RU106531U1 - DEVICE FOR TEACHING WALKING AND MOVEMENT OF A PATIENT WITH PSYCHONEUROLOGICAL DISTURBANCES AND DISEASES OF THE SUPPORT-MOTOR APPARATUS - Google Patents

Abstract

 1. A device for teaching walking and movement of a patient with neuropsychiatric disorders and diseases of the musculoskeletal system, containing a functional skeleton made of interconnected rigid elements of a tubular structure with the ability to control the length of each rigid element, while in the upper part of the element located vertically opposite the patient’s spine, from the back, the first transverse element is rigidly fixed, the ends of which are located opposite the patient’s shoulder joints with sides of the back, and in its lower part a second transverse element is rigidly fixed, the ends of which are opposite the patient's hip joints on the back side, elements located on the rear sides of the shoulder, forearm and hand pivotally connected to each other are articulated to the ends of the first transverse element the location of the elbow and wrist joints of the patient, elements located on the back of the thigh, lower leg and under the patient’s foot are articulated to the ends of the second transverse element rigidly connected to each other at the location of the patient’s knee and ankle joints, the rigid elements of the functional skeleton are equipped with devices for fixing the patient’s torso and upper and lower extremities on the functional skeleton, made in the form of elastic rods with adjustable tension, attached to the rigid elements, characterized in that in each of the hinge joints of the functional skeleton there is an electric motor kinematically connected with the hinge and a lower rigid element, which carries out about

Description

The utility model relates to medicine, namely, devices for teaching walking and patient movements with neuropsychiatric disorders and diseases of the musculoskeletal system.

Before proceeding to the description of known analogues and prototype, the following should be noted. Deterioration of the nervous, muscle and motor activity of patients with disorders of the central nervous system is associated with the presence of affected areas of the brain and spinal cord as a result of injuries, stroke, cerebral palsy, etc. In such patients, part of the neural connections are closed to the affected area, and therefore in patients motor stereotypes are violated, the ability to concentrate consciousness on performing certain tasks is reduced or absent, the muscles are inhibited in an arbitrary manner, and therefore the patient can perform chaotic unpredictable movements, as, for example, with hyperkinesis, or by sending constant signals to the muscles, which leads to their spasticity. Associated with this violation of motor activity increase the degree of formation of incorrect functional connections. In children, after the end of the period of formation of interneuronal connections, the brain “closes” for restructuring. Nevertheless, the stimulation of a large group of synergist muscles, forcing them to contract in a natural mode, leads to the fact that the brain forcibly receives a full three-dimensional picture of the position of the working muscles of the body, because irritation of all receptors of the body occurs (skin, muscle, temperature, visual, auditory, etc.), moreover, the irritation of proprioceptors associated with lengthening, contraction and rotation of muscle fibers in their correct natural mode occurs. Intensive stimulation of all receptors provides the facilitation of conduction and occlusion of nerve impulses corresponding to the correct movement. In addition, due to the predominant fatigue of the most strained muscle fibers, fibers that do not work in a normal situation are included in the work. The impulse from them is new to the brain, and as a result, new interneuronal connections are included. Further, since during the stimulation, as a result of analysis and summation, direct and reverse impulses are compelled to correspond to the correct functioning of the muscles, which the affected area of the brain is not able to provide, compensation is made for healthy areas of the brain affected by the inclusion of reserve functional interneuronal connections. Gradually, as stimulation sessions are conducted, the process of developing the correct reflexes takes place, and new functional connections from healthy areas of the brain increasingly compensate for the affected area. Thus, in the process of stimulation in a patient with absent motor stereotypes, the latter can be partially formed and subsequently used by the brain to implement the motor task.

The prior art devices are widely known for the treatment of patients with impaired posture and motor activity, for example, “A device for the treatment of patients with impaired posture and motor activity” (patent RU No. 2054907, IPC A61F 5/00, published on 02.27.1996, ), containing shoulder, elbow, wrist, pelvic, knee and foot supports, interconnected by fixing elements. The locking elements are made in the form of elastic rods and are located on the front, side and rear surfaces of the patient’s body parts. Each rod is connected at one end to a corresponding support, and the other through its tension regulator. Another device "Overalls for the treatment of patients with cerebral palsy and patients with the consequences of traumatic brain injury" described in patent RU No. 2131232, IPC A61F 5/02, publ. 06/10/1999, is a suit of complementary elements and contains a declinator for the upper body of the user, which is a supporting and staging bandage for the upper shoulder girdle and chest part of the body, made in the form of a pelot, the height of which is not less than the distance from the seventh cervical vertebra to the lower edge of the user's blades, and the width is not less than the distance between the vertical lines bounding the medial parts of the blades; supporting staging bandage for shoulders made in the form of pelots having the shape of triangles corresponding to the anthropometric dimensions of the shoulders and shoulder joints of the user; supporting and staging bandage for the lower back, made in the form of a belt having a device for interlocking with other supporting and staging elements; supporting staging bandages for the lower extremities, which are kneecaps and kneecaps, bandages on the front of each foot, bandages on each ankle joint and each calcaneal region. All parts of this device are interconnected by fixing longitudinal elements forming a flexible frame for the user's trunk and limbs, as well as elastic rods, the degree of elasticity of which shape, size and installation location can be changed in accordance with the physiological and muscular synergies of the user.

