JP2018064832A - Walking support orthosis - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a novel walking support orthosis being worn from the crus to the foot part for correcting rotational movement of the crus in walking.SOLUTION: A walking support orthosis 100 according to the present invention is a lower extremity orthosis including: a sole plate 120 having a pair of support side plates 110 that are provided upward from left/right edges; lower extremity columns 140 supported by joint plates 130 formed at tip ends of the support side plates 110; and lower extremity cuff 150 to be fixed to the lower extremity columns 140. The walking support orthosis is formed by rotationally supporting connecting shafts that are fixed to connecting members provided at the lower ends of the lower extremity columns 140, by rotational shaft bearings provided at the joint plates 130, and is configured to adjust anterior limit positions and posterior limit positions of rotational ranges of the rotational shaft bearings, where the left/right rotational ranges are differed from each other, and the inner foot-side and outer foot-side rotational ranges are variable. The lower extremity cuff 150 includes a curved part 151 for enabling creep and permits that the left/right rotational shaft bearings have different rotational ranges respectively.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a walking assist device, and more particularly, to a brace attached to a lower limb for the purpose of improving gait.

  At present, it is estimated that there are more than 30 million patients with knee osteoarthritis (hereinafter referred to as Osteoarthritis of the knee). Knee OA is a degenerative disease that occurs due to muscular weakness associated with aging, obesity, genetic factors, ligament relaxation, etc., and bone and cartilage of the knee joint are worn and deformed. As a symptom of the knee OA, the knee joint and cartilage are worn down to deform the knee joint, and pain is caused by the flexion and extension of the knee joint.

  When knee OA occurs, exercise that was appropriate until now will give a great load on the knee joint, causing changes in gait due to knee pain and knee joint position change, and a decrease in the range of action, I don't walk too much. As a result, muscular strength declines, and the vicious circle of further pain increases and ADL (Activities of Daily Living) and QOL (Quality of Life) decrease. In particular, abnormal gait indicating gait deviating from normal walking tends to appear in knee OA patients.

  The knee joint has two degrees of freedom of flexion, extension, and rotational movement on the knee joint axis. This rotational motion is a twisting motion that can be seen in the range of 30 degrees of the final extension of the knee joint, and is called the terminal extension rotational motion. The terminal extension rotation exercise is useful for absorbing shocks when touching the heel while walking, walking with a well-balanced body, and kicking with the thumb, and the rotation exercise is one of the essential exercises for walking.

  Regarding the rotational movement that occurs during walking, when the ankle plantar flexion, specifically, between the heel contact and the plantar contact, the lower leg rotates internally, and when the ankle dorsiflexion, specifically from the plantar contact The lower leg rotates externally during the late stance phase. However, many patients with knee OA have this rotational disorder of the knee joint.

  Examples of the therapy for knee OA patients include surgical therapy and conservative therapy. Examples of conservative therapy include the use of braces, exercise therapy, and drug therapy. Conservative therapy for knee OA patients using the orthosis includes a three-point fixed type knee orthosis and a knee orthosis utilizing a rotational motion.

  The three-point fixed type knee orthosis supports three points of the thigh, knee and lower leg. For example, there is an orthosis (Patent Document 1) that corrects knee joint deformation to normal alignment. A knee orthosis that uses a rotational motion is one in which the orthosis operates to assist the rotational motion of the thigh when the knee extends. For example, the inner joint and the outer joint have different shaft movement directions, and a flexible member that supports the thigh is deformed to induce correct terminal extension rotation (Non-Patent Document 1). There is an orthosis (Patent Document 2) that acts as a twisting moment that causes the thigh to rotate inward due to the restriction of the turning mechanism.

JP 2000-5247 A Japanese Patent Laid-Open No. 2006-19603

Kazufumi Takahashi, “Functions of OA Fantasy Knee Orthosis”, Journal of Japanese Prosthetics and Orthotics Association, 2008, Vol. 24, no. 1, p. 16-19

  Since the knee orthosis in the above example is fixed at the thigh and the lower leg, the fixing portion is easily displaced during walking. Displacement of the brace during walking not only makes the wearer feel uncomfortable and uncomfortable, but also may cause excessive rotation correction at the displaced position. In addition, when the wearer is a heavy O-leg, it may be difficult to apply the brace. Further, in the knee brace that assists in the rotation, there is a problem that the rotation of the lower leg rotation is difficult to adjust even though the degree of the disorder varies depending on each patient.

