JP2004510479A - Device for direct contact diagnosis of patients in non-contact position - Google Patents

Abstract

A device is disclosed that allows a physician to perform a physical examination of a patient remotely. The device includes a hand control unit (100) shaped to adapt to a doctor's hand, and a plurality of sensory adjustment subs capable of simultaneously detecting the applied pressure and applying the pressure to the doctor. Includes unit (140). The patient examination module (200) includes a plurality of sensory adjustment subunits (240) arranged in an array forming a flexible pad (202). In operation, the sensory adjustment subunit (240) of the patient examination module (200) receives from the hand control unit (100) a signal indicating the position and magnitude of the pressure applied to the hand control unit (100) by the physician. The pressure is then replicated in the patient via the sensory regulation subunit (240).
[Selection] Figure 1

Description

[0001]
(Field of Invention)
The present invention relates to a medical device that transmits tactile information from a remote location to an individual, and more particularly to a device that assists in diagnosing a patient at a location remote from a physician location.
[0002]
(Background of the Invention)
Computer society and improved performance for individuals to communicate over the Internet and other wide area networks are changing society today. These communication platforms enable efficient and effective worldwide data transfer and make this information available to the general public. The way people communicate, exchange information, and trade is being greatly influenced by these developments. Traditional business practices have evolved and any business using computers and websites has the potential to access consumers with computers around the world. Currently, each business has an essentially global customer base. While many businesses are using this trend, the medical industry is one of the most notable exceptions.
[0003]
The medical environment is extremely complex. Third parties in this area, as well as government officials involved in funding and management, are pressing patients, hospitals, and doctors to “normalize” medical issues into predictable business models, However, this is a difficult task. Due to the uniqueness of each individual and the fundamental properties underlying biological organisms, medicine is not an accurate science that can be correctly predicted in all respects. Collection of medical information, data storage, treatment methods, results, and business model building due to the variability of patients, patient illnesses, individual symptoms due to similar illnesses, and physician skills, training, and treatment methods It is difficult to standardize.
[0004]
Medical practice is also a very unique personal service. Sick patients interact with experts with unique skills with the expectation that their health will be improved or their pain will be alleviated. The underlying doctor-patient encounter is actually a complex data collection exchange. The data is processed by a physician, who then creates an optimal diagnosis and treatment plan. Input data from physician-patient interactions comes from a variety of sources, including patient physical examinations, laboratory tests, and radiographic imaging. The most important source of input information is often the actual physical examination of the patient. A physical examination consists of transmitting personal medical history information from the patient to the doctor, reviewing the medication the patient is currently taking, and direct observation and palpation of the patient's body by the doctor.
[0005]
Palpation of the patient's body involves gently applying hand pressure along the abdomen, chest, and extremities to determine the body's response to the palpation. Inflammatory conditions such as infections, abscesses, thrombosis (blood clots), perforation of hollow or non-hollow organs, or fractures produce a pain response with increased resistance. This is to “guard” or protect against harmful imparting stimuli. Tumor or organ hypertrophy can be detected by a change in resistance otherwise detected under normal skin surface. This is similar to feeling a stone in a shoe. Furthermore, fluid in the abdomen (ascites) can also be detected by applying hand pressure to one end of the abdomen and detecting fluid waves obtained at the opposite location in the same cavity.
[0006]
A professionally performed medical history and physical examination provides a correct diagnosis with an accuracy of nearly 90%. In most cases, laboratory and radiographic data provide additional details regarding diagnostic confirmation and patient status. In general, physicians collect all available input data from various sources, process the information against the physician's personal knowledge or reference base, and based on the information entered, It functions as a computer by establishing a list of what can be. The doctor then recommends a treatment plan that would improve the patient's health.
[0007]
Some of the data needed to make an accurate medical diagnosis can be exchanged between patients, laboratories, radiology, and physicians using a variety of communication methods. There is no need to match. The current communications revolution allows the exchange of medical history information, laboratory data, telemetry data, and radiology research via telephone, pager, fax, email, and video. These advances benefit all types of business, and medicine is no exception. However, as one medical-specific data collection process, doctors may make direct contact with the patient's body, and remote data acquisition is currently not possible in this regard.
[0008]
(Summary of the Invention)
The present invention provides a system that satisfies the needs identified above. The device includes a hand control unit, a remote test module, and a computer system that connects the hand control unit to the remote test module. The present invention relates generally to a system that allows a user to transmit a tactile stimulus, such as a pressure input, to a remote body. This causes the remote body to experience the stimulus and generate a response. The system further detects a remote tactile response of the body to generate feedback and transmits the tactile feedback to the user. The preferred embodiment of the present invention is directed to remote patient examination and includes a physician's hand control unit (HCU). The hand control unit is used by a physician to cause tactile stimulation and is connected to a patient examination module (PEM) by a computer system. The patient examination module applies a tactile stimulus to the patient and sends feedback corresponding to the detected response to the HCU.
[0009]
The HCU has at least one, preferably a plurality of sensory regulation subunits. The HCU is adapted to receive a doctor's hand and the doctor has access to the sensory regulation subunit. The PEM is adapted to receive in contact with a part of the patient's body, preferably by wrapping the part of the patient. The PEM has at least one, preferably a plurality of sensory regulation subunits, which are provided adjacent to the patient. The sensory adjustment subunit detects the force or pressure applied to the subunit and generates a corresponding output signal to apply the force and / or displacement in response to the input signal. Preferably, the detection and application of force occurs at approximately the same time. The sensory adjustment subunit of the HCU is connected to the sensory adjustment subunit of the PEM via a computer system. In one embodiment, the computer system includes a first computer attached to the HCU and a second computer attached to the PEM. Here, the first and second computers have compatible information communication systems, thereby enabling information communication between the first and second computers via the network.
[0010]
The HCU sensory adjustment subunit is connected to the PEM sensory adjustment subunit via software that feeds back the detected pressure, which allows the physician to simulate actual physical contact with a remote patient. It becomes possible.
