device for carrying out the exercise therapy by the automatic exercise configured as described above. Cybe mentioned in 6)
Although x and CPM are widely used for the purpose of strengthening muscle strength and preventing contracture in joint exercise, it is difficult to use them for exercise therapy other than them. Moreover, since the devices described in 7) and 8) have a simpler function than the exercise therapy device TEM in 2), the training effect beyond TEM cannot be expected. The walking training machine described in 9) is a device applied to a trainee who can walk.

The last device 10) is an experimental device for confirming the initial possibility of recovery of the lower limb movement control function by automatic movement which constitutes a biofeedback loop by visual stimulation. With this device, it was shown that the lower limb movement control function was restored in a limited range by the automatic movement which constituted the biofeedback loop by visual stimulation. The movable portion of this device does not include a mechanism for changing the load resistance, and thus has a limited application range.

[0008]

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. The idea that they are being used was the mainstream. With regard to the functional recovery of the hemiplegic upper and lower limbs, there were almost all reports that there was no difference in recovery depending on the content of exercise therapy. The present inventor recently revealed the possibility of exercise therapy that promotes the expression of plasticity in the brain, and is convinced that further improvement in the quality and quantity of training in the paralyzed upper and lower limbs can promote further recovery of motor function. did. In order to realize the promotion of recovery of motor function, it is necessary to devise an effective training exercise and further increase the number of repetitions of this 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 intended to provide an exercise therapy device that enables effective exercise therapy in order to solve such problems in the field of rehabilitation.

The object of the present invention is to restore the motor function due to central movement disorder by the reconfiguration and reprogramming of the neural circuit in the central nervous system. An object of the present invention is to provide an exercise therapy apparatus having a feedback loop incorporated therein. In this exercise therapy device, proper load resistance in automatic exercise increases the input of proprioceptive perception to the central nervous system associated with muscle contraction and joint movement, so it is extremely useful for further enhancing activity in areas related to motor control. Effective exercise therapy is possible. In addition, it provides a means for storing and analyzing upper and lower limb movement data, which can provide information for quantitatively grasping the process of recovery of motor function of a patient and its evaluation.

[0010]

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 sets an appropriate load resistance to the upper limbs or lower limbs of a patient and / or adds an automatic exercise while changing the appropriate load resistance in order to recover the functional deterioration due to paralysis of the upper and lower limbs caused by cerebrovascular disorder. What to do, to perform frequent repetitive movements by the paralyzed limb by the patient himself, and the functional disorder of the motor center and transmission path caused by cerebrovascular disorder is reconstructed in some way and the paralysis is recovered Therefore, it is possible to realize the exercise therapy that promotes it, promote the functional recovery by such plastic expression of the brain, and configure a biofeedback loop by visual stimulation. It is also to memorize and save motion data in training therapy and to quantitatively evaluate recovery of motor function.

The key points in constructing the exercise therapy apparatus for the upper and lower limbs of the present invention are: 1) realization of automatic exercise in which appropriate load resistance is applied to the upper and lower limbs, 2) construction of a biofeedback loop and its active utilization, And 3) storage and analysis of motion data.

With regard to the key point 1), the trajectory of the hand or foot to be exercised by the patient is set within an arbitrarily inclined plane to realize three-dimensional automatic movement of the upper and lower limbs. Also, by using information on the exertion force of the upper or lower limbs and / or information on the position and movement speed of the hand or foot, respectively, an appropriate load resistance is set and / or variably added to the automatic exercise. To do so. The following four points are given as examples of the therapeutic effect expected by appropriate load resistance to the upper or lower limbs by this exercise therapy device. A) Light resistance during exercise has the function of increasing proprioceptive input to the central nervous system associated with muscle contraction and joint movement. Therefore, the activity of the area related to motor control including the cerebellum is enhanced, and motor learning is facilitated. Since a light load has the effect of reducing spasticity and ataxia that occur during exercise, or unintentional paralysis limb blurring due to accompanying movements, repeated training to achieve the intended movement facilitates acquisition of the movement pattern that the paralysis limb wants to learn. it can. B) Addition of light resistance to the paralyzed limb enables voluntary suppression of extensor spasticity. Further, in general, a paralyzed muscle having a weak contraction is easy to sustain the muscle contraction by adding a light resistance. C) Since the load resistance in automatic exercise can be adaptively changed for each exercise direction, new exercise therapy for ataxia can be performed. D) Since load resistance can be applied even though it is an automatic exercise, it has an excellent effect on muscle strength recovery, maintenance, and strengthening.

Regarding the configuration of the biofeedback loop of the key point 2), the target motion trajectory to be exercised by the patient is presented on the display, and the position of the hand or foot on which the patient has exercised is used as the position index on the same display. By presenting them, 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. Fig. 1 also describes a visual feedback loop in which the patient visually gives a target load resistance value to the force to be exerted on the upper limbs or lower limbs in the automatic movement, and performs the automatic movement so that the upper limb or lower limb exertion force follows the force. I am doing it. The visual stimulus biofeedback loop relating to this force sense has an effect of making the feedback loop inside the living body conscious of the intrinsic perceptual information of the living body, and promoting reprogramming of the brain in the premotor cortex, the cerebellum, and the like. In addition, how to apply load resistance to the upper or lower limbs is very important in exercise therapy because it acts directly on the force sense that is the intrinsic perceptual information of the living body. Adaptive exercise therapy by skilled doctors and physiotherapists excels in this respect, and this exercise therapy device realizes such a function.

