RU222385U1 - WALKING TRAINER "RESISTANCE" - Google Patents

Abstract

The utility model relates to the field of medicine, namely to prosthetics and traumatology, and can be used in the rehabilitation of patients after amputation and prosthetics of the lower extremities, in adaptive sports. The simulator includes the following components: a belt, a rubber rod, and an additional set: a clamp for a support. The belt consists of a two-layer fabric base with sewn-in steel tires, double-sided footer overlays at the ends of the tires; fasteners that allow you to fix the belt at three levels: the lower chest, lower back and crests of the iliac bones of the pelvis; a device for attaching traction, located in the projection of the general center of gravity of the patient’s body. The belt is reinforced with fabric ribbons along the width and length of the belt, leather overlays on the grosgrain ribbon for fastening the traction. The rubber rod is made of stranded rubber with a fabric braid on the outside with solid or removable handles. The rubber rod is attached to the belt through the loop of the rod attachment device or using a carabiner. The clamp on the support is made of a tow strap or hemp rope with carabiners at the ends, designed for fastening the exercise machine with a rubber rod on a horizontal or vertical support. The technical task of the utility model is to develop a compact gait simulator with an even distribution of the load on the patient’s body and the ability to select the load taking into account his physical condition. The technical result of the utility model is the restoration of impaired physical qualities, in particular strength, speed and endurance, speed and strength abilities.

Description

TECHNICAL FIELD

The utility model relates to the field of medicine, namely to prosthetics and traumatology, and can be used in the rehabilitation of patients after amputation and prosthetics of the lower extremities, in adaptive sports.

TECHNICAL PROBLEM. BACKGROUND OF THE ART

It is known that amputation of the lower limb leads to loss of support. A long period of rehabilitation from several weeks to several years, moving in a wheelchair for a long time, and restriction of physical activity lead to the development of muscle atrophy, impairment of physical qualities such as strength, speed and endurance, and speed-strength abilities.

A resistance gait trainer is known (RU102519 U1, publ. March 10, 2011), which includes a frame on the upper and lower crossbars of which a rubber rod with foot stirrups attached at the ends is located through rollers. The frame is worn on the shoulders and belt like a backpack.

A known gait trainer with resistance (RU120012 U1, published 09/10/2012), consisting of a belt with rubber rods attached to it with stirrups for the feet.

When walking, vertically located rubber rods facilitate the work of the flexor muscles of both the knee and hip joints at the same time, and require significant muscle effort when extending them. The disadvantage of these technical solutions is: the limited possibility of using analogues when walking on a prosthesis after amputation of a leg at the level of the lower leg, and the impossibility of their use when truncation of the leg at the level of the thigh due to the lack of appropriate muscle groups.

There are known analogues for sports training and fitness that create resistance to walking forward by horizontal tension of a flexible power cord, which is attached on one side to a narrow belt in the lumbar region or to a system of belts worn on the shoulders and secured in the chest area, and on the other side to a support, to load or being held by another person.

The disadvantages of these technical solutions are:

• the location of traction in the area of the upper shoulder girdle and chest when walking with resistance leads to a compensatory tilt of the back forward and, accordingly, to excessive tension in the back muscles;

• attaching the rod to a narrow belt leads to excessive force on the lumbar area when walking under load.

There are known analogues used in the rehabilitation of patients with lower limb amputation, [1, 2] which involve the use of the following means:

Option 1 - use a wide elastic band located on the lower chest and lumbar region of the patient. The patient walks accompanied by a rehabilitation therapist without the use of additional means of support: crutches or canes. Resistance to the patient walking forward is provided by a constant tension force of the tape using the hands of the rehabilitation therapist holding the ends of the tape.

Option 2 - use a wide elastic band located at the level of the iliac crests of the pelvic bones of the patient who walks using two crutches. Resistance to the patient's walking forward is provided by the constant tension force of the tape, held by the hand of the rehabilitation therapist, due to the friction force created when the feet of the rehabilitation therapist, sitting on a stool with wheels, slide along the floor.

Option 3 - use a towing strap, the ends of which are tied to a car tire. The patient pulls the load while holding the towing strap on both sides with both hands. Resistance to the patient's walking forward is achieved by moving the total weight of the load of the car tire with the person sitting on it.

Option 4 - use a towing strap, the ends of which are tied to a car tire. The patient walks using one crutch. The towing strap is placed over the patient's shoulder. Resistance to the patient's walking forward is achieved by moving the total weight of the load of the car tire with the person sitting on it.