It is also known "Device for the treatment of patients with the consequences of damage to the central nervous system and with damage to the musculoskeletal system", described in patent RU No. 2165752, IPC A61H 3/00, publ. 04/27/2001, consisting of separate modules made with the possibility of independent use. The first module is a reclinator made in the form of a curved tape, the first ends of which are interconnected, and the second ends are fixed on this tape with the formation of two straps for placement on the shoulders of the user. The second module is a corrective corset, adapted for correction of the spine without load. The third module is a corrective device for the lower extremities, containing at least one first part, which is a complex bandage of the thigh and lower leg, having two flexible strips for fixing, respectively, above the knee joint and below it, at least one second part, which is a corrective device for the ankle joint and toes, having first and second flexible strips for placement on the ankle and foot, respectively, and at least one third of guide a single toe-plantar element. In this case, the device may have a fourth module containing one first part, which is a complex bandage of the shoulder and forearm, having two flexible strips for fixing respectively above and under the elbow joint, and one second part, which is a single corrective element for the palm and thumb .

A disadvantage of the known devices, selected as analogues, is that they allow you to restore impaired due to illness or damage to the patient’s movement, but for patients with an absent stereotype of movement, their use is not effective or not suitable.

As a prototype of the claimed device, an orthopedic apparatus for the treatment of spastic forms of cerebral palsy is described, described in the method according to patent RU No. 2040923, IPC A61H 3/00, publ. 08/09/1995, the Method is carried out by fixing the limbs in a physiological position, and predominantly determine the dominant muscle synergy, depending on this, fix the support belts with elastic traction on the shoulder, hip, knee and ankle joints, with the help of elastic traction give the body and limbs physiological the position, the achieved position is left for 3-8 hours, the procedures are carried out daily for two weeks, and a second course of treatment is carried out after 2-4 months.

An orthopedic apparatus that implements the method contains supporting elements interconnected by bonds. At the same time, support shoulder, lumbar, knee and ankle belts, longitudinal elastic traction for the trunk in front and behind it, elastic corrective traction for the upper and lower extremities, longitudinal elastic traction for the feet are introduced into the apparatus. Longitudinal elastic rods are connected to supporting elements located on the belt, elastic rods for upper and lower extremities connect the corresponding supporting elements of upper and lower extremities, and longitudinal elastic rods for feet connect the supporting elements of the feet.

The prototype device has the same drawbacks as its counterparts, namely, it does not allow the patient to form an absent stereotype of movement (walking).

The task to be solved by the utility model is the formation of the patient lacking a stereotype of movement and learning to walk and move.

This is achieved by the fact that in a known device designed to implement a method of teaching walking and movement of a patient with neuropsychiatric disorders and diseases of the musculoskeletal system, containing a functional skeleton made of rigid elements of a tubular structure with the possibility of adjusting the length of each rigid element, while in the upper of the part located vertically opposite the patient’s spine from the back, the first transverse element is rigidly fixed, the ends of which are rely opposite the patient’s shoulder joints from the back, and the second transverse element is rigidly fixed to its lower part, the ends of which are opposite the patient’s hip joints from the back, elements located on the back of the shoulder, forearm and hand are hinged to the ends of the first transverse element pivotally interconnected at the locations of the patient's elbow and wrist joints, elements located from the back of the joints are hinged to the ends of the second transverse element the horns of the thigh, lower leg and under the foot of the patient, hinged together at the location of the knee and ankle joints of the patient, the rigid elements of the functional skeleton are equipped with devices for fixing the body and upper and lower extremities of the patient on the functional skeleton, made in the form of elastic rods with adjustable tension, fastened to rigid elements according to a utility model:

- in each of the hinge joints of the functional skeleton there is an electric motor kinematically connected to the hinge and below the rigid element, which deflects the rigid element according to a given program;