Regarding the storage and analysis of the operation data of the key point 3), the position and exertion force of the hand or foot of the patient who exercised is measured by using a computer, and the operation data is stored and stored. Various evaluation values are calculated with a configuration in which the analyzed operation data can be analyzed.
These evaluation values are very important in quantitatively evaluating the effect of exercise therapy, and also lead to the development of new exercise therapy.

The exercise therapy apparatus is mainly based on automatic exercise,
It is a device intended to restore, maintain, and strengthen the motor function of the upper or lower limbs. The exercise therapy system is a system that includes measurement, storage, calculation and analysis including an exercise therapy device. The standard motion trajectory includes a standard trajectory that is position data of the hand or foot that the trainee should exercise and time-series data of standard moving speed. The target motion trajectory is obtained by converting the standard motion trajectory into a motion trajectory which is a target peculiar to the trainee. The target motion trajectory includes a target motion trajectory and a target value of load resistance of the upper limb or the lower limb. The target value of the load resistance is a value that the doctor or physical therapist determines based on the condition of the patient, and sets and / or changes the value. The motion index includes a position index that presents the position of the hand or foot that the trainee exercised and a force index that presents the exertion power of the upper limb or the lower limb.

The motion measuring means is a means for measuring an element of motion, for example, the position of the hand or foot in the plane,
It measures the exertion of load resistance of the upper or lower limbs. The range-of-movement measuring means is a means for measuring a possible range of motion of the hand or foot of the trainee, and includes calculation of range-of-movement characteristic values. The load resistance means applies load resistance to the exercise of the trainee's upper limbs or lower limbs, generates load resistance to the trainee's automatic exercise, and this load resistance measures its target value by the motion measuring means. It is set and / or variable by using the measured values of position and exertion force.

The standard trajectory is created for each trajectory pattern determined by analyzing and extracting a basic pattern of upper limb or lower limb movement in advance. For example, there are one vertical character, one right oblique character, one left oblique character, eight vertical characters, eight right oblique characters, eight left oblique characters, and an S-character / one character combination pattern. The movement cycle is the time for the hand or foot to go around the orbit.
The trajectory error is the distance between the position index and the target trajectory. The index error is the distance between the position index and the target index.

The motion data storage means stores motion data measured by the motion measuring means. The motion analysis means analyzes motion data, and includes the following elements. Trajectory length of hand or foot movement, its motion cycle, trajectory error, time integration of trajectory error, area of trajectory error, index error, time integration of index error,
Number of hesitations of hands or feet, spectral density of orbital error, ability of upper or lower limbs, maximum value of exertion, minimum value of exertion, average value of exertion, workload of exertion and time of exertion Such as integration.

The upper limb or lower limb exercise therapy device of the present invention is a device for performing exercise therapy for the purpose of recovering, maintaining and strengthening a motor function, and is applied to the exercise of the upper limb or lower limb of a trainee. Load resistance means for providing resistance,
A movement plane setting means for supporting the hand part or the leg part of the upper limb of the trainee to realize this movement in a plane, the position of the hand part or the leg part in the plane, and the load of the upper limb or the lower limb. Motion measurement means to measure exertion force against resistance, and action indicator presentation that presents position of hand or foot exercised by trainee as position index, or exertion force of upper limb or lower limb as force index Means and a target motion trajectory presenting means for presenting a trainee-specific target motion trajectory of the hand or foot to be trained by the trainee, or presenting a target value of load resistance of the upper or lower limbs. Have.

The load resistance means in the upper limb or lower limb exercise therapy apparatus of the present invention generates a load resistance with respect to the automatic exercise of the trainee. It may be capable of being set and / or variable by using a measured value of exertion force. The exercise plane setting means of the exercise therapy apparatus for the upper or lower limbs of the present invention holds the hand or foot of the trainee on the support without restraining the degree of freedom of joint of the hand or foot, and an inclined plane. The motion of the upper limb or the lower limb of the trainee may be realized by a linear motion mechanism for performing movement in the orthogonal coordinate direction and a link mechanism for performing movement in the polar coordinate direction. The target motion trajectory and the motion index are presented on the same display by the target motion trajectory presenting means and the motion index presenting means in the upper limb or lower limb exercise therapy apparatus to form a biofeedback loop utilizing visual stimulation. May be

An upper limb or lower limb kinematic therapy system of the present invention is a kinetic therapy system that supports a hand or foot of a trainee and realizes this exercise in a plane, the load resistance means, and A motion measuring means, a standard motion trajectory storing means that stores a standard motion trajectory that is position data of the hand or foot to be exercised by the trainee and time-series data of the standard moving speed, and A range of motion measuring means for measuring the possible range of motion of the hand or foot of the trainee and calculating a range of motion characteristic value, and the standard motion trajectory based on the range of motion characteristic value to convert the standard motion trajectory to a trainee-specific Target motion trajectory generation means for generating a target motion trajectory, the target motion trajectory presentation means, the motion index presentation means, and motion data storage means for storing motion data measured by the motion measurement means, The stored operating data are those having a motion analysis means for analyzing.

