JP2005245742A - Method of transitive motion - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a method of transitive motion for training allowing expanding of a joint movable region while suppressing the occurrence of spasticity even to a patient who is in a state where the spasticity after onset of strokes is strong. <P>SOLUTION: The method of transitive motion for carrying out the plantar flexion motion and the dorsiflexion motion of a leg joint includes: a setting step setting the upper limit position in a dorsiflexion direction or that in a plantar flexion direction of the leg joint movable range of the patient; a motion stoppage step for stopping the motion for a previously set period at the upper limit position in the dorsiflexion direction or that in the plantar flexion of the leg joint movable range of the patient; and a movable range expanding motion step for carrying out the dorsiflexion motion in the dorsiflexion direction further than the upper limit position of the dorsiflexion direction in the leg joint movable range after the motion stoppage step or for carrying out the plantar flexion motion in the plantar flexion direction further than the upper limit position of the plantar flexion direction in the leg joint movable range after the motion stoppage step. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a passive movement method for improving / preventing ankle contracture, poor circulation, etc. caused by illness or trauma.

  The range-of-motion exercise is an effective exercise for improving / preventing joint contracture and the like. The training includes automatic movements performed by the patient himself and passive movements performed by therapists. When performing a passive motion with human power, the burden is large and it is necessary to apply the same motion for a long time. Therefore, it is effective to perform the passive motion using a machine.

In the case of ankle joints, the most important exercises for recovery and maintenance of walking function are plantar flexion and dorsiflexion. As a conventional exercise training apparatus for ankle joints, there is an apparatus for performing an extension exercise on a joint having spasticity or contracture by changing an operation range or an operation speed based on a value of a joint torque. (See Patent Document 1).
US Pat. No. 6,599,255

  In the case of training for patients with strong spasticity after stroke onset, the tension is relieved by holding the foot for a certain time at the movement limit position at the start of training, and from the movement limit position at the start of training Furthermore, there is physical therapy knowledge that it is possible to move in the same direction (expansion of joint range of motion).

  However, this exercise (motion) is a burdensome task for a physical therapist because it needs to be performed at a very low speed so as not to give a stimulus that causes spasticity. Therefore, if this passive movement can be performed using the apparatus, the burden on the physical therapist can be greatly reduced. The conventional apparatus described in the above-mentioned Patent Document 1 performs an extension exercise by changing the operating range and speed according to the magnitude of torque generated in the joint, and obtains an effect of improving spasticity and contracture. Therefore, it is difficult to always obtain a constant pattern of training operation. Furthermore, since high-speed processing calculation of the torque signal is required, an advanced control device is required, and it is difficult to spread in terms of cost.

  The present invention has been made in view of the above-described problems of the prior art, and expands the range of motion of joints while suppressing the occurrence of spasticity even for patients who have a strong spasticity after the onset of stroke. The purpose of the present invention is to provide a passive movement method capable of performing training to enable the exercise.

  The present invention relates to a setting method for setting an upper limit position in a dorsiflexion direction or an upper limit position in a sole flexion direction of a patient's ankle joint movable range in a passive motion method for performing ankle joint sole flexion motion and dorsiflexion motion, An operation stop step for stopping the operation for a preset time at an upper limit position in the dorsiflexion direction or an upper limit position in the bottom flexion direction of the joint movable range, and an upper limit position in the dorsiflexion direction of the ankle joint movable range after the operation stop step Or a movable range expansion operation step of performing a buckling operation in the bottom bending direction further than the upper limit position of the bottom bending direction of the ankle movable range after the operation stopping step. Provided is a passive movement method characterized by comprising:

  Further, the movable range of the dorsiflexion operation or the bottom bending operation in the movable range expansion operation step can be arbitrarily set by the operator. The time in the operation stop step can be arbitrarily set by an operator.

  According to the present invention, in the passive movement method for performing the plantar flexion motion and dorsiflexion motion of the ankle joint, a setting step for setting an upper limit position in the dorsiflexion direction or an upper limit position in the plantar flexion direction of the patient's ankle joint movable range; An operation stop step for stopping the operation for a preset time at an upper limit position in the dorsiflexion direction or an upper limit position in the sole flexion direction of the ankle joint movable range, and an posterior flexion direction of the ankle joint movable range after the operation stop step. A movable range expansion operation step of performing a dorsiflexion operation in a dorsiflexion direction further than an upper limit position, or performing a dorsiflexion operation in a sole flexion direction further than the upper limit position of the ankle joint movable range after the operation stop step. Therefore, it is possible to expand the range of motion of the joint while suppressing the occurrence of spasticity even for patients who have strong spasticity after the onset of stroke.

Hereinafter, the best mode for carrying out the passive movement method according to the present invention will be described with reference to the drawings. 1 and 2, reference numeral 1 denotes a passive motion apparatus that can perform a sole bending motion and a dorsiflexion motion of an ankle joint for realizing the passive motion method according to the present invention. The passive motion apparatus 1 is mainly composed of a base part 2, a pair of arm parts 3, and a holding plate part 4.

