JP2021097987A - Support device for gait disorder and support method for gait disorder - Google Patents

Abstract

To provide a support device for gait disorder and a support method for gait disorder capable of efficiently giving support for gait disorder of an object person.SOLUTION: A chest/waist part of an object person is bent sideways from right to left alternately by applying exciting force according to output torque of a drive part to a first belt through a link part while controlling the output torque of the drive part so as to swingably drive an output shaft of the drive part in a normal rotation direction and a reverse rotation direction alternately with a vertical direction with respect to a back face of the object person as a rotation center at a desired periodic timing.SELECTED DRAWING: Figure 1

Description

The present invention relates to a gait disturbance support device and a gait disturbance support method, and is particularly suitable for application to a wearable motion assist device for assisting a gait disturbance associated with perkinsonism.

Parkinsonism is a motor symptom caused by the disruption of the coordinated coordination of the nervous system due to neurodegenerative diseases and cerebrovascular accidents, and is two or more of bradykinesia, muscle rigidity, postural instability and tremor. Refers to a condition in which symptoms are observed.

Patients with Parkinsonism have difficulty in standing and walking as their symptoms progress, and among them, accelerated walking, which is one of the typical gait disorders, gradually rushes forward and it is difficult to stop easily. The QOL (Quality of Life) has been forced to decrease due to the symptom.

It has been suggested that various functional declines are involved in gait disorders in Parkinsonism patients such as accelerated gait, such as postural disorders in which the trunk bends forward and rhythm formation disorders in which it is difficult to continue periodic exercise. It is thought that the bradykinesia, in which the amplitude of movement decreases, and the series effect, in which the stride gradually decreases, have an effect.

External cues have traditionally been widely used as an intervention method for Parkinsonist gait disturbances. This external cue is an intervention method that provides an immediate improvement effect by promoting increase in stride length and maintenance of gait by stimulating visual, auditory, and somatosensory systems.

The mechanism by which the external cue is effective is due to the activation of the feedback mechanism in the brain and the activity of compensatory neural circuits that generate motor commands and send them to the peripheral nervous system without going through the damaged part. It is believed that.

In daily life and physiotherapy, as external cues, instructions for straddling movements on the tape attached to the floor, rhythmic voices, tapping on the buttocks, etc. are used, but the environment is maintained and people are constant. It is difficult to use it on a daily basis because it requires physical assistance.

To avoid this difficulty, wearable devices that provide external cues such as the projection of lines on the floor by a laser light source on the toes, the presentation of rhythmic sound by earphones, and the presentation of vibrations to the wrist joint by a small cylinder have been conventionally used. Proposed by.

For example, using an acceleration sensor and an angular velocity sensor, a half-walking cycle representing the time from the landing of one foot of a pedestrian to the landing of the other foot was calculated, and the half-walking cycle was calculated based on the half-walking cycle. A walking support method has been proposed in which a pedestrian is given a tactile stimulus or an auditory stimulus based on the walking cycle fluctuation rate and the left-right balance fluctuation rate to reduce the fluctuation rate (see Patent Document 1).

JP 2015-177925 International Publication No. 2018/066151

However, the wearable device that gives an external cue is effective because it acts indirectly through sensory functions, rather than directly assisting the deterioration of posture control and rhythm generation, which are the causes of gait disturbance. There are large individual differences. For this reason, in physiotherapy, the patient's upper arm and shoulder are grasped from the lower and outer sides, and the patient is rhythmically swayed in the left-right direction while supporting the body to rise, thereby stably compensating for the movement of the center of gravity to the left and right, and posture control and rhythm. Methods that directly support the formation are also recommended.

In this way, in order to realize motion support that suppresses accelerated walking of Parkinsonist patients regardless of the third party or the external environment, the forward bending posture is reduced and the periodic support force in the left-right direction is required. A wearable system that realizes transmission is considered to be effective.

Incidentally, as a study of a wearable support system for Parkinsonism patients, a method of supporting the freezing foot by assisting the movement of the center of gravity at the beginning of walking by plantar flexion and dorsiflexion of the ankle joint has been developed (see Patent Document 2). ), It is not a method to support the functional deterioration that is the cause of accelerated walking.

The present invention has been made in consideration of the above points, and proposes a gait disturbance support device and a gait disturbance support method capable of efficiently supporting a gait disturbance of a subject.

In order to solve such a problem, in the present invention, a first belt worn near the chest of the subject and a second belt worn on the waist of the subject so that the shoulder blades of the subject can be abducted and abducted. And, it is fixedly attached to the center of the lower back of the subject in the second belt, has an output shaft whose rotation center is in the direction perpendicular to the back surface of the subject, and has the output shaft in the forward rotation direction or the reverse rotation direction. The drive unit that is driven to rotate, the link unit that connects the center of the upper back of the subject in the first belt and the output shaft of the drive unit, and the output shaft of the drive unit are set in the forward rotation direction and the reverse rotation direction at a desired cycle timing. A control unit that controls the output torque of the drive unit so as to alternately swing drive is provided, and the control unit applies a vibrating force corresponding to the output torque of the drive unit to the first belt via the link unit. As a result, the subject's chest and waist were made to bend laterally alternately to the left and right.

As a result, in the gait disturbance support device, a periodic support force is induced from the drive unit fixed to the center of the lower back of the subject to the first belt via the link portion, and the chest and waist of the subject are alternately left and right. By flexing laterally, it is possible to eliminate the posture disorder and rhythm formation disorder peculiar to Parkinson's disease while assisting the subject's trunk extension and rhythm formation.

Further, in the present invention, the drive unit includes a third belt that is fixedly attached to the drive unit and attached to an upper portion of the waist portion of the subject so as to maintain a predetermined height position with respect to the second belt. , The second belt and the third belt were fixed to the center of the lower back of the subject.

In this way, in the gait disturbance support device, the waist of the subject is widened in the height direction and wound around with two belts, the second belt and the third belt, so that the drive unit is wound when the output torque is generated. It can maintain a fixed state in the center of the lower back of the subject without rotating by itself.

Further, in the present invention, the foot load measuring unit is attached to the left and right foot surfaces of the subject and measures the load applied to each of the foot surfaces, and the load change measured by the foot load measuring unit causes the left and right sides of the subject to be measured. It is equipped with a center of gravity position detecting unit that detects the position of the center of gravity of the back surface of the foot, and the control unit is based on the left / right switching timing of the load applied to the positions of the center of gravity of the left and right foot surfaces of the subject detected by the center of gravity position detecting unit. , The drive unit is feedback-controlled so as to reduce the decrease in the walking cycle of the subject and suppress the walking obstacle. As a result, the gait disorder support device can support the gait disorder so that the fluctuation of the walking cycle is kept small for the subject suffering from Parkinson's disease.

Further, in the present invention, the control unit controls the output torque of the drive unit so as to alternately bend the chest and lumbar region of the subject to the extent that a predetermined level of load is applied to the sense of balance of the subject. I did. As a result, the gait disturbance support device can improve the memory-dependent movement by activating the function of the supplementary motor area, which is a region in the cerebral cortex of the subject where intervention is relatively weak.

Further, in the present invention, the link portion is set to have a link length so that the forward bending angle of the trunk of the subject is maintained within a predetermined range. As a result, in the gait disturbance support device, the forward bending posture can be reduced by the adduction of the scapula by the first belt worn by the subject and the extension of the thoracic spine by the link portion connecting the chest and the lumbar region.