[0011]
In a first preferred embodiment of the device, the PEM utilizes a sensory adjustment subunit having a mechanical piston type variable pressure generating device (eg, a linear actuator) to apply pressure in response to an input signal. In a second embodiment of the device, the PEM utilizes a barometric or hydraulic system and an expandable cell to generate an applied pressure in response to an input signal.
[0012]
In one aspect of the invention, the HCU includes a tracking ball and buttons accessible to the user's hand. This allows the physician to interact with the computer using the HCU in a manner similar to a computer mouse (eg, selecting a specific portion of the PEM to be interfaced).
[0013]
(Detailed description of preferred embodiments)
The devices disclosed herein allow a physician to directly examine a patient's body without the patient and physician contacting the body directly or being in close proximity. This allows the type of medical data normally obtained from direct hand contact between the patient and the physician to be collected and transmitted via conventional global information delivery systems. Currently, "teletherapy", i.e., the exchange of medical information between a patient and a doctor to provide a diagnosis and treatment plan is only possible to a certain point. If physical examination findings are critical to decision making, patients should be advised to see their physician or go to an emergency room where they can perform physical examinations Receive. The inability to remotely capture physical data and transfer it reliably to doctors at another location means that the evolution of medical practice and the evolution of global communications platforms and potential consumers It is a hindrance to the ability of medicine to take advantage of the benefits and efficiencies that have benefited from the face.
[0014]
In this specification, the following terms have the following meanings.
[0015]
The sensory adjustment subunit (1) detects the force applied to the device and generates an output signal associated with the detected force; and (2) receives the input signal and associates with the received input signal. By any device capable of generating forces and / or displacements is meant.
[0016]
The hand control unit, i.e., the HCU, is adapted to contact or receive a part of the user's body (e.g., the user's hand) and can be accessed by the received user's hand. Mean any device with sensory regulation subunits.
[0017]
A patient examination module, or PEM, is optionally adapted to receive a portion of a human (or other biological organism) biological tissue and has a sensory adjustment subunit adjacent to the received portion of biological tissue Means a device. Although PEM can be used in accordance with the present invention for patient examination, the term PEM also includes devices adapted for tactile sensations of biological tissue or other objects or materials for other purposes. Should be understood.
[0018]
Referring to FIG. 1, the present invention generally relates to remote acquisition and transmission of medical data obtained from the body in three parts: a hand control unit 100 (HCU), a patient examination module 200 (PEM), and a computer. Have software. These are for controlling the acquisition, calibration, transmission and conversion of body data between the physician (via HCU) and the patient (via PEM). The present invention allows a physician to apply hand pressure to the HCU 100. This hand pressure is transmitted to the patient at a remote location and applied via PEM 200 to a selected portion of the patient's body. The pressure response from the patient's body is conversely transmitted to the doctor, thereby simulating direct contact between the doctor and the patient.
[0019]
(Hand control unit (HCU))
The HCU 100 shown in FIG. 2 has a molded plastic shell 101 formed in the shape of an actual hand. The advantages of this type of structure are that it is light, easy to manufacture, durable and impact resistant. Other materials such as wood, paper, aluminum, stone, plexiglass (R), or materials that have not yet been developed can also be used in the device structure. The HCU 100 is shaped to fit a portion of the inner surface of a person's hand, or preferably the entire inner surface, and includes a palm surface 102 that includes a palm base 108 and a palm end 107, a fingertip 106, and a thumb portion 105. Have The purpose of any design structure is to provide a comfortable contact surface between the sensory part of the user's hand and the motor part and the HCU 100. In a preferred embodiment, the HCU 100 has a slight central ridge on the palm surface 102. The periphery of the palm surface 102 has a slight depression at the boundary 104 of the HCU 100 to accommodate a user's hand that is comfortably placed on the palm surface 102. The portion of the fingertip 106 and the slight palm elevation of the palm base 108 (the level of the user's knuckles is higher than the rest of the fingers and the hand) forms a broad base pyramid structure. This design provides maximum flexibility in terms of applying and receiving pressure, device control, and functionality to the fingertip, palm end, and palm base. The HCU 100 allows complete contact between the user's palm surface and all parts of the finger and the HCU 100 palm surface 102. In a preferred embodiment, the shell 101 of the HCU 100 is formed by two laterally placed segments 101a, 101b, with the transverse split 110 located generally at the center heel position of the user's palm. The two segments 101a, 101b are slidably connected to allow relative longitudinal movement to allow adjustment of the hand length. This is to adapt to various hand sizes. Optionally, HCU 100 may include a “globe” component (not shown). In this case, the entire hand is inserted into the hand control unit. This allows contact with the top (back) hand surface, thereby providing functionality related to the input of the examination's movements and sensations arising from the top of the operator's hand.
[0020]
Recesses or cavities 112, 114, 116 are provided in fingertip 106, palm end 107, and palm base 108, respectively. As shown most clearly in FIG. 3, a pressure relay and reception sensation adjustment subunit 140 is housed within each recess 112, 114, 116. The upper part 140 of the sensory regulation subunit consists of a slab 142 of a flexible material, for example, a silicone rubber or soft plastic matrix that forms a simulated skin surface. Other suitable materials may include other natural or artificial biomaterials (artificial, imitation, cultured, or engineered skin cells or their substitutes) for this “skin” contact surface. The size of each slab 142 varies depending on the size of each recess 112, 114, 116 of the HCU 100. In general, there is a fingertip size sensory adjustment subunit 140 for each of the fingertip 106 regions of the device, a palm base size subunit 140 for the palm base 108, and a palm end size subunit for the palm end 107. There is a unit 140. To increase the sensitivity and functionality of the HCU 100, each module is subdivided into a plurality, and each depression may contain a collection of smaller functional adjustment subunits based on the generic subunits described below.