The range of motion measuring means of the upper limb or lower limb exercise therapy system of the present invention is such that the trainee's hand or foot is supported in a plane defined by the motion plane setting means. The position of the point where the upper limb or the lower limb is extended forward, the point where horizontal abduction is performed, and the point where the upper limb is bent toward the body are measured, and the range of motion characteristic value of the hand or foot may be calculated. The standard trajectory of the standard motion trajectory in the exercise therapy system of the upper or lower limbs of the present invention,
It may have one vertical character, one right oblique character, one left oblique character, eight vertical characters, eight right oblique characters, eight left oblique characters, and an S-character / one character combination pattern.

In the exercise therapy system for upper limbs or lower limbs of the present invention, the standard motion trajectory may include, as parameters, a motion cycle in which the hand or foot goes around the trajectory and the movable range characteristic value. The target motion trajectory presenting means of the upper limb or lower limb exercise therapy system presents a target motion trajectory with a target trajectory indicating the position of the hand or foot and a target index moving on this trajectory at a target moving speed. It may be something that can. The motion index presenting means in the exercise therapy system for upper limbs or lower limbs of the present invention may have a function of presenting the position of the hand or foot and the moving speed thereof in the same presentation, line-symmetrical presentation and point-symmetrical presentation. .

The motion analysis means in the upper limb or lower limb movement therapy system of the present invention uses the trajectory length of the hand or foot movement, its movement cycle, orbit error which is the distance between the position index and the target trajectory, orbit. Time integration of error, area of orbital error, index error which is the distance between position index and target index, time integration of index error, number of hesitation of hand or foot, spectral density of orbital error, exertion of upper or lower limbs The maximum value of exerted power, the minimum value of exerted force, the average value of exerted force, the work amount of exerted force, and the time integral of exerted force may be calculated.

[0025]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described with reference to the drawings. The present invention relates to an upper limb or lower limb exercise therapy device, but since the configuration is the same, a lower limb exercise therapy device will be described. FIG. 2 is a diagram showing an example of the system configuration of the lower limb exercise therapy device of the present invention. The lower extremity exercise therapy system consists of a device body for trainees to perform training exercises and inspection exercises, a load resistance part, a measuring part, a computer for processing the measurement data, and a display used for visual stimulation to the trainees. . The trainee undergoing therapeutic training sits on a chair of the apparatus in a long sitting position, and the foot portion 101 of the lower limb is held by the support portion 211 as shown in FIG. This support part can move with load resistance in the track plane setting flat plate 201 that is arbitrarily tilted to realize automatic movement, and its in-plane position is the position measuring parts 309 and 311.
And is output as position information 409 and 411.

Further, since a load resistance due to the automatic movement of the lower limb is generated with respect to the movement of the supporting portion, force measuring portions 305 and 307 for measuring the exerted force of the lower limb are installed in this supporting portion. , Force information 405 and 407 are output. The load resistance of the device is given by the load resistance units 301 and 303, and the load resistance value is variable by the load resistance target commands 401 and 403 from the arithmetic processing unit 503 of the computer 501, respectively.

The upper limb exercise therapy apparatus and system thereof according to the present invention are the same as in FIG. 2 except that the lower limbs or the foot portions are the upper limbs or the hand portions. In addition to the above braking method, a method of controlling while measuring the load resistance may be used.

An example of the mechanism of the apparatus body will be described in detail with reference to FIG. The structure of the foot support portion is shown in FIG. The foot is gripped by the grip plate 213 and can rotate together with the outer frame 215. Since these axes of rotation are arranged so that they are orthogonal to the ankle, the joints of the foot can move freely. Regarding the upper limb, the joint has a different structure from the ankle joint, but the principle is the same. The base upper plate 217 and the base lower plate 219 of the supporting portion can move relatively freely in the x and y directions of FIG. 3A, and load cells 241 and 243 for measuring the force are installed between them. . With these load cells and load cell amplifiers 245 and 247,
The force measuring units 305 and 307 shown in FIG. 2 are configured.

The support portion 211 of the foot portion can be moved in the x and y directions with a small frictional resistance by the linear guides 221 and 223 of FIG. 3 (a). In order to apply load resistance to the foot support, linear movement of the foot support is converted into rotational movement by the power transmission parts 225 and 227 consisting of belts and pulleys, and continuously changes from the minimum value to the maximum value. A brake that can change the resistance torque value is installed. The braking force of the brake, in this case the braking torque, is the load resistance target command 4 from the arithmetic processing unit 503 of the computer 501.
01 and 403 control the brakes 231 and 233 via the brake servo amplifiers 235 and 237 to make them variable. The load resistance units 301 and 303 in FIG. 2 are composed of these brakes and servo amplifiers.

The position of the support portion of the foot portion was measured by inputting the rotary motion of the power transmission portion composed of the belt and the pulley described above by inputting the rotary encoders 251 and 253 and the output thereof to a counter board installed in a computer. These are
Position measuring units 309 and 311 and position information 40 shown in FIG.
9, 411.