Further, in the present invention, the first belt worn near the chest of the subject so that the scapula of the subject can be abducted and abducted is attached to the center of the upper back of the subject and the waist of the subject. The output shaft of the drive unit fixedly attached to the center of the lower back of the subject in the two belts is connected via the link portion, and the output shaft of the drive unit is perpendicular to the back surface of the subject at a desired cycle timing. The first step of controlling the output torque of the drive unit so that the forward rotation direction and the reverse rotation direction are alternately oscillated with the direction as the center of rotation, and the exciting force according to the output torque of the drive unit are applied to the link unit. By applying it to the first belt via the intervention, the subject is provided with a second step of alternately bending the chest and lumbar region to the left and right.

As a result, in the gait disturbance support method, a periodic support force is induced from the drive unit fixed to the center of the lower back of the subject to the first belt via the link portion, and the chest and waist of the subject are alternately left and right. By flexing laterally, it is possible to eliminate the posture disorder and rhythm formation disorder peculiar to Parkinson's disease while assisting the subject's trunk extension and rhythm formation.

As described above, according to the present invention, it is possible to realize a gait disorder support device and a gait disorder support method capable of efficiently supporting a gait disorder of a subject caused by Parkinson's disease.

It is explanatory drawing which shows the gait disorder and a factor by Parkinsonism. It is a schematic diagram showing the systematization of gait disturbance. It is a schematic diagram which shows the model coordinate system of the frontal plane simplified by this invention. It is a table showing the parameters used in the simulation. It is a graph which shows the simulation result of the phase plane at the position of the center of gravity of the coronal plane. It is an external view which shows the structure of the gait disturbance support device which concerns on embodiment of this invention. It is a block diagram which shows the internal structure of the power unit shown in FIG. It is a schematic diagram provided to explain the transmission method of the support force by the gait disturbance support device and the link length. It is a table showing the evaluation items according to the gait disorder of the subject who is a collaborator of the experiment. It is a schematic diagram which shows the marker attachment position of the 3D motion analysis system. It is explanatory drawing about the verification experiment of the immediate use effect on the staggering walking. It is a figure which shows an example of the result of the verification experiment of the immediate use effect on the staggering walking. It is explanatory drawing which shows the result of the verification experiment of the immediate use effect on the staggering walking. It is explanatory drawing which shows the result of the verification experiment of the immediate use effect on the staggering walking. It is explanatory drawing about the verification experiment of the immediate use effect on a small walk. It is a figure which shows an example of the result of the verification experiment of the immediate use effect on a small walk. It is explanatory drawing which shows the result of the verification experiment of the immediate use effect on a small walk. It is explanatory drawing which shows the result of the verification experiment of the immediate use effect on a small walk. It is explanatory drawing about the verification experiment of the immediate use effect on the accelerated walking. It is a figure which shows an example of the result of the verification experiment of the immediate use effect on the accelerated walking. It is explanatory drawing which shows the result of the verification experiment of the immediate use effect on the accelerated walking. It is a graph which shows the inclination of the linear regression line of the walking cycle, the maximum forward bending angle of the trunk, and the walking cycle. It is a figure which shows an example of the result of the trial (test 1) without wearing the gait disorder support device. It is a figure which shows an example of the result of the trial (test 2) with the gait disorder support device attached. It is a graph which shows the support force of the gait disorder support device and the floor reaction force of the right foot of the experiment collaborator. It is explanatory drawing which shows the result of the verification experiment of the immediate use effect on the accelerated walking. It is explanatory drawing which shows the result of the verification experiment of the immediate use effect on the accelerated walking. It is explanatory drawing about the verification experiment of the immediate use effect on a freezing foot. It is a figure which shows an example of the result of the verification experiment of the immediate use effect on a freezing foot. It is explanatory drawing which shows the result of the verification experiment of the immediate use effect on the freezing foot. It is explanatory drawing which shows the result of the verification experiment of the immediate use effect on the freezing foot. It is a schematic diagram which shows the relationship between each gait disorder and the use result of the gait disorder support device. It is explanatory drawing about the mechanism of the use effect by an immediate gait disorder support device. It is explanatory drawing about the mechanism of the use effect by an immediate gait disorder support device. It is explanatory drawing about the mechanism of the use effect by an immediate gait disorder support device. It is a figure which shows an example of the result of the verification experiment of the continuous use effect on a small walk. It is explanatory drawing which shows the result of the verification experiment of the continuous use effect on a small walk. It is explanatory drawing about the mechanism of the use effect by a continuous gait disorder support device. It is a block diagram which shows the internal structure of the power unit and the floor reaction force unit by another embodiment.

Hereinafter, one embodiment of the present invention will be described in detail with reference to the drawings.

(1) Systematization of gait disturbance due to parkinsonism The characteristics of parkinsonism are a decrease in motor regulation function due to depletion of dopamine in the brain and a movement disorder that makes it difficult to stand or walk as it progresses. The pathological conditions include muscle rigidity (gear-like resistance in joints), tremor (periodic tremor around 6 [Hz]), postural instability (lack of reflexive muscle contraction), and akinesia (movement). Slow or lacking).

Depending on Parkinsonism, various things such as "staggering gait (body staggering)", "wiggle walking (decrease in stride length)", "accelerated gait (forward rush)" and "freezing foot (involuntary stop)" Gait disturbances occur depending on the type and severity of the causative disorder.

Regarding these gait disorders due to Parkinsonism, as shown in FIG. 1, "staggered gait" is a decrease in the movement of the center of gravity on the left and right due to the rod-shaped trunk due to muscle rigidity, and the expression of abnormal rhythm, which is a rhythm formation disorder. It is expressed due to and. In addition, "small walking" is caused by a decrease in the movement of the center of gravity from side to side, an abnormal rhythm, and a decrease in the size of movement, which is a decrease in stride length due to bradykinesia. Further, "accelerated walking" is manifested by the forward deviation of the center of gravity due to the forward bending posture due to muscle rigidity, the above-mentioned wiggle walking, and the increase in step speed, which is acceleration due to the series effect. "Freezing feet" develop due to severe bradykinesia and the development of each gait disorder.

The systematic correlation of these gait disorders is shown in FIG. In this correlation diagram, based on the "stationary standing" state, the relationship from the lowest severity to "falling" through "staggering walking", "small walking", "accelerated walking" and "freezing foot". Is shown.

"State a" is a decrease in the ability to move the center of gravity (dystonia of the lower limbs, postural instability), "state b" is a decrease in the periodicity of movement (rhythm formation disorder), and "state c" is a decrease in the magnitude of movement (movement). , Series effect), assuming that the "state d" is a forward bending posture (dystonia of the trunk), the above-mentioned four types of gait disorders tend to transition to various gait disorders depending on the combination of these states a to d. Represents.

Thus, in Parkinsonist patients, various gait disorders depending on the severity are induced by the functional deterioration of posture and center of gravity movement.

(2) Principle of rocking support for suppressing accelerated walking according to the present invention Accelerated walking, which is one of the typical gait disorders related to parkinsonism, is a rush phenomenon caused by an increase in the step speed of a subject. is there. Falling and involuntary symptoms caused by accelerated walking have a great influence on QOL.

In the present invention, a gait test is performed by a Parkinsonism patient by physical intervention of a wearable system such as a gait disorder support device, and acceleration is performed by assisting posture disorder and rhythm formation disorder, which are factors of accelerated gait. Suppress walking.

In order to realize rocking support to suppress accelerated walking, we will create a simple model that considers the physiological and mechanical characteristics of Parkinsonist patients, and determine the method of imparting support through simulation. The swing support by the wearable system is started from a stationary standing position, and the subject starts walking in accordance with the swing to support the rhythm formation and the movement of the center of gravity during walking.