  The base part 2 includes a base 5 and a pair of support columns 6 erected on the base 5, and a rotary shaft 7 is rotatably attached to one support column 6. The base 5 is detachably provided with a crus holding portion 8 that holds the crus of the patient's foot 30. The crus holding unit 8 can be used, for example, when supporting the crus of the patient's foot 30 in the supine position (when lying on his back), and the patient can be moved in the sitting position (sitting state). When the exercise device 1 is used, the exercise device 1 can be used in a state where the lower leg holding portion 8 is removed.

  The rotating shaft 7 rotatably supported by the pair of support columns 6 passes through the support columns 6, and one end portion of the pair of arm portions 3 is attached to the outer portion of each support column 6 of the rotating shaft 7. Yes. The pair of arm portions 3 can rotate in the bottom bending direction and the back bending direction (see FIG. 1) integrally with the rotating shaft 7. In other words, the pair of arm portions 3 supported by the rotation shaft 7 can be rotated about the rotation shaft 7 in the bottom bending direction and the back bending direction (see FIG. 1). One end (upper end in FIG. 2) of the rotating shaft 7 is connected to a driving shaft of a driving motor 9 that is a driving source, and the rotating shaft 7 is rotated by the driving motor 9. By rotating the rotating shaft 7 forward and backward by the drive motor 9, the pair of arm portions 3 can be rotated in the bottom bending direction and the back bending direction (see FIG. 1). As shown in FIGS. 1 and 2, the rotating shaft 7 is controlled by the control means 50, which will be described later.

  As shown in FIG. 2, holding plate portions 4 that hold the patient's feet are connected to the other ends of the pair of arms 3. Therefore, the holding plate part 4 can rotate in the bottom bending direction and the back bending direction (see FIG. 1) together with the pair of arm parts 3. The holding plate portion 4 supported by the pair of arm portions 3 includes an outer frame plate 10 that is directly connected to the pair of arm portions 3, a central shaft 11 that is rotatably attached to the outer frame plate 10, and a central shaft. 11, and a rotating plate 12 that can be rotated in an inward direction and an outward direction (see FIG. 2) integrally with the body 11 and that directly holds the patient's foot provided in the frame of the outer frame plate 10. I have. The central shaft 11 extends in a direction orthogonal to the rotational shaft 7 at the central position of the rotating plate 12, and the rotating plate 12 rotates in the inward and outward directions around the central shaft 11. (See FIG. 3). Further, the rotating plate 12 is provided with a foot fixing portion 13 for fixing and holding the patient's foot on the rotating plate 12, and the foot fixing portion 13 rotates the patient's foot. It can be easily fixed to the moving plate 12. The foot is fixed so that the bottom dorsiflexion rotation center position of the ankle joint substantially coincides with the rotation axis 7. Thereby, the training operation of the ankle joint in the bottom flexion direction and the dorsiflexion direction by the driving force of the drive motor 9 is enabled.

  The rotating plate 12 can be provided with a fixing means (not shown) for fixing the rotating plate 12 at a desired position (angle) in the inward direction and the outward direction. By this fixing means, for example, the rotation plate 12 can be fixed by the fixing means at a position where pain caused when a patient who has joint contracture undergoes bottom flexion / dorsiflexion motion training is reduced, Patients who have joint contracture can perform plantar flexion / dorsiflexion exercise training without feeling pain. Note that the fixing means can be constituted by an appropriate means such as a screw.

  Moreover, the rotation plate 12 may be divided. For example, as shown in FIG. 4, the foot apex portion 14 and the heel portion 15 may be divided into two. In this case, the foot apex portion 14 and the heel portion 15 can rotate in the inward direction and the outward direction about the central axis 11 independently of each other.

  Moreover, as shown in FIG. 5, the arm part 3 and the outer frame plate 10 can be formed integrally. More specifically, the arm portion 3 'has a U-shaped cross section in the axial direction of the central axis 11, and a pair of right arm 3a and left arm 3b are connected by a horizontal arm 3c. ing. The horizontal arm 3 c extends in a direction orthogonal to the axial direction of the central axis 11. A central shaft 11 is attached to a central position on the inner surface side (right side in FIG. 5) of the horizontal arm 3c, and a rotation plate is provided on the central shaft 11 so as to be able to rotate in the inward direction and the outward direction. 12 is rotatably attached. Therefore, the configuration shown in FIG. 5 can be simpler than the configuration shown in FIGS. 1 and 2.

  Next, the control means that is a characteristic part of the present invention will be described. As described above, the rotating shaft 7 is controlled by the control means 50. As shown in FIGS. 1 and 2, the control means 50 includes a control computer (not shown), a switch unit (operation start switch, operation stop switch, emergency stop switch, etc.), a display unit (panel, etc.), an input unit, etc. Has been. In the input section, patient attribute data (or patient personal information data), operation patterns, operation ranges, operation speeds, training operation parameters such as the number of repetitions, and the like can be input. Regarding the operation range, in addition to the input using the input unit, the operator holds the holding plate unit 4 in a state of holding the patient's foot and in a state of freely rotating with respect to the rotary shaft 7 without performing control. It is also possible to move and directly teach the operating range. Also, various input data (information) can be displayed on the display unit.