The foot position information 409 and 411 is fetched by the arithmetic processing unit 503 of the computer 501, processed, and presented as a position index 621 on the display 601 by a ● mark. Also, the trainee's foot force information 405 and 4
07 is also taken into the arithmetic processing unit 503 of the computer 501, processed, and presented as a force index 611 on the display 601 with a ● mark.

The target motion trajectory for the trainee to perform the lower limb motion is calculated by using the data of the standard motion trajectory storage unit 521 and the range of motion characteristic value of the trainee measured by the range of motion measuring unit 511. It is generated by the target motion trajectory generation unit 513 as a target motion trajectory unique to the trainee. The generated target motion trajectory is processed by the arithmetic processing unit 503 and presented on the display 601 as a target trajectory 623 and a target index 625. On the other hand, the target value 613 of the load resistance is presented on the display, and at the same time, the force information 405 and 407 show the force index 611.
Is presented as. The trainee recognizes and determines the foot position index 621 presented on the display, the target trajectory 623 or the target index 625, and the load resistance target value 613 and the force index 611 as visual stimulation information 451. Perform the given task. The motion data of the foot of the trainee is stored in the motion data storage unit 523, and the motion analysis unit 51 analyzes the motion data using the data.
Done in 5.

The novelty of the present invention is to provide appropriate load resistance to automatic exercise and to significantly improve the effect of exercise therapy. In this embodiment, this is realized by using a computer controllable brake. The structure is shown in FIG. The position of the foot and the force exerted by the lower limbs are processed by a computer, a load target command for the brake is output, and the braking force of the braking device is controlled. Further, the characteristics of the braking force and the displacement output with respect to the load input to this braking device are as shown in FIG. 4 (b).

The features of the present invention are as follows. 1) Upper and lower limbs do not generate load resistance above a certain threshold. 2) Load resistance is generated by automatic movement of the upper and lower limbs and is controlled by the trainee. 3) It is safe because it does not exert passive force on the upper and lower limbs. In the feature 1), since the threshold value of load resistance can be controlled by feeding back the position and / or exertion force of the hand or foot, a wide range of exercise therapy can be performed, and a new exercise therapy or exercise function test can be performed. In addition, feature 2) has the function of increasing the proprioceptive input to the trainee's central nervous system,
It enhances the activity of the area related to brain motor control, and is extremely effective in motor learning. The safety of feature 3) is an essential condition for an exercise therapy device.

How to provide load resistance in this exercise therapy apparatus is extremely important. The magnitude of load resistance must be given appropriately according to the purpose of exercise therapy, that is, recovery, maintenance or enhancement of motor function. Regarding the maintenance and strengthening of the motor function, the load resistance is 1 to 80%, preferably 5 to 5 in absolute value, based on the maximum muscle force of the trainee in the isometric exercise in the limb position of the training exercise. It is 50%, and it may be determined in the same manner as in ordinary exercise training according to the purpose or situation of training.

For example, for recovery of motor function in central movement disorders such as stroke, a range of 3 kgf to 1 kgf at the maximum in the extension and flexion direction of the lower limbs and a maximum range of 2 kgf to 0.5 kgf in the abduction and abduction direction at the maximum are recommended. Is.
In the case of the upper limb, the range of 2 to 60% of the lower limb is a standard.

When focusing on strengthening the muscle strength, the upper limit may be set to the maximum muscle strength in consideration of fatigue and other conditions of the trainee, and a load exceeding the range described for maintaining and strengthening the motor function may be applied. .

The range of motion measuring means will be described for the lower limbs.
As for the upper limbs, the present invention can be realized as it is by replacing the feet with the hands. The measurement of the range of motion of the lower limbs is performed by the trainee in a posture in which the foot 101 is held by the support portion 211 of the apparatus in a posture to receive the training, and the lower limb is extended forward as shown in FIG. Based on the position information 409 and 411 of the three points of the point P2 which is horizontally abducted and the point P3 which is bent to the body side, FIG.
The range of motion characteristic value of the foot is calculated by the procedure shown in (b).

The standard motion trajectory is the standard motion trajectory storage unit 521.
Remembered in. Among them, the standard trajectory is vertical 1 letter (T1), right diagonal 1 letter (T2), left diagonal 1 letter (T3), right diagonal 8 letter (T4), vertical 8 letter (T5) as shown in FIG. , Left slant 8
It has a pattern of a letter (T6), and an S-shape / one-character combination (T7). However, these are for the right lower limb and the left lower limb are also prepared separately, and are all stored in a normalized form. The target index that moves at a specific speed for each standard trajectory is
The standard movement speed time-series data is normalized with respect to the movement cycle and stored in the standard movement trajectory storage unit 521.

As shown in FIG. 7, when the trainee's own range of motion characteristic value measured by the range of motion measuring unit 511, the standard trajectory stored in the standard motion trajectory storage unit 521, and the standard moving speed of the target index, The target motion trajectory generation unit 513 generates a target trajectory unique to the trainee and time-series data of the target moving speed of the target index, using the sequence data and the target motion cycle in which the foot goes around the trajectory during training. The generated target motion trajectory unique to the trainee is presented on the display 601 through the arithmetic processing unit 503.