- in front of the patient’s face, a video and audio information playback panel is installed that displays the patient’s movement in virtual space synchronously with the deviations of the rigid elements of the functional skeleton imitating the upper and lower limbs;

- vibrators are installed under the socks and heels of the patient’s feet;

- a rigid vertical element of the functional skeleton, located opposite the patient’s spine, in its middle part is made with a hinge and a kinematically connected electric motor that provides a left-to-right rotation of the patient’s body at a given angle;

- electric motors of the functional skeleton, a video and audio information playback panel, and vibrators are electrically connected to the control unit;

- on the rigid vertical element of the functional skeleton located opposite the patient’s spine, rigid rods are rigidly fixed for lifting the functional skeleton above the supporting surface.

In addition, on the surfaces of the rigid elements of the functional skeleton facing the spine and limbs of the patient, soft substrates of heat-insulating material are installed.

In addition, the rigid elements of the functional skeleton imitating the upper and lower extremities are equipped with devices for attaching elastic rods, which are rigid half rings facing the limbs of the patient with a concave surface and attached to the rigid elements of the functional skeleton.

In addition, the functional skeleton is equipped with sensors for monitoring the efforts of muscles in a spastic state and electrically connected to the control unit.

In addition, the functional skeleton is equipped with sensory sensors installed on the main muscle groups of the limbs involved in movement when walking, electrically connected to the control unit.

In addition, the playback panel is equipped with a video camera mounted opposite the patient's eyes, electrically connected to the control unit.

In addition, the functional skeleton is equipped with a patient heart rate monitor electrically connected to the control unit

The utility model is illustrated in the drawing, which schematically shows a device designed to teach walking and movements of patients who do not have a stereotype of movement, while figure 1 shows a functional skeleton, and figure 2 is one of the rigid elements with devices for fixing elastic rods.

The device comprises a functional skeleton made of interconnected rigid elements 1 of a tubular structure, for example, segments of metal pipes of rectangular cross section with the possibility of adjusting the length of each rigid element, which can be implemented with the telescopic structure of each rigid element with fixation in several positions (in FIG. 1 not shown). The first transverse element 2, the ends of which are opposite the patient’s shoulder joints from the back, is rigidly fixed in the upper part of the vertically located rigid element 1, located opposite the patient’s spine, and the second transverse element 3, the ends of which are opposite the hip joints, is rigidly fixed the patient from the back. The transverse elements 2 and 3 may have some curvature for more complete contact with the patient’s body. The ends 1 of the first transverse element 2 are pivotally mounted on the back of the shoulder, forearm and hand, articulated at the locations of the patient’s elbow and wrist joints. The hinges 4 in figure 1 are conventionally shown in circles. The ends 1 of the second transverse element 3 are pivotally mounted on the back of the thigh, lower leg and under the foot of the patient, pivotally interconnected (hinges 4 in figure 1) at the locations of the knee and ankle joints of the patient. The rigid elements 1 of the functional skeleton are equipped with devices for fixing the torso and upper and lower extremities of the patient on the functional skeleton, made in the form of elastic rods 5 with adjustable tension, for example, elastic bandages with buckles or "Velcro" attached to the rigid elements 1 using devices, made, for example, in the form of rigid semirings 6, facing a concave surface to the limbs of the patient and attached to the rigid elements 1 (see figure 2, which shows one rigid element 1 with located on it semicircles elastic rods 6 and 5). The elastic rod 5 can be attached to the half ring 6 with the help of “Velcro” fasteners, buttons, buckles, etc. An electric motor is installed in each of the hinge joints of the functional skeleton (not shown in FIG. 1), kinematically connected to the hinge and below the rigid element, which deflects the lower element according to a given program. The kinematic connection of the electric motor with a hinge and a rigid element can be carried out, for example, by means of a gear connection. Each electric motor is electrically connected, for example, by cable 7 to the control unit 8 (in Fig. 1, for ease of perception, only one cable 7 is shown connecting the knee joint with the control unit 8). Each individual motor deviates only one rigid element 1 of the functional skeleton according to a given program. In front of the patient’s face, a video and audio information playback panel 9 is installed, which displays the patient’s movement in virtual space synchronously with the deviations of the rigid elements 1 simulating the patient’s upper and lower limbs. Structurally, the playback panel 9 can be made in the form of a screen, or in the form of a helmet, worn on the patient’s head, with a screen placed in front of his eyes, mounted on the helmet, and headphones or a loudspeaker. The screen displays video information corresponding to the movement of the patient in virtual space with his imaginary walking, for example, in an apartment, street, etc., and the sound of grass, crunching snow when walking, talking to people close to the patient, street noise can be presented as audio information etc. Additionally, a panel (not shown in FIG. 1) can be installed on the panel 9, located opposite the patient’s eyes and designed to control the patient’s reaction (to expand the pupils) to video and audio information. The panel 9 is electrically connected by a cable 10 to the control unit 8. Under the socks and heels of the patient, vibrators 11 are installed, designed to create a short-term vibration effect with the imaginary onset of the heels and socks on the supporting surface, electrically connected by cable 12 to the control unit 8. Rigid vertical element 1, located opposite the patient’s spine, is made with a hinge and a kinematically connected electric motor, providing a left-to-right rotation of the patient’s body by a given angle ol (the rotations of the vertical element 1 in figure 1 are shown by a circular arrow). On the rigid vertical element 1 of the functional skeleton, located opposite the patient’s spine, rigid rods 13 are rigidly fixed, which ensure the lifting of the functional skeleton above the supporting surface 14 (the mechanism for providing lifting is not shown in FIG. 1). Additionally, on the surfaces of the rigid elements of the functional skeleton facing the spine and limbs of the patient, soft substrates made of heat-insulating material, for example, porous polyethylene foam lined with dense fabric (not shown in Fig. 1), can be installed. In addition, the physiological skeleton can be equipped with sensors for monitoring muscle effort installed on spastic muscle groups electrically connected to the control unit 8. These sensors prevent injury to the patient’s muscles under increased muscle load as a result of simulated patient walking (force sensors figure 1 is not shown). Additionally, the functional skeleton can be equipped with sensory sensors installed on the main muscle groups involved in the walking act, which transmit information from the patient’s muscles to the control unit 8, which, after processing the received information, sets the functional skeleton in motion and provides the corresponding video and audio information to play bar. Additionally, the playback panel is equipped with a video camera (not shown in FIG. 1), mounted opposite the patient’s eyes, electrically connected to the control unit. Also, the functional skeleton can be equipped with a patient’s pulse monitoring sensor (not shown in FIG. 1), electrically connected to the control unit. The control unit 8 is a computer with appropriate software and a system for collecting data from sensors of the functional skeleton.

