JP7020122B2 - Walking training system - Google Patents

Description

The present invention relates to a walking training system.

A technique for detecting the start of a fall by attaching an articulated structure for detecting a motor state to a subject in order to perform an avoidance action against a fall is known. (See, for example, Patent Document 1).

Japanese Unexamined Patent Publication No. 2010-22439

When a patient suffering from leg paralysis performs walking training as rehabilitation, if the walking training device predicts a fall at the start of the patient's walking movement and performs an avoidance movement, the training is not performed for the patient. Therefore, for example, when a paralyzed patient is trained to walk while continuing walking for a plurality of cycles by giving a degree of freedom to the movement of the gait within a range in which the paralyzed patient does not completely fall, the abnormality determination of the gait is determined to be a fall. Unlike the case of predicting, it becomes very difficult. For example, the gait of a paralyzed patient varies depending on the disease, and even if the amount of movement of a certain part involved in walking is similar to that of a healthy person, it is evaluated as abnormal walking when observed as a whole. There are also many.

On the other hand, if the paralyzed patient is completely assisted so as not to lose his / her posture, it may be far from the actual walking movement, and the rehabilitation effect of the patient is weakened. In the conventional walking training device, if the patient loses his / her balance and performs a fall avoidance motion, the training is terminated at that point, or the patient is surely supported and walked so as not to lose his / her balance. With such a device, a series of walking movements could not be evaluated as a whole, and it was not possible to correctly judge how close the walking movement was to a healthy person.

The present invention has been made to solve such a problem, and has a degree of freedom in gait movement within a range in which the patient does not completely fall in walking training of a paralyzed patient suffering from leg paralysis. It provides a walking training system that can correctly evaluate abnormal walking for various gaits while continuing walking for multiple cycles.

The walking training system according to one aspect of the present invention is a walking training system for training a paralyzed patient suffering from leg paralysis, and is a fall prevention device for preventing the paralyzed patient from falling and a patient suffering from paralysis. The walking motion is abnormal when the acquisition unit that acquires the amount of motion associated with the walking motion of each step of the paralyzed body including the leg and the motion volume acquired by the acquisition unit meet the predetermined abnormal walking criteria. It includes an evaluation unit that evaluates walking, and a calculation unit that calculates training results for a series of walking training based on the cumulative number of abnormal walking evaluated by the evaluation unit.

INDUSTRIAL APPLICABILITY According to the present invention, in gait training of a paralyzed patient suffering from leg paralysis, various gait steps are continued while allowing a degree of freedom in the movement of the gait within a range in which the patient does not completely fall and continuing walking in a plurality of cycles. It is possible to provide a gait training system that can correctly evaluate abnormal gait for the body.

It is a schematic perspective view of the walking training apparatus which concerns on this embodiment. It is a schematic perspective view of a walking assist device. It is a figure which shows the system configuration of the walking training apparatus. It is a figure explaining the 1st abnormal gait standard. It is a figure explaining the 2nd abnormal gait standard. It is a figure explaining the 3rd abnormal gait standard. It is a figure explaining the 4th abnormal gait standard. It is a figure explaining the 5th abnormal gait standard. It is a figure explaining the sixth abnormal gait standard. It is a figure explaining the 7th abnormal gait standard. It is a flow chart which shows the processing operation of a walking training apparatus. This is a display example showing the determination result. It is a schematic perspective view of the walking training device which concerns on a modification.

Hereinafter, the present invention will be described through embodiments of the invention, but the invention according to the claims is not limited to the following embodiments. Moreover, not all of the configurations described in the embodiments are indispensable as means for solving the problem.

FIG. 1 is a schematic perspective view of the walking training device 100 according to the present embodiment. The walking training device 100 is a device for a trainer 900, who is a hemiplegic patient suffering from paralysis in one leg, to perform walking training. The walking training device 100 mainly covers the control panel 133 attached to the frame 130 forming the entire skeleton, the treadmill 131 on which the trainer 900 walks, and the affected leg which is the leg on the paralyzed side of the trainer 900. It is provided with a walking assist device 120 to be worn.

The frame 130 is erected on a treadmill 131 installed on the floor. The treadmill 131 rotates the ring-shaped belt 132 by a motor (not shown). The treadmill 131 is a device that encourages the trainee 900 to walk. The trainee 900 who performs walking training rides on the belt 132 and tries a walking motion according to the movement of the belt 132.

The frame 130 supports a control panel 133 that houses an overall control unit 210 that controls motors and sensors, and a training monitor 138 that is, for example, a liquid crystal panel that presents the progress of training to the trainee 900. .. Further, the frame 130 supports the front tension portion 135 near the front of the upper head of the trainee 900, the harness tension portion 112 near the upper head, and the posterior tension portion 137 near the rear of the upper head. Further, the frame 130 includes a handrail 130a for the trainee 900 to grasp.

The camera 140 functions as an image pickup unit for observing the whole body of the trainee 900. The camera 140 is installed in the vicinity of the training monitor 138 so as to face the trainer. The camera 140 includes a set of a lens and an image sensor so that the angle of view is such that the whole body of the trainee 900 can be captured. The image pickup device is, for example, a CMOS image sensor, and converts an optical image formed on an image plane into an image signal.

One end of the front wire 134 is connected to the winding mechanism of the front tension portion 135, and the other end is connected to the walking assist device 120. The winding mechanism of the front tension portion 135 winds and unwinds the front wire 134 according to the movement of the affected leg by turning on / off a motor (not shown). Similarly, one end of the rear wire 136 is connected to the winding mechanism of the rear tension portion 137, and the other end is connected to the walking assist device 120. The winding mechanism of the rear tension portion 137 winds and unwinds the rear wire 136 according to the movement of the affected leg by turning on / off a motor (not shown). By such a coordinated operation of the front tension portion 135 and the rear tension portion 137, the load of the walking assist device 120 is offset so as not to be a burden on the affected leg, and further, the patient is affected according to the degree of setting. Assists the swinging motion of the legs.