Attitude control during a stationary standing position of a human being is expressed by superimposing active sensory feedback performed by integration of sensory information in the central nervous system and passive viscoelasticity caused by muscles, joint tissues, and the like. Since the neural feedback of Parkinson's disease patients can be regarded as a PD (proportional / differential) controller, and the characteristics of the human lower leg muscles can be regarded as a spring-mass-damper system, a simplified frontal plane model as shown in Fig. 1 is used. Represented as a coordinate system.

In this model coordinate system, body weight _M, the center of gravity of the front face value _{x COM,} power of neural feedback to _{F active,} passive force of _{F passive} from the _muscle, when a force which optionally exhibits _{F voluntary,} The balance of forces when a Parkinsonism patient voluntarily swings his / her body while standing still is expressed by the following equations (1) to (3).

Since it is difficult for Parkinsonism patients to generate and maintain spontaneous swing due to rhythm formation disorder, in the present invention, _{Perkinso is set} to 0 for F voluntary, C for viscosity coefficient C, and P + k for elastic modulus K. The stationary standing posture of the Nism patient is regarded as the damped vibration system of the spring mass damper represented by the following equation (4).

Here, considering that the measured vibration characteristics cannot be sufficiently expressed when the human body is modeled as one concentrated mass, and that physical therapy assists the lateral swing rhythmically while grasping the armpit circumference. In the simple model, the body weight is decomposed into the mass centers of the upper and lower body, and the vibration is excited by giving periodic support to the center of gravity of the upper body near the chest.

The upper body of mass _{m u,} the lower body mass _{m l,} upper body center of gravity position _{x u,} the lower body of the position of the center of gravity and _{x l, x COM} is expressed by the following equation (5).

In the model coordinate system of frontal that simplified 3, the viscosity coefficient of the upper body c _u and an elastic coefficient k _u, the lower body of the viscous coefficient the c _l and the elastic coefficient k _l, the equation of motion equation It is expressed as (6).

In this equation (6), x, u, M, C and K are expressed as the following equations (7) to (11), respectively.

As a result, if the transfer functions _{of the outputs x u} and x _{l for the input u are Gu} (s) and G _l (s), respectively, they are expressed as the following equations (12) and (13).

The equations (14) and (15) below hold from the relationship between the input and output amplitude ratios of each frequency transfer function.

Thus, equation (5), based on the equation (14) and _(15), when the amplitude of the _{x COM} and w, support force F is expressed by the following equation (16).

Here, since the postural control function of Parkinsonist patients is impaired, the transient state of the upper and lower body is assumed to be damped vibration. In addition, assuming that the natural angular frequency ω ₀ is the walking cycle of the subject and the angular frequency ω of the exciting force is 1.1 times the walking cycle based on the previous research of the external cue that performs rhythmic somatic sensory stimulation. , Attenuation ratio γ, elastic modulus and viscosity coefficient of upper body and lower body are expressed by the following equation (17).

A simulation was performed on this system using the numerical analysis software MATLAB (trade name) using the parameters shown in FIG. In addition, L was the amount of movement of the center of gravity in the horizontal direction during walking of a healthy person, and _mu and _ml were calculated from the ratio to the body weight. The phase plane of the center of gravity position x _COM of the frontal plane is shown in FIG. It was confirmed that the amplitude of x _COM was 0.025 [m], and the frequency at the time of steady vibration was 0.98 [Hz] against 0.94 [Hz] of the supporting force, which was about the same as the target value.

As described above, it is considered possible to support swinging to suppress accelerated walking by applying the excitation force calculated from the weight of the subject and the walking cycle to the center of gravity of the upper body.

(3) Configuration of Gait Disorder Support Device According to the Present Embodiment In FIG. 6, a wearable gait disturbance support device 10 according to the present embodiment is shown. In the gait disturbance support device 10, the first belt 11 is attached near the chest of the subject so that the shoulder blades of the subject can be abducted and abducted, and the second belt 12 is attached to the waist of the subject. ing.

A power unit 20 is fixedly attached to the center of the lower back of the subject in the second belt 12. As shown in FIG. 7, the power unit 20 includes a drive unit 21 including an actuator, a control unit 22 including a CPU (Central Processing Unit) that controls the entire device, and a storage unit 23 that stores various data. It has an operation unit 24 for operating the swing support on or off.

The drive unit 21 has an output shaft 21A whose rotation center is in the direction perpendicular to the back surface of the subject, and is adapted to rotate and drive the output shaft 21A in the forward rotation direction or the reverse rotation direction. Further, the center of the upper back of the subject in the first belt 11 and the output shaft 21A of the drive unit 21 in the power unit 20 are connected by a link portion 25 made of carbon fiber reinforced resin.

Further, a third belt 30 attached to an upper portion of the waist of the subject is fixedly attached to the drive unit 21 in the power unit 20 so as to maintain a predetermined height position with respect to the second belt 12. .. The drive unit 21 is fixed to the center of the lower back of the subject by the second belt 12 and the third belt 30.

Further, the control unit 22 controls the output torque of the drive unit 21 so as to swing the output shaft 21A of the drive unit 21 in the power unit 20 alternately in the forward rotation direction and the reverse rotation direction at a desired cycle timing. The control unit 22 applies a vibrating force corresponding to the output torque of the drive unit 21 to the first belt 11 via the link unit 25 to alternately bend the chest and waist of the subject to the left and right. it can.

A battery 26 for supplying electric power to the power unit 20 is mounted on the connecting portion of the first belt 11 with the link portion 25 so as to be detachably fixed and held.

As shown in FIG. 8A, when there is no misalignment of the subject's chest on the first belt 11 and the angle of the link portion 25 with respect to the vertical direction is sufficiently small, the link length of the link portion 25 is set to L, periodically. Assuming that the amplitude of the support force is F, the output torque τ of the drive unit 21 in the power unit 20 arranged on the waist of the subject is expressed by the following equation (18).

The rise of the output torque of the drive unit 21 is smoothed to prevent the balance from being lost due to the force immediately after the start of support.

As a result, the gait disturbance support device 10 induces a periodic support force from the drive unit 21 fixed to the center of the lower back of the subject to the first belt 11 via the link portion 25 to induce the subject's chest. By alternately bending the lumbar region to the left and right, it is possible to eliminate the posture disorder and rhythm formation disorder peculiar to Parkinson's disease while assisting the subject's trunk extension and rhythm formation.

That is, the chest and waist of the subject are attached by the first belt 11 and the second belt 12, respectively, and the drive unit 21 in the power unit 20 fixed to the waist transmits the support force to the chest via the link portion 25. By doing so, a horizontal force can be applied to the center of gravity of the upper body existing near the chest of the subject.

Further, in the gait disturbance support device 10, the waist portion of the subject is provided with a width in the height direction so that the second belt 12 and the third belt 30 are wound around the waist, whereby the drive unit 21 outputs torque. It is possible to maintain a fixed state in the center of the lower back of the subject without rotating by itself at the time of occurrence.

By the way, the subjects to whom the gait disturbance support device 10 is applied are Japanese whose height, weight, chest circumference, and waist circumference fall within the range of 5 [%] tilt values to 95 [%] tilt values, and the first belt 11 and the first belt. By adjusting the length of each of the two belts 12 and the height position of the third belt 30, the body weight difference of the subject is adjusted and the extension of the trunk is promoted.