  The operator operates the holding plate portion 4 in the state of holding the foot portion of the patient and rotating freely with respect to the rotating shaft 7 without controlling when inputting the training operation parameter in the input portion. When the person moves and directly teaches the motion range, the upper limit position (angle) in the dorsiflexion direction or the upper limit position (angle) in the plantar flexion direction of the patient's ankle movement range is set (input) (setting step). The ankle joint movable range is a patient's ankle joint movable range at the time of training. Further, at the time of this input, the operator can arbitrarily set the movable range (angle) of the back bending operation or the bottom bending operation in the movable range expanding operation step described later, and the stop time in the operation stopping step described later. Can be set arbitrarily.

FIG. 6 shows training for dorsiflexion movement. In FIG. 6, θ ₁ indicates an appropriate position (angle) within the range of movement of the ankle of the patient during training (when using), and θ ₂ represents the back of the range of movement of the ankle of the patient during training (when using). The upper limit position (angle) in the bending direction is shown. As described above, after inputting (setting) the training operation parameter, the operator presses an operation start switch (not shown) to start training, and at a speed set by the operator, the time t ₂ −t ₁ , Do dorsiflexion. Thereafter, at the upper limit position (angle) of the dorsiflexion direction of the patient's ankle movement range during training (when using), that is, at the angle θ ₂ , the operation is stopped for the stop time set by the operator (operation stop step). . Stretching can be performed during this stop time.

After the stop time has elapsed (after the operation stop step), the dorsiflexion operation is further performed in the dorsiflexion direction than the upper limit position (angle θ ₂ ) of the ankle joint movable range (movable range expansion operation step). More specifically, the dorsiflexion operation is performed for a time period t ₄ -t ₃ until the movable range (angle θ ₃ ) of the dorsiflexion operation in the movable range expansion operation step set by the operator. After reaching the position of the set position (angle θ ₃ ), the actuator moves in the buckling direction opposite to the dorsiflexion direction until the starting position θ ₁ .

  A plurality of operation stop steps can be set. FIG. 7 shows a graph when the operation stop step is set to be performed twice. Further, the series of operations shown in FIGS. 6 and 7 can be repeated a preset number of times or time. Further, it is possible to perform the operation in the prior art as shown in FIG. Further, as shown in FIG. 1, the patient can stop the operation by pressing an emergency stop switch 51 connected to the control means 50. The operation can be stopped when a torque greater than a preset value is applied by a torque sensor (not shown) provided on the rotating shaft 7. The operation can be stopped using an operation stop switch (not shown).

  The present invention can be used for functional training in hospitals, nursing homes, public facilities, and general households, and can be trained in either a supine position or a sitting position according to the physical condition of the patient.

FIG. 1 is a schematic diagram illustrating an example of a passive motion apparatus. FIG. 2 is a cross-sectional view showing another example of the passive motion apparatus. FIG. 3 is a schematic view showing an example of a rotation plate applicable to the passive motion apparatus. FIG. 4 is a schematic view showing another example of a rotating plate applicable to the passive motion apparatus. FIG. 5 is a cross-sectional view showing still another example of the passive motion apparatus. FIG. 6 is a graph showing an example of the passive movement method according to the present invention. FIG. 7 is a graph showing another example of the passive motion method according to the present invention. FIG. 8 is a graph showing still another example of the passive motion method according to the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Passive motion apparatus 2 Base part 3 Arm part 3 'Arm part 3a Right arm 3b Left arm 3c Horizontal arm 4 Holding plate part 5 Base 6 Support column 7 Rotating shaft 8 Lower leg holding part 9 Drive motor 10 Outer frame plate 11 Center axis 12 Rotating plate 13 Foot fixing part 14 Foot apex 15 heel part 30 Foot

Claims (3)

In the passive movement method that performs the plantar flexion motion and dorsiflexion motion of the ankle joint,
A setting step for setting the upper limit position in the dorsiflexion direction or the bottom flexion direction of the patient's ankle joint movable range;
An operation stop step for stopping the operation for a preset time at an upper limit position in the dorsiflexion direction or an upper limit position in the plantar flexion direction of the ankle joint movable range;
After the operation stop step, the dorsiflexion operation is further performed in the dorsiflexion direction than the upper limit position in the dorsiflexion direction of the ankle joint movable range, or after the operation stop step, further than the upper limit position in the sole flexion direction of the ankle joint movable range. A passive movement method comprising: a movable range expanding operation step of performing a bottom bending operation in a bottom bending direction. The passive movement method according to claim 1,
A passive movement method, wherein the movable range of the dorsiflexion operation or the bottom bending operation in the movable range expansion operation step can be arbitrarily set by an operator. In the passive movement method of Claim 1 or 2,
The passive movement method, wherein the time in the operation stop step can be arbitrarily set by an operator.

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