For example, an operator who is a training assistant sets a large level of assistance for a trainer who has severe paralysis. When the assist level is set to a large value, the front tension portion 135 winds up the front wire 134 with a relatively large force in accordance with the swing timing of the affected leg. As the training progresses and assistance is no longer needed, the operator sets the level of assistance to the minimum. When the assist level is set to the minimum, the front tension portion 135 winds up the front wire 134 with a force sufficient to cancel the own weight of the walking assist device 120 in accordance with the swing timing of the affected leg.

The walking training device 100 includes a fall prevention harness device as a safety device whose main components are an orthotic device 100, a harness wire 111, and a harness tension portion 112. The orthotic device 100 is a belt wrapped around the abdomen of the trainee 900 and is fixed to the waist by, for example, a hook-and-loop fastener. The device 100 includes a connecting hook 110a that connects one end of the harness wire 111 that is a hanging tool. The trainee 900 wears the orthotic device 100 so that the connecting hook 110a is located on the back back.

One end of the harness wire 111 is connected to the connecting hook 110a of the device 100, and the other end is connected to the winding mechanism of the harness tension portion 112. The winding mechanism of the harness tension portion 112 winds up and unwinds the harness wire 111 by turning on / off a motor (not shown). With such a configuration, when the trainee 900 is about to fall, the fall prevention harness device winds up the harness wire 111 according to the instruction of the overall control unit 210 that has detected the movement, and the trainee 900 uses the equipment 100 to wind the harness wire 111. Supports the upper body and prevents the trainer 900 from falling.

The equipment 110 includes a posture sensor 217 for detecting the posture of the trainee 900. The posture sensor 217 is, for example, a combination of a gyro sensor and an acceleration sensor, and outputs an inclination angle of the abdomen to which the orthotic device 110 is attached in the direction of gravity.

The management monitor 139 is attached to the frame 130 and is a display input device mainly for monitoring and operation by the operator. The management monitor 139 is, for example, a liquid crystal panel, and a touch panel is provided on the surface thereof. The management monitor 139 presents various menu items related to training settings, various parameter values at the time of training, training results, and the like.

The walking assist device 120 is attached to the affected leg of the trainee 900 and assists the trainer 900 in walking by reducing the load of extension and flexion at the knee joint of the affected leg. FIG. 2 is a schematic perspective view of the walking assist device 120. The walking assist device 120 mainly includes a control unit 121, a plurality of frames that support each part of the affected leg, and a load sensor 222 for detecting a load applied to the sole of the foot.

The control unit 121 includes an auxiliary control unit 220 that controls the walking assist device 120, and also includes a motor (not shown) that generates a driving force for assisting the extension movement and the flexion movement of the knee joint. The frames that support each part of the affected leg are the upper leg frame 122, the lower leg frame 123 rotatably connected to the upper leg frame 122, the foot palm frame 124 rotatably connected to the lower leg frame 123, and the anterior side. It includes a front connecting frame 127 for connecting the wires 134 and a rear connecting frame 128 for connecting the rear wires 136.

The upper leg frame 122 and the lower leg frame 123 rotate relative to each other around the _hinge axis Ha shown in the figure. The motor of the control unit 121 rotates according to the instruction of the auxiliary control unit 220 to force the upper leg frame 122 and the lower leg frame 123 to open relatively around the _hinge axis Ha or to close. .. The angle sensor 223 housed in the control unit 121 is, for example, _a rotary encoder, and detects the angle formed by the upper leg frame 122 and the lower leg frame 123 around the hinge axis Ha. The lower leg frame 123 and the foot palm frame 124 rotate relative to each other around the hinge axis _Hb shown in the figure. The relative rotating angle range is pre-adjusted by the adjusting mechanism 126.

The front side connecting frame 127 is provided so as to extend the front side of the upper thigh in the left-right direction and connect to the upper thigh frame 122 at both ends. Further, the front connecting frame 127 is provided with a connecting hook 127a for connecting the front wires 134 near the center in the left-right direction. The rear connecting frame 128 is provided so as to extend the rear side of the lower leg in the left-right direction and connect to the lower leg frame 123 extending vertically at both ends. Further, the rear connecting frame 128 is provided with a connecting hook 128a for connecting the rear wires 136 near the center in the left-right direction.

The upper thigh frame 122 includes an upper thigh belt 129. The upper thigh belt 129 is a belt integrally provided on the upper thigh frame, and is wrapped around the upper thigh of the affected leg to fix the upper thigh frame 122 to the upper thigh. This prevents the entire walking assist device 120 from shifting with respect to the legs of the trainee 900.

The load sensor 222 is a load sensor embedded in the foot flat frame 124. The load sensor 222 detects the magnitude and distribution of the vertical load received by the sole of the trainee 900. The load sensor 222 is, for example, a resistance change detection type load detection sheet in which electrodes are arranged in a matrix.

Next, the system configuration of the walking training device 100 will be described. FIG. 3 is a system configuration diagram of the walking training device 100. The overall control unit 210 is, for example, an MPU, and executes control of the entire device by executing a control program read from the system memory. The treadmill drive unit 211 includes a motor for rotating the belt 132 and a drive circuit thereof. The overall control unit 210 executes rotation control of the belt 132 by sending a drive signal to the treadmill drive unit 211. For example, the rotation speed of the belt 132 is adjusted according to the walking speed set by the operator.

