JP2015097714A - Motor function recovery device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an upper-extremity motor function recovery device capable of applying a plurality of stimuli to the nervous system and providing effective training without imposing an excessive burden on a patient in the bending/stretching exercises of the upper extremities.SOLUTION: The motor function recovery device causes the forearm of a patient with the hemiplegia to bend/stretch with respect to the upper arm so as to assist the recovery of the motor function. The motor function recovery device includes: a plate body that is supported so as to freely reciprocate in a prescribed direction within a substantially horizontal plane, with the levelness of a principal plane retained and on which the forearm is placed; and a holding member that, when the forearm is placed on the plate body, holds the forearm. When the forearm placed on the plate body is moved forward substantially to move the plate body, the holding member is moved in the moving direction of the plate body such that an amount of movement of the holding member is increased more than an amount of movement of the plate body. Subsequently, the upper arm is pressed in the direction of the forearm.

Description

  The present invention relates to a motor function recovery device that assists recovery of the motor function of the upper limb of a patient who has suffered from hemiplegia, and in particular, motor function recovery that assists the recovery of the motor function by bending and stretching the upper arm that flexes and stretches the forearm with respect to the upper arm Relates to the device.

  When hemiplegia is caused by a stroke or other causes and the motor function of the upper limb is impaired, rehabilitation is performed for the purpose of recovery. In such rehabilitation, a physical therapist or occupational therapist (hereinafter simply referred to as a therapist) gives a predetermined flexion / extension motion to the patient's upper limb, and also uses a device that gives the same flexion / extension motion. In the case of training by the device, even when the support of the therapist cannot be obtained, the patient can be voluntarily trained and the training amount can be increased. On the other hand, it is pointed out that even if the amount of training is increased, an excessive burden is placed on the patient, making it difficult to obtain the effect of rehabilitation.

  For example, Patent Document 1 discloses a device that repeatedly performs an action of extending a hand to a target position in a horizontal plane while obtaining information by vision as an upper limb rehabilitation device for paralysis. Such a device is said to enable effective training over a long period of time by reducing the burden placed on the patient by repeating simpler operations. That is, if the operation is repeated only in the horizontal plane, it is not necessary to coordinate the visual information from vertical to horizontal in the brain, and effective training can be performed while reducing the burden on the patient. As a detailed device configuration, the rotating shaft connected to the powder brake as a passive force generator that generates only the resistance against the force given by the patient, the parallel link mechanism pivotally supported by the rotating shaft, and the parallel link mechanism And a gripper that can be freely moved in a horizontal plane on the table. A display is provided in the table, and by displaying the target position on the display, the patient performs training to move the hand to the target position captured visually.

  In Patent Document 2, as a device that is intended to give effective rehabilitation of the upper limbs by a simpler but more realistic motion, the device operates with at least one degree of freedom among the three degrees of freedom of the patient's wrist. An apparatus for providing resistance via a functional fluid clutch is disclosed. When the arm connected to the space link mechanism including the functional fluid clutch is actively translated by bending and stretching the upper limb, a resistance force as a constant reaction force is applied to the upper limb. In addition, with the wrist's motor function, resistance to the wrist with three degrees of freedom (extension-bending, abduction-inversion, supination-inversion) is similarly applied by a rotating mechanism including a functional fluid clutch. It can be done.

  By the way, as a rehabilitation technique by a therapist, facilitating repetitive therapy using a facilitating phenomenon in which when a plurality of stimuli are given to the nervous system, the stimulus becomes larger than the sum of the stimuli given alone is known. Devices using the above-described facilitation phenomenon related to rehabilitation of the upper limb are also known.

  In Patent Document 3, as an upper limb rehabilitation device capable of giving a plurality of stimuli to the nervous system in order to enable effective functional recovery in a short period of time using a facilitating phenomenon, a device for assisting abduction movement of the upper limb Is disclosed. The apparatus includes a base body mounted on the back surface of the patient and a shoulder pad portion that is rotated by a drive motor mounted on the base body. The shoulder pad is provided with a lower support piece to be inserted under the patient's heel, thereby rotating the shoulder joint portion to assist the abduction movement of the upper limb. In addition, the upper arm is pressed by the lower support piece to promote muscle contraction. Thereby, a plurality of stimuli can be given to the shoulder joint.