The disadvantages of this technical solution are:

• during walking with resistance, the elastic band can gather into folds, ultimately forming a rubber band, which in turn can lead to compression of the rectus and oblique abdominal muscles;

• applying an elastic band to the area of the lower chest and abdomen, as well as to the area of the iliac crests of the pelvis leads to overload of the muscles of the lumbar region, which can ultimately lead to pain in the lumbar region;

• moving the load while holding the towing strap with both hands, the ends of which are tied to the load, leads to a compensatory tilt of the patient’s body forward with additional tension in the back muscles, excessive tension in the arm muscles, as well as blocking movements of the upper shoulder girdle;

• moving a fixed weight of a load, in particular, a tire with a person located on it, eliminates the possibility of selecting a load taking into account the physical condition of the patient, which in turn leads to difficulty moving forward on a prosthetic leg (especially on a hip prosthesis) or the impossibility of applying the specified training when mastering the prosthesis during primary prosthetics;

• bulkiness of items used as cargo.

The technical objective of the utility model is to develop a compact resistance gait simulator with uniform load distribution on the patient’s body and the ability to select the load taking into account his physical condition when mastering a lower limb prosthesis at the stage of primary prosthetics.

The technical result is the restoration of impaired physical qualities, in particular, strength, speed and endurance, speed-strength abilities of patients.

When developing the technical solution for the simulator, the following was taken into account.

1. It is known that the use of a corset-type belt design allows minimizing the load on the muscles of the back, abdomen and lower back and, when creating a gait simulator, will create more gentle conditions for the training process of restoring muscle function when mastering a lower limb prosthesis at the stage of primary prosthetics, taking into account weakened muscles on the side truncated limb.

2. It is known that in statics and dynamics, the balance and stability of the human body as a biomechanical system is ensured by the general center of gravity (GCC) of the body. According to research data [3], it has been determined that the GCT of the human body is located in the pelvic area on average 2.5 cm below the promontory of the sacrum and 4-5 cm above the transverse axis of the hip joint. Accordingly, the force impact when walking with resistance in the GCT projection will make it possible to more optimally distribute the load on the parts of the body, eliminating the restriction of movement of body segments, maintaining its equilibrium and stable position.

The technical result is achieved through the use of a set of the simulator proposed by the author, which includes: belt 1, rubber rod 2, in an additional configuration, and a clamp on the support (Fig. 5, D, E).

[01] The belt has a two-layer fabric base 1, namely: an inner layer of twill fabric, an outer layer of aviation fabric ACT-100; steel tires 3, sewn into a fabric base; footer linings 4, sewn externally on the projection of the location of the ends of the steel tires on both sides of the fabric base; apron 5 is two-layer: the inner layer is made of twill fabric, the outer layer is made of aviation fabric ACT-100; belt fasteners, consisting of hard 6 and soft 7 contact tape in the form of Velcro and rectangular metal buckles 8; device for fastening rod 9 from grosgrain ribbon 11 with carabiner 10.

The design of the belt uses ten steel tires 3, located at the front, 2 pieces to the left and right of the fasteners, and at the back, 3 pieces to the left and right of the device for fastening the rod 9.

The belt is fastened with three pairs of fasteners (Fig. 1) at the level of the lower chest, in the lumbar region and at the level of the iliac crests of the patient's pelvis.

The design of the belt, consisting of a fabric base with steel tires and fasteners, forms a frame that allows minimizing the force impact on the muscles of the back, abdomen and lower back, evenly distributing the load on the patient’s body.

Placing a device for attaching traction and, accordingly, rubber traction in the projection zone of the general center of gravity of the patient’s body creates optimal conditions for movement under load of both individual intact segments of the upper and lower extremities, and in their interaction, eliminating the restriction of their movements, as well as excessive tension in the muscles of the shoulder belt, back, abdomen and lower back.

The apron is designed to increase the range of sizes in the belt design.

Reinforcement of the fabric base of the belt with steel tires with footer overlays sewn on the ends on both sides; additional twill ribbons 13 along the entire length and width of the belt and leather overlays 12 on the grosgrain ribbon 11 of the device for fastening the rod 9 are made to prevent deformation and rupture of the fabric base, protect against damage to the grosgrain ribbon, which, in turn, improves overall performance properties of the belt, helps to increase the service life of the simulator as a whole.