The operation reception unit 212 receives input operations from the trainee 900 and the operator, and transmits an operation signal to the overall control unit 210. The trainee 900 and the operator operate the operation buttons provided on the device, the touch panel superimposed on the management monitor 139, the attached remote controller, etc., which constitute the operation reception unit 212, to turn the power on / off and to perform training. It gives instructions to start, inputs numerical values related to settings, and selects menu items.

The display control unit 213 receives the display signal from the overall control unit 210, generates a display screen, and displays it on the training monitor 138 or the management monitor 139. The display control unit 213 generates a screen showing the progress of training and a real-time image taken by the camera 140 according to the display signal.

The tension drive unit 214 includes a motor for pulling the front side wire 134 and its drive circuit constituting the front side tension portion 135, and a motor for pulling the rear side wire 136 constituting the rear side tension portion 137 and the motor thereof. Includes drive circuit. The overall control unit 210 controls the winding of the front wire 134 and the winding of the rear wire 136 by sending a drive signal to the tension drive unit 214, respectively. Further, not limited to the winding operation, the tensile force of each wire is controlled by controlling the driving torque of the motor. For example, the overall control unit 210 identifies the timing at which the affected leg switches from the standing state to the swinging state from the detection result of the load sensor 222, and increases or decreases the tensile force of each wire in synchronization with the timing, thereby increasing or decreasing the tensile force of the affected leg. Assists the swinging motion of.

The harness drive unit 215 includes a motor for pulling the harness wire 111 and a drive circuit thereof, which constitutes the harness tension unit 112. The overall control unit 210 controls the winding of the harness wire 111 and the tensile force of the harness wire 111 by sending a drive signal to the harness drive unit 215. For example, when the trainer 900 is predicted to fall, the overall control unit 210 winds a certain amount of the harness wire 111 to prevent the trainer from falling.

The image processing unit 216 performs image processing on the image signal received from the camera 140 in accordance with the instruction from the overall control unit 210 to generate image data. Further, the image processing unit 135 may perform image processing on the image signal received from the camera 140 in accordance with an instruction from the overall control unit 210 to perform a specific image analysis. For example, the image processing unit 135 detects the position of the foot (standing position) of the affected leg in contact with the treadmill 131 by image analysis. Specifically, for example, the stance position is calculated by extracting an image region near the tip of the foot flat frame 124 and analyzing the identification marker drawn on the belt 132 overlapping the tip.

As described above, the posture sensor 217 detects the tilt angle of the abdomen of the trainer 900 with respect to the gravity direction, and transmits the detection signal to the auxiliary control unit 220. The overall control unit 210 calculates the posture of the trainee 900, specifically, the inclination angle of the trunk, using the detection signal from the posture sensor 217. The overall control unit 210 and the attitude sensor 217 may be connected by wire or by short-range wireless communication.

The overall control unit 210 also plays a role as a function execution unit that executes various operations and controls related to control. The gait evaluation unit 210a evaluates whether or not the walking motion of the trainee 900 is abnormal walking by using the acquired various sensor information. The training determination unit 210b determines the training result for a series of walking trainings based on the cumulative number of abnormal gaits evaluated by the gait evaluation unit 210a. The specific processing will be described later.

As described above, the walking assist device 120 is attached to the affected leg of the trainee 900, but the walking training device 100 gives a command to the walking device 120 and receives sensor information, so that the overall control unit 210 The communication connection IF 219 connected to is provided. The walking assist device 120 is also provided with a communication connection IF 229 that is connected to the communication connection IF 219 by wire or wirelessly. The communication connection IF229 is connected to the auxiliary control unit 220 of the walking assist device 120. The communication connection IF 219 and 229 are communication interfaces such as a wireless LAN that conform to the communication standard.

The auxiliary control unit 220 is, for example, an MPU, and controls the walking assist device 120 by executing a control program given by the overall control unit 210. Further, the state of the walking assist device 120 is notified to the overall control unit 210 via the communication connection IF219 and 229. In addition, the walking assist device 120 is started / stopped in response to a command from the overall control unit 210.

The joint drive unit 221 includes a motor of the control unit 121 and a drive circuit thereof. By sending _a drive signal to the joint drive unit 221, the auxiliary control unit 220 encourages the upper thigh frame 122 and the lower leg frame 123 to open relatively around the hinge axis Ha, or to close them. .. Such movements assist the knee extension and flexion movements and prevent knee breakage.

As described above, the load sensor 222 detects the magnitude and distribution of the vertical load received by the sole of the trainer 900, and transmits the detection signal to the auxiliary control unit 220. The auxiliary control unit 220 receives and analyzes the detection signal to determine the state of the swing leg / stance and estimate the switching.

As described above, the angle sensor 223 detects the angle formed by the upper thigh frame 122 and the lower leg frame ₁₂₃ around the hinge axis Ha, and transmits the detection signal to the auxiliary control unit 220. The auxiliary control unit 220 receives the detection signal and calculates the opening angle of the knee joint.

The gait of a patient suffering from leg paralysis varies depending on the site and degree of the disease, and it is difficult to evaluate abnormal gait, which is judged to have a high risk of falling, based on one standard. Even if the gait is evaluated as abnormal gait when observed as a whole, when focusing on the movement of a part of the leg, it may be almost the same as the movement of normal walking. Therefore, conventional gait evaluation devices sometimes evaluate abnormal gait as normal gait.