JP 2013-128736 A JP 2006-247280 A JP 2009-11613 A

  As mentioned above, it is an upper limb rehabilitation device that incorporates repeated therapy by therapist into the device and gives multiple stimuli to the nervous system, enabling effective training without causing excessive burden on the patient There is a need for a device.

  The present invention has been made in view of such circumstances, and the object of the present invention is to provide a plurality of stimuli to the nervous system in the flexion and extension of the upper limb without causing an excessive burden on the patient. An object of the present invention is to provide an apparatus for recovering motor function of the upper limb that enables effective training.

  The motor function recovery device according to the present invention is a motor function recovery device that assists recovery of motor function by bending and stretching the forearm of a patient who has suffered hemiplegia with respect to the upper arm, and maintaining a horizontal surface of the main surface. A plate body that is supported so as to be capable of reciprocating in a predetermined direction within, and a gripping member that grips the upper arm when the forearm is placed on the plate body, The gripping member is moved so that the amount of movement of the gripping member is larger than the amount of movement of the plate when the forearm placed on the plate is moved substantially forward to move the plate. It moves in the moving direction of the plate and presses the upper arm in the direction of the forearm.

  According to this invention, a compressive force can be applied to the elbow joint in accordance with the timing of forward movement of the forearm, and as a result, a plurality of stimuli are applied to the nervous system in the flexion and extension movement of the upper limb. Such facilitating repeated therapy can provide effective training to patients in a short period of time. In addition, since the forearm placed on the plate is restrained from pronation and supination, the flexion and extension of the upper limb can be separated from the pronation and supination of the forearm, and the flexion and extension of the upper limb is highly optional. Can learn exercise. In addition, by separating the bending and stretching movement, the movement direction and direction of the elbow joint can be stabilized, and the above-described compression force can be stably applied.

  The above-described invention further includes an arm pivotally supported around a fulcrum in a vertical plane, and grips the plate and the upper arm of the grip member from the fulcrum side along the arm. A string-like traction portion connected to the annular portion may be connected. According to this invention, it is possible to apply a compressive force to the elbow joint in accordance with the timing of the forward movement of the forearm with a simple configuration.

  In the invention described above, the plate body is biaxially supported to be connected to the arm so as to swing the rear end portion of the plate while keeping the main surface horizontal with respect to the rotation of the arm. It is good. According to this invention, it is possible to maintain the level of the main surface of the plate body with a simple configuration without hindering the flexion / extension movement of the upper limb, to separate the flexion / extension movement of the upper limb, and to provide the elbow joint as a repeatable therapy It is possible to stably apply a compressive force to

  In the above-described invention, a resistance force applying unit that applies a resistance force to the rotation of the arm may be further provided. According to this invention, in addition to the application of compressive force to the elbow joint, resistance can be applied to the forearm in accordance with the timing of forward movement of the forearm, and the number of stimuli applied to the nervous system can be increased and more effective. Training can be given.

It is a side view of the motor function recovery apparatus by this invention. It is (a) top view of the principal part of the motor function recovery apparatus by this invention, (b) It is a side view. It is a side view of the motor function recovery apparatus by this invention. It is a side view of the motor function recovery apparatus by this invention. It is a side view of the upper limb showing the principle of pressing the upper arm in the direction of the forearm.

  A motor function recovery apparatus using a facilitation phenomenon according to an embodiment of the present invention will be described in detail with reference to FIGS.

  As shown in FIG. 1, the motor function recovery device 1 includes a resistance applying device 2 that is fixed to the floor and can apply a resistance torque to the rotation, a rotating shaft body 3 of the resistance applying device 2, and a rotation. It includes an arm 4 having a lower end fixed to the shaft body 3, a forearm mounting portion 10 connected to the arm 4, and a traction position adjusting member 5 fixed to the arm 4 at a position above the forearm mounting portion 10. . A gripping member 20 for gripping the upper arm A1 of the user (patient) P is attached to the pulling position adjusting member 5.

  The resistance applying device 2 is a device that can apply a resistance torque of an arbitrary magnitude at an arbitrary rotation angle with respect to the rotation of the arm 4. For example, a powder brake connected to the control device 6 can be used. The magnitude of the resistance torque and the rotation angle at which the resistance torque is loaded can be set by the control device 6.