The motion index presenting means has the function of presenting the position of the foot and its moving speed in the same presentation, line symmetry presentation and point symmetry presentation. Examples of the line symmetry presentation and the point symmetry presentation regarding the vertical eight-character target trajectory are shown in FIGS. 8A and 8B, respectively. Point A in FIG. 8 is the position of the foot on the device, and point B is the position of the position index of the foot presented on the display.

Target trajectory length (L0), trajectory length realized by motion (L1), its motion cycle (T), trajectory length ratio (L
1 / L0), orbit velocity (L1 / T), time integration of orbit error, time integration of index error, area of orbit error, orbit error time integration motion period ratio (time integration of orbit error / T), index error time Integral motion cycle ratio (time integration of index error / T), orbital error area Orbital length ratio (area of orbital error / L0), number of hesitations, and spectral density of orbital error, power of upper or lower limbs, power of exertion The maximum value, the minimum value of exertion power, the average value of exertion power, the work amount of exertion power, and the evaluation value of the time integral of exertion power are calculated, and the results are used to support the evaluation of the effect of exercise training.

The trajectory error described above is the distance between the position index and the target trajectory, and the index error is the distance between the position index and the target index. The number of hesitations is the number of times the movement direction of the position index continues to move in a direction that clearly does not return to the trajectory. Orbital error time integration is the orbital error integrated over a period of motion. The area of the trajectory error is the area of the figure surrounded by the motion trajectory and the target trajectory. The orbit error time integral motion period ratio is an average value of the orbit error with respect to the motion period. The orbit error area orbit length ratio is the average value of the orbit error area divided by the length of the target orbit. The index error time integration is the index error integrated over one cycle of the motion. The index error time integration motion cycle ratio is an average value obtained by dividing the index error by the motion cycle. By calculating the spectral density of the orbital error, the periodic motion component contained in the orbital error can be investigated.

[0044]

[Examples] The upper limb exercise therapy device and the lower limb exercise therapy device of the present invention were installed in the Kirishima Rehabilitation Center, Kagoshima University Hospital and clinically applied. An example of upper and lower extremity exercise therapy which has been clinically applied will be shown. A trajectory following task and an index following task were implemented as training and inspection. The trajectory tracking task is to move the position index of the hand or foot along the target trajectory, and the patient is required to move “smoothly, quickly and accurately”. The index tracking task is to move the position index of the hand or foot over the target index and move it along the target trajectory. The movement cycle of the target index is 1
2 seconds. As for the movement pattern, there are 8 vertical orbits and 8 diagonals.
The character orbit is adopted. In order to show the basic effect of load resistance, a constant load was selected and applied in the bending and stretching directions and in the abduction and rotation directions.

[Example 1] Example of hemiplegic lower extremity extensor spasticity In a case of hemiplegic lower extremity extensor spasticity, voluntary suppression of extensor spasticity is possible by adding light resistance to the paralyzed lower leg. became. In general, muscles that are paralyzed and weak in contraction are easily sustained by the addition of light resistance. For example, patient F (age: 42 years old, diagnosis: cerebral hemorrhage, paralyzed side: right)
FIG. 9 shows the motion trajectories in the orbit-following task inspection of the oblique 8-shaped motion pattern. In this figure, (a) shows a case of no load before training, (b) shows a case before training with a load of 1.5 kgf in the bending and stretching direction,
When the direction of inward / outward rotation is 1.0 kgf, the load in (c) is the same as that in (b) after training. In the training, the same task was repeated 50 times with a load of 1.5 kgf in the bending and stretching directions and 1.0 kgf of the inner and outer rotation directions.

From the motion trajectory diagram (a) before unloading before exercise, it can be seen that in the extension and abduction direction of the lower limbs, the control of the exercise is not well done due to spasticity. No significant difference was observed in the motion trajectory map under load before training (b) compared with the motion trajectory map under no load (a).
On the other hand, in the motion trajectory diagram (c) in the load inspection after the training, the entire trajectory becomes smooth, and it becomes possible to suppress voluntary extensor spasticity especially when the lower limb is extended,
It can be seen that the movement in the abduction direction is also expanding.

The orbital error area, which is one of the evaluation values, is 56.6 cm * cm in (a) and (b) in FIG.
Is 54.5 cm * cm, while in (c) it is 3
It was greatly reduced to 5.8 cm * cm. From the trajectory error area, it was found that the load resistance function of this exercise therapy device was effective in suppressing extensor spasticity and improving voluntary activity. From the above,
It has been found that the load training using the present exercise therapy device is extremely effective for such cases. In addition, one of the great features of this exercise therapy device is that the determination of spasticity and voluntaryness by changing the load can be quantitatively evaluated, for example, by taking the trajectory error area as an evaluation value. .

Example 2 Upper Limb Motor Function Recovery Test for Cerebral Thrombosis An example of a motor function recovery test for upper limb hemiplegia of stroke patients was shown. For example, patient S (age; 54 years old, diagnosis: cerebral thrombosis,
FIG. 10 shows the movement trajectories in the oblique 8-figure index following task test (paralysis side: right). The inspection was carried out under the condition that the load resistance was 0.3 kgf both in the bending and stretching directions and in the inward and outward rotation directions. In this figure, (a) is a motion trajectory before training, and (b) is a motion trajectory after two months have passed. In the training, the orbit-following task was usually performed 50 times a day, and 100 times when there were many, for the vertical 8-character target trajectory and the oblique 8-character target trajectory.