The inventors of the present application have found that there are patterns classified into at least seven in the abnormal gait observed in hemiplegic patients. That is, it was found that if the abnormal walking standard is set for each pattern, the walking motion can be evaluated as abnormal walking when the gait of the trainee matches any of the abnormal walking standards. Therefore, in the gait training device 100 according to the present embodiment, the gait evaluation unit 210a compares the amount of motion of each paralyzed body portion with each abnormal gait standard, and determines whether or not the gait motion is abnormal gait. evaluate. Each abnormal gait criterion and its evaluation method will be described below.

FIG. 4 is a diagram illustrating a first abnormal gait criterion. The figure is a schematic view when the paralyzed body part, which is the lower body on the affected leg side, is observed from the side with respect to the walking direction. Represents CL, ankle joint FJ, and foot FL. In this embodiment, "leg" and "leg" are used as terms indicating the entire lower part of the hip joint HJ, and "foot" and "foot" are used as terms indicating the portion from the ankle to the toe.

In order to determine whether or not the first abnormal gait criterion is met, the overall control unit 210 follows the walking direction from the hip joint HJ to the ankle joint FJ when the affected leg lands after the swing phase. The distance X ₁ is detected as the first movement amount associated with the walking movement. In the case of normal walking with a healthy leg, the point of landing after the swing period should be located in the walking direction (anterior) of the hip joint HJ. However, when walking the affected leg, it is not possible to move the affected leg sufficiently to the front because the affected leg cannot be swung sufficiently, and the leg may land slightly anterior to the hip joint HJ or land posterior to the hip joint HJ. be.

Therefore, "less than the reference distance X _c1 " is set as the first abnormal gait reference. If the distance X ₁ detected in the walking motion is less than the reference distance X _c 1, it is determined that the walking is abnormal. The overall control unit 210 acquires the detection signal from the load sensor 222 and the image data from the camera 140, and detects the distance X ₁ at the end of the swing phase using these information. For example, when X _c1 = 20 cm (= 20 cm forward from the hip joint HJ) and the detected distance X ₁ is 10 cm or -5 cm, the gait evaluation unit 210a abnormally walks the walking motion. Evaluate as. The reference distance X _c1 may be changed according to the physique of the trainee, the degree of progress of rehabilitation, and the like.

FIG. 5 is a diagram illustrating a second abnormal gait criterion. The figure is a schematic view when the paralyzed body part which is the lower body on the affected leg side is observed from the side with respect to the walking direction, and each body part is shown in the same manner as in FIG.

In order to determine whether or not the second abnormal walking criterion is met, the overall control unit 210 detects the sole load X2 in the swing phase of the affected leg as the _second movement amount associated with the walking movement. In normal walking with healthy legs, the soles of the feet do not touch the ground during the swing period. However, when walking the affected leg, the force to lift the entire leg is insufficient, so that the leg may be pushed forward with the sole of the foot in contact with the ground, which is a so-called drag walking.

Therefore, "greater than the reference load X _c2 " is set as the second abnormal walking reference. If the load X ₂ detected in the walking motion is larger than the reference load X _c2 , it is determined that the walking is abnormal. The overall control unit 210 acquires the detection signal from the load sensor 222 and the image data from the camera 140, and detects the load X ₂ in the swing phase using these information. Normally, X _c2 = 0 is set. That is, if the load from the sole of the foot is detected even in the swing phase, the gait evaluation unit 210a evaluates the walking motion as abnormal walking. However, depending on the degree of progress of rehabilitation, some grounding may be allowed, and for example, X _c2 = 10N may be set. Further, the integrated load during the swing period may be used as a reference value.

FIG. 6 is a diagram illustrating a third abnormal gait criterion. The figure is a schematic view when the paralyzed body part which is the lower body on the affected leg side is observed from the side with respect to the walking direction, and each body part is shown in the same manner as in FIG.

In order to determine whether or not the third abnormal walking criterion is met, the overall control unit 210 detects the flexion angle X3 of the knee joint NJ during the stance of the affected leg as the _third movement amount associated with the walking movement. do. In normal walking with a healthy leg, the knee joint NJ during stance does not bend so much. However, when walking the affected leg, the knee joint NJ may bend significantly during stance because the knee joint NJ does not have sufficient force to support the upper body. In some cases, it causes a so-called knee break.

Therefore, "less than the reference angle X _c3 " is set as the third abnormal walking reference. If the bending angle X ₃ detected in the walking motion is smaller than the reference angle X _c 3, it is determined that the walking is abnormal. The overall control unit 210 acquires the detection signal from the angle sensor 223 and the image data from the camera 140 _, and detects the bending angle X3 in the stance using these information. For example, when X _c3 = 165 degrees and the detected bending angle X ₃ is 140 degrees, the gait evaluation unit 210a evaluates the walking motion as abnormal walking. If the bending angle _{X3 continuously detected during stance is less than the reference angle Xc3 even} once, the gait evaluation unit 210a evaluates the walking motion as abnormal walking. The reference angle X _c3 may be changed according to the age of the trainee, the degree of progress of rehabilitation, and the like.

FIG. 7 is a diagram illustrating a fourth abnormal gait criterion. The figure is a schematic view when the paralyzed body part which is the lower body on the affected leg side is observed from the side with respect to the walking direction, and each body part is shown in the same manner as in FIG.

In order to determine whether or not the fourth abnormal gait criterion is met, the overall control unit 210 determines the walking direction from the hip joint HJ to the ankle joint FJ when the affected leg is swung out from the stance phase to the swing phase. The distance X4 along the line is detected as the _fourth movement amount associated with the walking movement. In the case of walking by a healthy person, the ankle joint FJ at the time of swinging is located to some extent posterior to the hip joint HJ. However, in walking by a paralyzed patient, the weight of the upper body cannot be freely transferred, so that the ankle joint FJ may start swinging before being sufficiently separated from the hip joint HJ.