Consider the operation of the device. Preliminarily, in accordance with the patient’s pathology, the admissible angular deviations of the joints of the upper and lower extremities are determined and these values are set in the control unit 8. After that, the patient is fixed on the functional skeleton by fixing elastic rods 5 on half rings 6 (lower and upper limbs are fixed, at least , two rods 5 on each rigid element 1). For example, the lower leg is fixed near the knee and ankle joints, the shoulder near the shoulder and elbow joints, the forearm near the elbow and wrist joints. The patient’s torso is fixed with elastic rods attached to the first transverse element 2, a vertical rigid element 1 located opposite the patient’s spine, and the second transverse element 3. The listed elements have devices for attaching elastic rods to them (buckles, Velcro, etc.) .d., not shown in FIG. 1). After fixing the patient in a physiological position (or close to it), the functional skeleton is attached to a vertical position and using rods 13 lift it to a certain height (for example, 0.2-0.3 m) above the supporting surface 14 so that the patient’s feet are in in the air. If necessary, force control sensors are installed on individual muscle groups (mainly on spastic muscles), and sensory sensors transmitting information from the muscles to the control unit are installed on the main muscles participating in the walking act to monitor the dynamics of exercises. After that, the control unit 8 is included, which, taking into account the previously determined permissible angular deviations of each of the joints, leads by means of a cable 7 and electric motors located near the hinged joints of the functional skeleton elements 1 into the cyclic movement of the elements 1 forward and backward with bending of the joints of the patient's upper and lower extremities (each joint bends within the range of angles acceptable for it). Synchronously with the beginning of movement of the functional skeleton from the control unit 8 via cable 10, video and audio information about the virtual movement of the patient in space with the corresponding visual and auditory sensations is supplied to the playback panel 9. This allows the patient with an absent stereotype of movement to recognize the phenomena inherent in walking (leg movement, flexion of limb joints, tension and relaxation of limb muscles), as well as visual and auditory perception of the walking process (surrounding objects moving towards the walking one, knocking of heels, rustling of fallen leaves etc.), and control of muscle efforts avoids unnecessary strain on muscles and pain. Using a video camera and a heart rate monitor, the patient’s reaction (to dilate the pupils) to the supplied video and audio information is monitored .. Vibrators 11 installed under the toes and heels of the foot, by means of a signal from the control unit 8 and cable 12 create short-term vibration effects of a given duration, amplitude and frequency at the moments of the imaginary attack of the heels and socks of the patient on the supporting surface 14, which creates the patient a feeling of real walking. Additionally, using the hinge and a kinematically connected electric motor located in the middle of the vertical rigid element of the functional skeleton, the patient's body can be rotated left - right by a predetermined angle.