  The arm 4 is a vertically extending rod body, and its lower end is fixed to the rotating shaft body 3 of the resistance applying device 2 so that the arm 4 can be rotated in the vertical plane (FIG. 1 paper surface) with the rotating shaft body 3 as a fulcrum. It is. As described above, the forearm mounting portion 10 is connected to the upper side of the pivot shaft 3 of the arm 4. Details of the forearm placement unit 10 will be described later.

  The traction position adjusting member 5 is fixed further above the arm 4 as described above. The pulling position adjusting member 5 is a loop-like member including a rod-like portion 51 that is parallel to the rotation surface of the arm 4 and substantially perpendicular to the extending direction of the arm 4. The pulling position fixing tool 21 of the gripping member 20 is slidably attached to the rod-shaped portion 51 and is temporarily fixed to the rod-shaped portion 51 with a screw or the like (not shown). That is, the position of the pulling position fixing tool 21 can be adjusted on the rod-shaped part 51. The traction position fixing tool 21 may be fixed to another part of the loop-shaped traction position adjustment member 5. The gripping member 20 further includes an elastic cord body 22 having one end fixed to the traction position fixture 21 and an annular portion 23 fixed to the other end of the elastic cord body 22. The annular portion 23 is, for example, a belt-like body provided with a fixture (not shown) such as a hook-and-loop fastener, and can be gripped by wrapping the user P on the upper arm A1 in a detachable manner and fixing it annularly with the fixture.

  As shown in FIG. 2, the forearm mounting portion 10 includes a fixing member 12 that is fixed to the arm 4 and protrudes rearward, and a shaft body 13, a relay member 14, a shaft body 15, and a joint member connected to the fixing member 12. 16 and the plate 11. Connected to the upper surface of the fixed member 12 is a relay member 14 whose one end is rotatably supported by a shaft body 13 having a rotation shaft parallel to the extending direction of the arm 4. The relay member 14 includes a shaft body 15 having a rotation shaft that is perpendicular to the rotation shaft of the shaft body 13 at the other end and perpendicular to the extending direction of the relay member 14. The shaft body 15 rotatably supports the joint member 16 at the other end of the relay member. The joint member 16 has one end side of the plate body 11 fixed to the upper surface thereof. Thereby, as shown by a broken line in FIG. 2A, the relay member 14 and the plate body 11 can rotate with respect to the arm 4 in a substantially horizontal plane. Further, as indicated by a broken line in FIG. 2B, the plate body 11 can be further rotated in the vertical plane. That is, the plate body 11 is biaxially supported and connected to the arm 4 so as to swing the rear end portion thereof. Here, when the joint member 16 is positioned so as to extend horizontally as shown by a solid line, the main surface 11a of the plate 11 is substantially horizontal. In other words, the plate body 11 is restrained from rotating about its longitudinal direction (front-rear direction) as a rotation axis.

  Next, a method of using the motor function recovery device 1 and its operation will be described with reference to FIGS.

  First, as shown in FIG. 1, for example, among the upper limbs of the user P sitting on a chair, the forearm A <b> 2 is placed on the plate 11 and fixed by the belt 19. At this time, the palm is positioned at the end of the plate member 11 on the joint member 16 side (front). That is, the end of the plate 11 opposite to the joint member 16 side (rear) is located in the vicinity of the elbow joint E. As a result, the end of the plate member 11 on the joint member 16 side is supported by the arm 4 via the relay member 14, and the opposite end is supported by the user's upper limb. Therefore, when the plate 11 is reciprocated in the front-rear direction in a substantially horizontal plane in accordance with the rotation of the arm 4, the main surface 11a is maintained horizontal, and the user is given by the inclination of the main surface 11a. Can reduce the excessive burden of.

  At this time, the forearm is fixed to the plate body 11 with the palm facing down and the thumb inward with the palm inward, or with the palm facing up and the thumb in the outward position. As described above, since the plate body 11 is also restrained from turning about its longitudinal direction as a turning axis, the main surface 11a is kept horizontal, and restrains the forearm or inward movement of the forearm A2. .