  Therefore, an object of the present invention is to provide a new walking support device that is worn from the lower leg part to the foot part and corrects the lower leg rotation movement during walking.

  That is, the present invention aims to achieve the above-described object, and the means of claim 1 is provided such that the walking support orthosis is formed on a bottom plate having a pair of support side plates facing upward from left and right edges, and on a tip of the support side plate. A lower limb brace that is supported by a joint plate portion to be supported and a crus cuff that is fixed to the lower limb strut, wherein a coupling shaft fixed to a coupling member provided at a lower end of the lower limb strut, The rotary plate is rotatably supported by a rotary bearing provided on the joint plate portion, and is configured to be able to adjust the front limit position and the rear limit position of the rotary range of the rotary bearing.

  According to a second aspect of the present invention, the rotation range is different between right and left, and the rotation range on the inner foot side and the outer foot side is variable.

  According to a third aspect of the present invention, the crus cuff includes a curved portion for enabling bending, and allows the rotation range different on the left and right of the rotation bearing.

  According to a fourth aspect of the present invention, the front limit position is a difference of greater than 0 degrees and less than 30 degrees on the left and right.

  The means of claim 5 is characterized in that the sole plate is formed up to the metatarsal abutment portion by providing an upper around the heel abutment portion.

  According to the configuration of the first aspect, the walking support device of the present invention can assist in the plantar flexion and dorsiflexion of the ankle joint, and can perform a conservative therapy that limits the flexion and extension operations of the knee joint. Compared with knee orthosis, it can be fixed with the foot, so there is little deviation of the orthosis, and knee OA patients who are difficult to wear knee orthosis, such as knee OA patients with severe O legs Even can be applied.

  According to the configuration of the second aspect, in the case of a patient having a lower leg internal rotation abnormality, the walking support device of the present invention increases the rotation range of the outer foot side from the inner foot side and In this case, the rotation range on the inner foot side can be set to be larger than that on the outer foot side.

  According to the configuration of the third aspect, the walking support device of the present invention easily adjusts the amount of rotation of the left and right lower legs according to the individual symptoms of the knee OA patient, and rotates the lower legs according to the dorsiflexion angle of the ankle joint. And there is no worry of unreasonable correction due to the deviation of the device. In addition, by combining the configurations of claims 1 to 3, the knee OA patient is guided to the correct rotation of the lower leg and touches the ground contact surface at the center of the buttock. The center of gravity moves in the order of the center of the toe and the center of the outer leg, and the gait can be corrected to a normal gait such as kicking out with the thumb in the late stage of stance and leaving the heel away from the contact surface.

  Further, according to the configuration of the fourth aspect, the walking support device of the present invention can sufficiently secure the amount of lower leg rotation of the knee OA patient and prevent the lower leg rotation more than necessary.

  Further, according to the configuration of the fifth aspect, the walking support device of the present invention can support the buttocks, assist the promotion of heel contact and kicking with the toes, and can enhance the effect of improving gait. .

1 is an overall perspective view of a walking assistance device according to the present invention. It is a side view of the sole plate of the walking assistance device of the present invention. It is the front view which expanded the joint board part of the walk assistance device of this invention. It is a schematic diagram explaining operation | movement of the leg support of the walking assistance device of this invention.

  Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings.

  FIG. 1 is a perspective view of the entire walking support device 100. The walking support device 100 is fixed to the leg plate 120, which is supported by a joint plate portion 130 formed at the tip of the support side plate 110, and a sole plate 120 in which a pair of support side plates 110 are provided upward from the left and right edges. And a lower leg brace 150. In addition, although it is preferable to fix to the leg of the walking assistance device 100 by the shin fastener 160 and the instep fastener 170, it is not limited to this. Examples of fixing means include a slip-on type, use of a hook-and-loop fastener, a buckle, and a race. The shin fastener 160 close to the meniscus of the knee OA patient is preferably made of a soft material.