Note that the pace of walking, the angle of deviation of the joints, and accordingly the load on the patient’s muscles, can vary widely by setting the appropriate program for control unit 8.

The duration of the walking training session is selected individually for each patient, depending on his condition and diagnosis, and it can be 25-45 minutes, sessions are carried out daily for 7-15 days adequately to how the patient adapts to the load. A second course of training, if necessary, is carried out after 1-2 months. Two types of patient load can be applied - temporary and power. With a temporary load, increase the duration of the session, but at the same time reduce the flexion angles in the joints and the rate of movement, and with power load reduce the duration of the session, but increase the angles of flexion of the joints, increase the pace.

Thus, the use of the claimed device allows you to gradually form the patient’s previously absent stereotype of movement, to master the basic skills of walking and movements and the associated visual and auditory sensations.

The claimed technical solution can also be used to relieve spasticity of individual muscle groups and eliminate joint contractures, which indicates its wider functionality compared to the known technical solutions. Currently, a technical task for the development of the device is being developed and a research plan is being formed. The device can be manufactured using well-known materials and equipment using modern computer technology.

Considering the above, as well as the novelty of the proposed technical solution and industrial applicability, the applicant believes that it can be protected by a patent for a utility model.

Claims (7)

1. A device for teaching walking and movement of a patient with neuropsychiatric disorders and diseases of the musculoskeletal system, containing a functional skeleton made of interconnected rigid elements of a tubular structure with the ability to control the length of each rigid element, while in the upper part of the element located vertically opposite the patient’s spine, from the back, the first transverse element is rigidly fixed, the ends of which are located opposite the patient’s shoulder joints with sides of the back, and in its lower part a second transverse element is rigidly fixed, the ends of which are opposite the patient's hip joints on the back side, elements located on the rear sides of the shoulder, forearm and hand pivotally connected to each other are articulated to the ends of the first transverse element the location of the elbow and wrist joints of the patient, elements located on the back of the thigh, lower leg and under the patient’s foot are articulated to the ends of the second transverse element rigidly connected to each other at the locations of the patient’s knee and ankle joints, the rigid elements of the functional skeleton are equipped with devices for fixing the patient’s trunk and upper and lower extremities on the functional skeleton, made in the form of elastic rods with adjustable tension, attached to rigid elements, characterized in that in each of the hinged joints of the functional skeleton there is an electric motor kinematically connected to the hinge and a lower rigid element, which carries out about deflection of a rigid element according to a given program, a video and audio information playback panel is installed in front of the patient, which displays the patient’s movement in virtual space synchronously with deviations of the rigid elements of the functional skeleton imitating the upper and lower limbs, vibrators are installed under the socks and heels of the patient’s feet, a rigid vertical element functional skeleton, located opposite the patient’s spine, in its middle part is made with a swivel and kinematic and an associated electric motor that provides left-right rotation of the patient’s body by a predetermined angle, electric motors of the functional skeleton, a video and audio information playback panel and vibrators are electrically connected to the control unit, and rigid rods are rigidly fixed to the first transverse rigid element of the functional skeleton to lift the functional skeleton above the supporting surface. 2. The device according to claim 1, characterized in that on the surfaces of the rigid elements of the functional skeleton facing the spine and extremities of the patient, soft substrates of heat-insulating material are installed. 3. The device according to claim 1, characterized in that the rigid elements of the functional skeleton imitating the upper and lower extremities are equipped with devices for attaching rods, which are rigid half rings facing the limbs of the patient with a concave surface and attached to the rigid elements of the functional skeleton. 4. The device according to claim 1, characterized in that the functional skeleton is equipped with sensors for monitoring the efforts of muscles in a spastic state and electrically connected to the control unit. 5. The device according to claim 1, characterized in that the functional skeleton is equipped with sensory sensors mounted on the main muscle groups of the extremities involved in movement when walking, electrically connected to the control unit. 6. The device according to claim 1, characterized in that the playback panel is equipped with a video camera mounted opposite the patient’s eyes, electrically connected to the control unit. 7. The device according to claim 1, characterized in that the functional skeleton is equipped with a sensor for monitoring the pulse of the patient, electrically connected to the control unit.