Therefore, "reference distance X _c4 or more" is set as the fourth abnormal gait reference. If the distance X ₄ detected in the walking motion is less than the reference distance X _c4 , it is determined that the walking is abnormal. The overall control unit 210 acquires the detection signal from the load sensor 222 and the image data from the camera 140, and uses these information to detect the distance _X4 at the time of swinging from the stance phase to the swing phase. For example, when X _c4 = -20 cm (= 20 cm posterior to the hip joint HJ), the detected distance X ₄ is -10 cm (= 10 cm posterior to the hip joint HJ) or 5 cm (= anterior to the hip joint HJ). When the distance is 5 cm), the gait evaluation unit 210a evaluates the gait motion as abnormal gait. The reference distance X _c4 may be changed according to the physique of the trainee, the degree of progress of rehabilitation, and the like.

FIG. 8 is a diagram illustrating a fifth abnormal gait criterion. The figure is a schematic view when the paralyzed body part which is the lower body on the affected leg side is observed from the side with respect to the walking direction, and each body part is shown in the same manner as in FIG.

In order to determine whether or not the fifth abnormal gait criterion is met, the overall control unit 210 sets the forward tilt angle X5 of the trunk TL during the stance of the affected leg to the _fifth accompanying walking motion. Detect as the amount of movement. In normal walking by a healthy person, the trunk TL during stance is slightly inclined forward with respect to the vertical line passing through the hip joint HJ. However, in walking of a paralyzed patient, the trunk TL may be greatly tilted forward with respect to the vertical line passing through the hip joint HJ in order to protect the lower body.

Therefore, "reference angle X _c5 or more" is set as the fifth abnormal walking reference. If the forward tilt angle X ₅ detected in the walking motion is equal to or greater than the reference angle X _c5 , it is determined that the walking is abnormal. The overall control unit 210 acquires the detection signal from the posture sensor 217 and the image data from the camera 140, and detects the tilt angle _X5 in the stance using these information. For example, when X _c5 = 10 degrees and the detected inclination angle X ₅ is 30 degrees, the gait evaluation unit 210a evaluates the walking motion as abnormal walking. The gait evaluation unit 210a evaluates the walking motion as abnormal walking when the inclination angle X ₅ continuously detected during the stance becomes the reference angle X _c5 or more even once. The reference angle X _c5 may be changed according to the age of the trainee, the degree of progress of rehabilitation, and the like.

FIG. 9 is a diagram illustrating the sixth abnormal gait criterion. The figure is a schematic view when the paralyzed body part which is the lower body on the affected leg side is observed from the front in the walking direction, and each body part is shown in the same manner as in FIG.

In order to determine whether or not the sixth abnormal walking criterion is met, the overall control unit 210 sets the inclination angle X6 of the trunk TL toward the affected leg side during the stance of the affected leg as the _sixth walking motion. Detected as the amount of movement of. In normal walking by a healthy person, the trunk TL during stance hardly swings to the left or right with respect to the vertical line passing through the hip joint HJ. However, when walking in a paralyzed patient, the trunk TL may lean forward significantly toward the affected leg with respect to the vertical line passing through the hip joint HJ due to fear of putting weight on the affected leg. be.

Therefore, "reference angle X _c6 or more" is set as the sixth abnormal walking reference. If the inclination angle X ₆ to the affected leg side detected in the walking movement is equal to or greater than the reference angle X _c6 , it is judged to be abnormal walking. The overall control unit 210 acquires the detection signal from the attitude sensor 217 and the image data from the camera 140, and detects the tilt angle _X6 during stance using these information. For example, when X _c6 = 10 degrees and the detected inclination angle X ₆ is 20 degrees, the gait evaluation unit 210a evaluates the walking motion as abnormal walking. The gait evaluation unit 210a evaluates the walking motion as abnormal walking when the inclination angle X ₆ continuously detected during the stance becomes the reference angle X _c6 or more even once. The reference angle X _c6 may be changed according to the age of the trainee, the degree of progress of rehabilitation, and the like.

FIG. 10 is a diagram illustrating a seventh abnormal gait criterion. The figure is a schematic view when the paralyzed body part which is the lower body on the affected leg side is observed from the side with respect to the walking direction, and each body part is shown in the same manner as in FIG.

In order to determine whether or not the seventh abnormal walking criterion is met, the overall control unit 210 sets the forward tilt angle _X7 of the trunk TL during the swing of the affected leg in accordance with the walking motion. Detected as the amount of movement of. In normal walking by a healthy person, the trunk TL during the swing leg tilts forward to some extent with respect to the vertical line passing through the hip joint HJ. However, in walking of a paralyzed patient, the weight of the upper body may not be able to move freely, and the trunk TL may be tilted backward with respect to the vertical line passing through the hip joint HJ.

Therefore, "less than the reference angle X _c7 " is set as the seventh abnormal walking reference. If the forward tilt angle X ₇ detected in the walking motion is less than the reference angle X _c7 , it is determined that the walking is abnormal. The overall control unit 210 acquires the detection signal from the posture sensor 217 and the image data from the camera 140, and detects the tilt angle _X7 in the swing leg using these information. For example, when X _c7 = -5 degrees (= tilted backward by 5 degrees) and the detected tilt angle X ₇ is -20 degrees, the gait evaluation unit 210a makes the walking motion abnormal. Evaluate as walking. If the inclination angle X ₇ continuously detected during the swing is less than the reference angle X _c7 even once, the gait evaluation unit 210a evaluates the walking motion as abnormal walking. The reference angle X _c7 may be changed according to the age of the trainee, the degree of progress of rehabilitation, and the like.