  Moreover, the annular part 23 is wound around the upper arm A1 of the user P among the gripping members 20, and this is gripped. Thereby, the upper arm A <b> 1 is connected to the traction position fixing tool 21 via the annular portion 23 and the elastic string body 22. As will be described later, the annular portion 23 presses the upper arm A1 toward the forearm A2 and applies a compressive force to the elbow joint E, so that the side close to the elbow joint E of the upper arm A1 (the distal end side of the humerus) is gripped. It is preferable to do.

  Subsequently, as shown in FIG. 3, the user P pulls the forearm A <b> 2 toward the near side (backward) and tilts the arm 4 backward. At this time, the distance between the pulling position fixture 21 and the annular portion 23 is the shortest, and the tension of the elastic cord body 22 is the smallest. Further, the forearm A2 is bent with respect to the upper arm A1 with the elbow joint E as a fulcrum.

  Further, as shown in FIG. 4, the user P pushes the forearm A2 forward and tilts the arm 4 forward. At this time, the forearm A2 is in a posture extended with respect to the upper arm A1. That is, the bending / extending movement of the upper arm A1 of the forearm A2, that is, the bending / extending movement of the upper limb can be performed.

  By the way, the traction position adjusting member 5 is fixed at a position above the forearm mounting portion 10 of the arm 4, and the rotation of the traction position fixing tool 21 is determined by the rotation radius of the plate body 11 accompanying the rotation of the arm 4. The radius is increased. Therefore, when the arm 4 is tilted forward, the amount of forward movement of the traction position fixture 21 is greater than the amount of forward movement of the plate 11. That is, the movement amount of the gripping member 20 is larger than the movement amount of the plate body 11. As a result, the distance from the pulling position fixing tool 21 to the annular portion 23 is increased, the tension of the elastic string body 22 is increased, and the upper arm A1 gripped by the annular portion 23 is pulled in the direction of the pulling position fixing tool 21.

  Referring also to FIG. 5, when the forearm A <b> 2 is pulled backward as shown in FIG. 5A, the tension applied to the elastic cord body 22 is the smallest as described above, and the tension is applied by the annular portion 23 by the tension. A force F0 is applied to the upper arm A1. On the other hand, when the forearm A2 is pushed forward as shown in FIG. 5 (b), the tension of the elastic cord body 22 is increased as described above. Due to the tension, the annular portion 23 applies a force F1 directed to the pulling position fixing tool 21 to the upper arm A1. The force F1 can be decomposed into a force Fa facing forward and a force Fb facing upward. The resolving force Fa presses the upper arm A1 forward, and applies a compressive force Fa 'to the elbow joint E.

  Thereby, the compression force Fa ′ can be applied to the elbow joint E in accordance with the timing of the forward movement of the forearm A2, and in addition to the stimulation to the elbow joint E for muscle movement in the flexion and extension of the upper limb, May be stimulated by compressing E. In other words, at least the nerve system of the elbow joint E can be applied with a plurality of stimuli to obtain the effect of the facilitating repeated therapy.

  In addition, by adjusting the position of the traction position fixture 21 with respect to the traction position adjustment member 5, the traction direction of the upper arm A1 by the elastic cord body 22 can be adjusted and the traction force can be adjusted. Thereby, the compression force applied to the elbow joint E can be adjusted, and the timing of applying the compression force with respect to the movement of the forearm A2 can also be adjusted. As a result, an excessive burden on the user can be reduced. Note that a string or a pulley may be interposed between the elastic string body 22 and the traction position fixing tool 21 to adjust the traction direction and the traction force.

  By the way, as described above, the force Fa that presses the upper arm A1 forward is a component force of the force F1 that presses the upper arm A1 toward the pulling position 21 by the annular portion 23. That is, by adjusting the traction position fixing tool 21 to at least a position in front of the annular portion 23, a force Fa that presses the upper arm A1 forward can be applied, and a compression force Fa 'can be applied to the elbow joint E.

  Moreover, it is preferable if the attachment position to the arm 4 of the forearm mounting part 10 or the traction position adjustment member 5 can be adjusted. Thereby, each turning radius can be adjusted and the difference of the moving amount | distance to the front of the board 11 and the holding member 20 can also be adjusted.