[0021]
Referring now to FIG. 4, the sensitivity adjustment subunit 140 includes a one-way single channel pressure transducer 144 that is implanted within a simulated skin slab 142. The working surface or pressure receiving surface 145 of the pressure transducer 144 is oriented upward (ie, in a direction opposite the user's palm surface). The pressure transducer 144 is oriented so that the pressure applied by the user is applied to the work surface 145 of the pressure transducer 144 and applied from the back of the transducer 144 and the wafer pressure or force is not directly sensed. In a preferred embodiment, a single pressure transducer 144 is placed in each fingertip 106 and each palm 107, 108 is subdivided into two pressure zones. A wire or other suitable connection mechanism (not shown) provides signal access to and from the pressure transducer 144.
[0022]
A simulated skin slab 142 having an embedded single channel pressure transducer 144 is mounted on a thin support platform 146, preferably made of metal or plastic. A variable force generating device such as a linear actuator, a single channel piston type variable resistor, or other variable pressure generating device 148 is attached to the lower surface of the support platform 146. The linear actuator (ie, variable pressure generating device 148) referred to herein as a “piston resistor” can be implemented in a number of ways known in the art, including electrical, mechanical, barometric pressure. Or a device that generates a variable force by a hydraulic process. A representative sampling of such a device is described, for example, in US Pat. No. 5,631,861 by Kramer (shown in FIGS. 8a-m) and is referred to in that patent as “finger tip texture simulator”. In a preferred embodiment of the present invention, a magnetically stimulated device is utilized. The piston register 148 provides a counter pressure or resistance to the underside of the simulated skin slab 142, depending on the response signal resulting from the patient test module 200 (described below). The slab 142, transducer 144, support platform 146, and piston resistor 148 are disposed in the recesses 112, 114, 116 of the HCU 100. A hole 150 is provided in each recess 112, 114, 116 to accommodate insertion of the free end of the piston register 148. The depth of the hole 150 is selected so that the support platform 146 is slightly elevated from the bottom of the depression so that the resistance felt by the user is only the resistance of the simulated skin slab 142 itself.
[0023]
Various types of pressure transducers are known in the art and are suitable for use with the present invention. For example, US Pat. No. 6,033,370 to Reinbold et al. Discloses a capacitive pressure transducer having a polyurethane foam dielectric sandwiched between two conductive layers. The present invention is not limited to this. Similar devices are disclosed by Duncan et al. In US Pat. No. 4,852,443. In this device, compressive protrusions on the capacitor electrode are placed on either side of the dielectric sheet. A pressure transducer based on a variable resistance component is disclosed in US Pat. No. 5,060,527 by Burgess.
[0024]
Referring again to FIG. 2, the corresponding thumb portion 105 of the HCU 100 houses buttons 152 that control functions related to computer software (eg, mouse click control or other input device) and select options. The underside of the HCU 100 supports the tracking ball 154, thereby providing a computer selection function and providing a two-dimensional coordinate position of the HCU 100 in space relative to the patient via the PEM 200. It will be apparent to those skilled in the art that buttons 152 and tracking ball 154 provide the basic functionality of a computer mouse and can be used to selectively interact with the computer in a well-known and well-known manner. It will also be apparent that other types of selection mechanisms (including touch sensitive pads and optical systems) can be utilized. The HCU 100 is further linked to a signal processor 130 and an analog-digital / digital-analog signal converter 132.
[0025]
The HCU 100 operates as an interface or point of contact between a physician and a remote patient. The HCU 100 receives a physically applied pressure signal generated by the physician's hand and converts the signal into an electrical signal via the pressure transducer 144. At the same time, the HCU 100 converts the incoming electrical signal resulting from the pressure response in the patient test module 200 to a resistance signal. This resistance signal is provided to a piston resistor 148 mounted relative to the support platform. The performance of the sensory adjustment subunit 140, which “senses” the input pressure applied by the user and at the same time provides the user with a direct resistance feedback response, is the actual result that occurs when the user presses his hand against another object. Simulate the event. The high resistance (actual patient response) detected by PEM 200 in response to direct pressure applied to the patient (as determined by input pressure from HCU 100) is relayed back to HCU 100 and piston resistor 148. Feedback to the doctor. The increasing resistance detected by PEM 200 corresponds to the increasing force being applied to the lower surface of support platform 146. This would perceive greater resistance, or “lack of elasticity”, for the simulated skin slab 142. This feedback resistance is perceived by the user as a direct response from the patient to the force applied by the physician.
[0026]
The HCU 100 can optionally be incorporated into a single or multiple multi-channel pressure transducer / resistor device, and / or the absolute value change in resistance can be converted to a physician's hand via a hand control unit. The thumb portion 105 is currently used for a command function of software, but may instead contain a sensory adjustment subunit 140. The ability to integrate thumb movement into the inspection process, the ability to return sensory input to the thumb of the hand, allows the functionality and sensitivity of the HCU 100 to be extended. The most complex embodiment of the HCU includes full contact with all parts of the operator's hand, and many sensory adjustment subunits 140 are installed throughout the HCU. Limiting the number of subunits 140 is only the ability to miniaturize these two-way pressure conversion devices. A number of sensory adjustment subunits allow the user to generate and receive physical and sensory input from all parts of the operator's hand.