  The support side plates 110 are provided in a pair so that when the knee OA patient wears the walking support device 100, the left and right edges of the sole plate 120 are generally directed to both knees of the knee OA patient.

  FIG. 2 is a side view of the sole plate 120. The sole plate 120 is a member with which the sole of the knee OA patient abuts, and is provided with an upper 122 around the heel abutting portion 121, to the metatarsal abutting portion 123, specifically, the middle foot of the knee OA patient. It is preferable to form the portion corresponding to the metatarsophalangeal joint connecting the bone and the proximal phalanx.

  Providing the upper 122 around the heel contact portion 121 is important in improving the gait of knee OA patients. By providing the upper 122, it is possible to control the ribs of the knee OA patient. In general, the stability of the radius is a reflection of the movement and deformation of the subtalar joint between the radius and the talus. When this normal pronation range of motion of the subtalar joint is blocked, stress is applied to the lower limbs, pelvis and lumbar spine, resulting in a pathological condition. The movement of the varus and valgus is linked to the pronation and rotation of the foot, and also affects the internal and external rotation of the lower leg and the valgus of the knee joint. Further, the upper 122 contributes to prevention of insole displacement. The insole can be used for adjusting the length of the left and right feet of the knee OA patient, adjusting the position of the knee joint of the knee OA patient of the O leg, and reducing the load on the knee joint as an arch support.

  Further, the sole plate 120 extends to the metatarsal abutment portion 123, and by making the tip of the metatarsophalangeal joint free, the tip of the foot of the knee OA patient directly touches the shoe sole, the ground, etc. Assist kicking with toes.

  The material of the sole plate 120 is required to have strength because it is necessary to attach the support side plate 110 and support the leg support 140, the lower leg cuff 150, and the like. For example, it is preferable to use 5 mm thick polypropylene which is a resin that is easy to mold and has high hardness, but it is not limited to 5 mm thick polypropylene as long as it is a strong material.

  With the above configuration, the sole plate 120 can support the buttocks, assist the promotion of the heel contact and kicking with the toes, and enhance the effect of improving the gait.

  The joint plate portion 130 is formed at the upper end of the support side plate 110 and supports the lower limb strut 140. The joint plate portion 130 supports the coupling shaft fixed to the coupling member provided at the lower end of the lower limb strut 140 by a rotation bearing provided on the joint plate portion 130 so as to be rotatable. Ankle joint bottom flexion (operation to stretch the ankle) and dorsiflexion (operation to bend the ankle) between the lower leg and the foot are allowed by the rotation bearing of the joint plate portion 130.

  The joint plate portion 130 of the present embodiment is configured to be able to adjust the front limit position and the rear limit position of the rotation range of the rotary bearing. A mechanism having such a configuration is called a double crenzac. By adjusting the rotation range almost uniformly on the left and right, it is possible to assist the plantar flexion and dorsiflexion of the ankle joint, and it is possible to perform conservative therapy that limits the flexion and extension movements of the knee joint.

  In addition, the walking support device 100 including the joint plate portion 130 having the double crenzac mechanism can be fixed with the foot as compared with the knee device, so that there is less occurrence of the device displacement, and the patient with knee OA is severe. It can also be applied to knee OA patients in which it is difficult to wear knee braces such as the O-legs.

  The rotation range of the joint plate portion 130 may be different on the left and right, and the rotation range on the inner foot side and the outer foot side may be variable. Here, the outer foot side refers to the little finger side of the foot, and the inner foot side refers to the thumb side of the foot. The walking support device 100 provided with such a joint plate portion 130 can rotate the lower leg according to the sole dorsiflexion angle of the ankle joint. Hereinafter, rotation of the lower leg will be described with reference to FIGS. 3 and 4.

  FIG. 3 is an enlarged front view of the joint plate portion 130. The joint plate part 130 can adjust the front limit position and the rear limit position of the rotation range according to the tightening depth of the rod rod 131 incorporated therein. Specifically, the rod rod 131 plays the role of a stopper for rotation. By deepening the tightening, the rotation range is narrowed, and conversely, the tightening is shallow, and the rotation range is wide. Become. FIG. 3 shows that the tightening of the rod rod 131 in front of the left joint plate 130 is shallower than the tightening of the rod rod 131 in front of the right joint plate 130, and the front limit position of the rotation range is set to the right joint. It shows that it is ahead of the front limit position of the rotation range of the plate part 130. In this case, the left joint plate 130 is tilted forward from the right joint plate 130.