[02] The rubber rod is made of stranded rubber with a fabric braid on the outside with monolithic (Fig. 5, A) or removable handles (Fig. 5, B, C), 3 m long, with a maximum load of up to 15 kg. The rubber rod is attached to the belt through the loop of the device for fastening the rod 9 or using a carabiner 10.

[03] The additional package includes a support clamp made of a tow strap or hemp rope with carabiners at the ends (Fig. 5, D, E), designed for fastening the exercise machine with a rubber traction on a horizontal or vertical support, for example: a vertical stand , tree, ladder rung. The simulator is used as follows.

For exercises accompanied by a rehabilitation therapist: first, a belt is placed on the patient’s back so that the device for attaching the traction is located in the projection of the general center of gravity of the patient’s body; then the belt is secured using fasteners sequentially at the level of the lower chest, then in the lumbar region and then at the level of the iliac crests of the patient’s pelvis; Through the loop of the grosgrain ribbon, the rod fastening devices attach a rubber rod to the belt.

Walking training using a simulator is carried out either in one pass over a distance of 150 to 300 m, or up to 5 passes, alternating with rest breaks for 3-5 minutes, over a distance from 50 to 100 m in the following ways:

• with constant tension of the rubber rod;

• with variable tension of rubber traction, increasing and decreasing the resistance force;

• by a combination of constant and variable tension of the rubber rod.

For self-study: first, attach a rubber rod to the belt through a device for attaching rods; then attach the clamp to the support; then connect the ends of the clamp to the ends of the rubber rod using carabiners; after this, a belt is put on and secured with clasps at the level of the lower chest, then in the lumbar region and then at the level of the iliac crests of the patient’s pelvis.

Walking training is carried out with variable tension of the rubber traction, taking 1-3 steps forward, increasing the tension force, 1-3 steps back, decreasing the tension force.

As experimental samples of the simulator proposed by the author, 3 belts were made, differing in size range: two No. 1 from size 40 to 50 (belt length taking into account the length of the apron 80-100 cm); one No. 2 from size 50 to 60 (belt length 100-120 cm).

To carry out training with patients at the prosthetic enterprise, belts No. 1 and 2 and a rubber rod in the form of a strand of multi-core rubber with a fabric braid on the outside with monolithic handles, 3 m long, with a maximum load of up to 15 kg were used.

For self-study, the patient used belt No. 1, a rubber rod in the form of a strand of stranded rubber with a fabric braid on the outside with removable handles, 3 m long, with a maximum load of up to 15 kg, and a support fixator: a hemp rope with carabiners at the ends.

During the year of operation of the simulator at the prosthetic enterprise, 42 training sessions were conducted with patients: men and women aged from 19 to 86 years, with unilateral amputation of the lower limb at the level of the leg and thigh at the stage of primary prosthetics. Reasons for leg amputation: vascular, infectious diseases, diabetes, combat wounds.

Patient training was carried out along the corridor of the prosthetic enterprise, accompanied by a rehabilitation specialist, both in one pass at a distance of 150 to 300 m, and up to 5 passes, alternating with rest breaks for 3-5 minutes, at a distance of 50 to 100 m with constant or variable tension of rubber traction and in their combination. The tension force of the rubber rod and its change, as well as the distance traveled, were agreed with the patient.

During the operation of the simulator, a technical result was obtained.

[001] The simulator has high performance properties that increase its service life. A visual inspection of the experimental belts and rubber traction used showed that over the course of a year of operation, no deformations, tears or ruptures of the fabric base and grosgrain tape of the device for fastening the traction, or damage to the rubber traction were detected.

[002] The simulator is an alternative means of transferring a patient to independent walking without additional means of support: crutches and canes.

It is known that the main means of transferring a patient from walking on a prosthesis after amputation of the lower limb using technical rehabilitation devices (TCP) to walking without them is a set of walking exercises for 4 and 2 steps using TCP: first two crutches, then one crutch and one cane, and then - two canes, one crutch, one cane, - and without using TCP [4].

EXAMPLE 1. Patient, 58 years old, amputation at the thigh level (upper 1/3 of the thigh - short stump), the reason for amputation is thrombosis of the vessels of the lower limb as a complication after suffering from COVID-19. Before training, the patient used two crutches when walking; Without crutches, due to fear of falling, he could walk no more than 3 meters.