[0027]
(Patient Examination Module (PEM))
Referring now to FIGS. 5 and 6, the PEM 200 consists of a pad or pad-like structure 202 made of a soft semi-flexible material (eg, nylon, rubber, silicone, or soft plastic substrate). The entire pad 202 is hard and preferably has viscoelastic properties similar to the simulated skin slab 142 of the HCU 100. The pad 202 is subdivided into basic structural units called cells or cell regions 204. The overall size of the pad 202 and the number of cells 204 within the pad 202 will vary depending on the particular application. Each cell region 204 preferably corresponds to a region in the pad 202 having a size similar to the corresponding sensory adjustment subunit 140 of the HCU 100. As shown in FIG. 6, a single channel pressure transducer 244 is mounted within each cell 204 and is oriented with the work / receiving surface 245 facing the patient. A preferred pad 202 is a continuous gel type structure 242 having a plurality of embedded pressure transducers 244. The back surface 206 of the pad 202 includes a flexible semi-rigid sheet. The presently preferred material for the back 206 is a plastic or polymer material. The plastic or polymer material provides a degree of deflection to maintain rigid support for the cell region 204 and yet provide adaptation to various body sizes. For example, stiffer materials such as metal, wood, or synthetic materials can also be used as long as they provide a rigid support structure and bend articulately along surfaces with various curves of the body. A linear actuator including a single channel piston type variable pressure generating sensory adjustment subunit 240 is attached to the underside of a thin support platform 246, preferably made of metal or plastic. The support platform 246 is preferably similar to the size of the fingertip 106 of the HCU 100. A piston-type variable pressure generating device 248, or similar linear actuator, is embedded within the support 206, generally centered directly below each pressure transducer 244 provided at the interface between the cell 204 and the support 206. , Directed below the center of the support platform 246 below the pressure transducer 244.
[0028]
The test pad 202 is applied directly to the portion of the patient's body surface to be examined and is held in place by a loop-hook closure 250 made of nylon, for example. Nylon loop-hook closure 250 provides adjustability and allows application to a variety of body shapes and sizes. The pad 202 is further as a vest for application to the chest, as a belt for application to the abdomen, as a sleeve, long glove, or glove for application to the upper limbs, and to the legs of the pants for application to the lower limbs Or it can be made as a boot or as a small strip for application to a small part such as a finger or toe. Although the preferred embodiment of the PEM is configured as a pad in place, a movable sensing unit that allows the patient, other staff, or a robot guide to move on the surface of the patient's epidermis or in the body cavity also It is within the scope of the present invention.
[0029]
In a preferred embodiment, the PEM 200 is attached to the command control box 300 via an electrical connection line 302. In the preferred embodiment, the instruction control box 300 includes a power supply 304, a small central processing unit (CPU) 306, a signal processor 308, a digital-to-analog converter 310, and a communication system 312. The command control box 300 transmits and receives data to and from the PEM 200 to link the PEM 200 to the physician's HCU 100. The power supply 304 preferably provides the ability to operate on both alternating current (home or industry) and direct current (battery operation). Although connection line 302 is shown, other data links, such as a wireless data link, are also within the scope of the present invention.
[0030]
The communication system 312 of the preferred embodiment includes an internal modem (not shown) that allows a physician's computer 160 located near the HCU 100 to connect to a remote computer 260 located near the PEM 200. Other communication systems are also possible, for example: (1) optical based / optical based communication including fiber optic cable channels and non-fiber optical based data / audio / visual signaling methods; (2) audio and / or Wireless communications including, but not limited to, radio frequency, ultra-high frequency, microwave, or satellite systems through which data information can be transmitted and received; (3) others that are radiation of infrared, magnetic, visible and invisible light Any future method of voice or data communication utilizing a currently unused medium such as the wavelength of the light, biological material (including biorobots or viral vectors), or particulate / semi-particulate). Optimally, the command control box 300 is connected to the pad 202 via a flexible connection line 302. This reduces the weight applied directly to the patient, limits size, and provides as much safety as possible (ie, reduced exposure to RF or microwave radiation by communication / data transmission). This is a consideration. Connection line 302 further connects pressure transducer 244 and variable pressure generating device 248 in sensory adjustment subunit 240 to power supply 304.
[0031]
Other device structures may incorporate single or multiple multi-channel pressure transducer / resistor devices, and the absolute resistance change may be returned to the user's hand through the HCU 100. In an attempt to improve the sensitivity or functionality of the PEM 200, each cell region 204 can be subdivided into multiple pieces, and multiple sensitivity adjustment subunits can be applied throughout the PEM 200. Limiting the number of functional subunits is only the ability to miniaturize these bidirectional sensitivity adjustment subunits. A number of small sensitivity adjustment subunits provide the ability to generate and receive mechanical and sensory inputs from any part of the PEM 200.
[0032]
The second embodiment of PEM 400 utilizes the pneumatic or hydraulic pressurization medium shown in FIGS. 7 and 8 instead of the electromechanical structure described above. In the second embodiment, the PEM 400 consists of a pad 402 or pad-like structure made of a soft semi-flexible material (eg, nylon, rubber, silicon, or soft plastic substrate). The pad 402 is subdivided into a plurality of cells 404. The overall size of pad 402 and the number of cells 404 in pad 402 will vary depending on the device model and application. Each cell 404 has one dual function inlet / outlet line 410 and one valve 414 that allows inflow / outflow of a pressurized medium such as air, water, hydraulic fluid, or electrochemical gel, and a single pressure. Designed as an airtight and liquid tight hollow chamber 416 with a transducer 444. Pressure transducer 444 is a single channel transducer similar to transducer 144 for HCU 100 described above. The pressure transducer 444 is mounted in a sheet of material that is applied directly to the patient's body surface. Thus, the open cell structure is behind the pressure transducer 444. The transducer receiving surface 445 is oriented to face the patient.
[0033]
The pad 402 is applied directly to the portion of the patient's body surface to be examined and is held in place by, for example, a loop-hook closure 250. The loop-hook closure 250 provides adjustability and allows application to a variety of body shapes and sizes. The pad 402 may further be made as a small strip for application to a small part such as a vest, belt, sleeve, long gloves, gloves, trouser legs, boots, or fingers or toes, as described above. The outer surface of the pad 402 may further include a heavy reinforcing layer (ie, lead, metal or plastic), if necessary, to provide additional stability or counter pressure. The inlet / outlet line 410 of each cell 404 is connected to a pump mechanism. The pump mechanism includes a pump (not shown) and a pressurized reservoir 418 that contains a pressurized medium. An intermediate valve 414 is provided along the inlet / outlet line 410 between the pressure reservoir 418 and each cell 404. The PEM 400 is attached to the command control box 300 via the connection line 302 as described above.