Although the seven abnormal gait criteria have been described above, other abnormal gait criteria may be added. When establishing abnormal gait criteria, it is important to determine multiple, not single, and in that case, does the abnormal gait criterion include at least two or more criteria regarding the amount of movement of different parts of the paralyzed body? , It is preferable to include two or more criteria regarding the amount of movement of the same part of the paralyzed body in different directions.

Here, two or more criteria regarding the amount of motion of different parts are selected from the criteria regarding the amount of motion of the trunk, the criteria regarding the amount of motion of the knee joint, and the criteria regarding the amount of motion of the foot beyond the ankle. Is good. In the above example, the criteria for the amount of motion of the trunk are the criteria of 5, 6 and 7, the criteria for the amount of motion of the knee joint are the third criteria, and the criteria for the amount of motion of the foot are. These are the first, second, and fourth criteria. When the movement amount of interest is selected in this way, when the actual gait should be evaluated as abnormal walking, even if one movement amount does not evaluate as abnormal walking, the other movement amount is regarded as abnormal walking. Through experiments, it became clear that they are often evaluated.

In addition, two or more criteria for the amount of motion of the same part of the paralyzed body in different directions are the criteria for the amount of motion of the trunk in the walking direction and the criteria for the amount of motion in the orthogonal direction orthogonal to the walking direction. It is good to include. In the above example, the relationship between any of the fifth and seventh criteria and the sixth criterion corresponds. Even if the movement amounts of interest are combined in this way, if the actual gait should be evaluated as abnormal walking, even if one movement amount does not evaluate as abnormal walking, the other movement amount indicates abnormal walking. It became clear through experiments that it is often evaluated as.

It was also found that the abnormal gait criteria should be different for the swing phase and the stance phase of the affected leg. The first criterion and the fourth criterion are criteria in the same direction at the same site as each other, but focus on the time point at which the swing phase is switched to the stance phase and the time point at which the stance phase is switched to the swing phase, respectively. Further, the fifth criterion and the seventh criterion are also the criteria of the same site in the same direction, but pay attention to the stance phase and the swing phase separately, respectively. That is, even if the movement amount is the same site and in the same direction, it can be evaluated as a different feature amount of walking movement if the observation time points are separated.

Next, the processing operation of the walking training device 100 will be described. FIG. 11 is a flow chart showing a processing operation. The flow starts when the training menu is selected by the trainer 900 or the operator and a series of training programs are started.

The overall control unit 210 resets the walking cycle counter n in step S101. Then, the treadmill drive unit 211 is driven to start the rotation of the belt 132, and the tension drive unit 214 and the joint drive unit 221 are driven according to the set adjustment value to execute the walking assist of the trainee 900. do. When the trainee 900 starts the directional movement, in step S102, each movement amount associated with the walking movement is acquired. Specifically, the image processing unit 216 analyzes the image signal acquired from the camera 140, or acquires the detection signals from the attitude sensor 217, the load sensor 222, and the angle sensor 223 and converts them into an operation amount.

In step S103, the overall control unit 210 determines whether or not one walking cycle has ended. The evaluation of abnormal gait may be performed for each step of the affected leg, but in the present embodiment, the evaluation is performed in one cycle of one step of the affected leg and one step of the healthy leg following this. Therefore, when the overall control unit 210 determines that one walking cycle has ended, it proceeds to step S104 to execute the evaluation, and when it determines that it has not finished yet, it returns to step S102 and continues to acquire each movement amount. ..

The gait evaluation unit 210a of the overall control unit 210 executes an evaluation of abnormal gait in step S104. Specifically, the amount of movement in each part, each direction, and each period in the walking movement is totaled, and it is confirmed whether or not the above-mentioned abnormal walking criteria are met. If it is evaluated as abnormal walking, the walking motion is determined to be failed walking. The gait evaluation unit 210a determines in step S105 whether or not one of the above abnormal gait criteria is met, and if it is determined that any one of the above abnormal gait criteria is met, the process proceeds to step S106 and the evaluation of the nth step is performed. Substitute "0" for the variable En. Then, the overall control unit 210 displays on the training monitor 138 and the management monitor 139 via the display control unit 213 that the step was a failed walk. On the other hand, if it is determined in step S105 that none of the above abnormal gait criteria is met, the process proceeds to step S108, and "1" is substituted for the evaluation variable En in the nth step. Then, the overall control unit 210 displays on the training monitor 138 and the management monitor 139 via the display control unit 213 that the step was a successful walk.

Here, when displaying the fact that the gait was unsuccessful in real time during training, it is preferable to display a simple and single display without indicating which abnormal walking standard was met. By presenting a failed gait with a simple, single display, the trainee 900 can recognize the minimum of his own situation without confusion during gait training. The means for indicating whether or not the walking is unsuccessful is not limited to the management monitor 139, but a buzzer sound, a blinking light, or the like can also be used. Again, it is preferred that the sound or light be presented to the trainer 900 in a simple and single manner. As described above, the management monitor 139 that presents the fact that the walking is unsuccessful, the device that generates sound or light, and the like function as a presentation unit that presents information regarding the evaluation by the walking evaluation unit 210a.

After finishing the failure display in step S107 or the success display in step S109, the overall control unit 210 proceeds to step S110 and increments the walking cycle counter n. Then, in step S111, it is determined whether or not the walking cycle counter n has reached the walking cycle number n ₀ scheduled in the series of walking training programs. If it is determined that the vehicle has not been reached, the process returns to step S102 and the walking training control is continued. If it is determined that the item has been reached, the process proceeds to step S112.