The patient was trained with a simulator, accompanied by a rehabilitation specialist, along the corridor of a prosthetic enterprise. 5 passes of 70 m were made according to the scheme: 1, 3 and 5 passes with constant tension of the rubber rod, 2 and 4 passes were made in a combination of constant and variable tension of the rubber rod, namely: the patient and the rehabilitation therapist alternately took steps forward (the tension force was increased due to the patient's step forward while the rehabilitation therapist stood still, then the tension force was reduced due to the subsequent step of the rehabilitation therapist). After each pass, the patient rested on the couch for 3-5 minutes.

After the training, the patient had a desire to walk on his own: he walked 40 m without crutches.

[003] The simulator is a means of restoring physical qualities impaired after amputation of the lower limb, in particular, strength, speed, endurance; speed-strength abilities.

This technical result is confirmed by an improvement in the dynamics of walking biomechanics, in particular, such as: distance traveled, speed and tempo of walking. The indicators were measured using three Neurosens sensors placed at the level of the ankles of the right and left legs and at the level of the sacrum, and the STEDIS software package, which allows one to evaluate the indicators of gait biomechanics.

EXAMPLE 2. Patient, 31 years old, amputation at the level of the lower leg, the cause of amputation was a mine explosion injury. Training with the simulator was carried out with constant tension of the rubber rod in one pass over a distance of 300 m. Measurements were carried out before and after training, at everyday and maximum walking pace for 2 minutes of walking along the corridor. During training, the patient walked without TCP.

According to Table 1, the result of the training is an increase in speed, distance traveled and walking pace, which indicates a significant improvement in physical qualities: strength, speed, endurance, and speed-strength abilities of the patient.

Thus, the simulator proposed by the author can be used in the training process in the form of adaptive sports chosen by patients.

[004] The simulator is a means of forming in the patient a proprioceptive perception of the prosthetic leg as a whole and its individual parts, and the work of the muscles, like their own leg.

The technical result is confirmed by patient reviews: Patient, 40 years old, hip prosthesis: “I felt that the prosthesis and the stump were like a single whole leg. After completing the training, it became much easier to move forward, I felt as if I was a ballet dancer, as if my own leg had appeared.”

Patient, 21 years old, prosthetic leg: “Before training, there was a feeling that the stump was in a flask, in something, but during the training this feeling was not there, I stopped feeling that my leg was in a prosthesis. During training under load, there was a feeling that you were walking on your own two legs, you felt the leg in the prosthesis as if it were your own; there was a perception with the prosthetic leg of all movements that you push off with both the right and left legs equally.” Patient, 49 years old, lower leg prosthesis: “Under load, there was a feeling that the prosthesis and stump were working like one leg.”

Patient, 22 years old, hip prosthesis: “When I walked with the exercise machine under load, I felt the leg on the prosthesis, like a real one, like my own, I even felt the work of the calf muscles on the amputated leg, which are actually not there... After completing the workout, I felt the heaviness of the prosthetic leg, such the same as your leg.” Patient, 31 years old, lower leg prosthesis: “When you take the first 3-4 steps, you pay attention to the prosthesis, and then you no longer feel it, but perceive the prosthetic leg as your full-fledged leg. After training, the prosthesis does not feel as if it is not there, as if the prosthetic leg works as equal to a healthy leg, like your full-fledged working leg.”

[005] The simulator is an alternative means of improving the psycho-emotional state of a patient who has undergone lower limb amputation by replacing fears and doubts with positive emotions, motivation to live on and master the prosthesis.

It is known that a means of improving the psycho-emotional state of a patient after amputation and prosthetics of the lower extremities is a set of dance exercises for teaching dancing - waltz and sirtaki [5].

The technical result is confirmed by patient reviews: Patient, 33 years old, hip prosthesis: “After training I want to live again.” Patient, 40 years old, hip prosthesis: “I experienced such strong positive emotions: “Wow, how easy it has become to walk!!!”

Patient, 49 years old, lower leg prosthesis: “After the training, the feeling of fear that I would limp when walking went away, I now have complete confidence that my normal gait will be restored, the same as it was before the injury.” Patient, 22 years old, hip prosthesis: “When... under load I felt the leg on the prosthesis as if it were my real leg... the work of the calf muscles on the amputated leg, which are actually missing,... I felt delighted, a strong impression, I really liked it!!! After finishing the workout, I walked easier, more straight, carried my weight more evenly, measuredly, felt the smoothness of the move, it became easy, I came to life!!!”