[0034]
Preferably, this control of PEM 400 is located away from the patient. This can reduce the weight applied directly to the patient, limit size when the pack is applied to small parts of the body such as limbs or fingers, or as much safety as possible (ie communication / data transmission). To reduce exposure to RF or microwave radiation). The specifications and functions of the instruction control box 300 are as described above. The connection line 302 further connects the pressure transducer 444 and the power source 304 and connects the inlet / outlet line 410 and the valve 414 for the pressurized medium.
[0035]
Depending on the particular HCU 100 design, the pump and pressurization reservoir 418 may both be housed within the command control box 300, both provided on the PEM 400 itself, or in any region independent of each other. May be included.
[0036]
The PEM 400 that utilizes air as the pressurized medium utilizes a semi-closed circuit design. In a preferred embodiment, the pump mechanism draws air from outside the unit into a single pressurized reservoir 418 provided on the back of the pad 402. The pressurized reservoir 418 is generally the same size as the pad 402. The valve 414 is provided at a plurality of positions in the pressurized reservoir 418 corresponding to the lower layer cell 404. Thus, the pressurized reservoir 418 is in direct communication with each pressure cell 404 via the intermediate valve 414. A pressure regulation circuit (not shown) is incorporated into the pressurized reservoir 418 to sense the pressure in the internal chamber and relay that information to the command control box 300, thereby ensuring proper chamber pressure. After the appropriate cell 404 is activated and the desired pump chamber pressure (corresponding to the appropriate applied pressure signal from the HCU 100) is achieved, the resulting patient response signal is sent to the command control box 300. The pump pumps the contents of the pressure chamber 416 into the atmosphere via the pump. The PEM 400 using a hydraulic pressurization medium consists of a built-in closed fluid system circuit.
[0037]
The function of the PEM 400 is to “transmit” the pressure applied by the user directly in the HCU 100 to the patient and send the resulting resistance response signal from the patient to the physician's HCU 100. Using software and the physician's HCU 100, various segments of the body within the PEM 400 can be examined by “selecting” the appropriate upper cell 404 to which pressure is to be applied. The software sends an appropriate command to open the valve 414 corresponding to the selected cell 404. The number of cells 404 selected corresponds to the body area of the patient that the physician wishes to “press” to elicit the patient's response to the applied “hand” pressure. Further, the physician can independently select a cell or body region where return pressure data can be transmitted to the user. In many cases, a pressurized cell may also send a return pressure data signal back to the physician's HCU 100 for some testing function, but it is best to pressurize one cell set and receive from a different cell set. is there.
[0038]
It is also conceivable that a second HCU is incorporated and adapted to adapt to the hand in the opposite direction to the first HCU. In this case, the physician uses one hand to apply pressure (via the first HCU and PEM) to one position of the patient and the pressure response from the other position of the patient to the other hand (first Through 2 HCUs).
[0039]
The computer software controls instructions for various functions of the physician's HCU 100, PEM 200 or 400, system dynamics, and communication protocols. The functions of the HCU 100 include a specific cell or a group of cells to be activated and a cell selection function for activating a cell that transmits the obtained return signal. The software further allows assigning specific pressure response pads of the designated physician's HCU 100 as transmit patches that transmit pressure signals and receive pads that transmit patient data to the physician.
[0040]
The spatial orientation of the physician's HCU 100 relative to the patient's body is further tracked by computer software. The movement of the HCU 100 can be converted and transmitted to the PEM 200 or 400, thereby simulating hand movements over the patient's body. In addition, an anatomy database may be captured, thereby providing a cross-sectional anatomical view and three-dimensional interpretation of the particular body region being examined.
[0041]
The software converts the physical pressure response applied to the HCU 100 by the physician into an electrical signal. Normalization, calibration, and real-time monitoring of signal and signal strength are typical program functions. The software is further responsible for electrical signal conversion and transmission protocols for transmission from the HCU 100 to the PEM 200 or 400 and vice versa. Transmission protocols include signal transmission via ground-based and non-ground-based communication platforms. All pump and valve commands calibrate and convert the pump chamber pressurization and the transmitted electrical signal to an appropriate pressurization command that correlates to a magnitude equivalent to the actual pressure applied at the hand control unit. As well as on / off states of selected valves, which are also controlled by the device software.
[0042]
FIG. 9 depicts a comprehensive process flow diagram of device functionality for both electromechanical and barometric / hydraulic embodiments of the present invention. Using the HCU 100, the physician selects the area of interest under the cell 204 or 404 that is to be activated. This part corresponds to the area to be inspected by hand. When pressure is applied to the HCU 100 via the sensory adjustment subunit 140, a signal is generated. This signal is transmitted to the physician's computer 160 via the signal processor 130 and the analog-to-digital converter 132. The physician's computer 160 then sends a computer command to activate the sensory adjustment subunit 240 or 440 of the PEM 200 or 400 below the area of interest. The region of interest is the region to which the HCU 100 pressure signal is to be directed. Thereafter, after the pressure stimulus is applied, the pressure transducer 244 or 444 corresponding to the area of the patient that the user wishes to “touch” is activated. This command activates the pressure transducer 244 or 444 of the receiving cell so that the output signal can be transmitted to the physician's HCU 100.
[0043]
Next, the physician directly presses the sensory adjustment subunit 140 of the HCU 100 with any combination of fingertips, palm base, and palm-end surfaces (from one fingertip to the entire palm surface) Generate the desired input pressure stimulus equal to the force normally applied during palpation. The applied pressure will vary depending on the individual, the situation, and the area of the patient being examined. The pressure applied by the physician to the sensory adjustment subunit 140 of the HCU 100 is sensed by the pressure transducer 144 and converted into an electrical output signal. The electrical output signal is transmitted to the signal processor 130, and the processed analog electrical signal is converted into a digital signal 132. The digital signal is then input to the physician's computer 160.