  Further, as described above, the forearm A <b> 2 is restrained by the plate body 11 in its supination motion or pronation motion. Thereby, even the user who controlled the upper limb by the joint movement can separate the flexion and extension movement of the upper limb from the supination movement or pronation movement of the forearm A2. The user can train the upper-limb flexion / extension movement separately from the joint movement with the supination movement of the forearm A2, and the like, and can learn the normal volute / extension movement of the upper limb with high volatility. Moreover, the movement direction and direction of the elbow joint E can be stabilized by separating the flexion and extension movements of the upper limbs. That is, it is possible to stably apply the compressive force to the elbow joint E by the gripping member 20.

  When the forearm A2 is fixed to the plate 11 in the pronation position, functional recovery of the pronation movement can be expected, and when the forearm A2 is fixed to the pronation position, recovery of the function of the supination movement can be expected. This is presumably because the user can recognize each posture of the pronation position or pronation position of the forearm according to the angle of the elbow joint during exercise even when the exercise is restricted.

  In the forearm mounting portion 10 (see FIG. 2), the relay member 14 and the plate body 11 can rotate in a substantially horizontal plane with the shaft body 13 as a rotation axis, so that the elbow joint E is moved slightly outward or inward. It is possible to smoothly perform the above-described flexion and extension movements of the upper limb without restricting the movement of the upper limb.

  In addition, the arm 4 is given a resistance torque of an arbitrary magnitude at an arbitrary position by the resistance applying device 2 during its rotation. That is, the resistance force in the direction opposite to the movement direction can be applied to the forearm A2 with respect to the bending and stretching movement of the upper limb. Thereby, in addition to the compressive force applied to the elbow joint E, a resistance force is also applied. That is, more effective training is possible by increasing the number of stimuli given to the nervous system. In order to obtain the maximum effect of such training, it is preferable to have the therapist adjust the traction position fixture 21 and the like and set the resistance applying device 2. After such adjustment and setting, the user can voluntarily perform effective upper-limb flexion and extension exercises.

  In the present embodiment, the arm 4 is rotated in the vertical plane, and the compression force is applied to the elbow joint E with a simple configuration using the difference in the rotation radius between the plate 11 and the gripping member 20 accompanying the rotation. However, the compression force can be similarly applied to the elbow joint E by other configurations. For example, a motor and a gripping member pulled by the motor are fixed to the plate body 11, and the gripping member is attached to the upper arm A1. In addition, a compression force can be applied to the elbow joint E even when the gripping member is pulled from the front or pressed from the rear by the power of a motor or the like at a predetermined timing in accordance with the back and forth reciprocation of the plate 11. .

  Up to this point, the representative embodiments according to the present invention and the modifications based thereon have been described, but the present invention is not necessarily limited thereto. That is, those skilled in the art will be able to find various alternative embodiments and modifications without departing from the scope of the appended claims.

DESCRIPTION OF SYMBOLS 1 Motor function recovery apparatus 2 Resistance provision apparatus 3 Rotating shaft body 4 Arm 11 Plate body 20 Holding member

Claims (4)

A motor function recovery device that assists recovery of motor function by bending and stretching the forearm of a patient who has developed hemiplegia with respect to the upper arm,
A plate for placing the forearm supported in such a manner as to be reciprocally movable in a predetermined direction within a substantially horizontal plane while maintaining the level of the main surface;
A gripping member that grips the upper arm when the forearm is placed on the plate, and
The gripping member is moved so that the amount of movement of the gripping member is larger than the amount of movement of the plate when the forearm placed on the plate is moved substantially forward to move the plate. An apparatus for recovering a motor function, wherein the apparatus moves in the moving direction of the plate and presses the upper arm in the direction of the forearm.   It further includes an arm pivotally supported around a fulcrum in a vertical plane, and is connected from the fulcrum side along the arm to the annular portion that grips the plate and the upper arm of the gripping member. The motor function recovery device according to claim 1, wherein a string-like traction portion is connected.   2. The plate body is biaxially supported and connected to the arm so as to swing a rear end portion thereof while maintaining the level of the main surface with respect to the rotation of the arm. Or the motor function recovery apparatus of 2.   The motor function recovery device according to claim 1, further comprising a resistance force applying unit that applies a resistance force to the rotation of the arm.

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