  The rod bar 131 is provided in front of and behind the joint plate portion 130 and is easy to adjust because of a simple mechanism. In the present embodiment, a spring may be applied to the front rod bar 131 to alleviate the impact during rotation. Further, the joint plate portion 130 may be controlled by hydraulic pressure or electricity for the purpose of mitigating impact during rotation.

  FIG. 4 is a schematic diagram for explaining the operation of the lower limb strut 140 of the walking assistance device 100 attached to the right foot. In FIG. 4, the left support side plate 210a and the right support side plate 210b are on the support side plate 110, the flat sole plate 220 is on the sole plate 120, the left joint plate portion 230a and the right joint plate portion 230b are on the joint plate portion 130, and the left lower limb. The strut 240a and the right leg support 240b correspond to the leg support 140, respectively. Since it is mounted on the right foot, the left side is the inner foot side and the right side is the outer foot side. In addition, the angles of the left lower limb support column 240a and the right lower limb support column 240b with respect to the vertical direction from the ground contact surface are θ and φ, respectively.

The schematic diagram of Fig.4 (a) shows the state of the left leg support 240a and the right leg support 240b when a heel contacts the ground. The time when the heel touches the ground is when the transition from the swing phase where the sole does not touch the ground to the stance phase where the sole touches occurs, and the angle α of the ankle joint between the lower leg and the foot at this time Based on Here, if the angle of the left lower limb support column 240a with respect to the vertical direction from the contact surface at this time is θ ₁ , and the angle of the right lower limb support column 240b is φ ₁ , then θ ₁ = φ ₁ .

The schematic diagram of FIG. 4B shows the state of the left leg strut 240a and the right leg strut 240b in the middle of the stance when the entire sole is grounded. At this time, the ankle joint is bent, and the ankle joint angle β is larger than α. In the case of a healthy person, the lower leg rotates to the inner foot side, that is, so-called internal rotation, from the ground contact of the heel where ankle plantar flexion occurs to the middle stage of stance. Here, when the angle of the left lower limb support column 240a with respect to the vertical direction from the ground contact surface at the middle stage of stance is θ ₂ and the angle of the right lower limb support column 240b is φ ₂ , θ ₂ > φ ₂ is satisfied.

When a patient with knee OA has an abnormality in internal rotation of the lower leg, the front limit position of the rotation range of the right joint plate portion 230b is set to the rotation range of the left joint plate portion 230a so that the outer foot side tilts forward from the inner foot side. It may be adjusted so that it is before the front limit position. By satisfying θ ₂ > φ ₂ , internal rotation of the lower leg is induced. By adjusting in this way, the internal rotation during ankle plantar flexion is corrected during walking.

The schematic diagram of FIG. 4C shows the state of the left lower limb strut 240a and the right lower limb strut 240b in the late stance phase from the heel to the toe to be separated from the ground contact surface. At this time, the ankle joint is bent back, and the angle γ of the ankle joint is smaller than α and β. If the subject is a healthy person, the lower leg rotates externally during the middle stance phase, when ankle dorsiflexion occurs, and during the late stance phase. Here, assuming that the angle of the left lower limb support column 240a with respect to the vertical direction from the ground contact surface at the later stage of stance is −θ ₃ , and the angle of the right lower limb support column 240b is φ ₃ , then φ ₃ > −θ ₃ .

When the knee OA patient has an abnormality in the lower leg external rotation, the front limit position of the rotation range of the left joint plate portion 230a is set to the rotation range of the right joint plate portion 230b so that the inner foot side tilts forward from the outer foot side. It may be adjusted so that it is before the front limit position. By satisfying φ ₃ > −θ ₃ , external rotation of the lower leg is induced. By adjusting in this way, at the time of walking, the external rotation is corrected at the time of ankle dorsiflexion after the internal rotation at the time of ankle bottom flexion.