From the motion trajectory diagram (a), it can be seen that, in the case of this patient, at the start of the exercise therapy, it was almost impossible to perform arm movements by superimposing the hand index on the target index. On the other hand, when two months passed after the start of the training, the recovery of paralysis was remarkable, the movement trajectory shown in Fig. (B) was extremely smooth, and the hand part accurately followed the target index. This result is due to the repetition of frequent training exercises,
It shows that the motor function is restored well. In addition, this exercise exercise is performed by the patient himself without the assistance of a doctor or a physical therapist, which is an advantage of the exercise therapy device.
Thus, the fact that the training effect can be quantitatively shown to the patient is also one of the extremely effective features of this device.

[Example 3] Patient S who is accustomed to the test for following the oblique 8-letter index following task (age: 54 years old, diagnosis: cerebral thrombosis, paralyzed side:
On the right), the trajectory following task inspection by the S-shaped / single-character combination pattern was performed. The same remarkable effect was obtained when 3 months passed after the start of training.

Example 4 Example of Involuntary Movement or Visual Ataxia Visual ataxia means that an object is visible and is recognized,
This is a symptom that the position of the limb shifts even if an attempt is made to extend the limb to that position because the positional information of the object is disconnected from the circuit used for motion control of stretching the limb. In addition to paralysis, in some cases of involuntary movements or visual ataxia, a light load has the same effect as a weight, reducing unintentional paralyzed limb movements during exercise and allowing intended movements .

For example, patient A (age: 76 years old, diagnosis:
FIG. 11 shows the movement trajectory in the trajectory following task test of the vertical eight-character movement pattern of cerebral thrombosis, visual ataxia, paralyzed side: left). In this figure, (a) shows a case of no load before training, (b) shows a direction of 2.0 kgf before and after training, a case of no load resistance in the inner and outer rotation directions, (c) shows a direction of 1.5 kgf, This is a case where after conducting training 50 times with a load resistance of 1.0 kgf in the inward / outward rotation direction, an inspection was performed under the same load conditions. Looking at the motion trajectory diagram (a) before the exercise without load, the characteristics of the motion due to visual ataxia are conspicuous, and the patient controls the motion of the foot so that the foot follows the target trajectory. , The feet are out of position. Following this inspection, a motion trajectory diagram when conducting an inspection with a load resistance of 2.0 kgf in the bending and stretching direction and no load in the inner and outer rotation directions,
It is a figure (b). Compared with the motion trajectory of Fig. (A), the motion trajectory of Fig. (B) shows that the unintentional paralyzed limb movement that occurs during exercise is slightly reduced due to the effect of load resistance, but a remarkable effect. Almost never.

On the other hand, the next day, the bending direction was 1.5 kg.
f, after carrying out 50 times of training with a load resistance of 1.0 kgf in the inner / outer rotation direction, an inspection was conducted under the same load conditions. Looking at the motion trajectory diagram (c) of this examination, it is clear that the unintentional movement of the paralyzed limb that occurs during exercise is reduced and that the intended motion is realized, as compared to the diagrams (a) and (b). There is. It is certain that it will be better with increasing training amount, and this exercise therapy device that can give proper load resistance to the lower limbs provides effective exercise therapy for cases with involuntary movement or visual ataxia. It turned out to be possible. Conventionally, for such a symptom, exercise therapy in which a constant load is applied with a weight or the like is generally carried out, but this device can adaptively change the load resistance in automatic exercise for each exercise direction. , A remarkable effect was recognized as a new exercise therapy.

[Example 5] Example of cerebellar ataxia Light resistance during exercise has a function of increasing proprioceptive input to the central nervous system associated with muscle contraction and joint movement. Therefore, the activity of the area related to motor control including the cerebellum is enhanced, and motor learning is facilitated. In such a state, if biofeedback is performed and training to realize the intended exercise is repeatedly performed,
It is possible to promote the acquisition of the movement pattern that the paralyzed limb wants to acquire.

For example, patient N (age: 60 years old, diagnosis:
FIG. 12 shows the trajectories of traumatic brain injury, cerebellar ataxia, paralyzed side: right) in the oblique 8-figure trajectory following task test. In this figure, (a) shows no load before the training, (b) shows the load before the training is 1.5 kgf in the bending / extension direction and 1.0 kgf in the inner / outer direction, and (c) shows the load after the training (b). Under the same conditions as.
In the training, the same task was repeated 50 times with a load of 1.5 kgf in the flexion / extension direction and 1.0 kgf in the inner / outer rotation direction, two times for a total of 100 times.

It can be seen from the motion orbit diagram (a) when no load is applied before training, that a motion with a small cycle, which is a feature of motion in cerebellar ataxia, occurs in the entire orbit. The motion trajectory diagram under load before training (b) is the motion trajectory diagram under no load (a)
In comparison, the occurrence of small-cycle movements, which is characteristic of movements in cerebellar ataxia, is rather increased. On the other hand, in FIG. 6C, the bending / extending direction is 1.5 kgf and the inner / outer rotation direction is 1.
It is a motion trajectory diagram of the test result performed under the same condition after the training repeated 100 times at 0 kgf. According to this figure, the expression of a small cycle motion, which is a feature of the motion in cerebellar ataxia, is significantly suppressed, It can be seen that the desired movement pattern of the paralyzed limb has been successfully realized. As a result, it was found that it is effective to add appropriate load resistance to the paralyzed limb as exercise therapy for cerebellar ataxia, and this exercise therapy device is excellent as a therapy device for carrying out it. Also,
The fact that the training effect can be quantitatively judged is also one of the extremely important features of this device.