[0044]
In the physician's computer 160, the software program is responsible for the software instructions of the linked system paths between the various transceivers of the HCU 100 and the PEM 200 or 400. These software instructions include signal processors 130, 308, pressure transducers 144, 244, 444, piston registers 148, and various pressure generating devices 248 for user side and patient side devices, and HCU 100 electrical input signals. To the electrical output signal of the corresponding PEM 200, 400. When a pump system is used with PEM 400, a pressure sensor (not shown) in media pressurization reservoir 418 is calibrated. The physician's computer 160 sends the electrical signals of the PEMs 200, 400 and associated software instructions to the remote computer 260 via the communication system 312. Alternatively, the patient side (ie, the remote side) may utilize a free standing command control box 300 provided near the PEM 200 or 400. The digital pressure generation signal is then converted to an analog electrical signal 310 by a digital-to-analog converter, post-processed (308), and then relayed to the appropriate pre-selected pressure generation device of the PEM 200 or 400. The PEM 200 or 400 then applies a directed pressure to the patient based on the pressure applied to the HCU 100 by the user or physician.
[0045]
With respect to the PEM 400, the software receives incoming electrical signals from each active area of the HCU 100, evaluates the magnitude of each of the input pressures applied to various parts of the HCU 100, and specifies this information. Responsible for converting to pump commands. The pressure command is then sent to the remote computer 260 at the patient's remote location or directly to the command control box 300 portion of the PEM 400 described above. The PEM 400 then activates the pump mechanism and pressurizes the pressurization chamber 418 to achieve an output pressure equal to the pressure directly applied to the HCU 100 by the physician. The internal pressure of chamber 418 is monitored by a pressure sensor. The pressure sensor provides continuous feedback on whether pumping needs to be continued or interrupted until the desired input pressure is achieved. The pressurized medium in the pressurized chamber 418 is then routed via the inlet / outlet line 410 to each of the selected cells 404 having an open pressure valve 414. The pressurized medium then flows into the selected cell 404 and increases the cell volume and cell internal pressure in response to the force applied by the physician at the HCU 100.
[0046]
The downward force applied to one of the PEMs 200 or 400 elicits an opposing response from the patient, but this opposing resistance is a large resistance, i.e., since there is no resistance and further depressions in the region are being examined. There are various conditions up to the "guard" state. This resistance from the patient in response to the applied force from the activated cell is detected by cell pressure transducer 244 or 444.
[0047]
The mechanical resistance response detected by the activated pressure transducer 244 or 444 of the PEM 200 or 400 is converted into an electrical signal. The electrical signal is sent to the command control box 300 or remote computer 260 at the patient's location. This analog electrical signal is processed (308) and converted to a digital signal 310 as described above with respect to the input instruction set. This digital signal is then transmitted to the physician's computer 160 via the communication system 312. As described above with respect to the output signal of the HCU 100, the software program receives incoming electrical signals from each active region of the PEM 200, 400, evaluates the magnitude of the respective output pressure of the PEM 200, 400, and It is responsible for converting the output pressure into an equivalent digital resistance signal of the HCU 100. The digital signal is then converted to an equivalent analog electrical signal 132, post-processed (130), and directed to the appropriate preselected piston register of the HCU 100. The output resistance generated by the piston resistor 148 in the HCU 100 is equal to the response pressure generated by the patient in response to the input pressure stimulus of the HCU 100.
[0048]
The opposing resistance provided by the piston register 148 provides the physician with a tactile stimulus of the patient's response to pressure applied on a selected area of the patient's body. The system is real-time and dynamic so that the physician can continuously simulate a press / release or press / partial release operation within a preselected cell. The three major components of the device, the physician's hand control unit, the computer software, and the patient test module, provide a system for continuous, real-time action / reaction feedback loops. The physician can then interpret the resistance difference between the pressure applied by the physician and the patient's resistance response perceived by the physician's hand to the hand control unit and can be used for medical decision making. .
[0049]
Flow charts illustrating the overall process controlled by the software of the preferred embodiment are shown in FIGS. 10A-10C. A user (generally a physician) first logs into the system 500. The login mechanism is provided by any conventional means including, for example, the HCU's biometric scanning device (ie, a fingerprint reader, not shown). Alternatively, further conventional requesters for user identification and password can be provided to the physician's computer 160. The software then queries the system date and time (502), establishes a connection with the PEM, checks the status of the HCU and PEM (504), and then establishes the necessary communication link between them (506). . In a preferred embodiment, the first database is accessed 508 by the physician's computer 160 to obtain various calibration factors for HCU and PEM components, such as pressure transducers and pressure generating devices (linear actuators). The software then performs various other initialization functions (510). The initialization function may include establishing a sampling rate for the pressure transducer, initializing and calibrating the component (eg, establishing a “zero pressure” level for the pressure transducer).
[0050]
Patient identification and biometric information is then entered (512) to verify the patient's identity with respect to the medical record and to establish basic parameters that may be useful for the examination. The basic parameters include, for example, an outline of the patient size and age. The physician then selects the position of the body to be examined (514). In the preferred embodiment, a database of physical data is accessed. (516). This database may contain comprehensive still images or videos of the body part to be examined. It is contemplated that embodiments of the present invention may use patient medical information and biometric information in addition to comprehensive information about the body part to be examined to adjust various system parameters. The system parameter is, for example, the sensitivity of the pressure transducer and the linear actuator. The physician then selects the portion of the HCU that provides the output signal to the PEM (518), selects the portion of the HCU that receives the feedback pressure from the PEM (520), and selects the cell of the PEM that receives the pressure signal from the HCU. Select (522) and select the PEM cell that transmits the pressure signal to the HCU 524 (524). In most applications, it is expected that there will be a one-to-one relationship between the active part of the HCU and the activated PEM cell. For example, the HCU sensory regulation subunit sends and receives pressure signals to and from the same PEM cell. However, the ability to break the relationship between the transmitted signal and the received signal is believed to provide additional functionality to the system. The present invention contemplates a system that is unable to break the relationship between the input pressure signal and the output pressure signal of the HCU.