That is, as shown in FIG. 8 (B), the link length L of the link portion 25 is obtained as the difference (AB) when the sitting scapula inferior angle height is A and the sitting iliac crest height is B. .. According to a general body size database, the sitting scapular inferior angle height A is in the range of 2.5 to 97.5 [%] tilt value, and the sitting iliac crest height B is also in the range of 2.5 to 97.5 [%] tilt value. It is possible to set the external dimensions that can be worn by 95 [%] of Japanese people as described above.

(4) Verification experiment of immediate use effect using gait disorder support device In this verification experiment, the gait disorder support device 10 was applied to a Parkinsonism patient, and four types of gait disorders (staggering gait, wiggle walking, acceleration) were applied. Confirm the applicability to the suppression of gait and freezing legs).

When selecting a subject to verify the immediate effect of intervention, it is a condition that all of the following five selection criteria are satisfied and at the same time, none of the four exclusion criteria is violated. The selection criteria are firstly that a doctor has diagnosed Parkinsonism, secondly that the Yahr severity classification is stage IV or lower, and thirdly that he / she is able to walk on his / her own and presents freezing legs. Fourth, the height is in the range of 140 to 180 [cm], and fifth, the weight is in the range of 40 to 50 [kg]. Exclusion criteria include, firstly, severe akinesia, rigidity or ataxia, secondly, difficulty in understanding instructions and expressing self-state, and thirdly, severe lower limbs. There is spasticity, deformity or rigidity, and fourthly, it is difficult to stand or walk on its own.

In this verification experiment, a trial without the gait disturbance support device 10 (test 1: Test1), a trial with the gait disturbance support device 10 attached (test 2: Test2), and the intervention of the test 2 Later, in a trial (test 3: Test 3) in a state where the gait disturbance support device 10 is not attached, the test is carried out three times each under a predetermined environment set for each subject.

Before conducting the trial (test 2) with the gait disturbance support device 10 attached, the support force should be adjusted through the fitting of the gait disturbance support device 10 and the practice of 2 trials with the cooperation of the physiotherapist. Then, the amplitude of the support force was set to 30 [%] of the value obtained from the simple simulation.

The gait disturbance support device 10 is attached with the length of the second belt 12 so that the second belt 12 on the lumbar region of the subject is located on the anterior superior iliac spine and the tip of the link portion 25 is located on the fifth thoracic vertebra. Adjust the position. Further, the caregiver (assistant) uses the operation unit 24 provided in the power unit 20 to start and stop the swing support for the target person.

The evaluation items for each gait disorder are shown in FIG. For "walking with wobbling" of ID: A, the central foot pressure distribution is the primary endpoint, and the synchronism is the secondary endpoint. For ID: B "walking in small steps", the number of steps is used as the primary evaluation item, and the synchronism is used as the secondary evaluation item. For "accelerated walking" with ID: C, changes in the walking cycle are the primary endpoints, and synchronism and posture are the secondary endpoints. For the "freezing foot" of ID: D, the number of steps is used as the primary evaluation item, and the synchronism is used as the secondary evaluation item. Here, "synchronization" represents the synchronization between the walking cycle of the subject and the support cycle of the system, and "posture" represents the forward bending angle of the trunk.

In this experiment, the "synchronism" by the subject was evaluated by the walking cycle and the ground reaction force (GRF), and the "posture" by the subject was evaluated by the maximum forward bending angle of the trunk and the center of foot pressure (COP). : Center of Pressure).

Specifically, the pressure distribution measurement system "Pedar-X" (trade name) is used to measure the walking cycle, left and right foot pressure centers (COP), and floor reaction force (GRF) of the subject. In addition, the forward bending angle of the trunk of the subject is measured at 100 [Hz] using the three-dimensional motion analysis system "VICON MX" (trade name).

FIG. 10 shows the attachment positions of a plurality of markers of the three-dimensional motion analysis system to be attached to the body surface of the subject. Each marker of the 3D analysis system is attached to the left and right acromion, greater trochanter, fibula head, lateral malleolus, and fifth metatarsal head in total, and is a line connecting the acromion and greater trochanter. The angle formed by the trunk is measured as the forward bending angle of the trunk.

(4-1) Verification experiment for staggering gait The subject who cooperated in the experiment was one Parkinson's disease patient (68 years old, female, current medical history 6 years) who exhibited staggering gait, and the symptom was predominant on the right side. As shown in FIG. 11 (A), the physical characteristics of the subjects who collaborated with the experiment were a weight of 46 [kg], a walking cycle of 1.0 [s], and dystonia equinus of the right ankle. Have. In addition, the support force of the gait disturbance support device 10 is set to 5.2 [N], and the support cycle is set to 1.1 [s].

As a test environment, as shown in FIG. 11B, the subject stood up from a chair and walked along a straight line of 3 [m], and was subsequently installed at 1 [m] intervals. The operation of alternately slaloming the three poles, returning to the original position, and sitting on the chair again is performed three times for each of the above-mentioned tests 1 to 3.

At that time, the distribution of the center of foot pressure of the subject's right foot during slalom walking is the primary endpoint, and the synchronization between the subject and the gait disturbance support device (system) 10 is the secondary endpoint. FIG. 11C shows the locus of the center of foot pressure and the maximum amount of movement of the frontal plane of the subject's right sole.

The state of the verification experiment of the immediate use effect on the staggering walking is shown in FIGS. 12 (A) to 12 (C). FIG. 13 (A) shows the results of measuring the maximum amount of movement at the frontal plane with an emphasis on the relationship between the locus of the center of gravity of the subject and the locus of the center of foot pressure.

Regarding the distribution of the center of foot pressure, the comparison result between the non-use (test 1) and the use (test 2) of the gait disturbance support device 10 confirmed that the maximum movement amount at the frontal plane tended to increase (test). FIG. 13 (B). In addition, the comparison result between the use of the gait disturbance support device 10 (test 2) and the use (test 3) shows that the maximum amount of movement at the frontal plane tends to decrease, that is, there is no tendency to maintain the effect. Was confirmed (figure).

From this, as shown in FIG. 14A, when the gait disturbance support device 10 is used (test 2), the subject always has no center of gravity on the sole of the foot during dynamic walking, and the stability of the movement of the center of gravity is improved. Therefore, it can be seen that the locus of the center of foot pressure tends to shift outward.

Regarding the synchronism, it was confirmed that the comparison results of the gait disturbance support device 10 when not in use (test 1), when in use (test 2), and after use (test 3) all match (synchronize) (test). FIG. 14 (B). That is, it was confirmed that the walking cycle (1.11 ± 0.08 [s]) of the subject and the support cycle (1.10 [s]) of the gait disturbance support device 10 tended to be synchronized. From this, it can be seen that the effect on the reduction of staggering walking when the gait disturbance support device 10 is used (test 2) is suggested.

(4-2) Verification experiment for wiggle walking The subjects who cooperated in the experiment were one patient with Parkinson's disease (progressive supranuclear palsy) who presented with wiggle walk (65 years old, male, current medical history 1 year). Symptoms are predominant on the right side. As shown in FIG. 15 (A), the physical characteristics of the subjects who are the collaborators of the experiment are a body weight of 64 [kg] and a walking cycle of 1.05 [s]. In addition, the support force of the gait disturbance support device 10 is set to 8.5 [N], and the support cycle is set to 1.2 [s].

As a test environment, as shown in FIG. 15 (B), the subject stands up from a chair, turns while walking along a straight line of 3 [m], returns to the original position, and sits on the chair again. The operation up to this is carried out three times for each of the above-mentioned tests 1 to 3.