In addition, since the present device is subjected to load resistance under automatic exercise, the effect of maintaining and enhancing muscle strength was also confirmed. The feature is that training and inspection including such effects can be performed quantitatively.

[0058]

Industrial Applicability As described above, the upper limb or lower limb exercise therapy system according to the present invention realizes a target exercise while appropriately applying load resistance in automatic exercise which is essential for promoting recovery of central palsy. It was revealed that the exercise therapy system has advantages such as the ability to automate the training of repetition, the ability to present the training effect to the patient and the utilization of the biofeedback effect, and the quantitative understanding of the training process. Light resistance during exercise has the function of increasing proprioceptive input to the central nervous system associated with muscle contraction and joint movement. Therefore, the activity of the area related to motor control including the cerebellum is enhanced, and motor learning is facilitated. Since a light load has the effect of reducing spasticity and ataxia that occur during exercise, or unintentional paralysis limb blurring due to accompanying movements, repeated training to achieve the intended movement facilitates acquisition of the movement pattern that the paralysis limb wants to learn. it can.

By adding light resistance to the paralyzed limb, voluntary suppression of extensor spasticity becomes possible. Further, in general, a paralyzed muscle having a weak contraction is easy to sustain the muscle contraction by adding a light resistance. Since the load resistance in automatic exercise can be adaptively changed for each exercise direction, new exercise therapy for ataxia can be performed. Since load resistance can be applied even though it is automatic exercise, it has an excellent effect on muscle strength recovery, maintenance, and strengthening. In addition, since it is possible to achieve the target exercise while appropriately applying resistance in automatic exercise like doctors and physiotherapists, it is possible to provide an inspection method for performing functional evaluation that could not be quantitatively evaluated until now. It was

[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 a system configuration of a lower limb exercise therapy device of the present invention.

FIG. 3 is a view showing an example of the mechanism of the lower limb exercise therapy device of the present invention.

FIG. 4 is a diagram showing a configuration (a) of a computer-controlled brake unit and a brake characteristic (b).

FIG. 5 is a diagram showing a method of measuring a range of motion (a) and a flow of calculation of a range of motion characteristic value (b).

FIG. 6 is a diagram showing patterns of standard trajectories stored in a standard motion trajectory storage unit.

FIG. 7 is a diagram showing a flow of generating a desired motion trajectory unique to a patient.

FIG. 8 shows, as an example, the position of the position index and the moving speed direction (point B) presented on the display with respect to the position of the hand or foot on the device and the moving speed direction (point A) with respect to the vertical 8-character target trajectory. It is a figure shown about a line symmetry presentation (a) and a point symmetry presentation (b).

FIG. 9 is a diagram showing a motion trajectory of an oblique 8-figure trajectory following task test for patient F. (A) is before training, with no load,
(B) is a diagram before and after training, in the case where the bending / extending direction load is 1.5 kgf and the inner / outer direction load is 1.0 kgf, and (c) is a diagram after the training, where the bending / extending direction load is 1.5 kgf and the inner / outer direction direction is 1.0 kgf. . The dimensions of the target trajectory are shown in the lower right.

FIG. 10 is a diagram showing a movement trajectory of an oblique 8-character index following task test of patient S. (A) is a figure before a training, when a bending / expanding direction load and an inner / outer direction load are 0.3 kgf, (b) is a figure after a training, and the same condition load. The dimensions of the target trajectory are shown in the lower row.

FIG. 11 is a diagram showing a motion trajectory of a vertical eight-character trajectory following task test of patient A. (A) is before training, with no load,
In the case of (b) before the exercise, the load in the bending / expanding direction is 2.0 kgf, and the load in the abduction / extension direction is not applied.
It is a figure in the case of kgf and load 1.0kgf in inner-outer rotation direction. The dimensions of the target trajectory are shown in the lower right.

FIG. 12 is a diagram showing a motion trajectory of an oblique 8-figure trajectory following task test for patient N. (A) is before training, with no load,
(B) is a diagram before and after the training, when the bending and stretching direction load is 1.5 kgf and the inner and outer rotation direction load is 1.0 kgf, and (c) is after the training, when the bending and stretching direction load is 1.5 kgf and the inner and outer rotation direction load is 1.0 kgf. is there. The dimensions of the target trajectory are shown in the lower right.