In step S112, the training determination unit 210b of the overall control unit 210 aggregates the evaluation results in a series of continuous walking walking training trials, and makes a determination to indicate the success level of the walking training trials. Specifically, the training determination unit 210b makes a training determination by calculating the ratio of the number of failed walks to the total number of walks of the affected leg and evaluating the number of fall avoidance operations in which the harness drive unit 215 is operated. Derived. The overall control unit 210 ends a series of processes after the training determination unit 210b displays the determination result on the training monitor 138 and the management monitor 139 via the display control unit 213 in step S113.

FIG. 12 is a display example showing the determination result on the management monitor 139. Walking speed, swing assist, and knee extension assist are parameters set as levels according to the difficulty level of the training menu. The walking speed is proportional to the speed at which the belt 132 of the treadmill 131 is rotated. In the initial stage of training, the walking speed is set to be slow. The swing assist is proportional to the assist force that assists the swing of the affected leg by winding and releasing the front wire 134 and the rear wire 136. In the final stage of training, the walking assist device 120 is pulled with a driving force sufficient to offset its own weight. The knee extension assist is proportional to the drive torque of the joint drive unit. Assist regularly in situations where the affected leg is prone to knee breakage.

Each gait evaluation represents the evaluation result of each gait cycle, for example, ○ represents success and × represents failure. In the example shown in the figure, it can be seen that the second step of the walking cycle for seven steps in one training is a failure, and the failure rate is 14% as a whole. Then, the training determination determined by the training determination unit 210b is displayed as, for example, "A" determination.

Since the walking training device 100 in the present embodiment includes a harness wire 111 or the like as a fall prevention device for preventing falls on the treadmill 131, the trainee can continuously perform walking training even if he / she is about to lose his / her posture. Can be continued. That is, the trainee can continue walking with a free gait according to his / her consciousness within the range of not falling. Therefore, it is possible to comprehensively determine the degree of normality for continuous walking required as a normal walking motion.

In particular, when a patient suffering from leg paralysis performs walking training as a rehabilitation, it is more effective to train at a difficulty level at which walking is barely established, that is, a difficulty level at which the posture collapses to some extent (so-called motor learning effect). Will increase. A training device that walks with full assistance so as not to lose posture has little training effect for the trainer. On the other hand, the training device that does not assist until the person loses his / her posture to the extent that he / she falls, but interrupts walking when he / she is about to fall to avoid falling, causes abnormal walking to the extent of continuous walking motion. I can't evaluate. Therefore, a training device that gives a certain amount of assistance to the trainer's leg is preferable, but until now it was not possible to objectively determine the degree of abnormality in the trainer's leg. It was difficult to adjust. Specifically, the therapist checked the training status of the patient and adjusted the setting of the next difficulty level, so the recovery effect of the patient depended on the experience and intuition of the therapist. .. However, since the walking training device 100 in the present embodiment can perform objective training determination, it is easy for an inexperienced therapist to determine the next training difficulty level, and therefore it is expected that the training effect of the patient will be improved. In addition, the doctor or trainer who confirms the training determination can objectively and simply grasp how close the series of walking movements of the trainee is to the normal walking movement.

Next, a modified example of the walking training device 100 will be described. FIG. 13 is a schematic perspective view of the walking training device 100 ′ according to the modified example. The walking training device 100'is different from the walking training device 100 in that the trainer 900 does not have the treadmill 131 and actually moves in the space surrounded by the frame 130. In the figure, the elements common to the walking training device 100 are designated by the same reference numerals and the description thereof will be omitted.

The walking training device 100'includes a harness tension portion 112, a front tension portion 135, and a guide rail 150 that guides the rear tension portion 137. The harness tension portion 112, the front tension portion 135, and the rear tension portion 137 are each moved along the guide rail by a motor (not shown). The overall control unit 210 determines the walking position of the trainee 900, and arranges the harness tension portion 112, the front tension portion 135, and the rear tension portion 137 at the optimum positions according to the position. In the walking training device 100'configured in this way, the trainer 900 actually moves relative to the floor surface, so that a feeling of accomplishment of the rehabilitation training can be obtained.

In the embodiment described above, when the trainee 900 performs training next time, the walking training devices 100 and 100'may set parameters such as a swing assist level according to the previous training determination. In this way, if the walking training device automatically adjusts the training intensity, the burden on the operator and the like can be reduced. Further, the walking speed or the like may be dynamically adjusted with respect to the evaluation of each step during the training. For example, when the evaluation of abnormal walking is continuous, the walking speed may be slowed down. With such dynamic control, the safety of the trainee can be ensured, and the difficulty level can be adjusted according to the ability.

In the embodiment described above, the trainee 900 has shown and described an example of a hemiplegic patient suffering from one of the legs, but the walking training devices 100 and 100'are also applied to the patient suffering from paralysis of both legs. obtain. In that case, the walking assist device 120 is attached to both legs to carry out the training. In that case, abnormal gait may be evaluated for each affected leg. By independently evaluating the abnormal gait for each affected leg, the degree of recovery can be individually determined.

One aspect of the embodiment described above will be summarized. The gait evaluation device is a gait evaluation device that evaluates the training gait of a paralyzed patient suffering from leg paralysis, and acquires a plurality of movement amounts of the paralyzed body including the affected leg, which is the leg suffering from paralysis. When at least one of the acquisition unit and the plurality of motion amounts acquired by the acquisition unit meets any of a plurality of predetermined abnormal walking criteria, it is evaluated that the walking motion is abnormal walking. The plurality of abnormal gait criteria including an evaluation unit include at least two or more criteria regarding the amount of motion of different parts of the paralyzed body, or the same parts of the paralyzed body in different directions from each other. Includes two or more criteria for motion.