At that time, the number of steps of the subject at the time of turning is set as the primary evaluation item, and the synchronization between the subject and the gait disturbance support device (system) 10 is set as the secondary evaluation item. FIG. 15C shows the loci of the soles of both feet when the subject walks while turning.

Figures 16 (A) to 16 (C) show the state of the verification experiment of the immediate effect on walking in small steps. The results of measuring the number of steps of the target person in the target area during turning are shown in FIGS. 17A and 17B.

Regarding the number of steps, it was confirmed that the comparison results between the non-use (test 1) and the use (test 2) of the gait disturbance support device 10 tended to decrease. In addition, the comparison results between the use of the gait disturbance support device 10 (test 2) and the use (test 3) confirmed that the reduced effect tended to be maintained.

From this, as shown in FIG. 18A, the number of steps of the subject decreases (that is, the stride length increases) when the gait disturbance support device 10 is used (test 2) and after use (test 3). Understand.

Regarding the synchronism, it was confirmed that the comparison results of the gait disturbance support device 10 when not in use (test 1), when in use (test 2), and after use (test 3) all match (synchronize) (test). FIG. 18 (B). That is, it was confirmed that the walking cycle (1.19 ± 0.09 [s]) of the subject and the support cycle (1.21 [s]) of the gait disturbance support device 10 tended to be synchronized. From this, it can be seen that the effect on the reduction of wiggle walking was suggested when the gait disturbance support device 10 was used (test 2) and after use (test 3).

(4-3) Verification experiment for accelerated walking The subject who cooperated in the experiment was one Parkinson's disease patient (64 years old, male, current medical history 19 years) who exhibited accelerated walking, and the symptom was predominant on the right side. As shown in FIG. 19 (A), the physical characteristics of the subjects who cooperated in the experiment were a weight of 70 [kg], a walking cycle of 0.97 [s], and a forward bending posture due to strong muscle stiffness. Present. In addition, the support force of the gait disturbance support device 10 is set to 10.1 [N], and the support cycle is set to 1.21 [s].

As a test environment, as shown in FIG. 19 (B), the operation of walking in a U shape around parallel bars having a width of 0.65 [cm] and a length of 10 [m] was performed for each of the above-mentioned tests 1 to 3 by 3 each. Conduct twice. In this verification experiment, the subjects were instructed not to grab the parallel bars as much as possible in each of the three trials, except when the balance was significantly lost.

At that time, the change in the walking cycle of the subject during straight (reciprocating) walking is the primary evaluation item, and the synchronization between the subject and the gait disturbance support device (system) 10 and the posture of the subject are the secondary evaluation items. To do. FIG. 19C shows the relationship between the number of steps and the walking cycle of the subject on the outward trip, turning, and returning trip. The linear regression line of the walking cycle on the outward and inbound routes is also shown.

The state of the verification experiment of the immediate use effect on the accelerated walking is shown in FIGS. 20A to 20C. FIG. 21 (A) shows the results of measuring changes in the walking cycle of the subject on the outward route, turning, and returning route. This change in the walking cycle is expressed as the slope of the temporary regression line, and when the slope is 0 value, it shows a constant speed, and when the slope is negative value, it shows that it gradually accelerates.

Regarding the change in the walking cycle, it was confirmed that the comparison result between the non-use (test 1) and the use (test 2) of the gait disturbance support device 10 tends to decrease (FIG. 21 (B)). In addition, the comparison results between the use of the gait disturbance support device 10 (test 2) and the use (test 3) confirmed that the reduced effect tended not to be maintained (Fig. Fig.).

From this, as shown in FIG. 21C, it can be seen that when the gait disturbance support device 10 is used (test 2), the decrease in the walking cycle is suppressed (that is, the rush is reduced).

The results of the verification experiment of the immediate use effect on the accelerated walking shown in FIGS. 20 (A) to 20 (C) described above are shown in FIGS. 22 (A) to 22 (C). As shown in FIG. 22 (A), the slope of the linear regression line of the walking cycle in each trial changes from an average of -0.0063 [s / step] to an average of -0.00013 [s / step] when the gait disturbance support device 10 is used. (Test 2) decreased to 2.1 [%] when the device was not used (Test 1). It was confirmed that the decrease in the inclination of the linear regression line of the walking cycle means that the decrease in the walking cycle for each walk was reduced by the gait disturbance support device 10, and that the accelerated walking of the subject can be suppressed. Was done.

As shown in FIG. 22 (B), the maximum forward bending angle of the trunk of the subject was reduced from 13.0 ± 3.9 [deg] to 5.9 ± 0.32 [deg] by the gait disturbance support device 10. As a result, the forward bending posture of the subject is reduced by the adduction of the scapula by the first belt 11 of the chest of the subject wearing the gait disturbance support device 10 and the extension of the thoracic spine by the link portion 25 between the chest and the lumbar region. It is believed that it was done.

In addition, as shown in FIG. 22C, the walking cycle of the subject is 1.19 ± 0.07, which is about the same as the swing support cycle of 1.21 [s] from 1.06 ± 0.13 [s] by the gait disturbance support device 10. It increased to [s] and the standard deviation of the gait cycle decreased.

The state of the left swing phase when the gait disturbance support device 10 is not used (test 1), the distribution of the left and right foot pressure centers (COP), and an example of the walking cycle for each walk are shown in FIGS. 23 (A) to 23 (C), respectively. Shown in. In addition, FIGS. 24 (A) to 24 (C) show the state of the left swing phase when the gait disturbance support device 10 is used (test 2), the distribution of the left and right foot pressure centers (COP), and an example of the walking cycle for each walk. Shown in.

Based on the comparison results of the left swing phase shown in FIGS. 23 (A) and 24 (A), the extension of the trunk was confirmed when the right leg, which is the dominant side of the symptom, was the support leg. Further, based on the comparison result of the distribution of the foot pressure center (COP) after turning shown in FIGS. 23 (B) and 24 (B), the heel of the distribution on the toe side in the sagittal plane at the foot pressure center of the right foot. Lateral deviations and reduced distribution variability at the coronal plane were confirmed. As a result, it is considered that the position of the center of gravity moved backward during the support leg period due to the reduction of the forward bending posture of the subject wearing the gait disturbance support device 10.

Further, based on the comparison results of FIGS. 23 (C) and 24 (C), when only the gait disturbance support device 10 is not used (test 1), the pace is disturbed before and after the turn, so that the fluctuation of the walking cycle becomes large and the walk turns. Although the walking cycle gradually decreased in the latter straight line, it was confirmed that the fluctuation of the walking cycle was small even after turning during use (test 2), and the walking cycle tended to be maintained.

FIG. 25 shows the support force of the gait disturbance support device 10 and the floor reaction force (GRF) of the right foot of the subject who is the collaborator of the experiment. Even when the swing support of the gait disturbance support device 10 and the walking of the target person are synchronized and a phase difference occurs between the support cycle of the gait disturbance support device 10 and the walking cycle of the target person during turning, the walking cycle becomes the support cycle. We were able to confirm the behavior of converging to the same phase.

FIG. 26 (A) shows the results of measuring the forward bending angle of the subject's trunk (the angle formed by the line connecting the acromion and the greater trochanter) with respect to the posture. When the value of this forward bending angle is 0, it indicates the extension of the trunk, and when it is a positive value, it indicates the forward bending of the trunk.

Regarding the posture, it was confirmed that the comparison result between the non-use (test 1) and the use (test 2) of the gait disturbance support device 10 tends to decrease (FIG. 26 (B)). In addition, the comparison results between the use of the gait disturbance support device 10 (test 2) and the use (test 3) confirmed that the reduced effect tended not to be maintained (Fig. Fig.).