[0051]
The software may further coordinate the position of the activated segment of the HCU with the PEM 526. Thereby, HCU movements similar to mouse movements are tracked by the system and changes corresponding to the activated PEM cells are made. A predetermined force change function is provided (528) before any force is applied to the system. This is, for example, an amplification / expansion or reduction / minimization of the power of the HCU and PEM output signals. A force is applied to the HCU by the user (530) and the pressure signal generates a low amperage signal (HCU-P1) in the pressure transducer 144 (532). The low amperage signal is transmitted to the signal processor to generate a signal having a corresponding higher amperage (534). The signal is then converted to a digital signal (D-HUC-P1) (536). D-HUC-P1 is used to generate (538) a digital pressure signal (D-PEM-P1) for the PEM and is sent (540) from the physician's computer 160 to the remote computer 260. The D-PEM-P1 pressure signal is then converted to a low amperage analog signal (PEM-P1) (542), which is provided to the PEM's variable pressure generating device 248 and a corresponding force is applied to the patient ( 546).
[0052]
The patient's resistance response is detected by the selected PEM cell (548), thereby generating a pressure response signal (PEM-P2) (550). PEM-P2 is processed to generate a signal with higher amperes (552) and digitized (D-PEM-P2) (554). The D-PEM-P2 pressure signal is used to generate a corresponding digital pressure signal for the HCU (556), transmitted from the remote computer to the physician's computer (558), and converted to an analog signal (560). ). This analog signal is provided to the appropriate HCU piston variable register 148 (562) to generate a response force at the HCU. When the examination is complete (566), the system is reset to allow the physician to begin another examination of another part of the patient's body. In other cases, the physician may apply additional force to detect additional responses from the patient.
[0053]
Although the process has been described with respect to a preferred embodiment, it will be apparent to those skilled in the art that modifications to the above process are possible. For example, an embodiment where the pressure signal from the pressure transducer can be used without pre-processing to have a higher amperage, or the pressure transducer is used with an integrated AD converter so that the digital signal is Directly generated embodiments may also be possible. Optionally, the HCU and PEM may be connected directly to a common computer or dedicated data processing system for the case where the user and patient are in close proximity. The present invention is clearly implemented without the additional functionality provided by the body database. In addition, it will be apparent to those skilled in the art how the process flow shown in FIGS. 10A-10C can be modified to enable the PEM hydraulic or barometric embodiments described above.
[0054]
(Additional uses)
Although the original intent of the HCU 100 was to simulate a physical examination of a patient at a remote location, applications in the medical field have been used in harsh environments such as deep sea, space, battlefield conditions, remote location, and / or mountains Includes the ability to examine a patient in a zone / jungle expedition, etc. The invention can also be applied to non-medical and / or recreational applications. In this case, it is desirable for the individual to inspect another person, body, or object at a remote location to elicit a feeling or tactile response.
[0055]
In addition, a portable version can be applied at medical offices in the workplace. This eliminates the need for the patient to actually leave the office and go to the doctor. Leaving the office and going to the doctor is very inefficient for both the patient and the doctor.
[0056]
Furthermore, as the use of robot tools to perform motions increases, the above invention may be modified to perform motions using a robot system while providing tactile feedback to a physician in a simple manner.
[0057]
The portable version is also used at home. In this case, some evaluation may eliminate the need to go to the emergency room after normal working hours. This efficiency has a major impact on the total cost of healthcare.
[0058]
Any application requiring physical structure tactile information or a three-dimensional tactile model required by a remote person is within the scope of the present invention.
[0059]
The present invention may further be applied to improve the ability of a blind person to communicate or feel an object without actually coming into direct physical contact with the object.
[0060]
Although the preferred embodiments described and described herein relate to examination of a patient's body surface, a PEM can also be configured for use in a body cavity or incision.
[0061]
Embodiments of the invention claiming exclusive property or privilege are set forth in the following claims.
[Brief description of the drawings]
[Figure 1]
FIG. 1 illustrates a preferred embodiment in which the system of the present invention is used, showing a doctor examining a patient at a remote location from the doctor.
[Figure 2]
FIG. 2 is a plan view of a hand control unit according to the present invention.
[Fig. 3]
FIG. 3 is a schematic cross-sectional view of the hand control unit of FIG.
[Fig. 4]
4 is a cross-sectional view of the sensory adjustment subunit for the hand control unit shown in FIG. 3 according to the present invention.
[Figure 5]
FIG. 5 is a front view of a preferred embodiment of a patient examination module for examining a patient's torso according to the present invention.
[Fig. 6]
6 is a cross-sectional view of the cell from the patient test module shown in FIG.
[Fig. 7]
FIG. 7 is a front view of a second preferred embodiment of a patient examination module for examining a patient's torso according to the present invention.
[Fig. 8]
8 is a cross-sectional view of the cell from the patient test module shown in FIG.
FIG. 9
FIG. 9 is a schematic process flow diagram of a preferred embodiment of the present invention.
FIG. 10A
FIG. 10A is a flow diagram detailing the operation of the software controlling the preferred embodiment shown in FIG.
FIG. 10B
FIG. 10B is a flow diagram detailing the operation of the software that controls the preferred embodiment shown in FIG.
FIG. 10C
FIG. 10C is a flow diagram detailing the operation of the software controlling the preferred embodiment shown in FIG.