Patient, 32 years old, lower leg prosthesis: “Psychologically, due to a complex fracture of the foot and ankle joint on the intact leg, I initially had doubts that I would not soon be able to stand on the prosthesis, much less walk independently. But training with a simulator, walking under load, gives you confidence in yourself, in your capabilities, you begin to understand that you can also do a lot with a prosthesis and you can adapt to everything. After the training, there was a desire to further master the prosthesis; there was a desire to go up and down a vertical staircase like a wall bars.” A few days later, the patient sent a video showing how he climbed a vertical ladder on a sports ground, climbed over to the other side, and went down the other side of the ladder.

[006] The simulator is available for use at the patient's location due to its compactness and light weight.

The simulator proposed by the author can be manufactured both industrially and at home.

GRAPHICS

Brief description of drawings

Fig. 1 - front view of the belt;

fig. 2 - rear view of the belt;

fig. 3 - location of the apron and metal buckles on the belt;

fig. 4 - arrangement of soft and hard tape-contact pairs on the belt;

fig. 5 - options for rubber rods and clamps on the support.

INFORMATION SOURCES

1. School of walking on a prosthesis. Sequential learning to walk on a prosthesis with a paired hip amputation. Fragment of walking with resistance. - [Electronic resource]: https://www.youtube.com/watch?v=sHe9BRKvn90&t=1150s&ab channel=Ottobo ck%D0%A0%D0%BE%D1%81%Dl%81%D0%B8%D1% 8F, publ. November 11, 2022.

2. Pump up your buttocks - it will always come in handy! The motto of our School of Walking on a Prosthesis is [Electronic resource]: https://www.youtube.com/shorts/gzv0Zn9jYO0, publ. April 12, 2023.

3. Usychenko V.V. Determination of the general center of gravity of the body of athletes specializing in highly qualified bodybuilding. // Pedagogics, psychology, medical-biological problems of physical training and sports. - 2008. - [Electronic resource]: https://cyberleninka.ru/article/n/opredelenie-obschego-tsentra-tvazhesti-tela-sportsmenov-spetsializiruvuschihsya-v-bodibildinge-vysokoy-kvalifikats.

4. Walking school. Lesson 9. Walking on a prosthesis using a cane. - [Electronic resource]: https://www.youtube.com/playlist?list=PL eJ yvHrNdUSC0NgcenVA8AYzgv6B L3R, publ. 06/19/2018.

5. Walking school. Lesson 15. Dancing: sirtaki, waltz.- [Electronic resource]: https://www.youtube.com/playlist?list=PL eJ yvHrNdUSC0NgcenVA8AYzgy6B L3R, publ. 09.26.2018.

Claims (4)

1. A gait trainer, including a belt having a two-layer fabric base containing an inner layer of twill fabric and an outer layer of AST-100 aviation fabric, steel tires sewn into the fabric base, footer linings sewn on the outside on the projection of the location of the ends of the steel tires with two sides of the fabric base, a two-layer apron to increase the range of sizes in the belt design, containing an inner layer of twill fabric and an outer layer of aviation fabric AST-100, belt fasteners consisting of hard and soft contact tape in the form of Velcro and rectangular metal buckles shapes, a device for attaching a rod made of a grosgrain ribbon with a carabiner, twill ribbons along the entire length and width of the belt and leather lining on the grosgrain ribbon, a device for attaching a rod, a rubber rod made of stranded rubber with a fabric braid on the outside with removable handles 3 m long and with a maximum load of up to 15 kg, the lock is on a support made of hemp rope with carabiners at the ends. 2. The exercise machine according to claim 1, characterized in that the belt made of a fabric base is made in the form of a frame structure with steel tires in the amount of 10 pieces, located at the front, 2 pieces to the left and right of the fasteners, and at the back, 3 pieces to the left and right of the device for traction fastenings, and three pairs of fasteners, allowing the belt to be fixed at three levels: on the lower chest, in the lumbar region and at the level of the iliac crests of the patient’s pelvis. 3. The exercise machine according to claim 2, characterized in that the device for attaching the rod to the belt and, accordingly, the rubber rod are located in the projection of the general center of gravity of the patient’s body. 4. The exercise machine according to claim 1, characterized in that the fabric base of the belt is reinforced with steel tires with double-sided footer pads sewn on the ends.