From this, as shown in FIG. 27 (A), when the gait disturbance support device 10 is used (test 2), the forward bending angle of the subject decreases, so that the subject's trunk extension is promoted (that is, that is). It can be seen that the center of gravity is displaced backward).

Regarding the synchronism, it was confirmed that the comparison results of the gait disturbance support device 10 when not in use (test 1), when in use (test 2), and after use (test 3) all match (synchronize) (test). FIG. 27 (B). That is, it was confirmed that the walking cycle of the subject (outward route: 1.18 ± 0.06 [s], inbound route: 1.17 ± 0.03 [s]) and the support cycle of the gait disturbance support device 10 (1.21 [s]) tend to be synchronized. From this, it can be seen that the effect on the reduction of accelerated walking was suggested when the gait disturbance support device 10 was used (test 2) and after use (test 3).

(4-4) Verification experiment for freezing legs The subject who cooperated in the experiment was one patient with Parkinson's disease (progressive supranuclear palsy) presenting freezing legs (80 years old, male, current medical history 6 years). Symptoms are predominant on the left side. As shown in FIG. 28 (A), the physical characteristics of the subjects who collaborated with the experiment were that the body weight was 70 [kg] and the walking cycle was 1.1 [s], and that the right half of the body was caused by multiple cerebral infarction. Has rigidity. In addition, the support force of the gait disturbance support device 10 is set to 4.7 [N], and the support cycle is set to 1.32 [s].

As a test environment, as shown in FIG. 28 (B), the subject stands up from a chair, turns while walking along a straight line of 3 [m], returns to the original position, and sits on the chair again. The operation up to this is carried out three times for each of the above-mentioned tests 1 to 3.

At that time, the number of steps of the subject at the time of turning is set as the primary evaluation item, and the synchronization between the subject and the gait disturbance support device (system) 10 is set as the secondary evaluation item. FIG. 28C shows the loci of the soles of both feet when the subject walks while turning.

The state of the verification experiment of the immediate use effect on the freezing foot is shown in FIGS. 29 (A) to 29 (C). FIG. 30A shows the result of measuring the number of steps of the target person in the target area during turning.

Regarding the number of steps, it was confirmed that the comparison result between the non-use (test 1) and the use (test 2) of the gait disturbance support device 10 tends to increase (FIG. 30 (B)). In addition, as a result of comparison between the use of the gait disturbance support device 10 (test 2) and the time after use (test 3), it was confirmed that freezing feet appeared after the use (the figure in the figure).

From this, as shown in FIG. 31 (A), when the gait disturbance support device 10 is used (test 2) and after use (test 3), dynamic walking (always on the sole of the foot) as before (test 1) is performed. It can be seen that there is a change from (no center of gravity) to quasi-moving gait (temporarily having a center of gravity on the sole of the foot). That is, when the gait disturbance support device 10 is used (test 2) and after use (test 3), the stability of the movement of the center of gravity is improved, and a change to a gait suitable for low-speed walking (increase in the number of steps) occurs. You can see that.

Regarding the synchronism, it was confirmed that the comparison results of the gait disturbance support device 10 when not in use (test 1), when in use (test 2), and after use (test 3) all match (synchronize) (test). FIG. 31 (B). That is, it was confirmed that the walking cycle (1.31 ± 0.07 [s]) of the subject and the support cycle (1.32 [s]) of the gait disturbance support device 10 tended to be synchronized. From this, it can be seen that the effect on the reduction of freezing feet was suggested when the gait disturbance support device 10 was used (test 2) and after use (test 3).

(4-5) Relationship with Effect of Use of Gait Disorder Support Device for Each Gait Disorder As a result of using the gait disorder support device 10 for the above-mentioned perkinsonism patients with each gait disorder, as shown in FIG. 32, When a subject with a right ankle varus apex walks swaying, when a subject with a trunk anteflexion walks at an accelerated pace, a subject with a left-sided muscle atrophy makes a freezing leg (severe movement slowness). In some cases, it was demonstrated to be effective when using the gait disturbance support device 10 (test 2). In addition, it was demonstrated that when a subject without posture disorder walks in small steps, it is effective when the gait disorder support device 10 is used (test 2) and after use (test 3).

From this, when the posture disorder suffers more severely than the rhythm formation disorder, the effect appears only when the gait disorder support device 10 is used (test 2), while the rhythm formation disorder suffers more severely than the posture disorder. In this case, it can be confirmed that the effect appears when the gait disturbance support device 10 is used (test 2) and after the use (test 3).

The mechanism of the effect of using the immediate gait disturbance support device 10 will be described. In the motor learning model of the cerebral-cerebellar connection as shown in FIG. 33, the physical movement is generated by both the feedback control by the sensory information and the feedforward control by the movement program.

In the central nervous system of the human body, when the subject has a planned movement trajectory that he / she wants to perform a walking movement, a movement command from the brain reaches the musculoskeletal system in the peripheral nervous system via a feedback controller to actually perform a walking movement. .. Information from the sensory system in the peripheral nervous system returns to the feedback controller in the central nervous system during the walking motion, and is processed and integrated in the brain to correct the error and perform feedback control.

In addition, when fast and accurate exercise is required, feedback delay occurs and complete error correction cannot be performed. Therefore, the motion commands required for walking exercise are predicted to be simulated in the brain, and the feedback information is relied on. Feedback control that performs walking motion without walking is performed by a feedforward controller of the central nervous system.

Then, in the central nervous system, the optimizer transmits the motion command from the brain to the musculoskeletal system to operate it, and adjusts to optimize with the feedback information returned from the sensory system.

Here, before the use of the gait disorder support device 10 (test 1), a subject who is a Parkinsonist patient has ataxia due to a malfunction of an optimizer in the central nervous system.

Subsequently, when the gait disturbance support device 10 is used (test 2), as shown in FIG. 34, a lateral swing support system is constructed so as to bypass the musculoskeletal system in the peripheral nervous system of the subject. , It is possible to improve the gait in walking motion. That is, the lateral swing support system directly supports the functional deterioration that is the cause of the gait disturbance by compensating the subject wearing the gait disturbance support device 10 for trunk extension and rhythmic movement of the center of gravity. Therefore, the gait can be changed temporarily to alleviate the symptoms.

Further, when the gait disturbance support device 10 is used (test 2), as shown in FIG. 35, the signal of the feedback information due to the gait improvement is amplified and returns to the feedback controller via the sensory system. An increase occurs. That is, when the major cause of gait disturbance is a decrease in the function of rhythmic movement of the center of gravity in the left-right direction, it is expected that the effect will be sustained by activating the motor control by the feedforward controller.

(5) Verification experiment of continuous use effect (small gait) using gait disorder support device The subject who is a collaborator of the experiment is one patient with Parkinson's disease (progressive supraclavicular palsy) who presents with small gait. Years old, male, current medical history 1 year), and symptoms are predominant on the right side. Similar to the above-mentioned immediate use effect verification experiment (Fig. 15A)), the physical characteristics of the subjects who are the collaborators of the experiment are a body weight of 64 [kg] and a walking cycle of 1.05 [s]. In addition, the support force of the gait disturbance support device 10 is set to 8.5 [N], and the support cycle is set to 1.2 [s].