Claims (29)

A device for remote direct contact diagnosis of a patient, comprising a hand unit, a patient examination module, and a computer, wherein the patient examination module and the hand control unit are operatively connected to the computer, And a device capable of generating a force in response to an input signal and generating an output signal in response to a detected force. The hand control unit includes at least one sensory adjustment subunit that generates an output signal directly related to the force applied to the sensory adjustment subunit and is responsive to the input signal. The device of claim 1, wherein applying the resistance force simultaneously is possible. The device of claim 2, wherein the at least one sensory regulation subunit includes a slab of elastic material having an embedded pressure transducer, the slab of elastic material being attached to a variable pressure generating device. The device of claim 3, wherein the variable pressure generating device is a single channel piston variable resistor. The device of claim 2, wherein the hand control unit further comprises means for selectively interacting with the computer. 6. The device of claim 5, wherein the means for selectively interacting with the computer comprises a tracking ball and a button. The hand control unit has an upper surface having a hand shape, further includes a front portion and a rear portion, and the front portion and the rear portion are slidably connected, whereby the hand control unit has different sizes. The device of claim 2, wherein the device can be adjusted to accommodate a hand. The upper surface having the shape of the hand includes four fingertip portions each including at least one sensory adjustment subunit, a palm end portion including at least one sensory adjustment subunit, and a palm including at least one sensory adjustment subunit. The device of claim 7, comprising a base. The patient examination module is
(A) a pad removably attachable to the patient, the pad comprising a plurality of expandable cells attached to a support and means for attaching the pad to the patient;
(B) a plurality of pressure transducers attached to the plurality of expandable cells, wherein the plurality of pressure transducers are adapted to generate a signal directly related to the interface pressure between the pad and the patient; When,
(C) a fluid medium that can be selectively directed to some of the plurality of expandable cells to produce a desired pressure within the expandable cell;
The device of claim 1, comprising: The device of claim 9, wherein the fluid medium is air. The device of claim 9, wherein the fluid medium is a hydraulic fluid. The device of claim 9, further comprising a plurality of electrically actuated valves, each provided between one of the plurality of expandable cells and a pressurized fluid medium reservoir. The device of claim 12, further comprising a command control box having a controller electrically connected to the plurality of valves and the plurality of pressure transducers. The hand control unit is
(A) a computer input device operably linked to the computer, wherein the user can select one or more cells of the patient examination module;
(B) at least one sensory adjustment subunit that includes a sensor capable of detecting pressure applied by the user, the sensor operably linked to the computer, wherein the sensor is detected At least one sensory regulation subunit that produces a signal proportional to pressure;
(C) a piston capable of applying a force detectable by the user, wherein the piston is operably linked to the computer and the applied force is applied to the signal generated by the patient examination module; A piston that responds,
The device of claim 9, comprising: 15. The device of claim 14, wherein the sensory adjustment subunit comprises a linear actuator connected to the support and a pressure transducer positioned between the linear actuator and the patient. 16. The device of claim 15, further comprising a command control box having a controller electrically connected to the sensory adjustment subunit. A device for remotely examining a patient, comprising: a hand control unit connected to a first computer having a first data communication system at a first location; and a second data communication system at a second location. A first patient communication module connected to the second computer, the first data communication system and the second data communication system so that the first computer can communicate with the second computer. A device that can interface. The device of claim 17, wherein the first data communication system and the second data communication system interface via a standard telephone line. The device of claim 17, wherein the first data communication system and the second data communication system interface via a global telecommunications system. The device of claim 17, wherein the first data communication system and the second data communication system interface via a fiber optic network. A device that simulates tactile interaction with a remote body,
(A) a hand control unit having at least one sensory adjustment subunit;
(B) an inspection subunit located remotely from the hand control unit, the inspection subunit having a plurality of sensory adjustment subunits;
(C) means for operably connecting at least one sensory adjustment subunit of the hand control unit to at least one sensory adjustment subunit of the examination unit, which is applied to one connected sensory adjustment subunit; Means adapted to cause a corresponding force to be applied by another connected sensory adjustment subunit; and
With a device. The device of claim 21, wherein the sensory adjustment subunit comprises at least one pressure transducer and at least one variable pressure generating device. The means for operatively connecting the sensory adjustment subunit comprises at least one computer and a communication system, the communication system comprising the sensory adjustment subunit of the hand control unit and the sensory adjustment subunit of the inspection module. The device of claim 21, wherein the device is operatively connected to the computer. The hand control unit further comprises means for selecting the at least one sensory adjustment subunit of the test module, the means being operatively connected to the at least one sensory adjustment subunit of the hand control unit; The device of claim 21. 25. The device of claim 24, wherein the selection means comprises a trackball disposed on the bottom surface of the hand control unit and a button disposed on the top of the hand control unit. A method for tactile examination of the body,
(A) wrapping a part of the body in an inspection module having a plurality of sensory adjustment subunits;
(B) operably connecting at least one of the sensory adjustment subunits of the test module to at least one sensory adjustment subunit on a remotely located hand control unit;
(C) manually applying a force to the at least one sensory adjustment subunit on the hand control unit, thereby generating a corresponding force in the connected sensory adjustment subunit of the test module, from the test module Detecting the feedback force of
Including the method. The method further comprises remotely selecting at least one of the plurality of sensory adjustment subunits of the test module that is operatively connected to the at least one sensory adjustment subunit of the hand control unit. Item 27. The method according to Item 26. 27. The operative connection of the inspection module to the hand control unit comprises transmitting a signal via a global telecommunications system between the inspection module and the hand control unit. Method. A method for tactile examination of the body,
(A) generating an output signal in response to an applied force and simultaneously placing the body part in an examination module having a plurality of sensory adjustment subunits capable of applying a force in response to a received input signal; Wrapping process,
(B) connecting the inspection module to a first communication system capable of transmitting and receiving the input and output signals;
(C) a hand control unit having at least one sensory adjustment subunit capable of generating an output signal in response to an applied force and simultaneously applying a force in response to a received input signal; Connecting to a second communication system capable of communicating with the first communication system;
(D) the first communication system and the second communication system so that an output signal of the hand control unit is received by the inspection module and an output signal of the inspection module is received by the hand control unit; Operatively connecting the
(E) a series of forces applied by hand to the sensory adjustment subunit of the hand control unit, thereby applied by the sensory adjustment subunit of the hand control unit and received from the test unit Allowing the force obtained from the output signal to be detected; and
Including the method.

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