[Explanation of symbols]

101 Lower limb foot 201 Motion plane setting plate 211 Foot support 213 foot grip plate 215 outer frame 217 Support upper part base plate 219 Lower base plate of support 221, 223 Linear motion guide 225, 227 Power transmission part consisting of belt and pulley 231 and 233 brakes 235, 237 Brake servo amplifier 241,243 load cell 245, 247 Load cell amplifier 251, 253 rotary encoder 301, 303 Load resistance part 305, 307 Force measurement unit 309, 311 Position measurement unit 401, 403 Load resistance target command 405 and 407 force information 409,411 Position information 451 Visual stimulation information 501 computer 503 Arithmetic processing unit 511 Range of motion measurement unit 513 Target motion trajectory generation unit 515 Motion analysis unit 521 Standard motion trajectory storage unit 523 Operation data storage unit 601 display 611 Force index presented on the display Target value of load resistance presented on the 613 display Position indicator presented on the 621 display Target trajectory presented on the 623 display Target index presented on the 625 display

   ─────────────────────────────────────────────────── ─── Continued front page    (72) Inventor Masataka Ono             2-19, Mureoka, Yoshida-cho, Kagoshima-gun, Kagoshima             Two (72) Inventor Yuei             2-2-502 Motomachi, Higashi-gun, Kagoshima City, Kagoshima Prefecture (72) Inventor Ryota Hayashi             Kagoshima Prefecture Kagoshima City Ujuku 1-chome 51-14-205 F-term (reference) 4C038 VA04 VA20 VB12 VB14 VC20

Claims (11)

[Claims] 1. A device for performing exercise therapy for the purpose of recovering, maintaining and strengthening the motor function of an upper limb or a lower limb, which is a load resistance means for giving a load resistance to the exercise of the upper limb or the lower limb of a trainee. And a movement plane setting means for supporting the hand of the trainee's upper limb or foot of the lower limb to realize this movement in a plane, the position of the hand or foot in the plane, and the upper limb or lower limb. Motion measuring means for measuring the load resistance and exerted force against it, and presenting the position of the hand or foot exercised by the trainee as a position index, or presenting the exerted force of the upper limb or lower limb as a force index And a target motion for presenting a target motion trajectory peculiar to the trainee on the hand or foot to be exercised, or presenting a target value of load resistance of the upper or lower limbs. An exercise therapy device having a work trajectory display means. 2. The load resistance means generates a load resistance with respect to an automatic exercise of a trainee, and a target value of this load resistance is obtained by using a measured value of a position and / or exerted force by the motion measuring means. 2. The exercise therapy device according to claim 1, which can be set and / or made variable. 3. The exercise plane setting means holds the hand or foot of the trainee on a support without restraining the degree of freedom of joint of the hand or foot, and moves in the orthogonal coordinate direction in an inclined plane. The exercise therapy device according to claim 1 or 2, wherein movement of the upper limbs or lower limbs of the trainee is realized by a linear motion mechanism that performs a movement and a link mechanism that performs a movement in a polar coordinate direction. 4. The biofeedback loop utilizing visual stimuli, wherein the target motion trajectory presenting means and the motion index presenting means present the target motion trajectory and the motion index on the same display, thereby forming a biofeedback loop utilizing visual stimulation. The exercise therapy device according to any one of 1. 5. An exercise therapy system for supporting a hand or foot of a trainee to realize this exercise in a plane, wherein the load resistance means, the motion measuring means, and the trainee exercise. Standard movement trajectory storage means that stores a standard movement trajectory consisting of the position data of the hand or foot to be moved and time-series data of the standard movement speed, and the hand or foot of the trainee Range of motion measuring means for measuring a range of motion and calculating a range of motion characteristic value, and generation of a target range of motion of the trainee by converting the standard motion path based on the range of motion characteristic value Means, the desired motion trajectory presentation means, the motion index presentation means, a motion data storage means for storing the motion data measured by the motion measuring means, and a motion analysis means for analyzing the stored motion data. Exercise therapy system having. 6. The upper limit or lower limb of the trainee is extended forward with the range of motion measuring means supported in a plane defined by the exercise surface setting means with the hand or foot of the trainee. The exercise therapy system according to claim 5, wherein positions of points, horizontal abduction points, and body-bent points are measured to calculate a range of motion characteristic value of the hand or foot. 7. The standard trajectory of the standard motion trajectory is one vertical line, one right diagonal line, one left diagonal line, eight vertical lines, eight right diagonal lines, and eight left diagonal lines.
The exercise therapy system according to claim 5 or 6, which has a character pattern and an S-character / one-character combination pattern. 8. The exercise therapy according to any one of claims 5 to 7, wherein the standard motion trajectory includes, as parameters, a motion cycle in which a hand or a foot goes around the trajectory and the movable range characteristic value. system. 9. The target motion trajectory presenting means can present a target motion trajectory by a target trajectory indicating a position of a hand or a foot and a target index moving on the trajectory at a target moving speed. 9. The exercise therapy system according to any one of claims 8 to 9. 10. The operation index presenting means has a function of presenting the position of the hand or foot and the moving speed thereof in the same presentation, line symmetry presentation and point symmetry presentation. Exercise therapy system. 11. The motion analysis means uses the orbital length of movement of the hand or foot, its movement cycle, orbital error which is the distance between the position index and the target orbit, time integration of the orbital error, and area of the orbital error. , Index error which is the distance between position index and target index, time integration of index error, number of hesitation of hand or foot, spectral density of orbital error, upper limb or lower limb exertion power, maximum exertion power, exertion power The exercise therapy system according to any one of claims 5 to 10, wherein the minimum value, the average value of the exertion power, the work amount of the exertion power, and the time integral of the exertion power are calculated.