As a test environment, the above-mentioned test 1 is a test environment in which the subject stands up from a chair, turns while walking along a straight line of 3 [m], returns to the original position, and sits on the chair again. Each of ~ 3 is carried out three times (FIG. 15 (B) described above). At that time, the number of steps of the subject at the time of turning is set as the primary evaluation item, and the synchronization between the subject and the gait disturbance support device (system) 10 is set as the secondary evaluation item.

These immediate use effect verification experiments will be carried out three times with a predetermined period. The first verification experiment (Day 1: Day 1), the second verification experiment (Day 2: Day 2) conducted one month after the experiment, and the third verification experiment conducted three months after the experiment. (Day 3: Day 3) was carried out respectively. Figures 36 (A) to 36 (C) show the immediate effect of use on wiggle walking in the third verification experiment (Day 3).

The results of measuring the number of steps of the target person in the target area during turning in the first to third verification experiments are shown in FIGS. 37 (A) and 37 (B). Regarding the number of steps, the state in which the number of steps decreased by the first verification experiment (Day 1) was maintained, and the number of steps decreased immediately after the second verification experiment (Day 2) as it was, so that the effect tends to be maintained. It was confirmed that there was.

From the second verification experiment (Day 2) to the third verification experiment (Day 3) three months later, the symptoms of wiggle walking are progressing again, and the third verification experiment (Day 3) It was confirmed that 3) tends to reduce and maintain the effect.

From this, it can be seen that by continuously using the gait disturbance support device 10, the effect of reducing the wiggle walking suffered by the subject is sustained. As a possibility of continuous use, as shown in FIG. 37 (C), when the current Parkinsonism symptom (medical history) is prolonged, appropriate use (intervention) is performed to suppress the aggravation and reduce the symptom. It was suggested that it may be possible to maintain the condition.

The mechanism of the effect of use by the continuous gait disturbance support device 10 will be described. First, in the motor learning model of the cerebral-cerebellar connection shown in FIG. 35 described above, when the gait disturbance support device 10 is used (test 2), the feedback information signal due to gait improvement is amplified and feedback control is performed via the sensory system. Returning to the vessel, an increase in sensory feedback occurs. That is, when the major factor of the gait disorder is the functional deterioration of the rhythmic movement of the center of gravity in the left-right direction, the motion control by the feedforward controller is activated.

When the gait disturbance support device 10 is continuously used a plurality of times, as shown in FIG. 38, the signal of the operation command due to the passage of time is attenuated via the feedback controller. That is, with the continuous use of the gait disturbance support device 10, the feedforward controller that controls the periodic movement of the center of gravity in the left-right direction (lateral direction) during walking has improved the gait by gradually reducing the wiggle walking. As a result, it is considered that it was temporarily activated.

(6) Effect of the gait disturbance support device of the present embodiment As described above, it was confirmed that when the subject wears the gait disturbance support device 10, the gait disturbance caused by Parkinson's disease can be suppressed. .. In fact, in all the trials, it was confirmed that the subject who was the collaborator of the experiment completed walking, and it was confirmed that there was no physical pain to the collaborator during and after the experiment. Furthermore, the subject was able to feel the swing support by the gait disturbance support device 10, and obtained the impression that it was easy to walk when the gait disturbance support device 10 was worn.

Therefore, it was confirmed that the attachment of the gait disturbance support device 10 can reduce the forward bending posture of the subject and the forward deviation of the center of gravity position due to the forward bending posture. The effect of suppressing gait disturbance can be obtained not only when the gait disturbance support device 10 is used immediately but also when it is continuously used by a subject who does not have a posture disorder.

In addition, a method has been reported in the past to support walking by presenting rhythm sounds to patients with Parkinson's disease and other dysfunctional persons of the cranial nerve system to draw in walking rhythms and to mutually adapt the walking rhythms of humans and devices. There is. From this, it is considered that the forcible pull-in phenomenon was excited between the gait disturbance support device 10 and the subject by the swing support.

Therefore, it was confirmed that it is possible to support the formation of a rhythm for maintaining the walking cycle by assisting the lateral swing by the gait disturbance support device 10.

According to the results of the above-mentioned verification experiment, the gait disturbance support device 10 according to the present invention compensates for the posture disorder and the rhythm formation disorder of the Parkinsonism patient, thereby reducing the decrease in the walking cycle and causing the occurrence of the gait disorder. It was confirmed that it was possible to suppress it.

The swing support method by the gait disturbance support device 10 acts indirectly on the sensory function in order to compensate for the functional deterioration of posture and rhythm formation, which is the cause of the gait disturbance, by acting directly and mechanically. This is a gait disorder support method that is more reliable than the conventional method of assistance.

In addition, when the gait disturbance support device 10 is used, the center of foot pressure (COP) distribution is centered on the front face value of the right foot, which is the dominant side of the symptom, even though the lateral swing to the subject is assisted. It can be seen that the intervention of the gait disturbance support device 10 improved the predominance of the symptom and the stability of gait at the support leg.

According to the gait disorder support device 10 according to the present embodiment, not only the gait disorder of the subject is immediately suppressed, but also the amount of the medicine to be taken in the currently commonly used drug therapy can be reduced. It will be possible. It has been suggested that the symptoms of Parkinson's disease can be further improved by the combined use of medical treatment or surgical treatment and rehabilitation. Since it is important for the disease, it is expected that the gait disorder support device will contribute to the support of the involuntary walking function remaining in Parkinson's patients.

(7) Other Embodiments As described above, in the present embodiment as described above, as the gait disturbance support device 10, the first belt is used as the gait disturbance support device 10 from the drive unit 21 fixed to the center of the lower back of the subject via the link unit 25. A case has been described in which a configuration is applied in which the chest and lumbar region of the subject is alternately bent sideways by inducing a periodic support force to 11, but the present invention is not limited to this, and the subject's body is not limited to this. If it is possible to eliminate the posture disorder and the rhythm formation disorder peculiar to Parkinson's disease while assisting the trunk extension and the rhythm formation, various other configurations may be applied.

Further, in the present embodiment, when the control unit 22 controls the drive unit 21 so as to reduce the decrease in the walking cycle of the target person and suppress the gait disturbance, the control unit 22 responds to the operation by the operation unit 24 by the caregiver. The case where the swing support to the subject is executed based on the data representing the desired cycle timing stored in the storage unit 23 has been described, but the present invention is not limited to this, and the body of the subject is not limited to this. Feedback control that autonomously adjusts the amplitude and period of the support force based on the state may be executed.

That is, as shown in FIG. 39 in which the corresponding portions corresponding to those in FIG. 7 are designated by the same reference numerals, the floor reaction force unit 40 is mounted on each pair of shoes (not shown) worn by the subject, and the power unit 50 is equipped with the floor reaction force unit 40. On the other hand, it is connected to enable wireless communication by short-range wireless communication methods such as Bluetooth (registered trademark) and RF-ID.

In each of the pair of floor reaction force units 40, the floor reaction force sensors 41 detect the reaction force against the load applied to the left and right soles of the subject. The floor reaction force sensor 41 is composed of, for example, a piezoelectric element that outputs a voltage corresponding to an applied load, a sensor whose capacitance changes according to a load, or the like, and changes in load due to weight transfer and the subject. It is possible to detect the presence or absence of contact between the leg and the ground.

In addition to the shoe structure, the floor reaction force unit 40 includes a floor reaction force sensor 41, a floor reaction force control unit 42 including an MCU (Micro Control Unit), and a wireless communication unit 43. After the output of the floor reaction force sensor 41 mounted on the sole is voltage-converted via the converter 44, the high frequency band is cut off via the LPF (Low Pass Filter) 45, and then the floor reaction force control unit 42 Is entered in.