In the above-mentioned gait evaluation device, the paralyzed patient is a hemiplegic patient who suffers from paralysis in one leg, and the evaluation unit does not suffer from the step by step of the affected leg and the step and paralysis of the affected leg. The evaluation of the abnormal gait may be performed for at least one of the cycles including one step of a healthy leg. Further, among the plurality of abnormal walking criteria, two or more criteria regarding the amount of motion of different parts are the criteria for the amount of motion of the trunk, the criteria for the amount of motion of the knee joint, and the criteria for the amount of motion of the foot beyond the ankle. It may be selected from the criteria. Further, among the plurality of abnormal walking criteria, two or more criteria regarding the amount of movement of the same part of the paralyzed body portion in different directions are the criteria regarding the amount of motion of the trunk with respect to the walking direction and the reference with respect to the walking direction. It may include a reference regarding the amount of movement in the orthogonal orthogonal direction. Further, the plurality of abnormal gait criteria may be different for the swing phase and the stance phase of the affected leg.

The gait training system includes a gait evaluation device according to any one of the above embodiments and a gait assist device to be attached to the affected leg, and the gait assist device is a plurality of sensors that acquire the motion amount associated with the gait motion. Has. In such a walking training system, the evaluation unit includes a treadmill that provides a walking surface on which the paralyzed patient walks, and a fall prevention device that prevents the paralyzed patient from tipping over on the treadmill. The abnormal gait may be evaluated for an attempt by the paralyzed patient to walk continuously on the treadmill. In addition, a presentation unit that presents information regarding evaluation by the evaluation unit may be provided. At this time, the presentation unit may perform a single abnormal presentation regardless of which of the plurality of abnormal gait criteria is met.

Further, the walking training system is a walking training system for training and walking a paralyzed patient suffering from paralysis of the leg, and includes a fall prevention device for preventing the paralyzed patient from falling and an affected leg which is a leg suffering from paralysis. The walking motion is abnormal when the acquisition unit that acquires the amount of motion associated with the walking motion of the paralyzed body portion and the motion amount acquired by the acquisition unit meet a predetermined abnormal walking standard. It includes an evaluation unit that evaluates walking, and a calculation unit that calculates training results for a series of walking training based on the cumulative number of abnormal walking evaluated by the evaluation unit.

The above-mentioned gait evaluation method is a gait evaluation method for evaluating training gait of a paralyzed patient suffering from leg paralysis, and is a plurality of movement amounts associated with walking motion of a paralyzed body including the affected leg, which is a leg suffering from paralysis. When at least one of the acquisition step and the plurality of motion amounts acquired by the acquisition step meets any of a plurality of predetermined abnormal walking criteria, the walking motion is regarded as abnormal walking. Having an evaluation step to evaluate, the plurality of abnormal gait criteria include at least two or more criteria regarding the amount of motion of different parts of the paralyzed body, or different from each other in the same part of the paralyzed body. Includes two or more criteria for directional movement.

100, 100'walking training device, 110 orthotic device, 110a connecting hook, 111 harness wire, 112 harness tension part, 120 walking assist device, 121 control unit, 122 upper leg frame, 123 lower leg frame, 124 foot flat frame, 126 adjustment mechanism , 127 front connecting frame, 127a connecting hook, 128 rear connecting frame, 129 upper leg belt, 130 frame, 130a handrail, 131 tread mill, 132 belt, 133 control panel, 134 front wire, 135 front tension part, 136 rear Side wire, 137 rear tension part, 138 training monitor, 139 management monitor, 140 camera, 150 guide rail, 222 load sensor, 210 overall control unit, 210a walking evaluation unit, 210b training judgment unit, 211 tread mill drive unit. , 212 Operation reception unit, 213 Display control unit, 214 Tension drive unit, 215 Harness drive unit, 216 Image processing unit, 217 Attitude sensor, 219 Communication connection IF, 220 Auxiliary control unit, 221 Joint drive unit, 222 Load sensor, 223 Angle sensor, 229 communication connection IF, 900 trainer, TL trunk, HJ hip joint, HL upper leg, NJ knee joint, CL lower leg, FJ ankle joint, FL foot

Claims (1)

It is a walking training system that performs training walking for paralyzed patients suffering from leg paralysis.
The fall prevention device that prevents the paralyzed patient from falling, the acquisition unit that acquires a plurality of movement amounts of the paralyzed body part including the affected leg, which is the leg suffering from paralysis, and the acquisition unit that accompanies the walking motion for each step.
An evaluation unit that evaluates that the walking motion is abnormal walking when the plurality of motion amounts acquired by the acquisition unit meet a plurality of predetermined abnormal walking criteria.
It is equipped with a calculation unit that calculates training results for a series of walking training based on the cumulative number of abnormal gaits evaluated by the evaluation unit.
The plurality of abnormal gait criteria include at least two or more criteria regarding the amount of movement of different parts of the paralyzed body, or two or more with respect to the amount of movement of the same part of the paralyzed body in different directions. Including the criteria of
The two or more criteria for the amount of movement of different parts of the paralyzed body are selected from the criteria for the amount of movement of the trunk, the criteria for the amount of movement of the knee joint, and the criteria for the amount of movement of the foot beyond the ankle. Being done
The two or more criteria for the amount of motion of the same part of the paralyzed body in different directions are the criteria for the amount of motion of the trunk in the walking direction and the criteria for the amount of motion in the orthogonal direction orthogonal to the walking direction. include,
Walking training system.

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