  Returning to FIG. 1, the lower limb strut 140 is supported by the joint plate 130 and extends upward generally along the tibia and ribs of the knee OA patient. A crus cuff 150 can be attached to the leg support 140.

  The lower leg cuff 150 is fixed to the lower limb strut 140 and includes a substantially semi-cylindrical (saddle-shaped) curved portion 151 for enabling bending. The bending portion 151 abuts on the lower leg of the knee OA patient and transmits the movement of the lower limb strut 140. Here, it is preferable to use a soft resin material for the bending portion 151 in order that the walking support device 100 allows different rotation ranges on the left and right of the rotation bearing of the joint plate portion 130. If the bending portion 151 is a rigid material without bending, it is difficult for the lower limb struts 140 and the joint plate portion 130 to be linked to perform different operations on the left and right. On the other hand, the bending portion 151 needs to have enough strength to support the lower leg of the knee OA patient. For example, it is preferable to use low-density polyethylene with a thickness of 3 mm, but the material is not limited to a low-density polyethylene with a thickness of 3 mm as long as the material has both strength and strength.

  When the lower leg cuff 150 is attached, the front limit position of the rotation range of the rotation bearing of the joint plate 130 is preferably greater than 0 degree and less than 30 degrees on the left and right sides, and preferably greater than 5 degrees and less than 30 degrees. It is more preferable to set it to a degree or less. By adopting such a configuration, the walking support device 100 of the present invention can secure a sufficient amount of lower leg rotation of the knee OA patient and prevent excessive rotation of the lower leg.

  The joint plate portion 130, the lower limb strut 140, and the lower leg cuff 150 are configured as described above, so that in the case of a patient having an abnormal internal rotation of the lower leg, the rotation range on the outer foot side is larger than the inner foot side. For patients with external rotation abnormalities, the rotation range of the inner foot side can be set larger than the outer foot side, and the amount of rotation of the left and right lower legs can be easily adjusted according to the individual symptoms of knee OA patients It is possible to rotate the lower leg according to the dorsal dorsiflexion angle of the ankle joint, and there is no worry of unreasonable correction due to the deviation of the device.

  In addition, with the above-described configuration, the walking support device 100 is in contact with the ground contact surface at the center of the buttock while guiding the knee OA patient to the correct rotation of the lower leg, and thereafter, the first and first steps toward the middle of the stance. 2. The center of gravity can be corrected to a normal gait such that the center of gravity moves in the order of the metatarsal head center and the center of the outer foot side, kicks with the thumb in the late stance phase, and the heel moves away from the contact surface.

100: Walking support equipment.
110: Support side plate.
120: sole plate, 121: heel contact portion, 122: upper, 123: metatarsal contact portion.
130: Joint plate part, 131: Rod rod.
140: Lower limb support.
150 ... lower leg cuff, 151 ... curved portion.
160 ... Tibial fastener.
170 ... Upper fastener.
210a ... left support side plate, 210b ... right support side plate.
220: Flat sole plate.
230a ... left joint plate part, 230b ... right joint plate part.
240a ... left lower limb support, 240b ... right lower limb support.

Claims (5)

A sole plate providing a pair of support side plates upward from the left and right edges;
Lower limb struts supported by a joint plate formed at the tip of the support side plate;
A lower limb orthosis comprising a lower leg cuff fixed to the lower limb strut,
A coupling shaft fixed to a coupling member provided at the lower end of the lower limb support is rotatably supported by a rotation bearing provided on the joint plate portion, and a front limit position of a rotation range of the rotation bearing A walking support device characterized by being configured to adjust a rear limit position.   The walking support device according to claim 1, wherein the rotation range is different between right and left, and the rotation range on the inner foot side and the outer foot side is variable.   The walking support device according to claim 1, wherein the lower leg cuff includes a bending portion for enabling bending, and allows the rotation range different on the left and right of the rotation bearing.   The walking support device according to any one of claims 1 to 3, wherein the front limit position is a difference between 0 degrees and 30 degrees or less on the left and right. The walking support device according to any one of claims 1 to 4, wherein the sole plate is formed up to a metatarsal abutment portion by providing an upper around the heel abutment portion.

Images