Based on the detection result of the floor reaction force sensor 41, the floor reaction force control unit 42 obtains the load change due to the weight shift of the subject and the presence or absence of ground contact, and the center of gravity according to the load balance applied to the left and right soles. The position is obtained, and this is transmitted as floor reaction force data via the wireless communication unit 43.

In this way, in the pair of floor reaction force units 40, it is possible to estimate which side of the subject's left or right foot the center of gravity is biased based on the data measured by each floor reaction force sensor 41. Although the floor reaction force unit 40 is composed of shoes, it may be configured as an insole that can be detachably loaded into the shoes of the subject.

The power unit 50 receives the floor reaction force data transmitted from the wireless communication unit 43 of the floor reaction force unit 40 via the wireless communication unit 51, and then inputs the data to the control unit 22. The control unit 22 reduces the decrease in the walking cycle of the target person and accelerates based on the left / right switching timing of the load applied to the positions of the center of gravity of the left and right foot surfaces of the target person detected by the floor reaction force control unit 42. The drive unit 21 is feedback-controlled so as to suppress walking.

As a result, the gait disorder support device 10 can support the gait disorder so that the fluctuation of the walking cycle is kept small for the subject suffering from Parkinson's disease. In particular, the symptoms of parkinsonism differ in the degree of progression and physical characteristics of each patient, and the diurnal variation of the patient itself is large, so the amplitude and cycle of support force are autonomously adjusted based on the physical condition of the subject. Feedback control is very effective.

Further, in the present embodiment, as shown in FIG. 38 described above, as a result of the subject continuously using the gait disturbance support device 10 a plurality of times, feedback control by activation of the feedforward controller accompanying gait improvement is performed. Although the case where the motion command signal is attenuated due to the passage of time from the vessel has been described, the present invention can further realize the function improvement effect by intervention in the cerebral cortex motor area based on the continuous use of the gait disturbance support device 10. Is.

That is, if the subject is a patient with basal ganglia, which is representative of Parkinson's disease, there is a tendency for selective impairment of memory-dependent movement to be observed. This memory-dependent exercise (internally inducible exercise) refers to a case in which the order of reaching a plurality of exercise goals is decided in advance by oneself, or the order is memorized and then executed. .. The supplementary motor area on the medial aspect of the cerebral cortex is active during memory-dependent exercise because it has anatomical close functional communication with the basal ganglia.

With the gait disturbance support device 10 attached, the subject is allowed to flex the chest and lumbar region alternately left and right by the control unit 22, and the semicircular canals that cause a feeling of rotation in the vestibular organs are stimulated to a sense of balance. Given a given level of load, the subject attempts to maintain gait balance using the entire body. The sense of balance is a sensation generated by stimulation of the vestibular organ, and information from the vestibular organ enters the vestibular nuclei, reaches the cerebral cortex via the thalamus, and is generated by receiving information processing there.

As a result, in the motor learning model of the subject's cerebellar-cerebellar connection, the sensory information from the sensory organs in the muscle group of the trunk / posture control system and the equilibrium sensory information generated by the stimulation by the device are combined and strengthened, and the cerebral cortex is strengthened. It is possible to activate the function of the supplementary motor area by feeding back to the supplementary motor area on the inner surface.

In this way, in the gait disturbance support device 10, the drive unit 21 causes the control unit 22 to alternately bend the chest and waist of the subject to the extent that a predetermined level of load is applied to the subject's sense of balance. By controlling the output torque, it is possible to activate the function of the supplementary motor area, which is a region in the cerebral cortex where intervention is relatively weak, and improve memory-dependent movement.

10 ... Gait disturbance support device, 11 ... 1st belt, 12 ... 2nd belt, 20, 50 ... Power unit, 21 ... Drive unit, 21A ... Output shaft, 22 ... Control unit, 23 ... Storage unit, 24 ... Operation unit, 25 ... Link unit, 26 ... Battery, 30 ... Third belt, 40 ... Floor reaction force unit, 41 ... Floor reaction force sensor, 42 ... Floor reaction force control unit, 43, 51 ... Wireless communication unit, 44 ... Converter, 45 ... LPF.

Claims (8)

The first belt worn near the subject's chest so that the subject's scapula can be abducted and abducted,
The second belt attached to the subject's waist and
It is fixedly attached to the center of the lower back of the subject in the second belt, has an output shaft whose rotation center is in the direction perpendicular to the back surface of the subject, and has the output shaft in the forward rotation direction or the reverse rotation direction. A drive unit that rotates and drives
A link portion connecting the center of the upper back portion of the subject in the first belt and the output shaft of the drive portion, and a link portion.
The output shaft of the drive unit is provided with a control unit that controls the output torque of the drive unit so as to swing and drive the output shaft of the drive unit alternately in the forward rotation direction and the reverse rotation direction at a desired cycle timing, and the control unit is the drive unit. A gait disturbance support device characterized in that the chest and lumbar region of the subject is alternately laterally bent to the left and right by applying a vibrating force corresponding to the output torque of the portion to the first belt via the link portion. .. A third belt, which is fixedly attached to the drive unit and attached to an upper portion of the waist of the subject so as to maintain a predetermined height position with respect to the second belt, is provided, and the drive unit is the drive unit. The gait disturbance support device according to claim 1, wherein the subject is fixed to the center of the lower back of the subject by the second belt and the third belt. A foot load measuring unit that is attached to the left and right foot surfaces of the subject and measures the load applied to each foot surface.
The control unit is provided with a center of gravity position detection unit that detects the positions of the center of gravity of the left and right back surfaces of the subject by the load change measured by the foot load measurement unit, and the control unit is detected by the center of gravity position detection unit. Based on the left / right switching timing of the load applied to the positions of the center of gravity of the left and right foot surfaces of the target person, the drive unit is feedback-controlled so as to reduce the decrease in the walking cycle of the target person and suppress the walking obstacle. The walking disorder support device according to claim 1 or 2, characterized in that. The control unit is characterized in that the output torque of the drive unit is controlled so that the chest and lumbar region of the subject is alternately laterally bent to the extent that a predetermined level of load is applied to the sense of balance of the subject. The gait disturbance support device according to any one of claims 1 to 3. The gait according to any one of claims 1 to 4, wherein the link portion has a link length set so that the forward bending angle of the trunk of the subject is maintained within a predetermined range. Disability support device. The center of the upper back of the subject in the first belt attached near the chest of the subject so that the scapula of the subject can be abducted and abducted, and the second belt attached to the waist of the subject. The output shaft of the drive unit fixedly attached to the center of the lower back of the subject is connected via the link portion.
The output torque of the drive unit is controlled so that the output shaft of the drive unit is oscillated alternately in the forward rotation direction and the reverse rotation direction with the direction perpendicular to the back surface of the subject as the center of rotation at a desired cycle timing. The first step and
A second step is provided in which the chest and lumbar portions of the subject are alternately laterally bent to the left and right by applying a vibrating force corresponding to the output torque of the drive unit to the first belt via the link portion. A gait disorder support method characterized by. In the first step, the gait disturbance is suppressed by reducing the decrease in the walking cycle of the subject based on the left / right switching timing of the load applied to the positions of the center of gravity of the left and right foot surfaces of the subject. The gait disturbance support method according to claim 6, wherein the drive unit is feedback-controlled. In the first step, the output torque of the drive unit is controlled so that the chest and lumbar region of the subject is alternately laterally bent to the extent that a predetermined level of load is applied to the sense of balance of the subject. The gait disorder support method according to claim 6 or 7.

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